1
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Kjær BH, Svensson RB, Warming S, Peter Magnusson S. Supraspinatus Muscle and Tendon Characteristics 1 Year After Surgical Rotator Cuff Repair Compared With Contralateral Shoulder: Data From the CUT-N-MOVE Trial. Am J Sports Med 2024; 52:2082-2091. [PMID: 38860727 DOI: 10.1177/03635465241255143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
BACKGROUND It is necessary to better understand the structural characteristics of the supraspinatus tendon and associated muscle after rotator cuff repair and in the event of retear. PURPOSE To study structural differences between the repaired and contralateral shoulders 1 year after rotator cuff repair in patients who received either progressive exercise therapy (PR) or usual care (UC) in a randomized controlled trial and to investigate whether there was interaction with tendon retear and limb dominance. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients with surgically repaired traumatic full-thickness rotator cuff tears involving the supraspinatus tendon were included. After surgery, they were randomized to PR or UC (active from postoperative week 2 or 6, respectively). The subacromial structures (acromiohumeral distance, supraspinatus tendon thickness, and vascularity) and the supraspinatus muscle thickness were examined with ultrasound at the 1-year follow-up. RESULTS A total of 79 patients were included. The characteristics of the 2 intervention groups (PR and UC) were comparable, including the Western Ontario Rotator Cuff Index score and number of retears. The authors found significantly thinner supraspinatus tendon (PR, P < .001; UC, P = .003) and reduced acromiohumeral distance (PR, P = .023; UC, P = .025) in the repaired versus the contralateral shoulders in both intervention groups. For neovascularization, there was no interlimb difference in either of the groups or between groups (PR vs UC). In patients with intact tendons, there was no interlimb difference in the muscle thickness, but in patients with tendon retear the muscle was significantly thinner on the repaired side (P = .024 and P < .001, respectively). When the dominant supraspinatus tendon was repaired (both groups), it was significantly thinner than the nondominant healthy tendon, but this difference was not seen when the nondominant supraspinatus tendon was repaired (P = .006). CONCLUSION One year after rotator cuff surgery, the repaired supraspinatus tendon was significantly thinner and the corresponding acromiohumeral distance was reduced. In patients with retear, the supraspinatus muscle was significantly thinner on the repaired side and early initiation of tendon-loading exercises did not affect these findings. REGISTRATION NCT02969135 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rene B Svensson
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susan Warming
- Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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2
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Kurtaliaj I, Hoppe ED, Huang Y, Ju D, Sandler JA, Yoon D, Smith LJ, Betancur ST, Effiong L, Gardner T, Tedesco L, Desai S, Birman V, Levine WN, Genin GM, Thomopoulos S. Python tooth-inspired fixation device for enhanced rotator cuff repair. SCIENCE ADVANCES 2024; 10:eadl5270. [PMID: 38941456 PMCID: PMC11212709 DOI: 10.1126/sciadv.adl5270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/23/2024] [Indexed: 06/30/2024]
Abstract
Rotator cuff repair surgeries fail frequently, with 20 to 94% of the 600,000 repairs performed annually in the United States resulting in retearing of the rotator cuff. The most common cause of failure is sutures tearing through tendons at grasping points. To address this issue, we drew inspiration from the specialized teeth of snakes of the Pythonoidea superfamily, which grasp soft tissues without tearing. To apply this nondamaging gripping approach to the surgical repair of tendon, we developed and optimized a python tooth-inspired device as an adjunct to current rotator cuff suture repair and found that it nearly doubled repair strength. Integrated simulations, 3D printing, and ex vivo experiments revealed a relationship between tooth shape and grasping mechanics, enabling optimization of the clinically relevant device that substantially enhances rotator cuff repair by distributing stresses over the attachment footprint. This approach suggests an alternative to traditional suturing paradigms and may reduce the risk of tendon retearing after rotator cuff repair.
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Affiliation(s)
- Iden Kurtaliaj
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ethan D. Hoppe
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Yuxuan Huang
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - David Ju
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Jacob A. Sandler
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Donghwan Yoon
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Lester J. Smith
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Linda Effiong
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
- Koru Medical Systems, Mahwah, NJ 07430, USA
| | - Thomas Gardner
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
| | - Liana Tedesco
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
| | - Sohil Desai
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
| | - Victor Birman
- Department of Mechanical and Aerospace Engineering, Missouri University of Science and Technology, St. Louis, MO 65409, USA
| | - William N. Levine
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
| | - Guy M. Genin
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Stavros Thomopoulos
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
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3
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Shen Z, Ye X, He Y, Shen G, Xu K, Zhang B, Wu L. Arthroscopic rotator cuff repair combined with platelet-rich plasma products can reduce the rate of retearing and improve clinical outcomes: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2024; 103:e38069. [PMID: 38701265 PMCID: PMC11062711 DOI: 10.1097/md.0000000000038069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Although several studies on the potential benefits of protein-rich plasma (PRP) therapy for rotator cuff injuries have been published, the results have been conflicting. Therefore, this study aimed to determine whether PRP is beneficial for the prevention of retears after arthroscopic rotator cuff repair (ARCR). METHODS Two reviewers conducted independent literature searches based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs) comparing a PRP treatment group with a control group were included. The quality of evidence was assessed using the Cochrane Collaboration Risk of Bias Tool. Clinical outcomes were compared using the risk ratio (RR) for dichotomous variables and weighted mean difference (WMD) for continuous variables. Statistical significance was set at P < .05. RESULTS This review included 21 RCTs (1359 patients). Significant results were noted in favor of PRP treatment compared with controls based on retearing rates (16.5% vs 23.6%, respectively; P = .002) and the Constant score in the short term (WMD: 1.98; 95% confidence interval [CI], 0.27-3.70; I2 = 0%; P = .02), medium term and long term (WMD: 2.56 [95% CI: 1.57-3.55]; I2 = 2%; P < .001); the University of California, Los Angeles score in the short term (WMD: 1.14 [95% CI: 0.43-1.85]; I2 = 25%; P = .002) but not in the medium and long term (WMD: 0.66 [95% CI: -0.16 to 1.48]; I2 = 57%; P = .11); and the visual analog scale score in the short term (WMD: -0.63 [95% CI: -0.83 to-0.43]; I2 = 41%; P < .001), medium and long term (WMD: -0.12 [95% CI: -0.19 to-0.05]; I2 = 0%; P = .008). There was no significant difference in American Shoulder and Elbow Surgeons scores between the treatment and control groups in the short term (WMD: -0.48 [95% CI: -2.80 to 1.85]; I2 = 22%; P = .69) or medium and long term (WMD: 0.92 [95% CI: -1.56 to 3.39]; I2 = 40%; P = .47). CONCLUSION Intraoperative use of PRP reduces the risk of rotator cuff repair failure, improves clinical outcomes, and reduces recurrence rates.
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Affiliation(s)
- Zhe Shen
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiaoang Ye
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yawen He
- Hangzhou Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Gaobo Shen
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Kuangying Xu
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Bingbing Zhang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Lianguo Wu
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
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4
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Migliorini F, Asparago G, Cuozzo F, Oliva F, Hildebrand F, Maffulli N. Patient outcomes and return to play after arthroscopic rotator cuff repair in overhead athletes: a systematic review. J Orthop Traumatol 2023; 24:3. [PMID: 36656423 PMCID: PMC9852377 DOI: 10.1186/s10195-023-00683-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Rotator cuff tear injuries in overhead athletes are common and may lead to chronic pain and joint disability, impairing sport participation and leading to premature retirement. The improvement of the patient reported outcome measures (PROMs) was evaluated, as were the time and level of return to sport and the rate of complication in overhead athletes who had undergone arthroscopic rotator cuff repair. METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. In September 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar and Embase. No time constraints were used for the search. All the clinical trials investigating arthroscopic rotator cuff repair in overhead athletes were accessed. RESULTS Data from 20 studies were collected. The mean length of the follow-up was 40 months. All PROMs improved at last follow-up: Kerlan-Jobe Orthopaedic Clinic score (P = 0.02), visual analogue scale (P = 0.003), Constant score (P < 0.0001), University of California Los Angeles Shoulder score (P = 0.006) and American Shoulder and Elbow Surgeons' score (P < 0.0001). Elevation also improved (P = 0.004). No difference was found in external and internal rotation (P = 0.2 and P = 0.3, respectively). In total, 75.4% (522 of 692 of patients) were able to return to play within a mean of 6.4 ± 6.0 months. Of 692 patients, 433 (62.5%) were able to return to sport at pre-injury level. Fourteen out of 138 patients (10.1%) underwent a further reoperation. The overall rate of complications was 7.1% (20 of 280). CONCLUSION Arthroscopic reconstruction of the rotator cuff is effective in improving function of the shoulder in overhead athletes, with a rate of return to sport in 75.4% of patients within an average of 6.4 months. LEVEL OF EVIDENCE III, systematic review. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Filippo Migliorini
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Giovanni Asparago
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy
| | - Francesco Cuozzo
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy
| | - Francesco Oliva
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy
| | - Frank Hildebrand
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Nicola Maffulli
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy ,grid.9757.c0000 0004 0415 6205Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, ST4 7QB Stoke On Trent, England ,grid.4868.20000 0001 2171 1133Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, E1 4DG London, England
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5
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Núñez JH, Montenegro JD, Surroca M, Ocrospoma-Flores B, Guerra-Farfán E, Mendez-Sanchez G, Fraguas A, Gómez O. Arthroscopic rotator cuff repair using a single or double row technique: A meta-analysis of randomized clinical trial. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023:S1888-4415(23)00256-4. [PMID: 38040196 DOI: 10.1016/j.recot.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE To compare the double row technique versus the single row technique for arthroscopic rotator cuff repair, in order to assess whether there are clinical differences. METHODS Systematic review of randomized clinical trials comparing the clinical results of the double-row technique versus the single-row technique in arthroscopic rotator cuff repair. Demographic, clinical, and surgical variables were analyzed, including functional scores, tendon healing rate, and re-tear rate. RESULTS Thirteen randomized clinical trials were selected. 437 patients in the single row group (50.7%) and 424 patients in the double row group (49.3%) were analyzed. No significant differences were found between the two groups in terms of age (P=.84), sex (P=.23) and loss to follow-up (P=.52). Significant differences were found for the better results of the double row technique at the UCLA level (P=.01). No significant differences were found on the Constant-Murley scale (P=.87) or on the ASES scale (P=.56). Similarly, there was a higher healing rate (P=.006) and less risk of rotator cuff re-tears with the double row technique (P=.006). CONCLUSIONS In rotator cuff repair, the double row technique was found to be superior to the single row technique in terms of better UCLA score, better tendon healing rate, and lower re-tear rate. No clinically significant differences were found on the Constant-Murley scale or on the ASES scale.
