1
|
Gumina S, Song HS, Kim H, Candela V. Arthroscopic evaluation of the rotator cuff vasculature: inferences into the pathogenesis of cuff tear and re-tear. Clin Shoulder Elb 2024; 27:203-211. [PMID: 38863404 PMCID: PMC11181063 DOI: 10.5397/cise.2024.00066] [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: 01/24/2024] [Revised: 03/15/2024] [Accepted: 03/28/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Little is known about alterations of the rotator cuff (RC) macroscopic vasculature associated with medical conditions and/or habits that predispose a person to diseases of the peripheral microcirculation. The high frequency of cuff tear and re-tear in patients with diabetes, hypercholesterolemia, uncontrolled arterial hypertension, or metabolic syndrome may be due to tissue hypovascularity. METHODS The macroscopic vasculature of both the articular and bursal sides of the posterosuperior RC was evaluated arthroscopically in 107 patients (mean age, 58.2 years) with no RC tear. Patients were divided into three groups according to medical comorbidities and lifestyle factors (group I, none; group II, smokers and/or drinkers and one comorbidity; and group III, two or more comorbidities). Pulsating vessels originating from both the myotendinous and osteotendinous junctions were assessed as "clearly evident," "poorly evident," or "not evident." RESULTS Groups I, II, and III comprised 36, 45, and 26 patients, respectively. Within the myotendinous junction, vessels were visualized in 22 group I patients (61%), 25 group II patients (55%), and 6 group III patients (23%) (P=0.007). Pulsating arterial vessels originating from the osteotendinous junction were seen in 42%, 36%, and 0% of patients, respectively (P<0.001). Within the bursal side of the RC, a dense anastomotic network was visualized (either clearly or poorly) in 94% (34), 80% (36), and 35% (9) of patients, respectively (P<0.001). CONCLUSIONS The macroscopic vasculature of the RC is influenced by pre-existing diseases and lifestyle factors, which may impair peripheral microcirculation. Level of evidence: III.
Collapse
Affiliation(s)
- Steafano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
- Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Hyun Seok Song
- Department of Orthopaedics Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyungsuk Kim
- Department of Orthopaedics Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy
| |
Collapse
|
2
|
Morris DLJ, Candal-Couto J, Watts AC, Rangan A, Tambe A. Scoping review: Evidence for long-term follow-up and monitoring in shoulder and elbow arthroplasty. Shoulder Elbow 2023; 15:593-601. [PMID: 37981966 PMCID: PMC10656974 DOI: 10.1177/17585732231156403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 11/21/2023]
Abstract
Aims Long-term follow-up and monitoring of asymptomatic shoulder and elbow arthroplasty remains contentious, with a wide spectrum of non-evidence-based mechanisms used. This scoping review aims to outline related evidence, thereby informing research requirements. Methods Studies relevant to shoulder and elbow arthroplasty follow-up, surveillance and time-related failure were included. The review included randomised controlled trials, systematic reviews and economic studies indexed in MEDLINE, Embase, Cochrane CDSR and Cochrane CENTRAL since 1 January 2012. In addition, all registry studies, follow-up studies, cohort studies and case reports indexed in MEDLINE since 1 January 2020 were included. The screening was undertaken by two reviewers. Key characteristics of each study were described, alongside a narrative review. Results Twenty-one articles were included. We were unable to identify evidence that long-term follow-up and monitoring of asymptomatic shoulder and elbow arthroplasty identifies failure or leads to a revision that is of reduced patient morbidity and cost. In addition, no evidence was apparent to inform whether patients will self-present with a failing implant. Several surveillance mechanisms were identified. Conclusion This scoping review highlights the paucity of evidence related to long-term follow-up and monitoring of shoulder and elbow arthroplasty, and the need for high-quality data to inform the development of evidence-based care pathways.
Collapse
Affiliation(s)
| | | | - Adam Charles Watts
- Upper Limb Unit, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Amar Rangan
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | | |
Collapse
|
3
|
Su-Bao D, Zhang B, Luo H, Liu Y, Chen-Li R, Zou Y, Qiang-Zeng S, Fu S, Liu G. Single knotless-anchor with two ethicon 2# for Ellman grade III bursal-side partial thickness rotator cuff tears: a cadaveric biomechanical study and short-term clinical evaluation. BMC Musculoskelet Disord 2023; 24:701. [PMID: 37658346 PMCID: PMC10474714 DOI: 10.1186/s12891-023-06841-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Several surgical techniques are used to treat bursal-side partial thickness rotator cuff tears (PTRCTs). However, use of single knotless-anchor with two Ethicon 2# repair technique for PTRCTs has not been reported. MATERIALS AND METHODS Bursal-side PTRCTs (Ellman grade III, 75% thickness of tears) were created in the supraspinatus tendon in 16 fresh-frozen cadaveric shoulders. The specimens were randomly assigned to two equal groups: (1) Group A (Transtendon repair), a single knotless-anchor repair with two Ethicon 2#; (2) Group B, Conversion repair (Double-row, DR). Post-repair, each specimen was subjected to cyclic loading test from 5 to 100 N (50 cycles), followed by an ultimate failure test. The displacement of greater tuberosity (mm) and ultimate (N) were recorded. In the clinical study, 12 patients diagnosed with Ellman grade III Bursal-side PTRCTs (using a single knotless anchor with two Ethicon 2# repair techniques) were operated on and analyzed. Visual analog scale (VAS), American Shoulder and Elbow Surgeons Score (ASES), Constant-Murley Score (CMS), and range of motion (ROM) were assessed before surgery and at final minimum follow-up (>1year). RESULTS There was no significant between-group difference with respect to load-to-failure test (Group A, 359.25 ± 17.91 N; Group B, 374.38 ± 13.75 N, P > 0.05). There were no significant differences with respect to rotator cuff displacement of 10 mm (Group A, 190.50 ± 8.52 N; Group B, 197.25 ± 6.84 N, P > 0.05) and 15 mm (Group A, 282.25 ± 12.20 N; Group B, 291.13 ± 14.74 N, P > 0.05). However, there was significant between-group difference with respect to displacement of 3 and 5 mm (P < 0.05). In the clinical trial, all patients were followed up for an average of 20.4 months (12-29 months). At the last follow-up after surgery(minimum>1year), the VAS score was 0.50 ± 0.67 (0-2), the ASES score was 86.50 ± 3.96 (79-92), the CMS score was 85.08 ± 5.65 (74-93), the mean Forward flexion ROM was 154.00°± 12.48° (131°-169°), and the abduction ROM was 165.00°±13.26° (138°-173°). There was a statistically significant difference between the results of the preoperative and the last postoperative follow-up. The results of the last postoperative follow-up were statistically different from those of the preoperative follow-up (P < 0.05). Regarding complications, stiffness (2 cases) and shoulder impingement (1 case) occurred in 3 cases (25%). CONCLUSION A single knotless anchor with two Ethicon 2# may provide a biomechanically and clinically feasible option for the treatment of bursal-side Ellman grade III PTRCTs, particularly in resource-constrained settings. MESH KEYWORDS Bursal-side Ellman Grade III; Single Knotless-anchor; Double-row repair; Biomechanical study; Short-term clinical evaluation.
Collapse
Affiliation(s)
- Ding Su-Bao
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
| | - Baolu- Zhang
- School of Nursing, Southwest Medical University, Lu Zhou Sichuan, Lu Zhou Sichuan, China
| | - Hong- Luo
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
| | - Yang- Liu
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
| | - Rui Chen-Li
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
| | - Yiyuan- Zou
- No.1 Orthopedic hospital of Chengdu,, Chengdu, Sichuan, China
| | - Sheng Qiang-Zeng
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
| | - Shijie- Fu
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
| | - Gang Liu
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China.
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China.
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China.
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| |
Collapse
|
4
|
Roubion RC, Field LD. "Double Row Rip-Stop" Arthroscopic Repair Technique for Acute, Retracted Rotator Cuff Tears. Arthrosc Tech 2023; 12:e1523-e1527. [PMID: 37780656 PMCID: PMC10533855 DOI: 10.1016/j.eats.2023.04.025] [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: 02/15/2023] [Accepted: 04/18/2023] [Indexed: 10/03/2023] Open
Abstract
Acute, retracted rotator cuff tendon tears are important to recognize and can present unique technical challenges to repair. Various arthroscopic techniques and suture configurations have been proposed for repair of acute tears with aims to maximize the repair footprint and optimize tendon fixation. The double row rip-stop configuration was designed and has been used for rotator cuff repair due to its potential advantages related to suture pullout, footprint reapproximation and load sharing. The purpose of this article is to present the author's arthroscopic technique for repair of acute, retracted rotator cuff tendon tears using a double-row, rip-stop suture configuration. The indications and authors' preferred arthroscopic technique for biceps tenodesis are also discussed.
Collapse
Affiliation(s)
- Ryan C. Roubion
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A
| | - Larry D. Field
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A
| |
Collapse
|
5
|
Young BL, Bitzer A, Odum S, Hamid N, Shiffern S, Connor PM. Healthcare costs of failed rotator cuff repairs. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:318-323. [PMID: 37588487 PMCID: PMC10426547 DOI: 10.1016/j.xrrt.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background The goal of this study was to estimate the short-term (∼2 years) healthcare costs of failed primary arthroscopic rotator cuff repair (RCR) in the United States. Methods A review of current literature was performed to estimate the number of RCR performed in the United States in the year 2022 and the rate of progression of these patients to lose repair continuity, reach clinical failure, and progress to nonoperative intervention and revision procedures. A review of the current literature was performed to estimate the costs incurred by these failures over the ensuing 2-year postoperative time period. Results The direct and indirect healthcare costs of structural and clinical failure of primary RCR performed in 2022 are estimated to reach $438,892,670 in the short-term postoperative period. The majority of the costs come from the estimated $229,390,898 in nonoperative management that these patients undergo after they reach clinical failure. Conclusion The short-term healthcare costs of failed arthroscopic RCR performed in the United States in 2022 are predicted to be $438,892,670. Although RCR improves quality of life, pain, function, and is cost-effective, there remains great potential for reducing the economic burden of failed RCR repairs on the US society. Investments into research aimed to improve RCR healing rates are warranted. Clinical Relevance Although RCR improves quality of life, pain, function, and is cost-effective, this study provides evidence that there remains great potential for reducing the economic burden of failed RCR repairs on the US society. Investments into research aimed to improve RCR healing rates are warranted.
