Incidence Of Retear Research Articles

Mid-term outcome of deep layer repair with the long head of the biceps autograft bridging for Kim classification type Ⅰ A delaminiated rotator cuff tear

Objective: To investigate the mid-term clinical outcome of deep layer repair with the long head of the biceps autograft bridging for Kim classification type ⅠA delaminated rotator cuff tear. Methods: A follow-up study. The clinical data of 42 consecutive patients with Kim classification type ⅠA delaminated rotator cuff tear admitted to the First Affiliated Hospital of Jinan University from January 2018 to June 2019 were retrospectively included. All patients underwent shoulder arthroscopic surgery. During the operation, the autogenous long head of the biceps tendon was transferred to repair the deep layer of delaminated rotator cuff tear. The preoperative and postoperative (last follow-up) visual analogue scale (VAS) for pain, University of California Los Angeles (UCLA) score, Constant-Murley shoulder score, range of motion (ROM) of the shoulder and radiographic results were statistically analyzed. Results: A total of 42 patients were included in this study. There were 18 males and 24 females, with an average age of (64.5±15.2) years and a mean follow-up of (43.9±7.1) months. At the last follow-up, ROM of abduction increased from 80.8°±26.5° to 154.2°±14.3°, and ROM of external rotation increased from 18.2°±13.6° to 31.8°±7.8°; the VAS score of pain decreased from (5.5±1.3) points to (0.7±0.7) points, the UCLA score increased from (21.3±3.7) points to (29.9±2.1) points, and the Constant-Murley score increased from (45.4±10.0) points to (87.2±4.8) points; the differences were all statistically significant (all P<0.001). The X-ray films showed that there were no upward of the humeral head in all the patients. MRI results indicated that rotator cuff re-teared in one case (Sugaya classification type Ⅲ), and healed in other cases (Sugaya classification type Ⅰ-Ⅱ). No complications such as upper limb nerve injury was found in all cases. Conclusion: Deep layer repair with the long head of the biceps autograft bridging can significantly alleviate the pain and improve the function of patients with Kim classification type ⅠA delaminated rotator cuff tear, and the incidence of retear is low.

Risk factors affecting rotator cuff retear after arthroscopic repair: a meta-analysis and systematic review.

Retear after arthroscopic rotator cuff repair (ARCR) consistently challenges medical staff and patients, and the incidence of retear after surgery is 10%-94%. The purpose of this study was to identify the risk factors that cause retear after ARCR and provide theoretical guidance for clinical intervention to reduce the occurrence of postoperative rotator cuff retear. The protocol for this meta-analysis was registered with PROSPERO (CRD42021225088). PubMed, Web of Science, and Embase were searched for observational studies on risk factors for rotator cuff retear after arthroscopic repair. Meta-analytical methods were used to determine the odds ratio or weighted mean difference of potential risk factors related to postoperative rotator cuff retear. Stata 15.1 was used to quantitatively evaluate the publication bias of the statistical results. Fourteen studies from 6 countries with a total of 5693 patients were included. The meta-analysis revealed that the risk factors for retear after rotator cuff repair were age, body mass index, diabetes, subscapularis and infraspinatus fatty infiltration, symptom duration, bone mineral density, tear length, tear width, tear size area, amount of retraction, critical shoulder angle, acromiohumeral interval, distance from the musculotendinous junction to the glenoid, operative duration, biceps procedure, and postoperative University of California Los Angeles shoulder score. These findings can help clinical medical staff identify patients who are prone to retear early after arthroscopic repair and develop targeted prevention and treatment strategies for modifiable risk factors, which are of great significance for reducing the occurrence of rotator cuff retear after ARCR.

Clinical Effect of PRP with DPASB on Full-Thickness Rotator Cuff Tears and Its Role in VAS, SST, and Constant Scores of Patients.

