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Morgan CN, Bonner KF, Griffin JW. Augmentation of Arthroscopic Rotator Cuff Repair: Biologics and Grafts. Clin Sports Med 2023; 42:95-107. [DOI: 10.1016/j.csm.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shibayama Y, Hirose T, Sugi A, Mizushima E, Watanabe Y, Tomii R, Iba K, Yamashita T. Relationship between preoperative size of rotator cuff tears measured using radial-slice magnetic resonance images and postoperative rotator cuff integrity: a prospective case-control study. JSES Int 2021; 6:279-286. [PMID: 35252927 PMCID: PMC8888162 DOI: 10.1016/j.jseint.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is useful for diagnosing shoulder diseases preoperatively. However, preoperative risk factors for retears have not been previously reported using a radial-slice MRI. Here, we investigated the relationship between the preoperative tear area of the rotator cuff evaluated using radial-slice MRI and the postoperative rotator cuff integrity. Our hypothesis is that larger tear area of the rotator cuff measured using radial-slice MRI would be associated with increased retear rates. Methods From June 2010 to October 2015, we treated 102 consecutive patients who underwent shoulder arthroscopy for reparable rotator cuff tears. The patient demographics, medical comorbidities, radiologic factors, tear size, fatty infiltration, muscle atrophy measured using oblique coronal and oblique sagittal MRI, and the tear area calculated using radial-slice MRI were assessed to compare the intact and retear groups in univariate and multivariate logistic regression analyses. The cutoff values of the independent factors were obtained using the receiver operating characteristic curve. Results Retears occurred in 15 of 102 (14.7%) patients. In the univariate analysis, significant differences were found between the two groups for tear size, fatty infiltration of the supraspinatus and infraspinatus, muscle atrophy, and tear area. In the multivariate analysis, the tear area was the independent factor that significantly affected the rate of retear. A tear area of 6.3 cm2 was the strongest predictor of retear with an area under the curve of 0.965, sensitivity of 86.7%, and specificity of 96.6%. Conclusion The tear area was the independent factor that most significantly affected the rate of retear and showed excellent accuracy with a cutoff value of 6.3 cm2. Radial-slice MRI may be a valuable diagnostic tool for assessing the postoperative rotator cuff integrity.
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Maldonado DR, Chen SL, Chen JW, Shapira J, Rosinksy PJ, Annin S, Lall AC, Domb BG. Prospective Analysis of Arthroscopic Hip Anatomic Labral Repair Utilizing Knotless Suture Anchor Technology: The Controlled-Tension Anatomic Technique at Minimum 2-Year Follow-up. Orthop J Sports Med 2020; 8:2325967120935079. [PMID: 33403217 PMCID: PMC7745569 DOI: 10.1177/2325967120935079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/09/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Labral tears are the most common abnormalities in patients undergoing hip arthroscopic surgery. Appropriate management is crucial, as it has been shown that better overall outcomes can be achieved with labral restoration. PURPOSE To report the patient-reported outcomes (PROs) at minimum 2-year follow-up of patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique in the setting of femoroacetabular impingement syndrome (FAIS). STUDY DESIGN Case series; Level of evidence, 4. METHODS Data were prospectively collected for patients who underwent hip arthroscopic surgery for FAIS for labral tear repair using the knotless controlled-tension anatomic technique. Patients were excluded if they had prior hip conditions, prior ipsilateral surgery, Tönnis grade >1, a lateral center-edge angle (LCEA) <25°, or workers' compensation claims. Preoperative and postoperative scores at minimum 2-year follow-up were recorded for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain. The proportion of patients who achieved the minimal clinically important difference (MCID) or patient acceptable symptomatic state (PASS) for the mHHS, HOS-SSS, and iHOT-12 were also reported. RESULTS A total of 309 hips were included. The mean patient age was 36.2 years (range, 12.8-75.9 years). The mean preoperative LCEA and alpha angle were 31.9° and 57.1°, respectively. A significant improvement on the mHHS (62.6 ± 15.7 preoperatively vs 86.9 ± 16.2 at 2-year follow-up), NAHS (63.1 ± 16.7 vs 86.1 ± 16.7), and HOS-SSS (39.8 ± 22.0 vs 74.2 ± 27.3) was found (P < .001 for all). A significant decrease was shown for VAS scores (P < .001). Also, 78.6% and 82.2% of patients achieved the MCID and PASS for the mHHS, respectively; 60.8% and 69.9% of patients met the MCID and PASS for the HOS-SSS, respectively; and the MCID for the iHOT-12 was met by 77.3% of patients. CONCLUSION In the setting of FAIS and labral tears, patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique demonstrated significant improvement in several validated PRO measures, the VAS pain score, and patient satisfaction at a minimum 2 years of follow-up. Based on this evidence, labral tear repair using the knotless controlled-tension anatomic technique seems to be a safe option.