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Affiliation(s)
- J H Núñez
- Arthoesport, Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Grupo Quirón Salud, Barcelona, España; Cirugía Ortopédica y Traumatología, Universitat de Barcelona; Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España.
| | - J D Montenegro
- Cirugía Ortopédica y Traumatología, Universitat de Barcelona; Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España
| | - M Surroca
- Cirugía Ortopédica y Traumatología, Universitat de Barcelona; Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España
| | - B Ocrospoma-Flores
- Arthoesport, Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Grupo Quirón Salud, Barcelona, España
| | - E Guerra-Farfán
- Arthoesport, Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Grupo Quirón Salud, Barcelona, España
| | - G Mendez-Sanchez
- Arthoesport, Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Grupo Quirón Salud, Barcelona, España
| | - A Fraguas
- Arthoesport, Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Grupo Quirón Salud, Barcelona, España
| | - O Gómez
- Arthoesport, Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Grupo Quirón Salud, Barcelona, España
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6
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Guity MR, Mirghaderi P, Mortazavi SMJ, Malek M, Moharrami A, Bagheri N, Sharifpour S. Early versus late physiotherapy following arthroscopic repair of small and medium size rotator cuff tear: a randomized clinical trial. INTERNATIONAL ORTHOPAEDICS 2023; 47:2795-2807. [PMID: 37608119 DOI: 10.1007/s00264-023-05924-5] [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: 04/18/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE We compared early and late physiotherapy for patients with small and medium size rotator cuff tears following arthroscopic repair. METHODS A single-centre, single-blinded, prospective parallel RCT was performed with two arms: early physiotherapy (start within the first week) versus late physiotherapy (start 4 weeks after surgery). Patients with small- to medium-sized isolated full-thickness superior rotator cuff tears were included and followed for 12 months. The primary outcome measures were shoulder function and range of motion (ROM) measured by the Constant-Murley score (CMS) at three months, six months, and 12 months. The other outcomes were the visual analog scale (VAS) pain and the rotator cuff ultrasound (US) evaluation by the Sugaya classification. RESULTS In three and six month follow-ups, CMS was significantly superior in the intervention group compared to controls (P < 0.05). However, only at the three month follow-up between-group difference met the minimal clinically important difference (MCID) (MCID = 10.4) (59.8 vs. 48.9). The intervention group experienced less pain than controls in the first six months (P < 0.001), and only the three month follow-up was clinically meaningful based on MCID (MCID = 1.4). Moreover, in the first six months, the shoulder ROM favoured the intervention group (P < 0.05). US grading of the supraspinatus and infraspinatus was similar between groups (P = 0.07). One retear occurred in the intervention group and another in the controls, detected by examination and US evaluation. CONCLUSION Following the arthroscopic repair of a small- to medium-sized rotator cuff tear, early physiotherapy showed promising results for pain, function, and range of motion. LEVEL OF EVIDENCE Level I therapeutic.
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Affiliation(s)
- Mohammad Reza Guity
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyman Mirghaderi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Surgical Research Society (SRS), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S M Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahrooz Malek
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Radiology Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Alireza Moharrami
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Bagheri
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Shoulder and Elbow Fellowship, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sadula Sharifpour
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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7
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Gaukroger A, Arnander M, Pearse Y, Tennent D. Tripod Technique to Augment Transosseous Equivalent Rotator Cuff Repair. Arthrosc Tech 2022; 11:e1203-e1208. [PMID: 35936846 PMCID: PMC9353144 DOI: 10.1016/j.eats.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/02/2022] [Indexed: 02/03/2023] Open
Abstract
The transosseous-equivalent Speedbridge™ technique is commonly used during rotator cuff repair; however, the soft bone of the lateral humerus may result in toggling of the lateral row anchors with subsequent de-tensioning of the repair. The technique presented here uses an additional third-row anchor, in a tripod fashion, that reduces the forces on the lateral humerus anchors and protects the repair.
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Affiliation(s)
- A. Gaukroger
- Address correspondence to Andrew Gaukroger, Shoulder Unit Department of Orthopaedics, St. George's University Hospital NHS Trust, Blackshaw Rd, Tooting, SW17 0QT, United Kingdom.
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8
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Storti TM, Pontes Júnior AC, Simionatto JE, Simionatto C, Faria RSS, Paniago AF. Comparação do tratamento artroscópico de ruptura do manguito rotador em pacientes com menos de 55 anos versus pacientes com mais de 65 anos. Rev Bras Ortop 2022; 57:599-605. [PMID: 35966436 PMCID: PMC9365455 DOI: 10.1055/s-0041-1741025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2022] Open
Abstract
Objective
To evaluate patients submitted to arthroscopic repair of the rotator cuff (RC) comparing the results of muscle, functional strength, and pain obtained in 2 distinct groups: patients < 55 years old (G55) and patients > 65 years old (G65).
Methods
Data collection was performed with 63 participants (29 < 55 years old and 34 > 65 years old), in 2 moments, analyzing: A) demographic, surgical and RC lesion characteristics; B) functional variables, muscle strength, and pain.
Results
Higher levels of anterior elevation force, lateral, and medial rotation of the operated shoulder were observed in group G55. However, when the difference between these forces of the operated shoulder and of the contralateral shoulder was evaluated, there was no significant difference between the groups. The other variables of function and pain were similar (
p
> 0.05). There was also no difference between the groups in the University of California at Los Angeles Shoulder Rating Scale (UCLA) (
p
= 0.56) and Constant-Murley Score (
p
= 0.99) scores.
Conclusion
Arthroscopic repair of the RC in older, active, selected patients may achieve functional improvement and quality of life similar to that performed in younger patients.
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Affiliation(s)
- Thiago Medeiros Storti
- Instituto do Ombro de Brasília, Brasília, DF, Brasil
- Instituto de Pesquisa e Ensino IPE HOME, Brasília, DF, Brasil
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9
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Storti TM, Ribeiro TDS, Faria RSS, Simionatto JE, Simionatto C, Paniago AF. Reparo artroscópico da lesão de manguito rotador: Uma análise da função, força muscular e dor entre técnicas de fileira simples e fileira dupla. Rev Bras Ortop 2022; 57:472-479. [PMID: 35785112 PMCID: PMC9246534 DOI: 10.1055/s-0041-1735943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 04/23/2021] [Indexed: 11/29/2022] Open
Abstract
Objective
To evaluate the patients submitted to arthroscopic repair of the rotator cuff (RC), comparing the functional results, muscle strength, and pain obtained after single row (SR) and double row (DR) techniques.
Methods
Data were collected at the postoperative follow-up (minimum of 12 months) of 128 patients submitted to arthroscopic RC repair from 2011 to 2018. The clinical-functional variables were collected through the clinical examination, and the demographic, surgical and injury variables of the RC were collected from the electronic medical records. The results were compared between the SR and DR groups.
Results
The DR group showed higher anterior elevation strength when compared with the SR group (SF: 4.72 ± 2.73 kg versus DR: 5.90 ± 2.73 kg;
p
= 0.017). The other variables of muscle strength, Constant-Murley Score, University of California at Los Angeles Shoulder Rating Scale (UCLA), and pain, were similar. Performing the stratification by size, in the analysis of small and medium injuries, no differences were found between the groups. However, in the analysis of large and extensive injuries, patients submitted to DR presented superiority of both muscle lifting strength (SF: 3.98 ± 2.24 kg versus DR: 6.39 ± 2.73 kg) and Constant score (SF: 81 ± 10 versus DR: 88 ± 7).
Conclusion
The use of the DR technique in arthroscopic RC repair allowed higher levels of muscle strength for anterior shoulder elevation when compared with the SF technique. Data stratification in large and extensive injuries showed superiority of anterior shoulder elevation muscle strength and of the Constant score in patients submitted to DR.
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Affiliation(s)
- Thiago Medeiros Storti
- Instituto do Ombro de Brasília, Brasília, DF, Brasil
- Hospital Ortopédico e Medicina Especializada, Instituto de Pesquisa e Ensino, Brasília, DF, Brasil
| | | | | | | | | | - Alexandre Firmino Paniago
- Instituto do Ombro de Brasília, Brasília, DF, Brasil
- Hospital Ortopédico e Medicina Especializada, Instituto de Pesquisa e Ensino, Brasília, DF, Brasil
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10
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Ponugoti N, Raghu A, Colaco HB, Magill H. A comparison of simple and complex single-row versus transosseous-equivalent double-row repair techniques for full-thickness rotator cuff tears: a systematic review and meta-analysis. JSES Int 2022; 6:70-78. [PMID: 35141679 PMCID: PMC8811406 DOI: 10.1016/j.jseint.2021.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Methods Conclusion
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Affiliation(s)
- Nikhil Ponugoti
- Orthopaedic Registrar, Hampshire Hospital NHS Foundation Trust, Basingstoke, Hampshire, UK
- Corresponding author: Nikhil Ponugoti, MBBS, DNB Ortho, MRCS, Registrar Office, Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, RG24 9NA, United Kingdom.
| | - Aashish Raghu
- Orthopaedic Registrar, East & North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Henry B. Colaco
- Consultant Orthopaedic Surgeon, Hampshire Hospital NHS Foundation Trust, Winchester, Hampshire, UK
| | - Henry Magill
- Orthopaedic Registrar, Chelsea and Westminster Hospital, London, UK
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11
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Patients who have undergone rotator cuff repair experience around 75% functional recovery at 6 months after surgery. Knee Surg Sports Traumatol Arthrosc 2021; 29:2220-2227. [PMID: 32347347 DOI: 10.1007/s00167-020-06019-z] [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: 12/08/2019] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The purposes of this study were to (1) evaluate changes in recovery patterns [i.e., clinical outcomes, range of motion (ROM)] in the first 12 months following surgery, (2) identify potential prognostic factors of early clinical outcomes after rotator cuff repair (RCR). METHODS The study cohort included 344 consecutive patients treated with RCR. Data were collected prospectively and included pre- and perioperative variables. Univariate and multivariate linear regression analyses for various parameters including demographics, pre- and perioperative variables were used to predict shoulder function at 12-month follow-up, as measured by clinical outcomes and ROM. RESULTS Significant improvement in all clinical scores and ROM were noted during serial follow-ups after RCR (all p < 0.001). Multivariate analysis revealed that female sex, older age, more anchors, diabetes mellitus, and preoperative stiffness were independently associated with worse shoulder function 3 months after RCR. Including the 3 months factors, heavy labor, use of the suture-bridge technique, and large tears were also independently associated with worse outcomes 6 months after surgery. Heavy labor, suture-bridge technique, diabetes mellitus, and preoperative stiffness were associated with significantly worse functional outcomes at 12 months after surgery (all p < 0.05). CONCLUSION Functional recovery based on clinical outcomes (i.e., UCLA, ASES scores) showed approximately 60% of ultimate recovery at 3 months and approximately 75% recovery at 6 months after RCR. Female sex, diabetes mellitus, preoperative stiffness, a larger number of anchors, suture bridge technique, heavy labor, old age and, larger tears were prognostic factors of poor clinical results or ROM in the short-term follow-up intervals. Knowledge of these prognostic factors may lead to improved insight for physicians to predict the pattern of the recovery and patient expectations accordingly. LEVEL OF EVIDENCE III, A cohort study.