Collapse
Affiliation(s)
- Bradley L. Young
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Alex Bitzer
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
- OrthoCarolina Shoulder and Elbow Center, Sports Medicine Center, Charlotte, NC, USA
| | - Susan Odum
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
| | - Nady Hamid
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
- OrthoCarolina Shoulder and Elbow Center, Sports Medicine Center, Charlotte, NC, USA
| | - Shadley Shiffern
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
- OrthoCarolina Shoulder and Elbow Center, Sports Medicine Center, Charlotte, NC, USA
| | - Patrick M. Connor
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
- OrthoCarolina Shoulder and Elbow Center, Sports Medicine Center, Charlotte, NC, USA
| |
Collapse
|
6
|
Bowen E, Allen A, Bedi A. Rotator Cuff Repair: How Many Rows? OPER TECHN SPORT MED 2023. [DOI: 10.1016/j.otsm.2023.150980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
7
|
Go TW, Park JE, Oh S, Cho M, Jo CH. Effect of Quality of Repair on Clinical and Structural Outcomes of Rotator Cuff Repair. Am J Sports Med 2022; 50:3915-3923. [PMID: 36341899 DOI: 10.1177/03635465221130759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anatomic repair of a torn rotator cuff tendon on the greater tuberosity (GT) is an important surgical goal in rotator cuff repair. However, few studies have investigated whether the efforts made to maximize coverage of the GT are associated with the clinical and structural outcomes after rotator cuff repair surgery. PURPOSE To investigate whether the quality of repair at the time of surgery is associated with clinical and structural outcomes after surgery and to identify factors influencing the quality of repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were retrospectively collected from 141 patients who underwent arthroscopic rotator cuff repair between 2008 and 2016. All repairs were classified according to the amount of postoperative GT coverage: A, complete coverage of the GT (n = 96); B, incomplete coverage, comprising more than half of GT (n = 27); C, incomplete coverage, comprising less than half of the GT (n = 16); and D, exposure of the glenohumeral joint (n = 2). All patients underwent magnetic resonance imaging 1 year after surgery. Clinical outcomes and structural integrity based on Sugaya classification were assessed 2 years and 1 year after surgery, respectively. Preoperative factors associated with the postoperative GT coverage (measured at the close of surgery) were identified using a multivariable proportional odds cumulative logit model. RESULTS The forward flexion strength in group A (10.3 ± 4.6 lb) was significantly greater than that in group C (6.5 ± 3.7 lb) (P = .003) 2 years after surgery. The postoperative Constant score in group A (76.6 ± 11.5) was greater than that in group C (66.7 ± 15.6) (P = .018). The number of cases that showed retearing of the repaired tendon was as follows: group A (5/96; 5.2%), group B (7/27; 25.9%), and group C (10/16; 62.5%). There was no significant difference in the changes of pain visual analog scale scores among groups 2 years after surgery (all P > .05). Also, there was no significant difference in the changes of range of motion in all directions among groups 2 years after surgery (all P > .05). Patients with preoperative GT coverage B included in the postoperative GT coverage groups through surgery were as follows: group A (23/45; 51.1%), group B (17/45; 37.8%), and group C (5/45; 11.1%). Preoperative GT coverage was the only independent factor that was associated with GT coverage in multivariable analysis. CONCLUSION Quality of repair, measured as the extent of postoperative GT coverage at the time of surgery, was associated with clinical and structural outcomes after rotator cuff repair surgery.
Collapse
Affiliation(s)
- Tae Won Go
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Eun Park
- Daegu Hansol Hospital, Daegu, Republic of Korea
| | - Sohee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Minjoon Cho
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chris Hyunchul Jo
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
8
|
Xiao M, Cohen SA, Cheung EV, Sherman SL, Abrams GD, Freehill MT. Limited Biomechanical Evidence Behind Single Row Versus Double Row Repair of Subscapularis Tears: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1193-e1201. [PMID: 35747639 PMCID: PMC9210385 DOI: 10.1016/j.asmr.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To systematically review the literature for studies investigating the biomechanical properties of constructs used to repair isolated subscapularis tears in time zero human cadaveric studies. Methods A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three electronic databases were searched for studies that reported on the construct technique and biomechanical outcomes for the repair of isolated subscapularis tears in human cadaveric specimens. Ultimate load, gap formation, stiffness, and failure mode were documented. Methodological quality was assessed using the Quality Appraisal for Cadaveric Studies (QUACS) scale. Results Six articles qualified (104 shoulders [72 single-row, 26 double-row, 6 transosseous]; mean QUACS score 10.5 ± 1) and were analyzed. Studies varied in the number and type of anchors and construct technique (1-2 anchors single-row; 3-4 anchors double-row; bioabsorbable or titanium anchors) and suture(s) used (no. 2 FiberWire or FiberTape), subscapularis tear type (25%, 33%, 50%, or 100% tear), and whether a knotless or knotted fixation was used. In studies that created full-thickness, upper subscapularis tears (Fox-Romeo II/III or Lafosse II), no significant differences were seen in ultimate load, gap formation, and stiffness for knotted versus knotless single-row repair (2 studies) and single-row versus double-row repair (1 study). Double-row repair of complete subscapularis tears demonstrated higher ultimate load, stiffness, and lower gap formation in 1 study. Ultimate load differed between the studies and constructs (single-row: range, 244 N to 678 N; double-row: range 332 N to 508 N, transosseous: 453 N). Suture cutout was the most common mode of failure (59%). Conclusion Because of the limited number of studies and varying study designs in examining the biomechanical properties of repair constructs used for subscapularis tears, there is inconclusive evidence to determine which construct type is superior for repairing subscapularis tears. Clinical Relevance Results from biomechanical studies of clinically relevant subscapularis repair constructs are important to guide decision-making for choosing the optimal construct for patients with subscapularis tears.
Collapse
Affiliation(s)
- Michelle Xiao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Samuel A. Cohen
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Emilie V. Cheung
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Seth L. Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Geoffrey D. Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Michael T. Freehill
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| |
Collapse
|
9
|
Lapner P, Henry P, Athwal GS, Moktar J, McNeil D, MacDonald P. Treatment of rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:e120-e129. [PMID: 34906681 DOI: 10.1016/j.jse.2021.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is ongoing controversy regarding optimal treatment for full-thickness rotator cuff tears. Given that the evidence surrounding the use of various treatment options has expanded, an overall assessment is required. OBJECTIVES The following were compared to determine which resulted in improved patient-reported function, pain, and reoperation rates for each: (1) double-row (DR) fixation and single-row (SR) fixation in arthroscopic cuff repair; (2) latissimus dorsi transfer (LDT) with lower trapezius transfer (LTT), partial rotator cuff repair, and superior capsular reconstruction (SCR); and (3) early and late surgical intervention. METHODS Medline, Embase, and Cochrane were searched through to April 20, 2021. Additional studies were identified from reviews. The following were included: (1) All English-language randomized controlled trials (RCTs) in patients ≥18 years of age comparing SR and DR fixation, (2) observational studies comparing LDT with LTT, partial repair, and SCR, and (3) observational studies comparing early vs. late treatment of full-thickness rotator cuff tears. RESULTS A total of 15 RCTs (n = 1096 randomized patients) were included in the meta-analysis of SR vs. DR fixation. No significant standardized mean differences in function (0.08, 95% confidence interval [CI] -0.09, 0.24) or pain (-0.01, 95% CI -0.52, 0.49) were observed. There was a difference in retear rates in favor of DR compared with SR fixation (RR 1.56, 95% CI 1.06, 2.29). Four studies were included in the systematic review of LDT compared with a surgical control. LDT and partial repair did not reveal any differences in function (-1.12, 95% CI -4.02, 1.78) on comparison. A single study compared arthroscopically assisted LDT to LTT and observed a nonstatistical difference in the Constant score of 14.7 (95% CI -4.06, 33.46). A single RCT compared LDT with SCR and revealed a trend toward superiority for the Constant score with SCR with a mean difference of -9.6 (95% CI -19.82, 0.62). Comparison of early vs. late treatment revealed a paucity of comparative studies with varying definitions of "early" and "late" treatment, which made meaningful interpretation of the results difficult. CONCLUSION DR fixation leads to similar improvement in function and pain compared with SR fixation and results in a higher healing rate. LDT transfer yields results similar to those from partial repair, LTT, and SCR in functional outcomes. Further study is required to determine the optimal timing of treatment and to increase confidence in these findings. Future trials of high methodologic quality comparing LDT with LTT and SCR are required.
Collapse
Affiliation(s)
- Peter Lapner
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
| | - Patrick Henry
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - George S Athwal
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, Western University, London, ON, Canada
| | - Joel Moktar
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Daniel McNeil
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, Western University, London, ON, Canada
| | - Peter MacDonald
- Section of Orthopaedic Surgery & The Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | | |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Boksh K, Haque A, Sharma A, Divall P, Singh H. Use of Suture Tapes Versus Conventional Sutures for Arthroscopic Rotator Cuff Repairs: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:264-272. [PMID: 33740395 DOI: 10.1177/0363546521998318] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various suture materials are available for arthroscopic rotator cuff repair. More recently, suture tapes have become popular as they are perceived to be easier to use with less soft tissue irritation. However, little is known about their biomechanical and clinical properties compared with conventional sutures in rotator cuff repairs. PURPOSE To perform a systematic review and meta-analysis on whether suture tapes are biomechanically superior to conventional sutures in arthroscopic rotator cuff repairs and whether this translates to superior functional outcomes and a lower incidence of retears. STUDY DESIGN Meta-analysis. METHODS The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: (rotator cuff repair OR arthroscopic rotator cuff repair) AND ("tape" OR "wire" OR "cord" OR "suture"). Data pertaining to certain biomechanical properties (contact area, contact pressure, gap formation, load to failure, and stiffness), retears, and patient-reported outcome measures (PROMs) were extracted. The pooled outcome data were analyzed by random- and fixed-effects models. RESULTS After abstract and full-text screening, 7 biomechanical and 6 clinical studies were included. All biomechanical studies were on animals, with 91 suture tapes and 91 conventional sutures compared. Suture tapes had higher contact pressure (mean difference [MD], 0.04 MPa; 95% CI, 0.01-0.08; P = .02), higher load to failure (MD, 52.62 N; 95% CI, 27.34-77.90; P < .0001), greater stiffness (MD, 4.47 N/mm; 95% CI, 0.57-8.38; P = .02), and smaller gap formation (MD, -0.30 mm; 95% CI, -0.45 to -0.15; P < .0001) compared with conventional sutures. From the clinical analysis of the 681 rotator cuff repairs treated with a suture tape (n = 380) or conventional suture (n = 301), there were no differences in retear rates between the groups (16% vs 20% suture tape and wire, respectively; P = .26) at a mean of 11.2 months. Qualitatively, there were no differences in PROMs between the groups at a mean of 36.8 months. CONCLUSION Although biomechanically superior, suture tapes showed similar retear rates and postoperative function to conventional sutures. However, higher-quality clinical studies are required to investigate whether there are no true differences.