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Affiliation(s)
| | - Sarah L. Chen
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jeffery W. Chen
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jacob Shapira
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | | | - Shawn Annin
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Ajay C. Lall
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Bedeir YH, Jimenez AE, Grawe BM. Recurrent tears of the rotator cuff: Effect of repair technique and management options. Orthop Rev (Pavia) 2018; 10:7593. [PMID: 30057724 PMCID: PMC6042049 DOI: 10.4081/or.2018.7593] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/13/2018] [Indexed: 12/13/2022] Open
Abstract
Retears of the rotator cuff, following operative repair, is not an uncommon event. Various factors have been shown to influence recurrence including the technique of repair. Multiple techniques have been performed with varying results and complications. The repair technique significantly affects the rate and pattern of retears. Although risk of retears with double row and suture bridge techniques is relatively low, medial cuff failure is a potential complication which poses significant challenges when revision repair is undertaken. Modifications in surgical techniques in, both, double row and suture bridge repairs can help decrease the risk of medial cuff failure. Thorough analysis of retear rates and patterns reported, and their relation with the repair technique, provides new insights about the pathogenesis of rotator cuff retears, their future prevention and appropriate management.
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Affiliation(s)
- Yehia H Bedeir
- Department of Orthopedic Surgery, University of Cincinnati Medical Center, OH, USA.,Department of Orthopedic Surgery, University of Alexandria Medical School, Egypt
| | - Andrew E Jimenez
- Department of Orthopedic Surgery, University of Cincinnati Medical Center, OH, USA
| | - Brian M Grawe
- Department of Orthopedic Surgery, University of Cincinnati Medical Center, OH, USA
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Jeong JY, Yoon YC, Lee SM, Yoo JC. Arthroscopic Incomplete Repair Using a "Hybrid Technique" for Large to Massive Rotator Cuff Tears: Clinical Results and Structural Integrity. Arthroscopy 2018; 34:2063-2073. [PMID: 29730212 DOI: 10.1016/j.arthro.2018.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 02/03/2018] [Accepted: 02/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The first aim of this study was to introduce the concept of hybrid repair (incomplete repair) for large to massive rotator cuff tears and to report clinical results and structural integrity of patients with a minimum 2-year follow-up. The second aim was to compare arthroscopic hybrid repair with partial repair for large to massive rotator cuff tears. METHODS We retrospectively evaluated 65 patients who underwent arthroscopic incomplete (hybrid) repair (45 patients) or partial repair (20 patients) for large to massive cuff tears from March 2011 to January 2015. The pain visual analog scale, function visual analog scale, American Shoulder and Elbow Surgeons, and Constant scores and range of motion (ROM) (active flexion, elevation, abduction, external rotation, and internal rotation) were assessed preoperatively, at first follow-up (approximately 6 months postoperatively), at second follow-up (1 year postoperatively), and at final follow-up (2 years postoperatively). The healing status of the repaired tendon was evaluated with postoperative magnetic resonance imaging, with a focus on tendon integrity. RESULTS Comparisons of the preoperative values and final follow-up results of hybrid repair showed significant improvement in the mean pain visual analog scale score (5.56 and 0.93, respectively), mean function visual analog scale score (4.77 and 8.59, respectively), and questionnaire results (American Shoulder and Elbow Surgeons score, 44.89 and 84.67, respectively; Constant score, 44.27 and 73.46, respectively) (all P ≤ .001). Most shoulder ROM measures showed some improvement compared with presurgical ROM at last follow-up (≥2 years). However, there was no statistical significance. Retears occurred in 9 patients (20%) in the hybrid-repair group. Most of the postoperative clinical outcomes showed excellent results with hybrid repair compared with partial repair. CONCLUSIONS Arthroscopic incomplete repair (hybrid technique) showed more satisfactory clinical trial outcomes than partial repair of large to massive rotator cuff tears. Therefore, we propose the use of incomplete repair, which provides improvements in both pain and functional outcomes, as another repair option for large to massive rotator cuff tears. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jeung Yeol Jeong