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12
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Zhang C, Wu J, Li X, Wang Z, Lu WW, Wong TM. Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair. Front Bioeng Biotechnol 2021; 9:657584. [PMID: 34178957 PMCID: PMC8226184 DOI: 10.3389/fbioe.2021.657584] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Rotator cuff tear is one of the most common shoulder problems encountered by orthopedic surgeons. Due to the slow healing process and high retear rate, rotator cuff tear has distressed millions of people all around the world every year, especially for the elderly and active athletes. This disease significantly impairs patients' motor ability and reduces their quality of life. Besides conservative treatment, open and arthroscopic surgery contributes a lot to accelerate the healing process of rotator cuff tear. Currently, there are many emerging novel treatment methods to promote rotator cuff repair. A variety of biological stimulus has been utilized in clinical practice. Among them, platelet-rich plasma, growth factors, stem cells, and exosomes are the most popular biologics in laboratory research and clinical trials. This review will focus on the biologics of bioaugmentation methods for rotator cuff repair and tendon healing, including platelet-rich plasma, growth factors, exosomes and stem cells, etc. Relevant studies are summarized in this review and future research perspectives are introduced.
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Affiliation(s)
- Cheng Zhang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jun Wu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiang Li
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zejin Wang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Weijia William Lu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Center for Human Tissues and Organs Degeneration, Shenzhen Institutes of Advanced Technology (CAS), Shenzhen, China
| | - Tak-Man Wong
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Morsy MG, Gawish HM, Galal MA, Waly AH. Arthroscopic Linked Triple Row Repair for Large and Massive Rotator Cuff Tears. Arthrosc Tech 2021; 10:e117-e125. [PMID: 33532217 PMCID: PMC7823101 DOI: 10.1016/j.eats.2020.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/20/2020] [Indexed: 02/03/2023] Open
Abstract
Recently, many arthroscopic techniques have been described to improve the outcomes in rotator cuff repair of large and massive tears; these include conventional double-row, suture bridge, and triple-row techniques, in an effort to optimally reconstruct the rotator cuff footprint and improve fixation. This report describes a modified triple-row repair technique that links the double-row and suture-bridge techniques in one construct, merging the advantages of both to maximize the footprint contact area and contact pressure, which may lead to better healing and faster rehabilitation.
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Affiliation(s)
- Mohamed G. Morsy
- Department of Orthopaedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Alexandria, Egypt,Address correspondence to Mohamed Gamal Morsy, M.D., 21411, Gleem, Alexandria, Egypt.
| | - Hesham M. Gawish
- Department of Orthopaedic Surgery and Traumatology, Kafr El Sheikh University, Kafr el-Sheikh, Egypt
| | - Mostafa A. Galal
- Department of Orthopaedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Alexandria, Egypt
| | - Ahmed H. Waly
- Department of Orthopaedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Alexandria, Egypt
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Anchorless Arthroscopic Transosseous and Anchored Arthroscopic Transosseous Equivalent Rotator Cuff Repair Show No Differences in Structural Integrity or Patient-reported Outcomes in a Matched Cohort. Clin Orthop Relat Res 2020; 478:1295-1303. [PMID: 32039957 PMCID: PMC7319398 DOI: 10.1097/corr.0000000000001151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anchored transosseous equivalent suture-bridge technique (TOE) is widely used for arthroscopic rotator cuff repair. It is unknown how patient outcomes scores, ROM, and integrity of the rotator cuff after repair using this anchored technique compare with those after repair using an anchorless transosseous technique (TO). QUESTIONS/PURPOSES (1) What are the differences in patient-reported outcomes (American Shoulder and Elbow Surgeons [ASES] score) and shoulder ROM between TO and TOE rotator cuff repair techniques at 1 and 2 years after surgery? (2) What is the difference in repair integrity as measured by the re-tear rate, assessed ultrasonographically at 1 year, between these two techniques? (3) What is the difference in procedure duration between the two techniques when performed by a surgeon familiar with each? METHODS We reviewed 331 arthroscopic rotator cuff repairs performed by one surgeon from December 2011 to July 2016 in this retrospective, matched-pair study. Of these patients, 63% (208 of 331) underwent repair with standard anchored technique (anchors placed in a double-row, TOE manner) and 37% (123 of 331) underwent anchorless TO repair, with the same indications for surgery between groups. Forty-four percent (91 of 208) of patients in the TOE group and 61% (75 of 123) of patients in the TO group met the inclusion criteria. Eighty percent (73 of 91) of patients in the TOE group and 88% (66 of 75) in the TO group had minimum 2-year follow-up. We matched each group to a cohort of 50 patients by sex, age, smoking status, and tear size (by Cofield classification: small, < 1 cm; medium, 1-3 cm; large, > 3-5 cm; or massive, > 5 cm). The resulting cohorts did not differ in mean age (TO, 62 years [range 53-65 years]; TOE, 58 years [range 53-65 years]; p = 0.79), mean BMI value (TO, 30 [range 27-33]; TOE, 29 [range 27-35]; p = 0.97), or dominant arm involvement (TO, 80%; TOE, 78%; p = 0.81). The cohorts were followed for at least 2 years (median, 3.2 years [interquartile range (IQR) 2.2-4.3] for TO and 2.9 years [IQR 2.0-3.5 years] for TOE). ASES scores and ROM were evaluated before surgery and at follow-up visits and were recorded in a longitudinally maintained institutional database. Repair integrity was assessed using ultrasonography at 1 year, as is standard in our practice. For each tear-size group, we calculated the proportion of intact tendon repairs versus the proportion of re-tears. Duration of surgery was recorded for each patient. RESULTS At 1 year, we observed no difference in median ASES scores (90 [IQR 92-98] for TO and 88 [IQR 72-98] for TOE; p = 0.44); external rotation (50° [IQR 45°-60°) for TO and 50° [IQR: 40°-60°] for TOE; p = 0.58); forward flexion (165° [IQR 160°-170°] for both groups; p = 0.91); or abduction (100° [IQR 90°-100°] for TO and 90° [IQR 90°-100°] for TOE; p = 0.06). Fourteen percent of shoulders (seven of 50) in each treatment group had evidence of re-tear at 1 year (p > 0.99): 0 of 2 small tears in each group, 0 of 7 medium tears in each group, five of 32 large tears in each group, and two of 9 massive tears in each group (all, p > 0.99). At 2 years, we found no differences in median ASES scores (92 [IQR 74-98)] for TO and 90 [IQR 80-100] for TOE; p = 0.84); external rotation (60° [IQR 50°-60°] for both groups; p = 0.74); forward flexion (170° [IQR 160°-170°] for both groups; p = 0.69); or abduction (100° [IQR 90°-100°] for both groups; p = 0.95). We found no differences between groups in mean ± SD procedure time, which was 103 ± 20 minutes for TO repair and 99 ± 20 minutes for TOE repair (p = 0.45). CONCLUSIONS TO and TOE techniques for arthroscopic rotator cuff repair results in no differences in ROM, ASES scores, re-tear rates, and surgical time. Randomized control trials are needed to confirm these similarities or determine a superior method of repair. Future cost analyses may also help to determine the relative value of each technique. LEVEL OF EVIDENCE Level III, therapeutic study.
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15
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Maassen NH, Somerson JS. A Majority of Single Versus Double-Row Rotator Cuff Repair Comparisons Fail to Consider Modern Single-Row Techniques. JBJS Rev 2020; 8:e0203. [DOI: 10.2106/jbjs.rvw.19.00203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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16
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Hurley ET, Maye AB, Mullett H. Arthroscopic Rotator Cuff Repair: A Systematic Review of Overlapping Meta-Analyses. JBJS Rev 2020; 7:e1. [PMID: 30939497 DOI: 10.2106/jbjs.rvw.18.00027] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Rotator cuff tears are a common pathology, with an increasing number of repairs being performed arthroscopically. The purpose of this study was to systematically review the results in the current meta-analyses on arthroscopic rotator cuff repair, looking specifically at double-row repair compared with single-row repair, at whether platelet-rich plasma should be used adjunctively at the time of the surgical procedure, and at the effects of early-motion compared with late-motion rehabilitation postoperatively. METHODS MEDLINE, Embase, and the Cochrane Library were screened for meta-analyses on arthroscopic rotator cuff repair. The levels and quality of the evidence were assessed, and the clinical outcomes were evaluated. A significant result was defined as p < 0.05. RESULTS Twenty-four meta-analyses were identified, with 10 meta-analyses on double-row repair compared with single-row repair, 7 meta-analyses on platelet-rich plasma compared with a control, and 7 meta-analyses on early motion compared with late motion. Studies found a significant result in terms of reduced retear rates and/or increased tendon-healing rate for double-row repair (6 of 10 studies; p < 0.05), without a clinically important improvement in functional outcomes (0 of 10 studies). There was a favorable outcome when using platelet-rich plasma in small-to-medium tears in terms of a reduced rate of retear (4 of 4 studies; p < 0.05). However, in the 1 study in which platelet-rich plasma was stratified into pure platelet-rich plasma and platelet-rich fibrin matrix preparation, there was a significantly lower retear rate for tears of all sizes with platelet-rich plasma and not with platelet-rich fibrin (p < 0.05). Range of motion was shown to be significantly better with early motion (5 of 6 studies; p < 0.05) in the majority of the meta-analyses, without an increased risk of retear (6 of 6 studies; p > 0.05). CONCLUSIONS The highest Level of Evidence and the highest-quality studies all supported the use of double-row repair, adjunctive platelet-rich plasma, and early-motion rehabilitation postoperatively in arthroscopic rotator cuff repair. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland.,Department of Trauma & Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Andrew B Maye
- Sports Surgery Clinic, Dublin, Ireland.,Department of Trauma & Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Snow M, Hussain F, Pagkalos J, Kowalski T, Green M, Massoud S, James S. The Effect of Delayed Injection of Leukocyte-Rich Platelet-Rich Plasma Following Rotator Cuff Repair on Patient Function: A Randomized Double-Blind Controlled Trial. Arthroscopy 2020; 36:648-657. [PMID: 31784365 DOI: 10.1016/j.arthro.2019.09.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of delayed application of leukocyte-rich platelet-rich plasma (PRP) on rotator cuff repair results as assessed by outcome scores and imaging at one year. METHODS Patients with a symptomatic rotator cuff tear awaiting arthroscopic repair were approached to take part in the study. Final eligibility for the study was confirmed at the time of surgery. A total of 97 patients were randomized to an ultrasound guided injection of leukocyte-rich PRP or normal saline between 10 and 14 days postsurgery. A total of 87 patients completed clinical evaluation and underwent magnetic resonance imaging imaging at 1 year. Outcome scores included the American Shoulder and Elbow Score, Constant score, Western Ontario Rotator Cuff Index, and the Disabilities of the Arm, Shoulder and Hand Score. Structural integrity of the repair was assessed according to the Sugaya grading. Muscle fatty infiltration was assessed on magnetic resonance imaging using the Goutallier classification. RESULTS At 1 year postsurgery, there was no significant difference between the treatment groups on any of the patient-reported outcome measures or Constant score. On postoperative imaging analysis, there was no difference in the retear rates (Sugaya 4 and 5) between the groups (21% in control group vs 15.3% in PRP group). Fatty infiltration on postoperative imaging was found to be significantly higher in the normal saline group compared with the PRP group (Kendall's tau-b P = .032). CONCLUSIONS The delayed application of PRP postrotator cuff repair did not improve function as measured by patient-reported outcome measures and Constant score at 1 year postoperatively. LEVEL OF EVIDENCE Level II, prospective randomized therapeutic trial.