Collapse
Affiliation(s)
- Khalis Boksh
- Academic Team of Musculoskeletal Surgery, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Aziz Haque
- Academic Team of Musculoskeletal Surgery, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ashwini Sharma
- Academic Team of Musculoskeletal Surgery, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Pip Divall
- Academic Team of Musculoskeletal Surgery, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Harvinder Singh
- Academic Team of Musculoskeletal Surgery, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
12
|
Tramer JS, Evans H, Ziedas AC, Swantek AJ, Jordan SE, Makhni EC. Quadriceps Tendon Repair Using Double-Row Suture Anchor Fixation. Arthrosc Tech 2021; 10:e2337-e2342. [PMID: 34754743 PMCID: PMC8556666 DOI: 10.1016/j.eats.2021.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023] Open
Abstract
Quadriceps tendon ruptures compromise the knee extensor mechanism and cause an inability to ambulate and significant functional limitations. Therefore, the vast majority of quadriceps tendon ruptures are indicated for operative intervention to restore patient mobility and function. Although these injuries were traditionally repaired using a transosseous repair technique, recent literature has shown that suture anchor repair may offer biomechanical advantages. Additionally, research in other areas of orthopaedics has found that a double-row suture anchor construct can offer additional biomechanical strength to tendinous repair. This technical note describes a safe and effective quadriceps tendon repair using a double-row suture anchor construct.
Collapse
Affiliation(s)
| | | | | | | | | | - Eric C. Makhni
- Address correspondence to Eric C. Makhni, M.D., M.B.A., Department of Orthopaedic Surgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, U.S.A.
| |
Collapse
|
13
|
GÜNAY M, EKEN G. The effect of row number on clinical and life quality outcomes of patients who underwent arthroscopic rotator cuff repair. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.957621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
14
|
Lapner P, Li A, Pollock JW, Zhang T, McIlquham K, McRae S, MacDonald P. A Multicenter Randomized Controlled Trial Comparing Single-Row With Double-Row Fixation in Arthroscopic Rotator Cuff Repair: Long-Term Follow-up. Am J Sports Med 2021; 49:3021-3029. [PMID: 34398641 PMCID: PMC8411465 DOI: 10.1177/03635465211029029] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The long-term outcomes of single- versus double-row fixation in arthroscopic rotator cuff repair are not currently known. PURPOSE To compare the treatment effects of the single- versus double-row suture technique in arthroscopic rotator cuff repair of full-thickness tears at 10-year follow-up. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients were evaluated at 10 years postoperatively. The primary outcome measure was the Western Ontario Rotator Cuff Index (WORC). Secondary outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Constant score, strength, and incidence of revision surgery. Ultrasound was used to evaluate the rotator cuff to determine repair integrity. Statistical analyses consistent with those of the main trial were conducted. RESULTS Of the original 90 participants, 77 (85%) returned at a mean follow-up of 10 years. At ten year follow-up, the WORC score was higher in the double row group (79.9 [95% CI, 16.2 to 99.1]) compared with the single row group (72.9, [95% CI, 4.3 to 100]), P = .020. From baseline to 2 years, the mean change in WORC scores for the single-row group was -48.5 compared with -40.6 for the double-row group, with a between-group difference of -7.8 (95% CI, -20.4 to 4.7). From 2 to 10 years, the change in WORC scores for the single-row group was 11.5 compared with -0.2 for the double-row group, with a between-group difference of 11.7 (95% CI, -0.7 to 24.3). From baseline to 10 years, the mean between-group difference was 3.9 (95% CI, -7.8 to 15.6). Similarly, a decrease in ASES scores was observed between 2 and 10 years for the single-row group (9.2 [95% CI, 0.9 to 17.5]; P = .029), with a nonsignificant decrease in ASES scores for the double-row group (6.2 [95% CI, -3.2 to 15.6]; P = .195) as well as a decrease in Constant scores for both the single- (9.5 [95% CI, 1.4 to 17.5]; P = .020) and double-row (14.4 [95% CI, 5.6 to 23.3]; P = .001) groups. Overall, 3 participants developed a full-thickness tear after 2 years: 2 from the double-row group and 1 from the single-row group. One participant from each study group underwent revision surgery after the 2-year time point. CONCLUSION A statistically significant (but likely not clinically important) difference in WORC scores was seen at 10-year follow-up in favor of double-row fixation. Between baseline and 10-year follow-up, a decrease in most outcome scores was observed in both the single- and the double-row groups. REGISTRATION NCT00508183 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Peter Lapner
- Division of Orthopaedic Surgery, The
Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada,Peter Lapner, MD, Division
of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, General
Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada (
)
| | - Ang Li
- Division of Orthopaedic Surgery, The
Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - J. W. Pollock
- Division of Orthopaedic Surgery, The
Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Tinghua Zhang
- Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Katie McIlquham
- Division of Orthopaedic Surgery, The
Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Sheila McRae
- Section of Orthopaedic Surgery,
University of Manitoba, Winnipeg, Manitoba, Canada,Pan Am Clinic, University of Manitoba,
Winnipeg, Manitoba, Canada
| | - Peter MacDonald
- Section of Orthopaedic Surgery,
University of Manitoba, Winnipeg, Manitoba, Canada,Pan Am Clinic, University of Manitoba,
Winnipeg, Manitoba, Canada
| |
Collapse
|
15
|
de Almeida Filho IA, Coelho DA. Rotator Cuff Healing. Rev Bras Ortop 2021; 56:291-298. [PMID: 34239192 PMCID: PMC8249069 DOI: 10.1055/s-0040-1713764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/15/2020] [Indexed: 11/05/2022] Open
Abstract
The present article broadly addresses the aspects that interfere with the healing process of the rotator cuff. Life habits, such as smoking and alcoholism, are considered, systemic factors such as diabetes mellitus, hypertension, and obesity, as well as local factors, among which are those related to the pre, peri, and postoperative periods. From an extensive literature review, with the citation of 60 scientific articles from both Western and Eastern literature, the authors intend to deepen the theme by bringing to medical practice conducts based on new established concepts.
Collapse
Affiliation(s)
- Ildeu Afonso de Almeida Filho
- Departamento de Ortopedia, Hospital Felício Rocho, Belo Horizonte, MG, Brasil
- Hospital Vera Cruz, Belo Horizonte, MG, Brasil
| | - Daniel Andrade Coelho
- Hospital Vera Cruz, Belo Horizonte, MG, Brasil
- Hospital Semper, Belo Horizonte, MG, Brasil
| |
Collapse
|
16
|
Arthroscopic release combined with single-row fixation or double-row suture bridge fixation in patients with traumatic supraspinatus tear and adhesive capsulitis non-responsive to conservative management: A prospective randomized trial. Orthop Traumatol Surg Res 2021; 107:102828. [PMID: 33524627 DOI: 10.1016/j.otsr.2021.102828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/27/2020] [Accepted: 11/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are few previous studies on traumatic supraspinatus tear with adhesive capsulitis. This study used arthroscopic release with single-row fixation or double-row suture bridge fixation to treat adhesive capsulitis of the shoulder with rotator cuff tears. Further, the clinical efficacy of arthroscopic release with single-row fixation and double-row suture bridge fixation was compared. HYPOTHESES Arthroscopic release combined with single-row fixation or double-row suture bridge fixation showed good clinical outcomes in patients with traumatic supraspinatus tear with adhesive capsulitis. METHODS A single-center prospective randomized trial was performed from June 2013 to June 2017. Of the 68 patients with traumatic supraspinatus tear and adhesive capsulitis who underwent arthroscopic release, 34 (22 with tear measuring≤3cm and 12 with tear measuring>3cm) were included in the single-row fixation group and 34 (20 with tear measuring≤3cm and 14 with tear measuring>3cm) were included in the double-row suture bridge fixation group. The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) and American Shoulder and Elbow Surgeons (ASES) shoulder scores, range of motion, time to achieve satisfactory scores, and rotator cuff re-tear rate were compared between the groups. RESULTS The range of motion, VAS score, UCLA and ASES shoulder scores significantly improved after surgery in both groups. There was a significant difference in the UCLA and ASES shoulder scores, time to achieve satisfactory scores, and rotator cuff re-tear rates in patients with tears measuring>3cm between the groups. CONCLUSIONS Arthroscopic release combined with single-row fixation or double-row suture bridge fixation showed good clinical outcomes in patients with traumatic supraspinatus tear with adhesive capsulitis. Therefore, the capsule of the shoulder should be thoroughly released to achieve such outcomes. For patients with rotator cuff tears measuring>3cm, double-row suture bridge fixation was superior to single-row fixation and the rotator cuff re-tear rate was low. LEVEL OF EVIDENCE I; prospective, randomized trial, treatment study.
Collapse
|
17
|
You JS, Monroe EJ, Friedman JM, Feeley BT, Lansdown DA, Zhang AL, Ma CB. Arthroscopic Single-Portal Subscapularis Tendon Repair. Arthrosc Tech 2020; 9:e1447-e1452. [PMID: 33134045 PMCID: PMC7587017 DOI: 10.1016/j.eats.2020.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/05/2020] [Indexed: 02/03/2023] Open
Abstract
Tears of the subscapularis tendon can be challenging to diagnose and treat. Because the subscapularis plays an important role in shoulder function, careful arthroscopic evaluation and treatment are necessary to restore function. Previous surgical techniques have ranged from full open repairs to complex arthroscopic procedures needing suture passer and/or retriever devices. We describe an arthroscopic surgical technique of subscapularis repair through a single anterior portal using only penetrating graspers. This approach can be used for partial upper-border subscapularis tears, as well as complete and retracted subscapularis tendon tears.
Collapse
Affiliation(s)
- Jae S. You
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Emily J. Monroe
- Heartland Orthopedic Specialist, Alexandria, Minnesota, U.S.A
| | - James M. Friedman
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Drew A. Lansdown
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Alan L. Zhang
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A.,Address correspondence to C. Benjamin Ma, M.D., Department of Orthopaedic Surgery, University of California San Francisco, 1500 Owens St, Box 3004, San Francisco, CA 94158, U.S.A.
| |
Collapse
|
18
|
Assenmacher AT, Alentorn-Geli E, Aronowitz J, Kergosien M, Schleck CD, Sánchez-Sotelo J, Cofield RH, Sperling JW. Patient-reported activities after bilateral reverse total shoulder arthoplasties. J Orthop Surg (Hong Kong) 2020; 27:2309499018816771. [PMID: 30526285 DOI: 10.1177/2309499018816771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Reverse shoulder arthroplasty (RSA) improves pain and function with very good satisfaction. Concerns exist about some activities of daily living (ADLs) involving internal rotation. The purpose of this study was to report how patients with bilateral RSA perform various ADLs. METHODS Thirty-one primary bilateral RSA patients (average age 76 years; 21 women and 10 men) completed a survey to assess various outcomes. The average time between the second arthroplasty and the survey was 2.7 years (range 1.0-7.8 years). RESULTS All clinical parameters were favorable. All patients reported being able to easily manage toileting and 87% reaching their back pocket. However, 29% found difficulty and 39% were unable to wash their back or put on bra. In comparison with various unilateral arthroplasty types, there was no statistical difference in overall activities ( p < 0.05). CONCLUSION Bilateral RSA can provide good functional outcome and high satisfaction. Patients manage most ADLs easily with some limitations in activities requiring extreme internal rotation.
