Large Tears Research Articles

Outcomes of repaired and intact rotator cable in large posterosuperior rotator cuff ruptures.

This study aimed to compare the clinical and functional outcomes of patients with large posterosuperior rotator cuff tears between those with intact rotator cables (crescent-shaped tears) and those with repaired rotator cables (U-, V-, or L-shaped tears). Eighty-two patients with a mean age of 64.05 ± 9.06 years who underwent arthroscopic repair due to large posterosuperior rotator cuff tears were evaluated with a follow-up period of 32 ± 5.9 months. Forty-two patients with an intact rotator cable and 40 patients with a repaired rotator cable (rotator cable restored with tendon-tendon sutures) were evaluated regarding preoperative and postoperative pain and functional outcomes. There was no significant difference in the constant score between the rotator cable repaired and the intact group (P=.22). However, when the sub-dimensions of the Constant score were compared separately, the forward flexion was significantly higher in the group with the intact rotator cable (P=.002). When the postoperative visual analog scale (VAS) scores were compared, lower scores were observed in the group with the repaired rotator cable (P < .001). In large posterosuperior rotator cuff tears, patients with a repaired rotator cables experienced more significant pain relief compared to those with intact rotator cables, although their forward flexion was lower. Therefore, a detailed analysis of the tear type and the rotator cable condition in large posterosuperior rotator cuff tears may help predict postoperative pain and functional outcomes. Level III case-control study.

Establishing Clinically Significant Improvement for Patients After Arthroscopic Surgery for Shoulder Instability With Large Labral Tears.

Patients with large labral tears represent a subset of traumatic shoulder instability cases. Outcomes after arthroscopic stabilization in these patients have been studied less compared with other tears. To establish minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) thresholds for patients after arthroscopic repair of labral tears ≥270°. Patient-reported outcome measures (PROMs) included the Rowe instability score, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain. Case-control study; Level of evidence, 3. A total of 52 arthroscopic large labral repairs (52 patients, mean age 28.7 years) performed in male active-duty military patients with a mean follow-up of 79.2 months (range, 24-117 months) met inclusion criteria and were included in the final analysis. All included patients completed the Rowe, ASES, SANE, and VAS pain preoperatively and at final follow-up, and the MCID, PASS, and SCB were calculated for each PROM score. Factors associated with achieving clinically relevant improvement were also calculated. The MCID, PASS, and SCB, respectively, for each PROM were as follows: 10.4 points, 90, and 35 points for the Rowe; 9.7 points, 80, and 43 points for the ASES; 9.9 points, 87, and 65 points for the SANE; and 1.1 points, 3, and 6 points for VAS pain. More than 90% of patients improved according to the MCID for each PROM, while >75% achieved the PASS threshold for each score. The percentage of patients who improved according to the SCB ranged from 9.6% for the ASES to 75% for the SANE. Maintenance of active-duty status was associated with achieving the MCID for the ASES and SANE, while recurrent instability was associated with lower rates of Rowe MCID achievement and SANE PASS achievement. Higher preoperative scores were also associated with lower rates of achieving clinical improvement. Thresholds found for the MCID, PASS, and SCB in active-duty patients undergoing surgery for shoulder instability with labral tears ≥270° were similar to those for all-comers with anterior instability. Factors associated with achieving success or lack thereof on PROMs included maintenance of active-duty status and lower preoperative PROM scores.

Muscle Compensation Strategies to Maintain Glenohumeral Joint Stability in Rotator Cuff Tears: A Cadaveric Study.

Superior translation of the humeral head is often identified in large and massive rotator cuff (RC) tears. However, the ability of the remaining RC muscles to compensate for the forces causing such superior translation in RC tears remains unclear. The purpose of this study was to investigate the impact of compensatory forces exerted by the remaining RC muscles on humeral head translation using a progressive RC tear model. Eight fresh-frozen cadaveric shoulders (mean donor age, 57 years) were tested using a custom shoulder testing system. In addition to an intact RC model, 3 RC tear models were created: a supraspinatus tear (Tear I); combined supraspinatus and infraspinatus tears (Tear II); and combined tears of the supraspinatus, infraspinatus, and superior one-third of the subscapularis (Tear III). Compensatory conditions were simulated by increasing the loading of the remaining RC muscles in each RC tear model. Humeral head translation was measured at different abduction and neutral rotation angles in each condition with normal and high deltoid muscle loading. Significant superior translation of the humeral head was observed in Tears II and III (but not Tear I), compared with the intact state, under high loading of the deltoid during abduction and during rotation. In Tear II, compensatory conditions involving increased loading of the teres minor and subscapularis muscles effectively reduced superior translation, so that no significant differences were observed compared with the intact state, even under high deltoid muscle loading. However, in Tear III, significant superior translation was still observed, regardless of the compensatory conditions. ompensation by the remaining RC muscles, particularly the teres minor and subscapularis, effectively reduced superior translation of the humeral head in the posterosuperior RC tear model, whereas this compensatory strategy was insufficient if tears also involved the superior one-third of the subscapularis. Patients with posterosuperior RC tears may find conservative treatment focusing on strengthening the remaining RC muscles, especially the subscapularis and teres minor, to be beneficial. Conversely, patients with repairable massive RC tears also involving the subscapularis tendon may benefit from surgical interventions aimed at primarily repairing the subscapularis tendon to restore the transverse force couple. Massive tears deemed not to be repairable should be evaluated for arthroplasty or other procedures.

Human Amniotic Membrane: A Seal for Complex Retinal Detachments.