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Affiliation(s)
- Martyn Snow
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom; Department of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Faisal Hussain
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Joseph Pagkalos
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Tomasz Kowalski
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Marcus Green
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Samir Massoud
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Steven James
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
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Repair of Rotator Cuff Tendon Defects in Aged Rats Using a Growth Factor Injectable Gel Scaffold. Arthroscopy 2020; 36:629-637. [PMID: 31784364 DOI: 10.1016/j.arthro.2019.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if the tendon-specific crosslinking gelatin (Col-Tgel) impregnated with growth factors promotes tendon healing at the bone interface and in a tendon window model. METHODS Two different Col-Tgel formulations were first tested in vitro by evaluating cell morphology and tendogenic differentiation. After the optimum formulation was determined, the gel was mixed with either transforming growth factor-β3 (TGF-β3) or growth differentiation factor-7 (GDF-7) growth factor and prepared for injections. Window defects were induced in 12 animals, which were randomized into the following treatments: (1) sham, (2) empty Col-Tgel, (3) Col-Tgel containing TGF-β3, or (4) Col-Tgel containing GDF-7. Based on these results, the sham, empty Col-Tgel, and Col-Tgel containing TGF-β3 were applied to the supraspinatus repair interface. Tendons were analyzed biomechanically and histologically using hematoxylin and eosin and Masson's trichrome staining. RESULTS In the window defect model, histologic scores were the best in rats treated with TGF-β3 containing Col-Tgel, followed by the empty Col-Tgel scaffold, and finally the sham control. The GDF-7 Col-Tgel was not further tested because occasional ectopic cartilage and bone formation was found in the prior window defect model. In the supraspinatus repair model, there was no statistical difference (P > .05) in the biomechanical strength among the 3 treatment groups, but load-to-failure ratio improved when TGF-β3 was added to the scaffold, suggesting improved tendon healing. CONCLUSIONS This pilot study evaluated the performance of an injectable gel tendon graft in a population of retired breeder rats. The results suggest that Col-Tgel containing TGF-β3 may be a useful adjunctive treatment for surgical repair of full-thickness rotator cuff tears. Histologic and biomechanical scores suggest that Col-Tgel containing TGF-β3 promotes tendon healing. CLINICAL RELEVANCE The results of this study suggest that shoulders injected with Col-Tgel may be a useful adjunctive treatment for repair of rotator cuff tears.
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Buckup J, Smolen D, Hess F, Sternberg C, Leuzinger J. The arthroscopic triple-row modified suture bridge technique for rotator cuff repair: functional outcome and repair integrity. J Shoulder Elbow Surg 2020; 29:308-315. [PMID: 31451350 DOI: 10.1016/j.jse.2019.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal technique for arthroscopic rotator cuff repair is still controversial. Large tears with a high grade of retraction have an especially high risk of retearing. This study reports the clinical and radiologic results of a triple-row modified suture bridge technique for the treatment of full-thickness rotator cuff tears with medium and high grades of retraction. METHODS A total of 101 shoulders in 100 patients underwent a triple-row modified suture bridge reconstruction for full-thickness rotator cuff tears with retraction grade II and grade III according to Patte; 81 patients were reached for follow-up 36.2 months after surgery. At follow-up, clinical outcome was assessed by the American Shoulder and Elbow Surgeons score, subjective shoulder value, visual analog scale score, University of California-Los Angeles shoulder score, and Constant score (CS). At follow-up, an ultrasound examination was performed to determine tendon integrity or retears in all patients. RESULTS The overall retear rate was 4.9% (4/81). The clinical outcome was good to excellent (American Shoulder and Elbow Surgeons score, 94 ± 11; subjective shoulder value, 92 ± 12; University of California-Los Angeles shoulder score, 33 ± 5; Constant score, 90 ± 9). In the radiologic follow-up, no retear was found in any of the follow-up patients after an average of 36.2 months. There was no significant difference in clinical outcome parameters between rotator cuff tears Patte II and Patte III (P > .05). CONCLUSION For tears with a high grade of retraction, surgical treatment using a triple-row modified suture bridge technique represents a good treatment option with a low rate of retearing and good to excellent clinical results.
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Affiliation(s)
- Johannes Buckup
- Center for Minimally Invasive Surgery, Etzelclinic, Pfäffikon, Switzerland; Department of Sport Traumatology, Knee, and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.
| | - Daniel Smolen
- Center for Minimally Invasive Surgery, Etzelclinic, Pfäffikon, Switzerland
| | - Florian Hess
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Switzerland
| | | | - Jan Leuzinger
- Center for Minimally Invasive Surgery, Etzelclinic, Pfäffikon, Switzerland
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Li H, Chen Y, Chen S. Postoperative residual pain is associated with a high magnetic resonance imaging (MRI)-based signal intensity of the repaired supraspinatus tendon. Knee Surg Sports Traumatol Arthrosc 2019; 27:4014-4020. [PMID: 31451843 DOI: 10.1007/s00167-019-05651-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/26/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess patients with and without postoperative residual pain and to compare clinical function and magnetic resonance imaging (MRI) appearance of the repaired supraspinatus tendon between patients with and without pain. METHODS One-hundred and seventeen patients with supraspinatus tear were included in this study. Visual Analog Scale (VAS) scores for pain were assessed at a follow-up of at least 1 year. Patients with residual shoulder pain were enrolled in the residual pain group (RP group) and patients without pain enrolled in the no pain group (NP group). The American Shoulder and Elbow Surgeons (ASES) shoulder evaluation form, the modified University of California at Los Angeles (UCLA) score and the Fudan University Shoulder Score (FUSS) were also used to evaluate shoulder function. MRI examinations were performed to evaluate rotator cuff integrity according to the Sugaya method, and muscular hypotrophy, fatty infiltration, and signal/noise quotient (SNQ) of the rotator cuff tendon. RESULTS Thirty-five patients had residual pain (RP group) and 82 patients had no pain (NR group). At the final follow-up, there was a significant difference in ASES (92 ± 8 points vs 76 ± 10 points; p < 0.001), UCLA (32 ± 3 points vs 28 ± 3 points; p < 0.001), FUSS (90 ± 7 points vs 80 ± 9 points; p < 0.001) and strength (9 ± 3 kg vs 6 ± 2 kg; p < 0.001) between the NP group and the RP group, respectively. Postoperative MRI revealed that there was no significant difference in the retear rate (9.8% vs 8.6%; ns), the muscular hypotrophy (ns), and the fatty infiltration index (0.9 ± 0.2 vs 0.9 ± 0.2; ns) between the NP and the RP groups, respectively. The postoperative tendon SNQ of the RP group was significantly higher than that of the NP group (4.6 ± 2.5 vs 3 ± 1.7; p < 0.001). There was a significant association between tendon SNQ and VAS for this cohort ([Formula: see text] = 0.29; p = 0.003). CONCLUSION Postoperative residual pain is associated with a high MRI signal intensity of the repaired supraspinatus tendon. Since high signal intensity of tendon tissue indicates degenerated tendon tissue quality, it highlighted the necessity of debriding the degenerated rotator cuff tendon tissue. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Road, Shanghai, 200040, People's Republic of China
| | - Yuzhou Chen
- Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Road, Shanghai, 200040, People's Republic of China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Road, Shanghai, 200040, People's Republic of China.
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Arthroscopic Rotator Cuff Repair in 2019: Linked, Double Row Repair for Achieving Higher Healing Rates and Optimal Clinical Outcomes. Arthroscopy 2019; 35:2749-2755. [PMID: 31500765 DOI: 10.1016/j.arthro.2019.02.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/08/2019] [Accepted: 02/21/2019] [Indexed: 02/02/2023]
Abstract
The primary aim of rotator cuff repair surgery is to restore the musculotendinous units by creating a complete, tension-free repair construct that optimizes conditions for tendon-to-bone healing. There are many factors outside the control of the surgeon that are capable of affecting the healing process; however, there are also a number of important technical considerations that the surgeon can control, including familiarity with methods to deal with immobile tissues and techniques to perform novel repair constructs. It is clear that linked double row repairs are more likely to heal, and healed rotator cuff repairs best restore shoulder strength, improve patients' satisfaction, and maximize functional outcomes.
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Ackley JF, Kolosky M, Gurin D, Hampton R, Masin R, Krahe D. Cryopreserved amniotic membrane and umbilical cord particulate matrix for partial rotator cuff tears: A case series. Medicine (Baltimore) 2019; 98:e16569. [PMID: 31348285 PMCID: PMC6709267 DOI: 10.1097/md.0000000000016569] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Amniotic membrane (AM) and umbilical cord (UC) are well known to have anti-inflammatory properties and have been shown to promote healing in various orthopedic indications. This study investigated whether intra-articular injection of AM/UC particulate matrix promotes healing of partial rotator cuff tears (RCTs).A case series was performed on 10 patients that received injection of 50 mg AM/UC for partial RCTs that were refractory to conservative treatment. Outcomes included Penn Shoulder Score (PSS) questionnaire, range of motion examination, and magnetic resonance imaging (MRI) analysis before and at 6 months. Final MRI analysis was performed by a musculoskeletal radiologist in a blinded fashion.Average PSS score (out of 100) increased from 46.8 ± 23.7 at baseline to 82.0 ± 19.1 at 6 months. The average PSS sub-scores of pain, satisfaction, and function increased 78.4%, 37.1%, and 82.3% from baseline, respectively. The subject's range of motion was 77.9% at baseline and increased to 99.9% at 6-months. Follow-up MRI scans did not demonstrate any significant change in RCT size. No adverse events were noted.This small case series provides preliminary data for use of cryopreserved AM/UC particulate matrix in patients with refractory partial RCTs.