Collapse
Affiliation(s)
| | | | | | | | - Cathy D Schleck
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Robert H Cofield
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
19
|
Fırat A, Aydın M, Tecimel O, Öçgüder A, Sanisoğlu Y, Uğurlu M. Comparison of the clinical and radiological outcomes of arthroscopic transosseous and transosseous-equivalent double-row rotator cuff repair techniques. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:178-185. [PMID: 32254034 DOI: 10.5152/j.aott.2020.02.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study compared the clinical and radiological results of the arthroscopic transosseous (ATO) and transosseous-equivalent (TOE) double-row rotator cuff repair techniques. METHODS Prospective data collected from patients treated with ATO (32 women and 7 men, mean age: 57.03±6.39 years) and TOE (36 women and 8 men; mean age: 57.86±7.81 years) techniques were retrospectively evaluated. The visual analog scale score, Constant score, and Oxford shoulder score were used to assess the clinical results. Anchor pullout on standard anteroposterior shoulder radiographs and rotator cuff re-tear on magnetic resonance images were examined at the final follow-up to evaluate the radiological results. Rotator cuff re-tears were graded as per the classification system described by Sugaya et al. Results: The mean follow-up duration was 33.3±11.8 months. No difference was observed in the demographic data of the two groups. Significant improvement was observed in the postoperative shoulder scores of the groups; however, no difference was observed between the groups. Re-tear was detected in 10 patients of the TOE group and 9 patients of the ATO group. Age, tear size, and retraction level could cause re-tear. CONCLUSION In the treatment of rotator cuff tears, the ATO and TOE techniques may achieve considerable improvements in shoulder functions in the short term. LEVEL OF EVIDENCE Level III, Therapeutic study.
Collapse
Affiliation(s)
- Ahmet Fırat
- Department of Orthopedics, Ankara City Hospital, Ankara, Turkey
| | - Mustafa Aydın
- Department of Orthopedics, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Osman Tecimel
- Department of Orthopedics, Ankara City Hospital, Ankara, Turkey
| | - Ali Öçgüder
- Department of Orthopedics, Ankara City Hospital, Ankara, Turkey
| | - Yavuz Sanisoğlu
- Department of Biostatistics, Yıldırım Beyazıt University, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Mahmut Uğurlu
- Department of Orthopedics, Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
20
|
Rossi LA, Rodeo SA, Chahla J, Ranalletta M. Current Concepts in Rotator Cuff Repair Techniques: Biomechanical, Functional, and Structural Outcomes. Orthop J Sports Med 2019; 7:2325967119868674. [PMID: 31565664 PMCID: PMC6755640 DOI: 10.1177/2325967119868674] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
There is substantial evidence indicating that double-row (DR) repair restores
more of the anatomic rotator cuff footprint and is biomechanically superior to
single-row (SR) repair. Transosseous-equivalent (TOE) techniques have shown
biomechanical advantages when compared with traditional DR, including increased
contact at the rotator cuff footprint, higher pressure at the tendon-bone
interface, and increased failure strength. Several meta-analyses of evidence
level 1 and 2 studies have shown a lower rate of failed/incomplete healing when
DR repair was compared with SR repair types. There is some limited evidence that
TOE techniques improve healing rates in large and massive tears as compared with
SR and DR. Overall, most level 1 and 2 studies have failed to prove a
significant difference between SR and DR repairs in terms of clinical outcomes.
However, most studies include only short-term follow-up, minimizing the impact
that the higher rate of retears/failed healing seen with SR repairs can have in
the long term. There are no high-quality clinical studies comparing different DR
configurations, and there are currently not enough clinical data to determine
the functional advantages of various DR technique modifications over one
another. Although numerous biomechanical and clinical studies comparing
different rotator cuff repair techniques have been published in the past decade,
none has achieved universal acceptance. It is essential for the orthopaedic
surgeon to know in detail the available literature to be able to apply the most
appropriate and cost-effective technique in terms of healing and functional
outcomes. This review provides a critical analysis of the comparative
biomechanical and clinical studies among SR, DR, and TOE techniques reported in
the literature in the past decade.
Collapse
Affiliation(s)
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
| | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
| | | |
Collapse
|
21
|
Thompson SM, Prinold JAI, Hill AM, Reilly P, Emery RJH, Bull AMJ. The influence of full-thickness supraspinatus tears on abduction moments: the importance of the central tendon. Shoulder Elbow 2019; 11:19-25. [PMID: 31019558 PMCID: PMC6463383 DOI: 10.1177/1758573217717104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/21/2017] [Accepted: 05/22/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Detachment of the central tendon of the supraspinatus from its insertion is considered to be crucial to functional deficit. The aim of the present study was to assess the function of the supraspinatus in terms of abduction moments by introducing different tear configurations to assess the functional effect of the central tendon insertion. METHODS Ten fresh frozen shoulders from five cadavers were prepared for testing. A testing protocol was established to measure the abduction moment of the supraspinatus under physiological loading tailored to the anthropometrics of each specimen. Four conditions were tested: intact supraspinatus; complete detachment of portion of the supraspinatus tendon anterior to the main central tendon; detachment of the main central tendon; and detachment of the region of the supraspinatus posterior to the main central tendon. RESULTS There was a significant and large reduction in abduction moment when the central tendon was sectioned (p < 0.05). A smaller reduction in abduction moment was found when the regions anterior and posterior to the main central tendon were sectioned (p < 0.05). CONCLUSIONS The central tendon is vital in the role of functional arm abduction through force transmission through the intact rotator cuff. Reinsertion of the central tendon in the correct anatomical location is desirable to optimize functional outcome of surgery.
Collapse
Affiliation(s)
- Simon M. Thompson
- Imperial College London, St Mary’s Hospital, Praed Street, Paddington, London, UK
| | - Joe A. I. Prinold
- Imperial College London, Department of Bioengineering, South Kensington Campus, London, UK
| | - Adam M. Hill
- Imperial College London, Department of Bioengineering, South Kensington Campus, London, UK
| | - Peter Reilly
- Imperial College London, St Mary’s Hospital, Praed Street, Paddington, London, UK
| | - Roger J. H. Emery
- Imperial College London, St Mary’s Hospital, Praed Street, Paddington, London, UK
| | - Anthony M. J. Bull
- Imperial College London, Department of Bioengineering, South Kensington Campus, London, UK,Anthony M. J. Bull, Imperial College London, Department of Bioengineering, South Kensington Campus, London SW7 2AZ, UK.
| |
Collapse
|
22
|
Kuptniratsaikul V, Laohathaimongkol T, Umprai V, Yeekian C, Prasathaporn N. Pre-operative factors correlated with arthroscopic reparability of large-to-massive rotator cuff tears. BMC Musculoskelet Disord 2019; 20:111. [PMID: 30885179 PMCID: PMC6421693 DOI: 10.1186/s12891-019-2485-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 03/03/2019] [Indexed: 12/16/2022] Open
Abstract
Background The purpose of this study is to determine the pre-operative factors that are associated with reparability of the large-sized and massive rotator cuff tears. Methods Sixty-six patients were included in this prognostic study. Demographic data, radiographic and MRI parameters were collected. Arthroscopic rotator cuff repair was performed for all included patient. Complete rotator cuff repair was achieved when the tendon covered up at least 50% of the anatomical footprint. The receiver operating characteristic (ROC) curve was analysed to define the cut-off level of each significant factor. Results Eleven large-sized rotator cuff tears and fifty-five massive rotator cuff tears were defined from MRI. Fifty-four patients were in the complete repair group, and twelve patients were in the partial repair group. The mean duration between MRI and surgery of 5.5 weeks. Reparability was correlated with age, mediolateral (ML) and anteroposterior (AP) tear size, rotator cuff arthropathy, superior migration of humeral head, fatty infiltration and atrophy of the supraspinatus muscle, and fatty infiltration of infraspinatus muscle (p < 0.05). The ROC curve defined a cut-off level of each predicting factor which included age of ≥65 years, mediolateral tear size of ≥36 mm, anteroposterior tear size of ≥22 mm, Hamada’s rotator cuff arthropathy of ≥class2, acromiohumeral interval of ≥6 mm, ≥stage3 supraspinatus fatty infiltration, the presence of supraspinatus muscle atrophy, and ≥ stage1 infraspinatus fatty infiltration. In multivariated regression analysis, age, acromiohumeral interval, and anteroposterior tear size were statistically associated with the reparability. The intra- and inter-observer reliabilities were moderate to excellent. Conclusion Age, ML tear size, AP tear size, rotator cuff arthropathy, superior migration of humeral head, fatty infiltration of supraspinatus and infraspinatus muscles and supraspinatus muscle atrophy all correlate with reparability of large to massive rotator cuff tear.
Collapse
Affiliation(s)
| | | | - Vantawat Umprai
- Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
| | - Chuenrutai Yeekian
- Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
| | - Niti Prasathaporn
- Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand.
| |
Collapse
|
23
|
Complete Talar Extrusion Treated With an Antibiotic Cement Spacer and Staged Femoral Head Allograft. J Am Acad Orthop Surg 2018; 26:e324-e328. [PMID: 29933260 DOI: 10.5435/jaaos-d-16-00748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Complete talar extrusion is rare and usually associated with a high-energy mechanism of injury causing complete dissociation of the talus from the surrounding bony and soft-tissue structures with enough force to expel the talus out of the body. Treatment can be complicated by infection, osteonecrosis, posttraumatic osteoarthritis, and leg length discrepancy, which may require multiple subsequent surgeries for improved outcome and quality of life. Reimplantation of the native talus affords maintenance of joint height and favorable outcomes have been reported. Failed reimplantations have been successfully managed with arthrodesis with or without a bone allograft. We report a case of talar extrusion initially treated with a talus-shaped impregnated antibiotic spacer, followed by femoral head allograft and tibiocalcaneal fusion. This treatment resulted in radiographic evidence of bony fusion at 12 weeks without subsequent infection and good clinical outcome at 2-year follow-up.