- Department of Radiology, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Young Cheol Yoon
- Division of Sports Medicine, Department of Physical Medicine and Rehabilitation, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Orthopedic Surgery, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Department of Orthopedic Surgery, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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Factors affecting rotator cuff integrity after arthroscopic repair for medium-sized or larger cuff tears: a retrospective cohort study. J Shoulder Elbow Surg 2018; 27:1012-1020. [PMID: 29290609 DOI: 10.1016/j.jse.2017.11.016] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/01/2017] [Accepted: 11/06/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND We wished to identify the preoperative prognostic factors associated with structural integrity after repair of medium-sized and larger rotator cuff tears and to determine the cutoff values using receiver operating characteristic curve analysis. METHODS The study included 180 patients with medium-sized and larger rotator cuff tears. Each had a minimum 2-year postoperative follow-up by magnetic resonance imaging. We assessed several patient-related and disease-related preoperative factors using univariate and multivariate logistic regression analysis. To determine the cutoff value for the significant variables, receiver operating characteristic curve analysis was performed. RESULTS Retears occurred in 28 of the 180 patients (15.6%). Univariate analysis found that retear was significantly affected by the type of work and pattern of tear. The rate of retear was significantly increased in diabetes and with increasing tear size, extent of retraction, delamination, and fatty infiltration. Furthermore, reduced remnant tendon length, distance from the musculotendinous junction to the face of the glenoid, occupation ratio, and acromiohumeral interval were also significant risk factors. In the multivariate analysis, body mass index, diabetes, dyslipidemia, extent of retraction, delamination, distance from musculotendinous junction to face of glenoid, occupation ratio, fatty infiltration of infraspinatus, and acromiohumeral interval remained significant risk factors. The extent of retraction (22.2 mm) and the occupation ratio (53.5%) showed highly accurate cutoff values for predicting retear. CONCLUSION Multiple factors influenced the healing process after rotator cuff repair. The best predictors were the extent of retraction and occupation ratio, which could help assist in determining the prognosis after rotator cuff repairs.
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Kawakami J, Gotoh M, Matsuura K, Shin K, Fujito I, Tanaka A, Matsunaga S, Imai T, Nagamatsu T, Madokoro K, Shiba N. Cut-off values of the Japanese Orthopaedic Association score corresponding to Constant scores for evaluating outcomes in rotator cuff tear. J Orthop Surg (Hong Kong) 2018; 25:2309499017720002. [PMID: 28699405 DOI: 10.1177/2309499017720002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To clarify the cut-off value of the Japanese Orthopaedic Association (JOA) score corresponding to rotator cuff tear outcome as evaluated by the Constant score. METHODS The subjects were 230 patients with rotator cuff tear. The Constant and JOA scores on the first examination in our hospital were evaluated. After investigation of the correlation between the Constant and JOA scores, the cut-off JOA score was calculated, corresponding to excellent, good and fair outcomes as evaluated by the Constant score. RESULTS The Constant and JOA scores on the first examination were 49.64 ± 12.84 and 72.52 ± 12.84, respectively, with a strong correlation ( r = 0.87, p < 0.01). Receiver operating characteristic analysis revealed that the cut-off JOA score was 87.0 for excellent outcome (area under the curve, AUC: 0.93; sensitivity: 100%; specificity: 88.6%; p < 0.01), 84.0 for good outcome (AUC: 0.94; sensitivity: 100%; specificity: 83.4%; p < 0.01) and 78.0 for fair outcome (AUC: 0.88; sensitivity: 100%; specificity: 71.3%; p < 0.01). CONCLUSIONS In patients with rotator cuff tear, good outcome as judged by a Constant score of ≥80 corresponds to a JOA score cut-off of 84.0. Judgement of the treatment outcomes and evaluation of the surgical method may be more accurate when using clear cut-off values for the scoring system employed, such as those determined in our study.