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Affiliation(s)
- J Freeland Ackley
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
- Southwest Sports Medicine, Waco, TX
| | | | - Danielle Gurin
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
| | - Robert Hampton
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
| | - Richard Masin
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
| | - David Krahe
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
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Technique for a Novel Arthroscopic Transosseous Rotator Cuff Repair. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2019. [DOI: 10.1097/bte.0000000000000159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Derwin KA, Sahoo S, Zajichek A, Strnad G, Spindler KP, Iannotti JP, Ricchetti ET. Tear characteristics and surgeon influence repair technique and suture anchor use in repair of superior-posterior rotator cuff tendon tears. J Shoulder Elbow Surg 2019; 28:227-236. [PMID: 30318274 PMCID: PMC6339588 DOI: 10.1016/j.jse.2018.07.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/13/2018] [Accepted: 07/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The factors that associate with surgical decisions about repair technique and the number of suture anchors used in rotator cuff repair have not been previously investigated. This study investigated the extent to which patient, surgeon, and surgical factors associate with performing single-row vs. double-row repair technique and ultimately with the number of suture anchors used. METHODS Our institution's prospective surgical cohort was queried for patients undergoing suture anchor repair of superior-posterior rotator cuff tendon tears between February 2015 and August 2017. Exclusion criteria were patients with isolated subscapularis tears, tears that were not repaired, repairs without suture anchors, repairs involving graft augmentation, and repairs by surgeons with fewer than 10 cases. Multivariable statistical modeling was used to investigate associations between patient and surgical factors and the choice of repair technique and number of suture anchors used. RESULTS A total of 925 cases performed by 13 surgeons met inclusion criteria. Tear type (full thickness), tear size (medium, large, and massive), a greater number of torn tendons, repair type (arthroscopic), and surgeon were significantly associated with performing a double-row over a single-row repair. Tear size, a greater number of torn tendons, double-row repair technique, and surgeon were significantly associated with a greater number of anchors used for repair. CONCLUSIONS Our findings suggest that in the absence of data to conclusively support a clinical benefit of one repair technique over another, surgeons' training, experience, and inherent practice patterns become the primary factors that define their surgical methods.
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Affiliation(s)
- Kathleen A. Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA,Address for Correspondence: Kathleen A. Derwin, PhD, Department of Biomedical Engineering, Lerner Research Institute, ND20, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA, Phone: 216-445-5982; Fax: 216-444-9198;
| | - Sambit Sahoo
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alexander Zajichek
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gregory Strnad
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Clevel and Clinic, Cleveland, OH, USA
| | - Kurt P. Spindler
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Clevel and Clinic, Cleveland, OH, USA
| | - Joseph P. Iannotti
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Clevel and Clinic, Cleveland, OH, USA
| | - Eric T. Ricchetti
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Clevel and Clinic, Cleveland, OH, USA
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Li H, Chen Y, Chen S. Enhancement of rotator cuff tendon-bone healing using bone marrow-stimulating technique along with hyaluronic acid. J Orthop Translat 2019; 17:96-102. [PMID: 31194057 PMCID: PMC6551361 DOI: 10.1016/j.jot.2019.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/11/2018] [Accepted: 01/02/2019] [Indexed: 12/17/2022] Open
Abstract
Objective The purpose of this study was to investigate the effect of hyaluronic acid (HA) in the tendon–bone healing process after rotator cuff repair in a rabbit model. Methods In vitro, rat bone marrow stromal cells (rBMSCs) were cultured in media for cartilage-related and inflammation-related gene expression levels examination at 1.0 mg/mL of HA. In vivo, 48 New Zealand white rabbits underwent rotator cuff repair surgery, and they were randomly divided into three groups: (1) control group (n = 16), (2) microfracture (MF) group accepting MF treatment (n = 16) and (3) MF/HA group accepting MF with HA treatment (n = 16). Four rabbits from each group were sacrificed at 6 and 12 weeks postoperatively for histological evaluation and biomechanical testing. Results In vitro experiments reveal that HA significantly decreased inflammation-related mRNA expression (IL-1, TNFα) compared with the control group. At 6 weeks after surgery, there was no significant difference of load-to-failure between groups. At 12 weeks after surgery, the mean failure load of the MF/HA group was significantly higher than that of the control group (100.5 ± 10.1 N vs. 68.0 ± 6.2 N; p = 0.0115). The mean failure load of the MF group appeared higher than that of the control group, whereas there was no significant difference (p > 0.05). Histologically, more chondrocytes were clustered at the tendon–bone interface, and more extracellular matrixes were produced in the MF/HA group. The interface of the MF/HA group appeared similar with the normal tendon–bone interface. Conclusion HA may play a crucial role in the acceleration of tendon-to-bone healing which might be through inhibiting inflammation. Rotator cuff repair using MF along with HA led to better tendon–bone healing and a subsequent increase of biomechanical strength at the repair site. The translational potential of this article HA injection is very common for patients with rotator cuff disease because of its antiinflammatory action and adhesion prevention preoperatively. The HA injection during surgery provides an antiinflammatory effect during tendon–bone healing process and leads to better tendon–bone healing postoperatively.
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Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, 12 Wulumuqi Zhong Road, Shanghai 200040, People's Republic of China
| | - Yuzhou Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, 12 Wulumuqi Zhong Road, Shanghai 200040, People's Republic of China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, 12 Wulumuqi Zhong Road, Shanghai 200040, People's Republic of China
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Aydin N, Karaismailoglu B, Gurcan M, Ozsahin MK. Arthroscopic double-row rotator cuff repair: a comprehensive review of the literature. SICOT J 2018; 4:57. [PMID: 30547879 PMCID: PMC6294008 DOI: 10.1051/sicotj/2018048] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/22/2018] [Indexed: 12/14/2022] Open
Abstract
Rotator cuff repairs seek to achieve adequate tendon fixation and to secure the fixation during the process of biological healing. Currently, arthroscopic rotator cuff repair has become the gold standard. One of the earliest defined techniques is single-row repair but the inadequacy of single-row repair to precisely restore the anatomical footprint as well as the significant rates of retear especially in large tears have led surgeons to seek other techniques. Double-row repair techniques, which have been developed in response to these concerns, have various modifications like the number and placement of anchors and suture configurations. When the literature is reviewed, it is possible to say that double-row repairs demonstrate superior biomechanical properties. In regard to retear rates, both double row and transosseous equivalent (TOE) techniques have also yielded more favorable outcomes compared to single-row repair. But the clinical results are conflicting and more studies have to be conducted. However, it is more probable that superior structural integrity will yield better structural and functional results in the long run. TOE repair technique is regarded as promising in terms of better biomechanics and healing since it provides better footprint contact. Knotless TOE structures are believed to reduce impingement on the medial side of tendons and thus aid in tendon nutrition; however, there are not enough studies about its effectiveness. It is important to optimize the costs without endangering the treatment of the patients. We believe that the arthroscopic TOE repair technique will yield superior results in regard to both repair integrity and functionality, especially with tears larger than 3 cm. Although defining the pattern of the tear is one of the most important guiding steps when selecting the repair technique, the surgeon should not forget to evaluate every patient individually for tendon healing capacity and functional expectations.
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Affiliation(s)
- Nuri Aydin
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | | | - Mert Gurcan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Pauly S, Klatte-Schulz F, Stahnke K, Scheibel M, Wildemann B. The effect of autologous platelet rich plasma on tenocytes of the human rotator cuff. BMC Musculoskelet Disord 2018; 19:422. [PMID: 30497435 PMCID: PMC6267832 DOI: 10.1186/s12891-018-2339-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/14/2018] [Indexed: 12/29/2022] Open
Abstract
Background Platelet rich plasma (PRP) is widely used in rotator cuff repairs but its effect on the healing process is unclear. Several cell culture studies on the effect of allogenic PRP have reported promising results but are not transferable to clinical practice. The aim of the present study is to assess the possible effect of autologous PRP on rotator cuff tendon cells. The amount of growth factors involved with tendon-bone healing (PDGF-AB, IGF-1, TGF-β1, BMP-7 and -12) is quantified. Methods Rotator cuff tissue samples were obtained from (n = 24) patients grouped by age (>/< 65 years) and sex into four groups and cells were isolated and characterized. Later, autologous PRP preparations were obtained and the effect was analyzed by means of cell proliferation, collagen I synthesis and expression of collagen I and III. Furthermore, the PRPs were quantified for growth factor content by means of platelet-derived growth factor (PDGF-AB), insulin-like growth factor (IGF-1), transforming growth factor (TGF-β1), as well as bone morphogenetic protein (BMP) -7 and − 12. Results Cell proliferation and absolute synthesis of collagen I were positively affected by PRP exposure compared to controls (p < 0.05), but expression and relative synthesis of collagen I (normalized to cell proliferation) were significantly reduced. PRP contained high amounts of IGF-1 and lower levels of TGF-β1 and PDGF-AB. The amounts of BMP-7 and -12 were below the detection limits. Conclusions PRP is a source of growth factors such involved with tendon-bone healing. PRP had an anabolic effect on the human rotator cuff tenocytes of the same individual in vitro by means of cell proliferation and absolute, but not relative collagen I synthesis. These results encourage further studies on clinical outcomes with more comparable standards in terms of preparation and application methods. Level of evidence Controlled laboratory study.
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Affiliation(s)
- Stephan Pauly
- Julius Wolff Institut, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Franka Klatte-Schulz
- Julius Wolff Institut, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitaetsmedizin, Berlin, Germany
| | - Katharina Stahnke
- Julius Wolff Institut, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Markus Scheibel
- Julius Wolff Institut, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Britt Wildemann
- Julius Wolff Institut, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitaetsmedizin, Berlin, Germany.,Department of Experimental Traumatology, Universitaetsklinikum Jena, Jena, Germany
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Rotator Cuff Repair: Single Row Repair Versus Double Row Repair and Superior Capsular Reconstruction. Sports Med Arthrosc Rev 2018; 26:171-175. [PMID: 30395062 DOI: 10.1097/jsa.0000000000000228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The surgical management of rotator cuff (RC) tears has progressed considerably in recent decades. Arthroscopic procedures now represent the mainstay of contemporary treatment approaches. The success of repair is predicated upon the achievement of a secure, durable repair that promotes tendon-to-bone healing. Both single and double row (DR) suture anchor configurations have been described to achieve stable fixation. Although consensus is lacking with regard to the clinical superiority of one configuration over another, trends in the literature suggest that DR repairs may optimize the likelihood of tendon healing and restoration of shoulder strength. In cases of truly irreparable RC tears, superior capsular reconstruction is a promising alternative to open tendon transfer and arthroplasty procedures. The purposes of this concise review are to: (1) explain our preference for a DR repair configuration in almost all circumstances; and (2) advocate superior capsular reconstruction as a viable treatment tactic for truly irreparable RC tears in the absence of significant glenohumeral arthritis.