The aim of the study is to probe the effects of platelet-rich plasma (PRP) plus double-row anchor suture bridge (DRASB) under shoulder arthroscopy on the postoperative VAS, SST and Constant scores, rotator cuff tendonbone healing, and re-tear of patients with full-thickness rotator cuff tear (RCT). A total of 60 patients with full-thickness RCT treated in our institution from August 2019 to January 2020 were picked and assigned to either group A (n = 30) or group B (n = 30) on a voluntary basis. Group B received DRASB under shoulder arthroscopy, whereas group A underwent DRASB under shoulder arthroscopy plus PRP. We compared the curative effects of both groups. Week 2, 4, 8, 12 after surgery and 6 months after surgery, VAS scores of patients in both groups declined saliently, whereas SST and Constant scores elevated, and the decrease/increase amplitude of patients in group A was sharply higher than that in group B (p < 0.05). At T2 and T3, abduction 90° external rotation, abduction 90° internal rotation, abduction and anteflexion in both groups increased strikingly, and group A harbored a brilliantly higher increase than group B (p < 0.05). At T2 and T3, serum NO and IL-6 contents were prominently dwindled in both groups, and group A held a plainly higher decrease than group B (p < 0.05). At T3, in comparison to group B, the rotator cuff tendonbone healing rate and quality of life scores in group A were higher (p < 0.05), whereas retear rate was dramatically lower (p < 0.05). DRASB under shoulder arthroscopy plus PRP therapy can blatantly meliorate the curative effect of patients with full-thickness tear, improve the shoulder joint function and tendonbone healing rate, reduce the postoperative pain degree and the incidence of retear, and can be more broadly promoted and applied clinically.

Which Factors Influence Clinical Outcomes After Superior Capsular Reconstruction Surgery?

Background:Arthroscopic superior capsular reconstruction (ASCR) has recently been introduced as an alternative treatment for patients with massive irreparable rotator cuff tears. However, the results of ASCR are still limited, and little information about retear after ASCR or subsequent treatment has been reported.Purpose:To investigate the retear rate of patients who underwent ASCR and to analyze the clinical outcomes of treatments performed for a retear.Study Design:Case-control study; Level of evidence, 3.Methods:This was a retrospective analysis of prospectively collected data from 42 patients (46 shoulders) who underwent ASCR between March 2015 and April 2018. All patients were divided into 2 groups: those with no retear (30 shoulders) and those with retear (16 shoulders). Pre- and postoperative clinical and radiological results were compared between the 2 groups. The retear pattern and treatment outcomes of the retear group were analyzed.Results:The overall incidence of retear was 35% (16/46). No difference was found in preoperative demographic or clinical data between the 2 groups. Preoperative magnetic resonance imaging data showed a significant between-group difference in the preoperative Goutallier grade of the subscapularis (1.5 ± 1.1 in the no-retear group vs 2.5 ± 1.3 in the retear group; P = .016). In the retear group, there were 10 cases of lateral side tears, 3 cases of midsubstance tears, 2 cases of medial side tears, and 1 case of medial and lateral tears. Reoperation was performed in 8 patients who had lateral insertion tear.Conclusion:Overall, clinical scores improved after ASCR in patients with massive irreparable rotator cuff tears. However, 35% (16/46) of the patients showed retear, and lateral side retear occurred in 68% (11/16). The clinical outcome of the patients with preoperative subscapularis atrophy or postoperative lateral side retears was worse, and reoperation was often required. Therefore, it is important that the lateral side be firmly fixed during the ASCR procedure.

Are We Doing Too Many Margin Convergence? A Prospective MRI Study on Re-Tear Rate after Arthroscopic Rotator Cuff Repair

The use of margin convergence, despite helpful to achieve a successful intra-operative complete repair for arthroscopic assisted rotator cuff repair, did not protect the repair from re-tear. Re-tear after successful arthroscopic rotator cuff repair is common. It is notorious that large and massive cuff tear is associated with a lower successful intra-operative complete repair and a higher postoperative re-tear rate. Margin convergence is commonly used to achieve intra-operative complete repair. Despite a very popular technique, the relationship between margin convergence and re-tear after rotator cuff repair is not known. It was hypothesized that there was no difference in the re-tear rate between the repair performed with margin convergence and those without. A prospective study on primary arthroscopic assisted complete repair of full thickness supraspinatus tendon tear using double-row suture-bridge technique was carried out in the author’s institution from 2010 to 2013. 60 repairs were recruited after applying inclusion and exclusion criteria. The follow-up rate at one-year post-operation was 98% and that of two-year was 95%. 50 patients (83%) received reassessment MRI. The repair status was classified according to Sugaya classification. Full thickness re-tear was defined as Sugaya Type IV or V repair. Association of use of margin convergence technique with retear after rotator cuff repair was examined using univariate analysis with Chi square test. The potential association of retear rate and other known patient-related and cuff-related risk factors (including age, DM, active smoking, heavy manual worker, tear size, tear retraction, tear topography in sagittal plane, tear morphology, number of full thickness tendon tear) were examined. Multivariate analysis was then conducted to determine the most significant factor predicting the rate of re-tear. 50 arthroscopic complete repair of full thickness supraspinatus tendon tear using double-row suture-bridge technique with reassessment MRI was studied. The average age was 59 years. 19 were male and 31 were female. Right shoulder was involved in 36 patients. The average follow-up was 37 +/- 13 months. There was 19 full thickness re-tear found on reassessment MRI (11 Sugaya IV and 8 Sugaya V). The incidence was 38%. 10 patients received margin convergence during the repair. The incidence of re-tear after repair with margin convergence was 80% and that without was 28% (p=0.002). The other risk factors identified by univariate analysis to be significantly associated with incidence of re-tear was (1) large and massive tear (p=0.018); (2) increased number of full thickness tendon tear (p=0.03); (3) medial retraction of tear (p=0.001) and (4) Geometric classification of tear morphology (p=0.004). After running mulivariate analysis, the most significant factor predicting re-tear after arthroscopic rotator cuff repair was medial retraction of tendon (p=0.048). The re-tear rate of Patte I, II and III were 24%, 50% and 100% respectively. The incidence of rate of re-tear was significantly higher when margin convergence was used (80% vs 28%, p=0.002). The most important factor predicting rate of re-tear was degree of tear retraction (p=0.048). Despite helping to achieve a successful intraoperative complete repair, the use of margin convergence did not protect the repair in Patte II and III retraction from going into re-tear.