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Affiliation(s)
- Junichi Kawakami
- 1 Department of Orthopedic Surgery, Kurume University School of Medicine Graduate School, Asahi-machi, Kurume, Fukuoka, Japan.,2 Department of Rehabilitation, Saiseikai Yahata General Hospital, Haruno-machi, Kitakyushu, Fukuoka, Japan
| | - Masafumi Gotoh
- 3 Department of Orthopedic Surgery, Kurume University Medical Center, Kokubu-machi, Kurume, Fukuoka, Japan
| | - Koumei Matsuura
- 4 Department of Orthopedic Surgery, Saiseikai Yahata General Hospital, Haruno-machi, Kitakyushu, Fukuoka, Japan
| | - Kunichika Shin
- 4 Department of Orthopedic Surgery, Saiseikai Yahata General Hospital, Haruno-machi, Kitakyushu, Fukuoka, Japan
| | - Ikuhisa Fujito
- 2 Department of Rehabilitation, Saiseikai Yahata General Hospital, Haruno-machi, Kitakyushu, Fukuoka, Japan
| | - Aya Tanaka
- 5 Department of Rehabilitation, Kugimiya Orthopedic & Rehabilitation Clinic, Tsurumi, Beppu, Oita, Japan
| | - Saho Matsunaga
- 2 Department of Rehabilitation, Saiseikai Yahata General Hospital, Haruno-machi, Kitakyushu, Fukuoka, Japan
| | - Takaki Imai
- 1 Department of Orthopedic Surgery, Kurume University School of Medicine Graduate School, Asahi-machi, Kurume, Fukuoka, Japan
| | - Takashi Nagamatsu
- 1 Department of Orthopedic Surgery, Kurume University School of Medicine Graduate School, Asahi-machi, Kurume, Fukuoka, Japan
| | - Kazuya Madokoro
- 6 Department of Physical Therapy, Technical School of Medical and Welfare Ryokuseikan, Nishishinmachi-machi, Tosu, Saga, Japan
| | - Naoto Shiba
- 7 Department of Orthopedic Surgery, Kurume University, Asahi-machi, Kurume, Fukuoka, Japan
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Gilmer BB. Double-Row Suture Anchor Repair of Posterolateral Corner Avulsion Fractures. Arthrosc Tech 2017; 6:e997-e1001. [PMID: 28970983 PMCID: PMC5621161 DOI: 10.1016/j.eats.2017.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 03/07/2017] [Indexed: 02/03/2023] Open
Abstract
Posterolateral corner avulsion fractures are a rare variant of ligamentous knee injury primarily described in the skeletally immature population. Injury is often related to a direct varus moment placed on the knee during sporting activities. Various treatment strategies have been discussed ranging from nonoperative management, to excision of the bony fragment, to primary repair with screws or suture. The described technique is a means for achieving fixation of the bony avulsion using principles familiar to double-row transosseous equivalent rotator cuff repair. Proximal anchors are placed in the epiphysis, and sutures are passed in horizontal mattress fashion. Once tied, the limbs of these same sutures are then passed to more distal anchors. Remaining eyelet sutures can be used to manage peripheral tissue. The final repair provides anatomic reduction and compression of the fragment to its bony bed with minimal extracortical hardware prominence and no violation of the physis. Risks include potential for physeal injury or chondral damage to the lateral femoral condyle through aberrant anchor placement. Postoperative care includes toe-touch weight-bearing restrictions and range of motion restrictions of 0°-90° in a hinged brace for 6 weeks followed by gradual return to activity.