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Kjær BH, Magnusson SP, Warming S, Henriksen M, Krogsgaard MR, Juul-Kristensen B. Progressive early passive and active exercise therapy after surgical rotator cuff repair - study protocol for a randomized controlled trial (the CUT-N-MOVE trial). Trials 2018; 19:470. [PMID: 30176943 PMCID: PMC6122575 DOI: 10.1186/s13063-018-2839-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/04/2018] [Indexed: 01/08/2023] Open
Abstract
Background Rotator cuff tear is a common cause of shoulder disability and results in patients predominantly complaining of pain and loss of motion and strength. Traumatic rotator cuff tears are typically managed surgically followed by ~ 20 weeks of rehabilitation. However, the timing and intensity of the postoperative rehabilitation strategy required to reach an optimal clinical outcome is unknown. Early controlled and gradually increased tendon loading has been suggested to positively influence tendon healing and recovery. The aim of this trial is therefore to examine the effect of a progressive rehabilitation strategy on pain, physical function and quality of life compared to usual care (that limits tendon loading in the early postoperative phase) in patients who have a rotator cuff repair of a traumatic tear. Methods The current study is a randomized, controlled, outcome-assessor blinded, multicenter, superiority trial with a two-group paralleled design. A total of 100 patients with surgically repaired traumatic rotator cuff tears will be recruited from up to three orthopedic departments in Denmark, and randomized to either a progressive early passive and active movement program or a limited early passive movement program (usual care). The primary outcome measure will be the change from pre-surgery to 12 weeks post-surgery in the Western Ontario Rotator Cuff Index questionnaire. Secondary outcomes include the Disabilities Arm, Shoulder and Hand questionnaire (DASH), range of motion, strength and tendon healing characteristics from ultrasound measurements at 12 months follow up. Discussion We hypothesized that patients who receive the progressive rehabilitation strategy will benefit more with respect to pain reduction, physical function and quality of life than those who receive care as usual. If this is confirmed our study can be used clinically to enhance the recovery of patients with traumatic rotator cuff tear. Trial registration ClinicalTrials.gov, NCT02969135. Registered on 15 November 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2839-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark. .,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark.
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark.,Institute of Sports Medicine, Department of Orthopaedic Surgery M, Copenhagen Bispebjerg-Frederiksberg Hospital, and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susan Warming
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark
| | - Marius Henriksen
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark.,The Parker Institute, Bispebjerg-Frederiksberg Hospital, Ndr. Fasanvej 57, DK-2000, Frederiksberg, Copenhagen, Denmark
| | - Michael Rindom Krogsgaard
- Section for Sports Traumatology M51, Department of Orthopaedic Surgery, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark
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Jancuska J, Matthews J, Miller T, Kluczynski MA, Bisson LJ. A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff. Orthop J Sports Med 2018; 6:2325967118797891. [PMID: 30320144 PMCID: PMC6154263 DOI: 10.1177/2325967118797891] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The number of systematic reviews and meta-analyses published on the rotator cuff (RC) has increased markedly. PURPOSE To quantify the number of systematic reviews and meta-analyses published on the RC and to provide a qualitative summary of the literature. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic search for all systematic reviews and meta-analyses pertaining to the RC published between January 2007 and September 2017 was performed with PubMed, MEDLINE, and the Cochrane Database of Systematic Reviews. Narrative reviews and non-English language articles were excluded. RESULTS A total of 1078 articles were found, of which 196 met the inclusion criteria. Included articles were summarized and divided into 15 topics: anatomy and function, histology and genetics, diagnosis, epidemiology, athletes, nonoperative versus operative treatment, surgical repair methods, concomitant conditions and surgical procedures, RC tears after total shoulder arthroplasty, biological augmentation, postoperative rehabilitation, outcomes and complications, patient-reported outcome measures, cost-effectiveness of RC repair, and quality of randomized controlled trials. CONCLUSION A qualitative summary of the systematic reviews and meta-analyses published on the RC can provide surgeons with a single source of the most current literature.
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Affiliation(s)
- Jeffrey Jancuska
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - John Matthews
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - Tyler Miller
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - Melissa A. Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - Leslie J. Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
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Li H, Chen Y, Chen J, Hua Y, Chen S. Large Critical Shoulder Angle Has Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair. Am J Sports Med 2018; 46:1892-1900. [PMID: 29723034 DOI: 10.1177/0363546518767634] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The critical shoulder angle (CSA) is the angle created between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion. A few studies recently investigated the relation between CSA and functional outcomes after rotator cuff repair. However, there is a lack of research investigating the effect of CSA on postoperative tendon integrity after rotator cuff repair. PURPOSE To assess the effects of the CSA on postoperative tendon integrity after rotator cuff repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All patients who underwent rotator cuff repair for full-thickness supraspinatus tears by 1 senior surgeon between January 2010 and January 2014 were included in this study. All patients had standardized anteroposterior shoulder radiographs the day before surgery. CSA and acromial index (AI) were measured. AI was derived by measuring the distance from the glenoid plane to the lateral border of the acromion and dividing it by the distance from the glenoid plane to the lateral aspect of the humeral head. Functional scores-including American Shoulder and Elbow Surgeons shoulder evaluation form, modified University of California at Los Angeles score, Constant-Murley score, and visual analog scale for pain-were used to evaluate shoulder function at a minimum follow-up of 2 years. Meanwhile, magnetic resonance imaging examinations were performed to evaluate rotator cuff integrity according to the Sugaya method and the signal/noise quotient (SNQ) of the rotator cuff tendon. RESULTS A total of 90 patients were included in this study: 42 patients with a single-row repair and 48 with a double-row repair. There was a significant positive correlation between CSA or AI and tendon SNQ. On the basis of CSA, the patients were divided into 2 groups: large CSA (>38°) and control (CSA ≤38°). At final follow-up, the large CSA group and the control CSA group demonstrated no significant differences in American Shoulder and Elbow Surgeons, University of California at Los Angeles, Constant, and visual analog scale scores. Postoperative magnetic resonance imaging revealed that the large CSA group had 9 cases of retear, with a significantly higher retear rate than the control group (15% vs 0%, P = .03). Furthermore, the tendon SNQ of the large CSA group was significantly greater than that of the control group. CONCLUSION CSA did not appear to influence postoperative functional outcomes, while those in the large CSA group had poor tendon integrity after rotator cuff repair. These findings indicate that a large CSA is associated with an increased risk of rotator cuff tendon retear after repair.
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Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yuzhou Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
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Thiébat G, Capitani P, de Girolamo L, Perucca Orfei C, Facchini F, Schoenhuber H, Viganò M. The Effect of Three Different Suture Anchors for Rotator Cuff Repair on Primary Cultures of Human Bone Marrow Mesenchymal Stem Cells. JOINTS 2018; 6:100-103. [PMID: 30051106 PMCID: PMC6059850 DOI: 10.1055/s-0038-1660789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/02/2018] [Indexed: 10/31/2022]
Abstract
Purpose The purpose of this study is to investigate the in vitro biocompatibility of three different suture anchors (all-suture anchor, metal anchor, and polyetheretherketone anchor), commonly used for the rotator cuff repair. Methods To assess the biocompatibility of the anchors, the possible cytotoxicity and the immunogenicity of the devices were assessed by cell viability assay and cell count on cultures of bone marrow stem cells (BMSCs) and peripheral blood leucocytes (PBLs), respectively. The possible inhibitory effect of the devices on BMSCs osteogenic potential was evaluated by alkaline phosphatase activity and matrix deposition assay. Results The viability of BMSCs was slightly reduced when cultured in the presence of the devices (-24 ± 3%). Nevertheless, they were able to differentiate toward the osteogenic lineage in all culture conditions. The proliferation of PBLs and the production of interleukin-2 were not enhanced by the presence of any device. Conclusion The analyzed devices did not significantly affect the normal cells functions when directly cultured with human primary BMSCs or PBLs, in terms of osteogenic differentiation and inflammatory reaction. Clinical Relevance A deeper knowledge of the biological reactions to different devices used in rotator cuff surgeries would improve the clinical outcome of these procedures.
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Affiliation(s)
- Gabriele Thiébat
- Sport Traumatology Centre, Istituto Ortopedico Galeazzi, Milano, Italy
| | - Paolo Capitani
- Sport Traumatology Centre, Istituto Ortopedico Galeazzi, Milano, Italy
| | - Laura de Girolamo
- Orthopaedic Biotechnology Laboratory, Istituto Ortopedico Galeazzi, Milano, Italy
| | | | | | | | - Marco Viganò
- Orthopaedic Biotechnology Laboratory, Istituto Ortopedico Galeazzi, Milano, Italy
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Jeong HY, Kim HJ, Jeon YS, Rhee YG. Factors Predictive of Healing in Large Rotator Cuff Tears: Is It Possible to Predict Retear Preoperatively? Am J Sports Med 2018; 46:1693-1700. [PMID: 29595993 DOI: 10.1177/0363546518762386] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many studies have identified risk factors that cause retear after rotator cuff repair. However, it is still questionable whether retears can be predicted preoperatively. PURPOSE To determine the risk factors related to retear after arthroscopic rotator cuff repair and to evaluate whether it is possible to predict the occurrence of retear preoperatively. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This study enrolled 112 patients who underwent arthroscopic rotator cuff repair with single-row technique for a large-sized tear, defined as a tear with a mediolateral length of 3 to 5 cm. All patients underwent routine magnetic resonance imaging (MRI) at 9 months postoperatively to assess tendon integrity. The sample included 61 patients (54.5%) in the healed group and 51 (45.5%) in the retear group. RESULTS In multivariate analysis, the independent predictors of retears were supraspinatus muscle atrophy ( P < .001) and fatty infiltration of the infraspinatus ( P = .027), which could be preoperatively measured by MRI. A significant difference was found between the two groups in sex, the acromiohumeral interval, tendon tension, and preoperative or intraoperative mediolateral tear length and musculotendinous junction position in univariate analysis. However, these variables were not independent predictors in multivariate analysis. The cutoff values of occupation ratio of supraspinatus and fatty infiltration of the infraspinatus were 43% and grade 2, respectively. The occupation ratio of supraspinatus <43% and grade ≥2 fatty infiltration of the infraspinatus were the strongest predictors of retear, with an area under the curve of 0.908, sensitivity of 98.0%, and specificity of 83.6% (accuracy = 90.2%). CONCLUSION In patients with large rotator cuff tears, it was possible to predict the retear before rotator cuff repair regardless of intraoperative factors. The retear could be predicted most effectively when the occupation ratio of supraspinatus was <43% or the fatty infiltration of infraspinatus was grade ≥2. Predicting retear preoperatively may help surgeons determine proper treatment and predict the postoperative prognosis.