Collapse
|
24
|
Senna LF, Ramos MRF, Bergamaschi RF. Reparo artroscópico do manguito rotador: fileira simples versus fileira dupla – Resultados clínicos após um a quatro anos. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
|
25
|
Senna LF, Ramos MRF, Bergamaschi RF. Arthroscopic rotator cuff repair: single-row vs. double-row - clinical results after one to four years. Rev Bras Ortop 2018; 53:448-453. [PMID: 30027077 PMCID: PMC6052182 DOI: 10.1016/j.rboe.2018.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 05/04/2017] [Indexed: 01/20/2023] Open
Abstract
Objective Evaluate and compare the results of single-row (SR) vs. double-row (DR) arthroscopic rotator cuff repair. Methods From December 2009 to May 2013, 115 arthroscopic rotator cuff repairs were performed using suture anchors. After applying the exclusion criteria, there were 75 patients (79 shoulders) to be evaluated, retrospectively, of whom 53 (56 shoulders) attended re-evaluation. The patients were divided into two groups: SR with 29 shoulders, and DR) with 27 shoulders. The scoring systems for clinical evaluation were those of the University of California at Los Angeles (UCLA) and the American Shoulder and Elbow Surgeons (ASES). Results The mean follow-up period in the SR group was 37.8 months vs. 41.0 months in the DR group. The average UCLA score was 30.8 in the SR group vs. 32.6 in the DR group. This difference was not statistically significant (p > 0.05). The averages measured by the ASES score also showed no significant difference – 82.3 and 88.8 in the SR and DR groups, respectively. Conclusion No statistically significant difference was found between SR and DR arthroscopic rotator cuff repair performed by a single surgeon in the comparative analysis of UCLA and ASES scores.
Collapse
Affiliation(s)
- Luís Filipe Senna
- Serviço de Ortopedia e Traumatologia, Hospital Universitário Gaffrée e Guinle, Rio de Janeiro, RJ, Brazil
- Corresponding author.
| | - Max Rogério Freitas Ramos
- Serviço de Ortopedia e Traumatologia, Hospital Universitário Gaffrée e Guinle, Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
26
|
Milks RA, Kolmodin JD, Ricchetti ET, Iannotti JP, Derwin KA. Augmentation with a reinforced acellular fascia lata strip graft limits cyclic gapping of supraspinatus repairs in a human cadaveric model. J Shoulder Elbow Surg 2018; 27:1105-1111. [PMID: 29398399 DOI: 10.1016/j.jse.2017.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/15/2017] [Accepted: 12/03/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND A reinforced biologic strip graft was designed to mechanically augment the repair of rotator cuff tears that are fully reparable by arthroscopic techniques yet have a likelihood of failure. This study assessed the extent to which augmentation of human supraspinatus repairs with a reinforced fascia strip can reduce gap formation during in vitro cyclic loading. METHODS The supraspinatus tendon was sharply released from the proximal humerus and repaired back to its insertion with anchors in 9 matched pairs of human cadaveric shoulders. One repair from each pair was also augmented with a reinforced fascia strip. All repairs were subjected to cyclic mechanical loading of 5 to 180 N for 1000 cycles. RESULTS All augmented and nonaugmented repair constructs completed 1000 cycles of loading. Augmentation with a reinforced fascia strip graft significantly decreased the amount of gap formation compared with nonaugmented repairs. The average gap formation of augmented repairs was 1.5 ± 0.7 mm after the first cycle vs. 3.0 ± 1.2 mm for nonaugmented repairs (P = .003) and 5.0 ± 1.5 mm after 1000 cycles of loading, which averaged 24% ± 21% less than the gap formation of nonaugmented repairs (7.0 ± 2.8 mm, P = .014). CONCLUSION Cadaveric human supraspinatus repairs augmented with a reinforced fascia strip have significantly less initial stroke elongation and gap formation than repairs without augmentation. Augmentation limited gap formation to the greatest extent early in the testing protocol. Human studies are necessary to confirm the appropriate indications and effectiveness of augmentation scaffolds for rotator cuff repair healing in the clinical setting.
Collapse
Affiliation(s)
- Ryan A Milks
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joel D Kolmodin
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph P Iannotti
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kathleen A Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
27
|
Jeong JY, Park KM, Sundar S, Yoo JC. Clinical and radiologic outcome of arthroscopic rotator cuff repair: single-row versus transosseous equivalent repair. J Shoulder Elbow Surg 2018; 27:1021-1029. [PMID: 29289493 DOI: 10.1016/j.jse.2017.10.040] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is ongoing controversy regarding the ideal repair modality for rotator cuff tear, with single-row (SR) repair and double-row transosseous equivalent (TOE) repair as the main contenders. METHODS This study included 415 patients who underwent arthroscopic rotator cuff type I (complete coverage of the greater tuberosity footprint) or II (incomplete coverage) repair between January 2006 and December 2012. SR repair followed the conventional protocol. For double-row TOE repairs, 4 medial sutures were inserted with 2 lateral row anchors. The patients were evaluated for cuff integrity (on magnetic resonance imaging at 6 months postoperatively) and for clinical outcome (pain on the visual analog scale and various scores assessing shoulder function; all logged preoperatively and postoperatively at 3 months, 6 months, and at the last follow-up). RESULTS SR and TOE repairs were performed in 46% and 54% of patients, respectively. Type I and type II repairs were performed in 87% and 13% of patients, respectively. The overall incidence of retear assessed on postoperative magnetic resonance imaging was 6.74%. The incidence of retear in the SR group was statistically significantly higher only in large-sized tears (28.57% vs. 4.5%; P = .028). Among the postoperative scores at the final follow-up, only the function on the visual analog scale differed significantly between the groups (P < .01), with patients treated by TOE repair showing higher scores (8.47 ± 1.70 vs. 7.91 ± 1.66). CONCLUSION In this large cohort study, SR and TOE repair provided similar clinical and radiologic outcomes. Nevertheless, TOE repair was associated with significantly improved healing rate for large-sized tears.
Collapse
Affiliation(s)
- Jeung Yeol Jeong
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keun Min Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Shyam Sundar
- Department of Orthopedic Surgery, Ortho One Orthopaedic Speciality Centre, Coimbatore, Tamil Nadu, India
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
28
|
Robinson S, Krigbaum H, Kramer J, Purviance C, Parrish R, Donahue J. Double row equivalent for rotator cuff repair: A biomechanical analysis of a new technique. J Orthop 2018; 15:426-431. [PMID: 29881170 DOI: 10.1016/j.jor.2018.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/16/2018] [Indexed: 01/09/2023] Open
Abstract
Introduction There are numerous configurations of double row fixation for rotator cuff tears however, there remains to be a consensus on the best method. In this study, we evaluated three different double-row configurations, including a new method. Our primary question is whether the new anchor and technique compares in biomechanical strength to standard double row techniques. Methods Eighteen prepared fresh frozen bovine infraspinatus tendons were randomized to one of three groups including the New Double Row Equivalent, Arthrex Speedbridge and a transosseous equivalent using standard Stabilynx anchors. Biomechanical testing was performed on humeri sawbones and ultimate load, strain, yield strength, contact area, contact pressure, and a survival plots were evaluated. Results The new double row equivalent method demonstrated increased survival as well as ultimate strength at 415N compared to the remainder testing groups as well as equivalent contact area and pressure to standard double row techniques. Conclusions This new anchor system and technique demonstrated higher survival rates and loads to failure than standard double row techniques. This data provides us with a new method of rotator cuff fixation which should be further evaluated in the clinical setting. Level of Evidence Basic science biomechanical study.
Collapse
Affiliation(s)
- Sean Robinson
- San Francisco Orthopaedic Residency Program, 450 Stanyan St, San Francisco CA 94117, United States
| | | | - Jon Kramer
- San Francisco Orthopaedic Residency Program, 450 Stanyan St, San Francisco CA 94117, United States
| | | | | | | |
Collapse
|
29
|
Outcomes of shoulder arthroplasty in diabetic patients as assessed by peri-operative A1C. INTERNATIONAL ORTHOPAEDICS 2018; 42:1923-1934. [DOI: 10.1007/s00264-018-3874-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
|
30
|
A new scale measuring translation of the humeral head as a prognostic factor for the treatment of large and massive rotator cuff tears. J Shoulder Elbow Surg 2018; 27:196-203. [PMID: 29056484 DOI: 10.1016/j.jse.2017.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Failure rates after rotator cuff repair remain high in patients with massive tears. Although superior translation of the humeral head has been used to assess the severity of rotator cuff tears, the relevance of anterior migration of the humeral head to clinical outcomes has not been established. The purpose of this study was to investigate the potential role of the T-scale, a measure of the anterolateral translation of the humeral head, as a prognostic factor for rotator cuff repair. METHODS One hundred twenty consecutive patients with full-thickness rotator cuff tears underwent primary rotator cuff repair. The T-scale and acromiohumeral interval (AHI) were measured preoperatively on axial computed tomography scans and radiographs, respectively. The correlations of the T-scale and AHI with previously published scores and active forward elevation (FE) were investigated. The outcome of rotator cuff repairs was compared between patients with positive and patients with negative preoperative T-scale values. RESULTS The preoperative T-scale but not AHI correlated significantly with postoperative FE and clinical scores in patients with large to massive tears but not in those with small to medium tears. Postoperative FE and clinical scores were significantly higher in patients with positive T-scale values than in those with negative T-scale values. The relative risk of retear was 2.0 to 7.9 times greater in patients with negative T-scale values. CONCLUSION Patients with large to massive tears and negative T-scale values had poorer clinical outcomes and higher retear rates. A negative T-scale value represents a useful prognostic factor for considering reverse shoulder arthroplasty in patients at greater risk of retear after rotator cuff repair.
Collapse
|
31
|
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.
Collapse
|
32
|
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: 3.8] [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.
Collapse
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
| |
Collapse
|
33
|
Kwak JM, Heo SK, Jung GH. Six-year survival of reimplanted talus after isolated total talar extrusion: a case report. J Med Case Rep 2017; 11:348. [PMID: 29241447 PMCID: PMC5731080 DOI: 10.1186/s13256-017-1517-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 11/20/2017] [Indexed: 12/28/2022] Open
Abstract
Background Open total extrusion of the talus without concomitant fracture is an extremely rare injury. We present 6-year follow-up data of a patient treated using a temporary spanning external fixator and less invasive single K-wire fixation. Case presentation A 55-year-old Asian man who had a totally extruded talus without fracture underwent immediate reimplantation surgery. A spanning external fixator with single antegrade K-wire fixation was applied to maintain the reimplanted talus. During 6 years of follow-up, he could walk without aids and could squat, corresponding to an American Orthopaedic Foot and Ankle Society score of 85. We found that the suspect lesion that was evident at 6 months after surgery had disappeared at 12 months postoperatively on the basis of sequential follow-up magnetic resonance imaging. There was no evidence of osteonecrosis of the dislocated talus at the final follow-up. Conclusions In patients with a totally extruded talus, a surgical strategy including immediate reimplantation of the talus and a temporary spanning fixator with single K-wire fixation might be useful to allow early mobilization around the ankle joint and to prevent additional damage of the foot without significant complications.