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Affiliation(s)
- Brian B. Gilmer
- Address correspondence to Brian B. Gilmer, M.D., Mammoth Orthopedic Institute, 85 Sierra Park Road, P.O. Box 660, Mammoth Lakes, CA 93546, U.S.A.Mammoth Orthopedic Institute85 Sierra Park RoadP.O. Box 660Mammoth LakesCA93546U.S.A.
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Khair MM, Lehman J, Tsouris N, Gulotta LV. A Systematic Review of Preoperative Fatty Infiltration and Rotator Cuff Outcomes. HSS J 2016; 12:170-6. [PMID: 27385947 PMCID: PMC4916083 DOI: 10.1007/s11420-015-9465-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/18/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fatty infiltration (FI) of the muscle as graded by the Goutallier classification (GC) is a well-known sequela following rotator cuff injury. The degree to which this predicts the success of rotator cuff repair is unknown. QUESTIONS/PURPOSES We conducted a systematic review to address the following questions: (1) Does the grade of FI of the rotator cuff muscles present preoperatively predict retear rates postoperatively? (2) Are amounts of preoperative FI predictive of functional outcomes following repair? METHODS Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Central Register of Controlled Trials online databases were searched for all literature published between January 1966 and March 2015. Keywords were chosen to achieve a broad search category. All articles were reviewed by three of the authors, and those meeting the study inclusion criteria were selected for data abstraction. RESULTS The systematic literature review yielded 11 studies reporting on a total of 925 shoulders. Rotator cuffs with moderate or significant FI preoperatively (grades 2-4) had a significantly higher retear rate than those with no or minimal FI (grades 0-1) (59 vs. 25%, p = 0.045). Four studies reported postoperative Constant scores and preoperative GC scores. One study found that lower GC scores were associated with higher Constant scores postoperatively, one found no association, and the data was inconclusive in the other two. CONCLUSIONS While lower preoperative GC scores are associated with lower rates of rotator cuff retear following repair, there is insufficient data to make conclusions on the effects of FI on functional outcomes following repair.
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Affiliation(s)
| | - Jason Lehman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Nicholas Tsouris
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Cho BK, Kim YM, Park KJ, Park JK, Kim DK. A prospective outcome and cost-effectiveness comparison between two ligament reattachment techniques using suture anchors for chronic ankle instability. Foot Ankle Int 2015; 36:172-9. [PMID: 25237170 DOI: 10.1177/1071100714552079] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are various ligament reattachment techniques for the modified Brostrom procedure. There have been few comparative studies on recently developed techniques. This prospective study was performed to compare the functional outcomes of 2 different ligament reattachment techniques using suture anchors. We furthermore evaluated the cost-effectiveness of the suture bridge technique. METHODS Forty-five amateur athletes under 30 years of age were followed for more than 2 years. Twenty-four procedures with the suture anchor technique and 21 procedures with the suture bridge technique were performed by one surgeon. The functional evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), Karlsson score, Sefton grading system, and the period to return to various forms of exercise (jogging, spurt running, jumping, one leg standing for >1 minute, walking on uneven ground, and going down stairs). Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate mechanical stability. RESULTS There were no significant differences on AOFAS score, FAOS, Karlsson score, Sefton grade, and stress radiographs. There were no significant differences on the return to exercises, except for jumping. As the most common complication, there were 3 cases of skin irritation by suture materials in the suture anchor group and 2 cases of intraoperative breakage of the suture anchor in suture bridge group. CONCLUSIONS Both ligament reattachment techniques using suture anchors showed similar functional outcomes. Considering the additional medical expenses incurred by more suture anchors, the modified Brostrom procedure using the suture bridge technique had low cost-effectiveness. Proper indication and clinical usefulness of suture bridge technique for chronic ankle instability will be addressed in further studies. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Byung-Ki Cho
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Yong-Min Kim
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Kyoung-Jin Park