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Affiliation(s)
- Ho Yeon Jeong
- Department of Orthopaedic Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Hwan Jin Kim
- Department of Orthopaedic Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Yoon Sang Jeon
- 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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Linderman SW, Golman M, Gardner TR, Birman V, Levine WN, Genin GM, Thomopoulos S. Enhanced tendon-to-bone repair through adhesive films. Acta Biomater 2018; 70:165-176. [PMID: 29427745 DOI: 10.1016/j.actbio.2018.01.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/04/2018] [Accepted: 01/23/2018] [Indexed: 12/16/2022]
Abstract
Tendon-to-bone surgical repairs have unacceptably high failure rates, possibly due to their inability to recreate the load transfer mechanisms of the native enthesis. Instead of distributing load across a wide attachment footprint area, surgical repairs concentrate shear stress on a small number of suture anchor points. This motivates development of technologies that distribute shear stresses away from suture anchors and across the enthesis footprint. Here, we present predictions and proof-of-concept experiments showing that mechanically-optimized adhesive films can mimic the natural load transfer mechanisms of the healthy attachment and increase the load tolerance of a repair. Mechanical optimization, based upon a shear lag model corroborated by a finite element analysis, revealed that adhesives with relatively high strength and low stiffness can, theoretically, strengthen tendon-to-bone repairs by over 10-fold. Lap shear testing using tendon and bone planks validated the mechanical models for a range of adhesive stiffnesses and strengths. Ex vivo human supraspinatus repairs of cadaveric tissues using multipartite adhesives showed substantial increase in strength. Results suggest that adhesive-enhanced repair can improve repair strength, and motivate a search for optimal adhesives. STATEMENT OF SIGNIFICANCE Current surgical techniques for tendon-to-bone repair have unacceptably high failure rates, indicating that the initial repair strength is insufficient to prevent gapping or rupture. In the rotator cuff, repair techniques apply compression over the repair interface to achieve contact healing between tendon and bone, but transfer almost all force in shear across only a few points where sutures puncture the tendon. Therefore, we evaluated the ability of an adhesive film, implanted between tendon and bone, to enhance repair strength and minimize the likelihood of rupture. Mechanical models demonstrated that optimally designed adhesives would improve repair strength by over 10-fold. Experiments using idealized and clinically-relevant repairs validated these models. This work demonstrates an opportunity to dramatically improve tendon-to-bone repair strength using adhesive films with appropriate material properties.
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Savin DD, Romeo A. Technique and Outcomes for Knotless Transosseous Rotator Cuff Repair. OPER TECHN SPORT MED 2018. [DOI: 10.1053/j.otsm.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Do functional outcomes and cuff integrity correlate after single- versus double-row rotator cuff repair? A systematic review and meta-analysis study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:593-605. [PMID: 29442181 DOI: 10.1007/s00590-018-2145-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study is to perform a systematic review and meta-analysis of all available level I prospective randomized controlled trials comparing arthroscopic single-row (SR) with double-row (DR) rotator cuff repairs by both clinical outcomes and radiological re-tear rates. METHODS PubMed, EMBASE, Google Scholar, and Cochrane databases search was done for level I RCTs comparing clinical and radiological outcomes after SR versus DR rotator cuff repair. Clinical outcomes included UCLA, ASES, Constant, WORC, and SANE scores; structural outcomes included MRI, MRA, or US. RESULTS Seven level I studies were included (5 mid-term and 2 short-term). Postoperative ASES, Constant, WORC, and SANE scores showed nonsignificant slightly better function of DR groups. Only, UCLA score showed significantly better scores with DR repair (p = 0.007). Full-thickness re-tear incidence was reported in 15/174 (8.6%) in DR group and 20/175 (11.4%) in SR group (p = 0.44). Partial-thickness re-tear rate was reported in 18/174 patients (10.3%) in DR group and 41/175 patients (23.4%) in SR group (p = 0.009). CONCLUSION Within the domain of level I mid-term and short-term studies, DR repair showed significant better UCLA score only. (ASES, Constant, WORC, and SANE scores showed no significance.) This may correlate weakly with the significant lower partial-thickness re-tear rates of DR repairs. In contrary, long-term level III studies showed a direct correlation of both functional outcomes and cuff structural integrity, with significant superiority of DR over SR repair techniques. LEVEL OF EVIDENCE Level 1, systematic review and meta-analysis.
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Abstract
This present article summarizes established and current developments and aspects of rotator cuff surgery. Achieved milestones as well as current approaches are presented and assessed with respect to their clinical and radiographic impact. Despite biomechanical and technical improvements in modern rotator cuff repair techniques, re-defect and re-tearing rates could not be fully eliminated. Meanwhile, the importance of biological processes around successful tendon-bone reintegration has been increasingly recognized. Hence, this article presents the current scientific standing regarding biological growth factors, platelet-rich plasma and rotator cuff augmentation techniques (with allogenic/autologous grafts). In summary, there are clear biomechanical advantages as well as many promising approaches to biological augmentation; however, the latter have not yet been transferred into regular clinical application.
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Hohmann E, König A, Kat CJ, Glatt V, Tetsworth K, Keough N. Single- versus double-row repair for full-thickness rotator cuff tears using suture anchors. A systematic review and meta-analysis of basic biomechanical studies. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:859-868. [PMID: 29270867 DOI: 10.1007/s00590-017-2114-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/08/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this study was to perform a systematic review and meta-analysis comparing single- and double-row biomechanical studies to evaluate load to failure, mode of failure and gap formation. MATERIALS AND METHODS A systematic review of MEDLINE, Embase, Scopus and Google Scholar was performed from 1990 through 2016. The inclusion criteria were: documentation of ultimate load to failure, failure modes and documentation of elongation or gap formation. Studies were excluded if the study protocol did not use human specimens. Publication bias was assessed by funnel plot and Egger's test. The risk of bias was established using the Cochrane Collaboration's risk of bias tool. Heterogeneity was assessed using χ 2 and I 2 statistic. RESULTS Eight studies were included. The funnel plot was asymmetric suggesting publication bias, which was confirmed by Egger's test (p = 0.04). The pooled estimate for load to failure demonstrated significant differences (SMD 1.228, 95% CI: 0.55-5.226, p = 0.006, I 2 = 60.47%), favouring double-row repair. There were no differences for failure modes. The pooled estimate for elongation/gap formation demonstrated significant differences (SMD 0.783, 95% CI: 0.169-1.398, p = 0.012, I 2 = 58.8%), favouring double-row repair. CONCLUSION The results of this systematic review and meta-analysis suggest that double-row repair is able to tolerate a significantly greater load to failure. Gap formation was also significantly lower in the double-row repair group, but both of these findings should be interpreted with caution because of the inherent interstudy heterogeneity. LEVEL OF EVIDENCE Systematic review and meta-analysis.
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Affiliation(s)
- Erik Hohmann
- Clinical Medical School, University of Queensland, St. Lucia, Australia. .,Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa. .,Department of Orthopaedic Surgery and Sports Medicine, Valiant Clinic/Houston Methodist Group, PO Box 414296, Dubai, United Arab Emirates.
| | - Anya König
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Cor-Jacques Kat
- Faculty of Engineering, University of Pretoria, Pretoria, South Africa
| | - Vaida Glatt
- University of Texas Health Science Center, San Antonio, TX, USA
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia.,Department of Surgery, School of Medicine, University of Queensland, St. Lucia, Australia.,Queensland University of Technology, Brisbane, Australia.,Orthopaedic Research Institute of Australia, Sydney, Australia
| | - Natalie Keough
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Ebert JR, Wang A, Smith A, Nairn R, Breidahl W, Zheng MH, Ackland T. A Midterm Evaluation of Postoperative Platelet-Rich Plasma Injections on Arthroscopic Supraspinatus Repair: A Randomized Controlled Trial. Am J Sports Med 2017; 45:2965-2974. [PMID: 28806095 DOI: 10.1177/0363546517719048] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP) has been applied as an adjunct to rotator cuff repair to improve tendon-bone healing and potentially reduce the incidence of subsequent tendon retears. PURPOSE To investigate whether the midterm clinical and radiographic outcomes of arthroscopic supraspinatus repair are enhanced after repeated postoperative applications of PRP. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 60 patients (30 control; 30 PRP) were initially randomized to receive 2 ultrasound-guided injections of PRP to the tendon repair site at 7 and 14 days after double-row arthroscopic supraspinatus repair or not. A total of 55 patients (91.7%) underwent a clinical review and magnetic resonance imaging (MRI) at a mean of 3.5 years after surgery (range, 36-51 months). Patient-reported outcome measures (PROMs) included the Constant score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Oxford Shoulder Score (OSS), and visual analog scale (VAS) for pain. Global rating of change (GRC) scale and patient satisfaction scores were evaluated. Structural integrity of the surgical repair was assessed via MRI using the Sugaya classification system. RESULTS At the midterm review, there was no difference between the groups for any of the PROMs. No differences between the groups were demonstrated for the subjective and range of motion subscales of the Constant score, although a significantly higher Constant strength subscale score was observed in the PRP group (3.3 points; 95% CI, 1.0-5.7; P = .006). There was no evidence for any group differences in MRI scores or retear rates, with 66.7% of PRP patients and 64.3% of control patients rated as Sugaya grade 1. Two control patients had symptomatic retears (both full thickness) within the first 16 weeks after surgery compared with 2 PRP patients, who suffered symptomatic retears (both partial thickness) between 16 weeks and a mean 3.5-year follow-up. CONCLUSION Significant postoperative clinical improvements and high levels of patient satisfaction were observed in patients at the midterm review after supraspinatus repair. While pain-free, maximal abduction strength was greater in the midterm after PRP treatment, repeated applications of PRP delivered at 7 and 14 days after surgery provided no additional benefit to tendon integrity.
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Allan Wang
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Department of Orthopaedic Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia.,Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science and Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Robert Nairn
- Perth Radiological Clinic, Perth, Western Australia, Australia
| | | | - Ming Hao Zheng
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Timothy Ackland
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
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Galanopoulos I, Ilias A, Karliaftis K, Papadopoulos D, Ashwood N. The Impact of Re-tear on the Clinical Outcome after Rotator Cuff Repair Using Open or Arthroscopic Techniques - A Systematic Review. Open Orthop J 2017; 11:95-107. [PMID: 28400878 PMCID: PMC5366380 DOI: 10.2174/1874325001711010095] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 12/20/2022] Open
Abstract
Background: It is generally accepted that rotator cuff repair gives satisfactory results in the long term, although most studies have so far shown a fairly high rate of structural failure or re-tear. The purpose of this review study is to assess whether failure of the repaired cuff to heal could negatively affect the functional outcome. Methods: This article includes an extensive Internet PubMed based research in the current English-language literature including level I to level V studies as well as systematic reviews. Results: According to this extended study research, the results are mixed; certain reports show that patients with a healed rotator cuff repair have improved function and strength compared to those with structural failure, whereas other studies support the generally perceived concept that tendon re-tear does not lead to inferior clinical outcome. Conclusion: Further high-level prospective studies with larger numbers of patients and longer follow up are needed to overcome the current debate over function between healed and failed rotator cuff repairs.