Collapse
Affiliation(s)
- Jae-Man Kwak
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Sung-Keun Heo
- Department of orthopaedic surgery, Gi-Jang Hospital, Busan, Republic of Korea
| | - Gu-Hee Jung
- Department of Orthopaedic Surgery, College of Medicine, Gyeongsang National University, and Gyeongsang National University Changwon Hospital, 555 Samjungja-Dong, Changwon-si, 642-160, Republic of Korea.
| |
Collapse
|
34
|
Taniguchi N, D'Lima DD, Suenaga N, Ishida Y, Lee D, Goya I, Chosa E. Translation of the humeral head scale is associated with success of rotator cuff repair for large-massive tears. BMC Musculoskelet Disord 2017; 18:511. [PMID: 29202746 PMCID: PMC5715556 DOI: 10.1186/s12891-017-1874-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/24/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Although a loss of rotator cuff integrity leads to the superior migration of the humeral head, the parameters that characterize the anterolateral migration of the humeral head have not been established. The purpose of this study was to investigate the correlation between the translation of the humeral head scale (T-scale) and clinical outcomes of rotator cuff repair, as well as the correlation between the T-scale and radiologic parameters. METHODS One hundred thirty-five consecutive patients with full-thickness rotator cuff tears underwent primary rotator cuff repair. The T-scale, which indicates the distance from the center of the humeral head to the lateral coracoacromial arch, was measured on axial computed tomography scans, and the acromiohumeral interval (AHI) was measured radiographically. The correlation of the two parameters with the clinical scores of the Japanese Orthopaedic Association and University of California-Los Angeles scores and active forward elevation (FE) were evaluated at the preoperative and postoperative stages, respectively. RESULTS The postoperative T-scale and AHI correlated well with the postoperative FE and clinical scores in the patients with large-massive tears but not in those patients with small-medium tears and preoperative large-massive tears. A significant correlation was observed between the postoperative T-scale and AHI. The T-scale was subject to cuff repair integrity. CONCLUSIONS We demonstrated that the postoperative T-scale was well correlated with the clinical results and postoperative AHI after rotator cuff repair for large-massive tears, indicating that poor outcomes are associated with combined superior and anterolateral migration of the humeral head following retears.
Collapse
Affiliation(s)
- Noboru Taniguchi
- Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan. .,Department of Medical Science, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan.
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education, Scripps Clinic, 11025 North Torrey Pines Road, Suite 200, La Jolla, CA, 92037, USA.,Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - Naoki Suenaga
- The Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Hokushin Orthopaedic Hospital, 1-18 Kikusuimotomachi 3-jou 3-chome, Shiroishi-ku, Sapporo, 003-0823, Japan
| | - Yasuyuki Ishida
- Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Deokcheol Lee
- Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Isoya Goya
- Hakuaikai Kaisei Hospital, 16-27 Nishi-23 Minami-2, Obihiro, Hokkaido, 080-2473, Japan
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| |
Collapse
|
35
|
Bills CC, Field ED, Field LD. "Double-Row Rip-Stop" Technique for Arthroscopic Rotator Cuff Repair. Arthrosc Tech 2017; 6:e2053-e2059. [PMID: 29430400 PMCID: PMC5799086 DOI: 10.1016/j.eats.2017.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/04/2017] [Indexed: 02/03/2023] Open
Abstract
Rotator cuff repair depends on both the fixation strength of the chosen repair construct and the local healing response of the repaired tissue. Among a growing discussion surrounding the superiority of one surgical technique over another, the surgeon's ability to complete a rotator cuff repair with technical acuity in a timely manner remains paramount. Double-row repairs as well as rip-stop configurations have been proposed to limit failures found after arthroscopic rotator cuff repairs. Implementation of both techniques during arthroscopic shoulder surgery may represent a technical challenge for the average orthopaedist. The purpose of this article is to give simple instructions for reproduction of an arthroscopic double-row rip-stop repair for rotator cuff fixation.
Collapse
Affiliation(s)
- Collin C. Bills
- Address correspondence to Collin C. Bills, M.D., Mississippi Sports Medicine & Orthopaedic Center, 1325 East Fortification St, Jackson, MS 39202, U.S.A.Mississippi Sports Medicine & Orthopaedic Center1325 East Fortification StJacksonMS39202U.S.A.
| | | | | |
Collapse
|
36
|
Zhao S, Su W, Shah V, Hobson D, Yildirimer L, Yeung KWK, Zhao J, Cui W, Zhao X. Biomaterials based strategies for rotator cuff repair. Colloids Surf B Biointerfaces 2017. [PMID: 28633121 DOI: 10.1016/j.colsurfb.2017.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Tearing of the rotator cuff commonly occurs as among one of the most frequently experienced tendon disorders. While treatment typically involves surgical repair, failure rates to achieve or sustain healing range from 20 to 90%. The insufficient capacity to recover damaged tendon to heal to the bone, especially at the enthesis, is primarily responsible for the failure rates reported. Various types of biomaterials with special structures have been developed to improve tendon-bone healing and tendon regeneration, and have received considerable attention for replacement, reconstruction, or reinforcement of tendon defects. In this review, we first give a brief introduction of the anatomy of the rotator cuff and then discuss various design strategies to augment rotator cuff repair. Furthermore, we highlight current biomaterials used for repair and their clinical applications as well as the limitations in the literature. We conclude this article with challenges and future directions in designing more advanced biomaterials for augmentation of rotator cuff repair.
Collapse
Affiliation(s)
- Song Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Vishva Shah
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Divia Hobson
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Lara Yildirimer
- Barnet General Hospital, Royal Free NHS Trust Hospital, Wellhouse Lane, Barnet EN5 3DJ, London, UK
| | - Kelvin W K Yeung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
| | - Wenguo Cui
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Soochow University, 708 Renmin Rd., Suzhou, Jiangsu 215006, China.
| | - Xin Zhao
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
| |
Collapse
|
37
|
Early NA, Elias JJ, Lippitt SB, Filipkowski DE, Pedowitz RA, Ciccone WJ. Suture spanning augmentation of single-row rotator cuff repair: a biomechanical analysis. J Shoulder Elbow Surg 2017; 26:337-342. [PMID: 27720412 DOI: 10.1016/j.jse.2016.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/14/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND This in vitro study evaluated the biomechanical benefit of adding spanning sutures to single-row rotator cuff repair. METHODS Mechanical testing was performed to evaluate 9 pairs of cadaveric shoulders with complete rotator cuff repairs, with a single-row technique used on one side and the suture spanning technique on the other. The spanning technique included sutures from 2 lateral anchors securing tendon near the musculotendinous junction, spanning the same anchor placement from single-row repair. The supraspinatus muscle was loaded to 100 N at 0.25 Hz for 100 cycles, followed by a ramp to failure. Markers and a video tracking system measured anterior and posterior gap formation across the repair at 25-cycle intervals. The force at which the stiffness decreased by 50% and 75% was determined. Data were compared using paired t-tests. RESULTS One single-row repair failed at <25 cycles. Both anterior and posterior gap distances tended to be 1 to 2 mm larger for the single-row repairs than for the suture spanning technique. The difference was statistically significant at all cycles for the posterior gap formation (P ≤ .02). The trends were not significant for the anterior gap (P ≥ .13). The loads at which the stiffness decreased by 50% and 75% did not differ significantly between the 2 types of repair (P ≥ .10). CONCLUSIONS The suture spanning technique primarily improved posterior gap formation. Decreased posterior gap formation could reduce failure rates for rotator cuff repair.
Collapse
Affiliation(s)
- Nicholas A Early
- Department of Orthopedic Surgery, Cleveland Clinic Akron General, Akron, OH, USA
| | - John J Elias
- Department of Research, Cleveland Clinic Akron General, Akron, OH, USA.
| | - Steven B Lippitt
- Department of Orthopedic Surgery, Cleveland Clinic Akron General, Akron, OH, USA
| | | | | | | |
Collapse
|
38
|
Abdelshahed M, Mahure SA, Kaplan DJ, Mollon B, Zuckerman JD, Kwon YW, Rokito AS. Arthroscopic Rotator Cuff Repair: Double-Row Transosseous Equivalent Suture Bridge Technique. Arthrosc Tech 2016; 5:e1297-e1304. [PMID: 28149729 PMCID: PMC5263183 DOI: 10.1016/j.eats.2016.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 07/22/2016] [Indexed: 02/06/2023] Open
Abstract
Following a failed course of conservative management, arthroscopic rotator cuff repair (ARCR) has become the gold standard treatment for patients presenting with symptomatic rotator cuff (RC) tears. Traditionally, the single-row repair technique was used. Although most patients enjoy good to excellent clinical outcomes, structural healing to bone remains problematic. As a result, orthopaedic surgeons have sought to improve outcomes with various technological and technical advancements. One such possible advancement is the double-row technique. We present a method for repairing an RC tear using double-row suture anchors in a transosseous equivalent suture bridge technique. The double-row technique is believed to more effectively re-create the anatomic footprint of the tendon, as well as increase tendon to bone surface area, and apposition for healing. However, it requires longer operating times and is costlier. This report highlights this technique for ARCR in an adult by using a double-row transosseous equivalent suture bridge.
Collapse
Affiliation(s)
| | | | - Daniel J. Kaplan
- Address correspondence to Daniel J. Kaplan, B.A., NYU Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY 10016, U.S.A.NYU Hospital for Joint Diseases333 East 38th Street4th FloorNew YorkNY10016U.S.A.
| | | | | | | | | |
Collapse
|
39
|
Nicholas SJ, Lee SJ, Mullaney MJ, Tyler TF, Fukunaga T, Johnson CD, McHugh MP. Functional Outcomes After Double-Row Versus Single-Row Rotator Cuff Repair: A Prospective Randomized Trial. Orthop J Sports Med 2016; 4:2325967116667398. [PMID: 27757408 PMCID: PMC5051628 DOI: 10.1177/2325967116667398] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: The functional benefits of double-row (DR) versus single-row (SR) rotator cuff repair are not clearly established. Purpose: To examine the effect of DR versus SR rotator cuff repair on functional outcomes and strength recovery in patients with full-thickness tears. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Forty-nine patients were randomized to DR or SR repairs; 36 patients (13 women, 23 men; mean age, 62 ± 7 years; 20 SR, 16 DR) were assessed at a mean 2.2 ± 1.6 years after surgery (range, 1-7 years; tear size: 17 medium, 13 large, 9 massive). The following data were recorded prior to surgery and at follow-up: Penn shoulder score, American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) results; range of motion (ROM) for shoulder flexion, external rotation (ER) at 0° and 90° of abduction, and internal rotation (IR) at 90° of abduction; and shoulder strength (Lafayette manual muscle tester) in empty- and full-can tests, abduction, and ER at 0° of abduction. Treatment (SR vs DR) × time (pre- vs postoperative) mixed-model analysis of variance was used to assess the effect of rotator cuff repair. Results: Rotator cuff repair markedly improved Penn, ASES, and SST scores (P < .001), with similar improvement between SR and DR repairs (treatment × time, P = .38-.10) and excellent scores at follow-up (DR vs SR: Penn, 91 ± 11 vs 92 ± 11 [P = .73]; ASES, 87 ± 12 vs 92 ± 12 [P = .21]; SST, 11.4 ± 1.0 vs 11.3 ± 1.0 [P = .76]). Patients with DR repairs lost ER ROM at 0° of abduction (preoperative to final follow-up, 7° ± 10° loss [P = .013]). ER ROM did not significantly change with SR repair (5° ± 14° gain, P = .16; treatment by time, P = .008). This effect was not apparent for ER ROM at 90° of abduction (treatment × time, P = .26). IR ROM improved from preoperative to final follow-up (P < .01; SR, 17° ± 27°; DR, 7° ± 21°; treatment × time, P = .23). Rotator cuff repair markedly improved strength in empty-can (54%), full-can (66%), abduction (47%), and ER (54%) strength (all P < .001), with no difference between SR and DR repairs (P = .23-.75). All clinical tests with the exception of the lift-off test were normalized at follow-up (P < .05). Conclusion: Outcomes were not different between SR or DR repair, with generally excellent outcomes for both groups. Rotator cuff repair and subsequent rehabilitation markedly improved shoulder strength.