Critical period and risk factors for retear following arthroscopic repair of the rotator cuff.

The incidence of retear following rotator cuff repair remains a major concern, and the cause and timing of retear remain unclear. The aim of this study was to prospectively investigate the timing of retears following rotator cuff repair at multiple time intervals. The hypothesis was that the 'critical period' for retears extends beyond the first three post-operative months. The authors prospectively studied 206 shoulders that underwent arthroscopic double-row (without suture bridge) suture anchor repair for rotator cuff tears. Patients were recalled to three follow-up visits at the following post-operative time intervals: 3, 6, and 12months or longer. Ultrasonography was performed at each visit, and Constant score was collected during the last visit. A total of 176 shoulders attended all required follow-up visits with mean age 56.0years. Ultrasonography revealed retears in 16 shoulders (9.1%) at 3months, in 6 shoulders (3.4%) at 6months, and in 5 others (2.8%) at the last follow-up, while it confirmed intact rotator cuffs in 149 shoulders (84.7%) at the last follow-up (median 35.5; range 12-61). The incidence of retears was significantly associated with tear size (p=0.001) and tendon degeneration (p=0.003). The 'critical period' for healing following rotator cuff repair, during which risks of retears are high, extends to the first 6months. The risk of retear is greatest for massive 3-tendon tears, which may require longer periods of protection. The clinical relevance of this study is the identification of patients at risk of retear and the adjustment of their rehabilitation strategy and time for return to work. III.

Influence on Functional Recovery of Mononuclear Cell Transplantation in Rotator Cuff Repair: A Preliminary Report

Rotator cuff tears occur mainly due to overload of the tendons, which leads to a progressive degenerative process and to rotator cuff tears. Surgical treatment is indicated in more advanced stages of the lesion. Retear affects approximately 35% of patients. The goal of the present study was to investigate the effect of mononuclear cell transplantation in rotator cuff repairs in relation to patient functional recovery. Thirty patients with rotator cuff tear were divided into two groups and submitted to rotator cuff repair. In addition to the surgical procedure, the experimental group was submitted to transplantation of mononuclear bone marrow cells. One to two years post-op, both groups were submitted to evaluation of pain, amplitude of movement, retears, and isokinetic evaluation of flexion-extension movements, external and internal rotations, and abduction and adduction of the shoulder. The operated shoulder was compared to the healthy shoulder. Mann-Whitney test was used to evaluate the percentage improvement of the operated shoulder in relation to the healthy shoulder. SPSS (13.0) was used for statistical analyses; the level of significance was p<0.05. The control and the experimental groups presented near-normal values for the variables analyzed in the comparison between shoulders. However, the experimental group showed better results than the control group. Functional recovery of patients submitted to repair with mononuclear cell transplantation was different than that of controls: the incidence of retear was lower in the experimental group; also, the muscle torque and balance values were closer to the healthy shoulder values for the experimental group than the controls.

Paper # 164: The Result of Isolated Arthroscopic Meniscal Repairs: Evaluation of Return to Function and Incidence of Re-Tear

Paper # 164: The Result of Isolated Arthroscopic Meniscal Repairs: Evaluation of Return to Function and Incidence of Re-Tear