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Ji-Kang Park
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Do-Kyoon Kim
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
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Cho BK, Kim YM, Shon HC, Park KJ, Cha JK, Ha YW. A ligament reattachment technique for high-demand athletes with chronic ankle instability. J Foot Ankle Surg 2014; 54:7-12. [PMID: 25441285 DOI: 10.1053/j.jfas.2014.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Indexed: 02/03/2023]
Abstract
The present prospective study was conducted to evaluate the clinical outcomes of the new ligament reattachment procedure for chronic lateral ankle instability in high-demand athletes. A total of 24 athletes <30 years old were followed for >2 years after undergoing the modified Brostrom procedure using the suture bridge technique. The clinical evaluation included the Karlsson score, the Sefton grading system, and the period to return to exercise. As an evaluation of mechanical stability, the talar tilt angle and anterior talar translation were measured on stress radiographs. The Karlsson score had improved significantly from a preoperative average of 43.5 points to 92.2 points. Using the Sefton grading system, 22 (91.7%) patients achieved satisfactory results. The period to return to exercise was as follows: a mean of 8.4 weeks for jogging, 12.5 weeks for spurt running, 10.5 weeks for jumping, 9.2 weeks for 1 leg standing for >1 minute, 10.6 weeks for walking on uneven ground, and 11.2 weeks for going downstairs. The talar tilt angle and anterior talar translation had improved significantly from the preoperative average of 15.4° and 13.3 mm to 3.8° and 4.2 mm at 2 months postoperatively and 4.9° and 4.8 mm at the final follow-up visit, respectively. The modified Brostrom procedure using the suture bridge technique resulted in satisfactory clinical outcomes comparable to those with conventional ligament reattachment techniques. The suture bridge technique appears to be an effective treatment option for chronic ankle instability in high-demand athletes.
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Affiliation(s)
- Byung-Ki Cho
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
| | - Yong-Min Kim
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Hyun-Chul Shon
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Kyoung-Jin Park
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Jung-Kwon Cha
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Yoon-Won Ha
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
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Arthroscopic suture-bridge repair for small to medium size supraspinatus tear: healing rate and retear pattern. Arthroscopy 2013; 29:10-7. [PMID: 23159493 DOI: 10.1016/j.arthro.2012.06.020] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 06/21/2012] [Accepted: 06/21/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the study was to assess the repair site integrity after transosseous equivalent/suture-bridge (TOE/SB) repair with the use of magnetic resonance imaging (MRI). METHODS One hundred seven consecutive shoulders with a small to medium-size full-thickness supraspinatus tear were repaired arthroscopically with use of the TOE/SB technique. There were 64 men and 41 women, and mean age at the time of surgery was 54.8 years (range, 21 to 74 years). All patients underwent postoperative MRI and clinical examination. Mean follow-up was 16.1 months (range, 12 to 28 months). RESULTS The mean Constant score improved from 54.5 ± 12.5 points preoperatively to 80 ± 12.1 points postoperatively (P < .0001). The mean pain score improved from 7 ± 2 points preoperatively to 13 ± 2.5 postoperatively (P < .0001). The mean active forward flexion improved from 151° ± 37° preoperatively to 169° ± 14° postoperatively (P < .0001). The mean Constant score was 81 points when repaired tendon had healed and it was 72.6 points when repaired tendon was unhealed (P = .02). Smoking status was found to have detrimental influence on the tendon healing (P = .04). Postoperative MRI showed a healed repair in 96 (89.7%) of 107 shoulders. Among 11 retears, 10 occurred at the greater tuberosity and 1 occurred at the musculotendinous junction. CONCLUSIONS Arthroscopic TOE/SB repair of full-thickness supraspinatus tendon led to a healing rate of 89.7%. Patients with healed tendons according to MRI had significant better functional and subjective outcome. Smoking habit was found to be detrimental on healing. Retears occurred mainly at tendon-bone interface at the greater tuberosity, whereas medial cuff failure was observed in only one case in the mean time of follow-up. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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