Collapse
Affiliation(s)
- Stephen J Nicholas
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Steven J Lee
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Michael J Mullaney
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Timothy F Tyler
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Takumi Fukunaga
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Christopher D Johnson
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| |
Collapse
|
40
|
Black EM, Austin LS, Narzikul A, Seidl AJ, Martens K, Lazarus MD. Comparison of implant cost and surgical time in arthroscopic transosseous and transosseous equivalent rotator cuff repair. J Shoulder Elbow Surg 2016; 25:1449-56. [PMID: 27068378 DOI: 10.1016/j.jse.2016.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/21/2015] [Accepted: 01/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND We investigated the cost savings associated with arthroscopic transosseous (anchorless) double-row rotator cuff repair compared with double-row anchored (transosseous-equivalent [TOE]) repair. METHODS All patients undergoing double-row arthroscopic rotator cuff repair from 2009 to 2012 by a single surgeon were eligible for inclusion. The study included 2 consecutive series of patients undergoing anchorless or TOE repair. Excluded from the study were revision repairs, subscapularis repairs, patients with poor tendon quality or excursion requiring medialized repair, and partial repairs. Rotator cuff implant costs (paid by the institution) and surgical times were compared between the 2 groups, controlling for rotator cuff tear size and additional procedures performed. RESULTS The study included 344 patients, 178 with TOE repairs and 166 with anchorless repairs. Average implant cost for TOE repairs was $1014.10 ($813.00 for small, $946.67 for medium, $1104.56 for large, and $1507.29 for massive tears). This was significantly more expensive compared with anchorless repairs, which averaged $678.05 ($659.75 for small, $671.39 for medium, $695.55 for large, and $716.00 for massive tears). Average total operative time in TOE and anchorless groups was not significantly different (99 vs. 98 minutes). There was larger (although not statistically significant) case time variation in the TOE group. CONCLUSIONS Compared with TOE repair, anchorless rotator cuff repair provides substantial implant-related cost savings, with no significant differences in surgical time for medium and large rotator cuff tears. Case time for TOE repair varied more with extremes in tear size.
Collapse
Affiliation(s)
- Eric M Black
- Department of Orthopaedic Surgery, Summit Medical Group, Berkeley Heights, NJ, USA
| | - Luke S Austin
- The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexa Narzikul
- The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Adam J Seidl
- The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Kelly Martens
- Department of Orthopaedic Surgery, Mid-Atlantic Permanente Medical Group, Largo, MD, USA
| | - Mark D Lazarus
- The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| |
Collapse
|
41
|
Duchman KR, Goetz JE, Uribe BU, Amendola AM, Barber JA, Malandra AE, Fredericks DC, Hettrich CM. Delayed administration of recombinant human parathyroid hormone improves early biomechanical strength in a rat rotator cuff repair model. J Shoulder Elbow Surg 2016; 25:1280-7. [PMID: 26948004 DOI: 10.1016/j.jse.2015.12.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite advances in intraoperative techniques, rotator cuff repairs frequently do not heal. Recombinant human parathyroid hormone (rhPTH) has been shown to improve healing at the tendon-to-bone interface in an established acute rat rotator cuff repair model. We hypothesized that administration of rhPTH beginning on postoperative day 7 would result in improved early load to failure after acute rotator cuff repair in an established rat model. METHODS Acute rotator cuff repairs were performed in 108 male Sprague-Dawley rats. Fifty-four rats received daily injections of rhPTH beginning on postoperative day 7 until euthanasia or a maximum of 12 weeks postoperatively. The remaining 54 rats received no injections and served as the control group. Animals were euthanized at 2 and 16 weeks postoperatively and evaluated by gross inspection, biomechanical testing, and histologic analysis. RESULTS At 2 weeks postoperatively, rats treated with rhPTH demonstrated significantly higher load to failure than controls (10.9 vs. 5.2 N; P = .003). No difference in load to failure was found between the 2 groups at 16 weeks postoperatively, although control repairs more frequently failed at the tendon-to-bone interface (45.5% vs. 22.7%; P = .111). Blood vessel density appeared equivalent between the 2 groups at both time points, but increased intracellular and extracellular vascular endothelial growth factor expression was noted in the rhPTH-treated group at 2 weeks. CONCLUSIONS Delayed daily administration of rhPTH resulted in increased early load to failure and equivalent blood vessel density in an acute rotator cuff repair model.
Collapse
Affiliation(s)
- Kyle R Duchman
- Department of Orthopaedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| | - Jessica E Goetz
- Department of Orthopaedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Bastian U Uribe
- Department of Orthopaedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Andrew M Amendola
- Department of Orthopaedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Joshua A Barber
- Department of Orthopaedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Allison E Malandra
- Department of Orthopaedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Douglas C Fredericks
- Department of Orthopaedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Carolyn M Hettrich
- Department of Orthopaedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| |
Collapse
|
42
|
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: 3.4] [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.
Collapse
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
| |
Collapse
|
43
|
Kim SH, Kim J, Choi YE, Lee HR. Healing disturbance with suture bridge configuration repair in rabbit rotator cuff tear. J Shoulder Elbow Surg 2016; 25:478-86. [PMID: 26541205 DOI: 10.1016/j.jse.2015.08.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/13/2015] [Accepted: 08/25/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Medial row failure has been reported in the suture bridge technique of rotator cuff repair. This study compared the healing response of suture bridge configuration repair (SBCR) and parallel type transosseous repair (PTR). METHODS Acute rotator cuff repair was performed in 32 rabbits. Both shoulders were repaired using PTR or SBCR. In PTR, simple PTR was performed through 2 parallel transosseous tunnels created using a microdrill. In SBCR, 2 additional crisscross transosseous tunnels were added to mimic arthroscopic SBCR. At 1, 2, and 5 weeks postoperatively, comparative biomechanical testing was performed in 8 rabbits, and histologic analysis, including immunohistochemical staining for CD31, was performed in 4 rabbits. RESULTS Failure loads at 1 week (38.12 ± 20.43 N vs 52.00 ± 27.23 N; P = .284) and 5 weeks (97.93 ± 48.35 N vs 119.60 ± 60.81 N; P = .218) were not statistically different between the SBCR and PTR groups, respectively, but were significantly lower in the SBCR group than in the PTR group (23.56 ± 13.56 N vs. 44.25 ± 12.53 N; P = .009), respectively, at 2 weeks. Markedly greater fibrinoid deposition was observed in the SBCR group than in the PTR group at 2 weeks. For vascularization, there was a tendency that more vessels could be observed in PTR than in SBCR at 2 weeks (15.9 vs 5.6, P = .068). CONCLUSIONS In a rabbit acute rotator cuff repair model, SBCR exhibited inferior mechanical strength, and fewer blood vessels were observed at the healing site at 2 weeks postoperatively. Medial row tendon failure was more common in SBCR. Surgeons should consider the clinical effect of SBCR when performing rotator cuff repair.
Collapse
Affiliation(s)
- Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jangwoo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Eun Choi
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hwa-Ryeong Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
44
|
Imam MA, Abdelkafy A. Outcomes following arthroscopic transosseous equivalent suture bridge double row rotator cuff repair: a prospective study and short-term results. SICOT J 2016; 2:7. [PMID: 27163096 PMCID: PMC4849220 DOI: 10.1051/sicotj/2015041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 12/19/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The transosseous-equivalent cross bridge double row (TESBDR) rotator cuff (RC) repair technique has been developed to optimize healing biology at a repaired RC tendon insertion. It has been shown in the laboratory to improve pressurized contact area and mean foot print pressure when compared with a double row anchor technique. Pressure has been shown to influence healing between tendon and bone, and the tendon compression vector provided by the transosseous-equivalent suture bridges may enhance healing. The purpose was to prospectively evaluate the outcomes of arthroscopic TESBDR RC repair. METHODS Single center prospective case series study. Sixty-nine patients were selected to undergo arthroscopic TESBDR RC repair and were included in the current study. Primary outcome measures included the Oxford Shoulder Score (OSS), the University of California, Los Angeles (UCLA) score, the Constant-Murley (CM) Score and Range of motion (ROM). Secondary outcome measures included a Visual Analogue Scale (VAS) for pain, another VAS for patient satisfaction from the operative procedure, EuroQoL 5-Dimensions Questionnaire (EQ-5D) for quality of life assessment. RESULTS At 24 months post-operative, average OSS score was 44, average UCLA score was 31, average CM score was 88, average forward flexion was 145°, average internal rotation was 35°, average external rotation was 79°, average abduction was 150°, average EQ-5D score was 0.73, average VAS for pain was 2.3, and average VAS for patient satisfaction was 9.2. CONCLUSION Arthroscopic TESBDR RC repair is a procedure with good post-operative functional outcome and low re-tear rate based on a short term follow-up.
Collapse
Affiliation(s)
- Mohamed Abdelnabi Imam
-
The South West London Elective Orthopaedic Centre Dorking Road Epsom
KT18 7EG London UK
-
Orthopaedic Surgery and Trauma Department, Faculty of Medicine, Suez Canal University Circular Road 41522
Ismailia Egypt
| | - Ashraf Abdelkafy
-
Orthopaedic Surgery and Trauma Department, Faculty of Medicine, Suez Canal University Circular Road 41522
Ismailia Egypt
| |
Collapse
|
45
|
Lucena TR, Lam PH, Millar NL, Murrell GAC. The temporal outcomes of open versus arthroscopic knotted and knotless rotator cuff repair over 5 years. Shoulder Elbow 2015; 7:244-55. [PMID: 27582985 PMCID: PMC4935122 DOI: 10.1177/1758573215581775] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/19/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND The present study aimed to determine how repair technique influenced structural and clinical outcomes at 5 years post-surgery. METHODS Three cohorts of patients had repair of a symptomatic rotator cuff tear using (i) an open double-row mattress repair technique (n = 25); (ii) arthroscopic single-row simple suture knotted technique (n = 25); or (iii) arthroscopic single-row inverted mattress knotless technique (n = 36) by one surgeon. Standardized patient- and examiner-determined outcomes were obtained pre-operatively and postoperatively with a validated protocol, ultrasound were also performed at the same time. RESULTS Retear occurred more often after open repair (48%) at 5 years than after arthroscopic knotted (33%) and arthroscopic knotless (26%) repair. Retear was associated with increasing age, pre-operative tear size and weaker pre-operative and 5 years postoperative cuff strength. Between 2 years and 5 years, the open repair group experienced an increase in the frequency of pain during activity, as well as in the difficulty experienced and the severity of pain during overhead activities (p < 0.05) and, at 5 years, also experienced more difficulty with overhead activities, compared to the arthroscopic knotless repair group. CONCLUSIONS At 5-year follow-up, arthroscopic rotator cuff repair techniques resulted in fewer retears and better outcomes compared to an open double-row technique.