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Affiliation(s)
- Ilias Galanopoulos
- Department of Orthopedics, 401 General Military Hospital of Athens, Athens, Greece
| | - Aslanidis Ilias
- Department of Orthopedics, 401 General Military Hospital of Athens, Athens, Greece
| | | | | | - Neil Ashwood
- Department of Orthopedics, Queen's Hospital, Burton-on-Trent, United Kingdom
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Chillemi C, Mantovani M, Osimani M, Castagna A. Arthroscopic transosseous rotator cuff repair: the eight-shape technique. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:399-404. [PMID: 28124131 DOI: 10.1007/s00590-017-1906-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/16/2017] [Indexed: 11/29/2022]
Abstract
All-arthroscopic anchorless transosseous suture techniques combine the advantages of the open transosseous repair with the benefits of arthroscopic technique. However, all the techniques described until now are very complex, difficult to reproduce and associated with an increased surgical time. The authors developed a novel all-arthroscopic anchorless transosseous suture technique easy to perform and to reproduce. This procedure maximizes the tendon-footprint contact area obtaining both medial and lateral fixation without using any device, employing only 1 suture tape so to avoiding the risk of suture twist. The preparation of two transosseous tunnels is very easily and safely performed thanks to a dedicated instrument. The procedure is described in details. Moreover, the preliminary favorable results after a minimum follow-up of 12 months are reported.
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Affiliation(s)
- Claudio Chillemi
- Department of Orthopaedic Surgery, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Via F. Faggiana, 1668, Latina, Italy.
| | | | - Marcello Osimani
- Department of Radiological Sciences, University of Rome "Sapienza", ICOT, Latina, Italy
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Saccomanno MF, Sircana G, Cazzato G, Donati F, Randelli P, Milano G. Prognostic factors influencing the outcome of rotator cuff repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016. [PMID: 26197937 DOI: 10.1007/s00167-015-3700-y] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To identify prognostic factors significantly associated with rotator cuff repair outcome and define the strength of these associations. METHODS Search was performed using electronic databases. Studies reporting prognostic factors affecting rotator cuff repair outcome were included. Primary outcomes were: structural integrity, Disabilities of the Arm, Shoulder and Hand score, American Shoulder and Elbow Surgeons score, and Constant score. Each other outcome was considered as secondary outcome. Descriptive statistics was used. When possible, meta-analyses were performed. Methodological quality was assessed using the Quality In Prognosis Studies Tool. A best evidence synthesis was performed using the Grading of Recommendations Assessment, Development and Evaluation framework adapted to prognostic studies. RESULTS Sixty-four studies were included. Methodological quality was high only for twelve studies. The overall quality of evidence was low to very low. Meta-analyses were possible only for seven studies. Older age and larger tears size were found to affect retear risk. Results were controversial for fatty infiltration, acromioclavicular joint or biceps procedures, acromiohumeral distance, delamination of tendon edges, musculotendinous junction position, number of tendons involved, and tendon length, quality and retraction. Baseline scores and workers compensation claim predicted functional outcomes. Subjective outcome was also affected by patient's expectations. CONCLUSIONS Despite the large number of outcomes and prognostic factors evaluated by a relative small number of studies, almost not prognostic in design, it was not possible to reach any definitive conclusion regarding the most relevant predictors of outcome of rotator cuff repair. Moreover, the low methodological quality of the included studies and, subsequently, the low quality of evidence, seriously affected the strength of recommendation of the present review. Based on data available, retear risk is mainly affected by older age and larger tears size. Baseline scores and work compensation claim are the most significant predictors for functional outcomes. LEVEL OF EVIDENCE Systematic review of level I-IV prognostic studies, Level IV.
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Affiliation(s)
- Maristella F Saccomanno
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Giuseppe Sircana
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Gianpiero Cazzato
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Fabrizio Donati
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Pietro Randelli
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giuseppe Milano
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy.
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Ostrander RV, Smith J, Saper M. Triple-Row Modification of the Suture-Bridge Technique for Arthroscopic Rotator Cuff Repair. Arthrosc Tech 2016; 5:e1007-e1013. [PMID: 27909668 PMCID: PMC5124061 DOI: 10.1016/j.eats.2016.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/09/2016] [Indexed: 02/03/2023] Open
Abstract
Recent advances to improve outcomes in rotator cuff repair include using arthroscopic double-row suture-bridge techniques in an effort to reconstruct the rotator cuff footprint and improve fixation. However, when using this technique for larger tears, it can be difficult to get the lateral portion of the rotator cuff into an anatomic position. This report describes a triple-row modification of the suture-bridge technique that results in significantly more footprint contact area and contact pressure compared with the double-row and standard suture-bridge techniques. Maximizing the rotator cuff footprint contact area exposes more of the tendon to bone and may improve the healing potential.
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Affiliation(s)
- Roger V. Ostrander
- Address correspondence to Roger V. Ostrander III, M.D., Andrews Institute for Orthopaedics and Sports Medicine, 1040 Gulf Breeze Pkwy, Gulf Breeze, FL 32561, U.S.A.Andrews Institute for Orthopaedics and Sports Medicine1040 Gulf Breeze PkwyGulf BreezeFL32561U.S.A.
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Spiegl UJ, Euler SA, Millett PJ, Hepp P. Summary of Meta-Analyses Dealing with Single-Row versus Double-Row Repair Techniques for Rotator Cuff Tears. Open Orthop J 2016; 10:330-338. [PMID: 27708735 PMCID: PMC5041206 DOI: 10.2174/1874325001610010330] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 05/16/2015] [Accepted: 02/01/2016] [Indexed: 02/07/2023] Open
Abstract
Background: Several meta-analyses of randomized clinical trials have been performed to analyze whether double-row (DR) rotator cuff repair (RCR) provides superior clinical outcomes and structural healing compared to single-row (SR) repair. The purpose of this study was to sum up the results of meta-analysis comparing SR and DR repair with respect on clinical outcomes and re-tear rates. Methods: A literature search was undertaken to identify all meta-analyses dealing with randomized controlled trials comparing clinical und structural outcomes after SR versus DR RCR. Results: Eight meta-analyses met the eligibility criteria: two including Level I studies only, five including both Level I and Level II studies, and one including additional Level III studies. Four meta-analyses found no differences between SR and DR RCR for patient outcomes, whereas four favored DR RCR for tears greater than 3 cm. Two meta-analyses found no structural healing differences between SR and DR RCR, whereas six found DR repair to be superior for tears greater than 3 cm tears. Conclusion: No clinical differences are seen between single-row and double-row repair for small and medium rotator cuff tears after a short-term follow-up period with a higher re-tear rate following single-row repairs. There seems to be a trend to superior results with double-row repair in large to massive tear sizes.
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Affiliation(s)
- U J Spiegl
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Germany
| | - S A Euler
- Department of Trauma Surgery and Sports Traumatology, Medical University Innsbruck, Austria
| | | | - P Hepp
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Germany
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Samuelson EM, Odum SM, Fleischli JE. The Cost-Effectiveness of Using Platelet-Rich Plasma During Rotator Cuff Repair: A Markov Model Analysis. Arthroscopy 2016; 32:1237-44. [PMID: 26927681 DOI: 10.1016/j.arthro.2015.12.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 10/06/2015] [Accepted: 12/02/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE To perform a cost-utility analysis to determine if the use of platelet-rich plasma (PRP) products during arthroscopic rotator cuff repair (RCR) is cost-effective. METHODS A cost-utility analysis was conducted using a Markov decision model. Model inputs including health utility values, retear rates, and transition probabilities were derived from the best evidence available in the literature regarding full-thickness rotator cuff tears and their repair, as well as the augmentation of their repair with PRP. Costs were determined by examining the typical patient undergoing treatment for a full-thickness rotator cuff tear in a private orthopaedic clinic and outpatient surgery center. RESULTS The cost per quality-adjusted life-year ($/QALY) of RCR with and without PRP was $6,775/QALY and $6,612/QALY, respectively. In our base case, the use of PRP to augment RCR was not cost-effective because it had exactly the same "effectiveness" as RCR without PRP augmentation while being associated with a higher cost (additional $750). Sensitivity analysis showed that to achieve a willingness-to-pay threshold of $50,000/QALY, the addition of PRP would need to be associated with a 9.1% reduction in retear rates. If the cost of PRP were increased to $1,000, the retear rate would need to be reduced by 12.1% to reach this same threshold. This compared with a necessary reduction of only 6.1% if the additional cost of PRP was $500. CONCLUSIONS This cost-utility analysis shows that, currently, the use of PRP to augment RCR is not cost-effective. Sensitivity analysis showed that PRP-augmented repairs would have to show a reduced retear rate of at least 9.1% before the additional cost would be considered cost-effective. LEVEL OF EVIDENCE Level III, analysis of Level I, II, and III studies.
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Affiliation(s)
| | - Susan M Odum
- OrthoCarolina Research Institute, Charlotte, North Carolina, U.S.A
| | - James E Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A
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Abstract
Compared with smaller tears, massive rotator cuff tears present significant clinical management dilemmas for the treating surgeon because they are often fraught with structural failure and poor outcomes. To optimize healing, current surgical methods look to optimize footprint coverage and enhance the biological environment for healing. Double-row techniques have demonstrated clear biomechanical advantages in controlled cadaveric studies, but have yet to demonstrate clear clinical efficacy over more simple repair techniques. When repairs for massive rotator cuff tears fail, options include revision repair or superior capsular reconstruction, an option to bridge the tissue gap with human dermal allograft or fascia lata autograft in hopes of containing the humeral head from superior migration and precluding rotator cuff arthropathy. Although latissimus transfers remain a reasonable option for massive, irreparable rotator cuff tears in appropriately indicated patients, clinical results are often unpredictable. Older patients with chronic, massive rotator cuff tears with pseudoparalysis can achieve predictable, often excellent clinical results with a reverse total shoulder arthroplasty. [Orthopedics. 2016; 39(3):145-151.].
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Wani Z, Abdulla M, Habeebullah A, Kalogriantis S. Rotator cuff tears: Review of epidemiology, clinical assessment and operative treatment. TRAUMA-ENGLAND 2016. [DOI: 10.1177/1460408615596770] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Rotator cuff tears (RTCs) are the most common cause of shoulder disability. There has been a proportional increase in the prevalence of RCT in accordance with the rising trend of an ageing population. In this article we review the current literature encompassing RCT epidemiology, risk factors and aetiopathogenesis. We also summarize the current diagnostic modalities, treatment options, rehabilitation and outcomes.
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Affiliation(s)
- Zubair Wani
- University Hospital Birmingham, Birmingham, UK
| | - Mohamed Abdulla
- Department of Anatomy, University of Birmingham Medical School, UK
| | | | - Socrates Kalogriantis
- University Hospital Birmingham, Birmingham, UK
- Department of Anatomy, University of Birmingham Medical School, UK
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