Collapse
Affiliation(s)
- Thomas R Lucena
- Orthopaedic Research Institute, Research & Education Centre, St George Hospital, Sydney, Australia
| | - Patrick H Lam
- Orthopaedic Research Institute, Research & Education Centre, St George Hospital, Sydney, Australia
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation and Department of Surgery, Glasgow, UK
| | - George AC Murrell
- Orthopaedic Research Institute, Research & Education Centre, St George Hospital, Sydney, Australia,George AC Murrell, Orthopaedic Research Institute, Research & Education Centre (Level 2), St George Hospital, 4–10 South Street, Kogarah, Sydney, NSW 2217, Australia. Tel: +61 2 9113 2827
| |
Collapse
|
46
|
Pandis P, Prinold JA, Bull AM. Shoulder muscle forces during driving: Sudden steering can load the rotator cuff beyond its repair limit. Clin Biomech (Bristol, Avon) 2015; 30:839-46. [PMID: 26139549 PMCID: PMC4577652 DOI: 10.1016/j.clinbiomech.2015.06.004] [Citation(s) in RCA: 22] [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: 06/01/2014] [Revised: 05/29/2015] [Accepted: 06/08/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Driving is one of the most common everyday tasks and the rotator cuff muscles are the primary shoulder stabilisers. Muscle forces during driving are not currently known, yet knowledge of these would influence important clinical advice such as return to activities after surgery. The aim of this study is to quantify shoulder and rotator cuff muscle forces during driving in different postures. METHODS A musculoskeletal modelling approach is taken, using a modified driving simulator in combination with an upper limb musculoskeletal model (UK National Shoulder Model). Motion data and external force vectors were model inputs and upper limb muscle and joint forces were the outputs. FINDINGS Comparisons of the predicted glenohumeral joint forces were compared to in vivo literature values, with good agreement demonstrated (61 SD 8% body weight mean peak compared to 60 SD 1% body weight mean peak). High muscle activation was predicted in the rotator cuff muscles; particularly supraspinatus (mean 55% of the maximum and up to 164 SD 27 N). This level of loading is up to 72% of mean failure strength for supraspinatus repairs, and could therefore be dangerous for some cases. Statistically significant and large differences are shown to exist in the joint and muscle forces for different driving positions as well as steering with one or both hands (up to 46% body weight glenohumeral joint force). INTERPRETATION These conclusions should be a key consideration in rehabilitating the shoulder after surgery, preventing specific upper limb injuries and predicting return to driving recommendations.
Collapse
|
47
|
Arthroscopic knotless-anchor rotator cuff repair: a clinical and radiological evaluation. Knee Surg Sports Traumatol Arthrosc 2015; 23:2628-34. [PMID: 24792075 DOI: 10.1007/s00167-014-3026-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 04/19/2014] [Indexed: 01/26/2023]
Abstract
PURPOSE The goal of this study was to evaluate the clinical and radiological results of the arthroscopic knotless-anchor Speed-Bridge technique, in particular the pattern and the rate of retears. The results were compared with a modified Suture-Bridge knot-tying technique (mDR). The hypothesis is that arthroscopic knotless-anchor Speed-Bridge rotator cuff repair is a sufficient technique to address supraspinatus tears and differs in pattern of retears when compared to mDR. METHODS This study includes twenty-two consecutive patients (8f/14m ø 63.3 ± 7.2 years) undergoing knotless-anchor Speed-Bridge repair. The subjective shoulder value (SSV), Constant score (CS) and Western Ontario Rotator Cuff (WORC) Score were used for clinical follow-up. MRI scans were conducted within 3 weeks post-operatively, after 1 and after 2 years for analysis of (a) tendon integrity (according to Sugaya), (b) muscle atrophy according to Thomazeau and (c) fatty infiltration. Results were compared with 20 patients operated in mDR (ø 61.2 ± 7.5 years). RESULTS The mean follow-up was 24.4 ± 4.7 months. The average SSV was 88.7 ± 14.9 %, the CS was 78.2 ± 13.2 points (contralateral side 78.5 ± 16.6) and the WORC Score averaged 87.1 ± 18.2 %. On magnetic resonance imaging, the integrity failure rate was 22.7 % (n = 5). The pattern of retear was a medial cuff failure in 2/5 cases (mDR 4/5, n.s.). Muscular atrophy or fatty degeneration did not increase between surgery and follow-up (n.s.). Compared with mDR (25 %) reconstruction, no significant differences were obtained regarding integrity failure rate and muscular atrophy (n.s.). CONCLUSION The modified knotless-anchor Speed-Bridge technique shows good to excellent clinical results as well as acceptable retear rates. This technique eliminates medial and lateral knot impingement. Concerning the potential reduction in the medial strangulation of the tendon, there is a need for further clinical research.
Collapse
|
48
|
Ying ZM, Lin T, Yan SG. Arthroscopic single-row versus double-row technique for repairing rotator cuff tears: a systematic review and meta-analysis. Orthop Surg 2015; 6:300-12. [PMID: 25430714 DOI: 10.1111/os.12139] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 08/31/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The purpose of this study was to systematically review published reports that compare the outcomes of single-row and double-row suture anchor fixation in arthroscopic rotator cuff repair. METHODS Combined data regarding relevant patient characteristics, rotator cuff pathology, surgical techniques, postoperative rehabilitation regimens, University of California at Los Angeles (UCLA) Scores, Constant scores, American Shoulder and Elbow Society (ASES) scores, tendon healing, incidence of recurrent rotator cuff defects, shoulder muscle strength, range of motion, surgical time and patient satisfaction were assessed. RESULTS Seven eligible randomized controlled studies and four prospective cohort studies were identified. There were no significant differences between the single-row and double-row groups in terms of Constant or ASES scores. However, UCLA scores, tendon healing, abduction shoulder strength index (SSI), external rotation SSI and internal rotation SSI were significantly better for double-row technique than for single-row technique. A statistically significant advantage for double-row repair according to UCLA score and external rotation SSI was found in the subgroup with tears greater than 3 cm. CONCLUSION No definite conclusion could be drawn about differences in overall outcomes of double- and single-row techniques for repairing for small to medium (<3 cm) or large to massive (>3 cm) rotator cuff tears, even though some measures of clinical outcome showed significant differences between these two techniques.
Collapse
Affiliation(s)
- Zhi-min Ying
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | |
Collapse
|
49
|
A biomechanical and histological comparison of the suture bridge and conventional double-row techniques of the repair of full-thickness rotator cuff tears in a rabbit model. BMC Musculoskelet Disord 2015; 16:148. [PMID: 26076895 PMCID: PMC4466809 DOI: 10.1186/s12891-015-0601-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 05/27/2015] [Indexed: 12/20/2022] Open
Abstract
Background The suture bridge (SB) technique and conventional double-row (DR) are both effective in repair of full-thickness rotator cuff tears . However, increasing numbers of scholars believe that the SB technique produces better results than conventional DR because of the higher bone-tendon contact area and pressure. However, The clinical outcomes have been mixed and little direct evidence has been supplied in vivo. This study was designed using the SB and DR techniques to determine which is the better technique. Methods Sixty-four New Zealand white rabbits were randomly divided into 2 groups, the SB group and DR group. SB and DR were then used to repair their rotator cuff tears. Rabbits were then sacrificed at the 2nd, 4th, or 8th week after surgery and a histological comparison was made. The biomechanical comparison was made at the 8th week. Results The load to failure of the SB group was 134.59 ± 17.69 N at the 8th postoperative week, and that was significantly higher than in the DR group (103.83 ± 6.62, P = 0.001), but both repair groups remained lower than in the control group (199.25 ± 14.81). Histological evaluation showed that both the SB and DR groups healed at the bone-tendon interface. But there were subtle differences between the two groups in the structure and morphology of collagen fibers and cartilage cells at bone-tendon interface. In general, the collagen fibers of the SB group were more compact than those of the DR group at all times tested. At the 4th and 8th weeks, the collagen fibers and cartilage cells in the SB group were arranged in a column modality, but those in the DR group were distributed horizontally. Conclusion The SB technique facilitated healing more effectively than the conventional DR technique. The difference in morphology of collagen fibers and cartilage cells may be related to the difference in bone-tendon contact pressure.
Collapse
|
50
|
Wang E, Wang L, Gao P, Li Z, Zhou X, Wang S. Single-versus double-row arthroscopic rotator cuff repair in massive tears. Med Sci Monit 2015; 21:1556-61. [PMID: 26017641 PMCID: PMC4459574 DOI: 10.12659/msm.893058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background It is a challenge for orthopaedic surgeons to treat massive rotator cuff tears. The optimal management of massive rotator cuff tears remains controversial. Therefore, the goal of this study was to compare arthroscopic single- versus double-row rotator cuff repair with a larger sample size. Material/Methods Of the subjects with massive rotator cuff tears, 146 were treated using single-row repair, and 102 were treated using double-row repair. Pre- and postoperative functional outcomes and radiographic images were collected. The clinical outcomes were evaluated for a minimum of 2 years. Results No significant differences were shown between the groups in terms of functional outcomes. Regarding the integrity of the tendon, a lower rate of post-treatment retear was observed in patients who underwent double-row repair compared with single-row repair. Conclusions The results suggest that double-row repair is relatively superior in shoulder ROM and the strength of tendon compared with single-row repair. Future studies involving more patients in better-designed randomized controlled trials will be required.
Collapse
Affiliation(s)
- EnZhi Wang
- Department of Orthopaedic Surgery, People's Hospital of Zhangqiu, Zhangqiu, Shandong, China (mainland)
| | - Liang Wang
- Department of Orthopaedic Surgery, People's Hospital of Zhangqiu, Zhangqiu, Shandong, China (mainland)
| | - Peng Gao
- Department of Orthopaedic Surgery, People's Hospital of Zhangqiu, Zhangqiu, Shandong, China (mainland)
| | - ZhongJi Li
- Department of Orthopaedic Surgery, People's Hospital of Zhangqiu, Zhangqiu, Shandong, China (mainland)
| | - Xiao Zhou
- Department of Orthopaedic Surgery, People's Hospital of Zhangqiu, Zhangqiu, Shandong, China (mainland)
| | - SongGang Wang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| |
Collapse
|