To evaluate the efficacy of human amniotic membrane (hAM) transplantation for complex retinal detachments (RD). A retrospective analysis of consecutive patients who underwent vitreoretinal surgery with hAM transplantation for complex RD was conducted. The indications included high myopic macular hole (MH)-associated RD (n=5), traumatic large macular tears (n=4), combined RD with MH due to cicatricial retinopathy of prematurity (n=2) and severe retinitis (n=1), and morning glory syndrome (n=1). Surgical procedures, anatomical and functional results, and complications were noted. Thirteen eyes of 13 patients with a median age of 7 years (range, 0-65 years) were included. The follow-up was 15 months (range, 6-30 months). All eyes achieved MH sealing. Sealing occurred after a single surgery in 75% of eyes, while 25% required a second surgery due to hAM contraction/dislocation. The retina was attached and silicone oil could be removed in 92% of eyes during follow-up. The mean logarithm of the minimum angle of resolution visual acuity increased from 2.08±0.49 to 1.78±0.70 (p=0.07). Optical coherence tomography showed good integration of the hAM grafts with the retina, albeit without discernible retinal layer differentiation in any case. Amniotic membrane grafting appears to be promising for anatomical sealing of MHs and posterior retinal tears in complex RDs such as those associated with degenerative myopia, severe trauma, tractional membranes, and retinal shortening, where conventional surgical techniques are likely to fail. Further research is needed to clarify the regenerative potential and functional capacity of hAM grafts in severe retinal pathologies.

Comparison of arthroscopic-assisted mini open and all arthroscopic repair methods in small to large size rotator cuff tears

Aim: This study aimed to compare the functional and clinical results of all arthroscopic (AA) and arthroscopic-assisted mini open (AAMO) rotator cuff tear (RCT) repair methods with a minimum 2 years follow-up. Methods: In this retrospective study, patients who operated with the AA repair method were included in group 1 and patients who operated with AAMO RCT repair method were included in group 2. Between January 2018 and June 2021. All patients were evaluated with shoulder range of motion (ROM), the Disabilities of the Arm, Shoulder and Hand (DASH), Constant Murley Score (CMS) and visual analog scale (VAS) pain score preoperatively and postoperatively. Postoperative evaluation was made on the 3rd, 6th, 12th, and 24th months. In addition, the length of hospital stay, and surgery time were evaluated. Results: Eighty patients (48 female, 32 male) were included in group 1, who were treated with the AA technique. Sixty-seven patients (28 male, 39 female) were included in group 2, who were treated with the AAMO technique. The average follow-up time was 29,36 ±3,48 months for group 1, 28,12±2,87 months for group 2. No significant difference was detected between group 1 and group 2 for length of hospital stay and follow-up time (p&gt;0,05). At the postoperative 3rd-month follow-up measurements, a statistically significant difference was determined between group 1 and group 2 for abduction, flexion measurements, VAS score, and DASH score (p=0,03, p=0,04, p=0,02, p=0,01 respectively). At the 24th month postoperative follow-up, statistically no significant difference was determined between groups 1 and 2 in terms of ROM, VAS, and functional scores. Conclusion: In the early recovery period, AA repair provides better ROM, DASH, and VAS scores. However, in long-term follow-up, no significant difference was detected in AA and AAMO repair in terms of functional results, ROM, and VAS scores.

What influences the decision to undergo rotator cuff repair surgery: A survey of clinician's perspectives.

Many factors may influence a patient's decision to undergo rotator cuff repair surgery. The aim of this survey was to understand from a clinician's perspective how different factors influence the likelihood of a patient undergoing a repair. An online survey presenting a range of clinical scenarios was distributed through professional networks to understand how each patient related factor influenced the likelihood of a patient undergoing a rotator cuff repair. One hundred three clinicians completed the survey. Clinicians indicated that patients were more likely to undergo a repair if they were younger, had a traumatic or larger tear, high pain levels (64.1%), high functional demands (93.2%), and arm weakness (86.4%). Surgery was less likely in older patients who had degenerative or smaller tears, diabetics (62.1%), smokers (78.9%) and those with high body mass index (57.3%). 74.8% of clinicians indicated a repair was more likely if the patient expected that surgery was required to improve symptoms. From a clinician's perspective, the decision to undergo surgery is complex, it is influenced by onset, age, tear size and other health related factors. Patient expectations of treatment also appear to influence the decision, and this is an area that needs further exploration.

Regeneration of full thickness common extensor tendon tear after percutaneous microfragmented adipose graft.

Tennis elbow, also commonly known as lateral epicondylitis or common extensor tendinosis, is a common musculoskeletal injury in the adult population. Currently, the standard treatment regimen prescribed for this injury involves a combination of rest, physical therapy, bracing and anti-inflammatory medications. If refractory to these conservative measures, platelet-rich plasma has been shown effective. However, in the case of full thickness tears, surgery has remained the only treatment option until now. We present a case report of a 56-year-old man with a diagnosis of a left large full thickness tear and rupture with retraction of his common extensor tendon (CET) following a corticosteroid injection. The patient was treated with microfragmented adipose transfer. He was re-evaluated around 7weeks and again at 15weeks post-treatment and demonstrated ultrasound evidence of complete bridging and remodeling of his prior full thickness CET tear and resolution of retraction. This case presents a promising option for patients with full thickness CET tears who would like to refrain from or are unable to have surgery. Further research and possible randomized controlled trials are needed to further assess the full efficacy of microfragmented adipose transfer in the treatment of full thickness CET tears.

Superior Capsular Reconstruction Versus Reversed Total Shoulder Arthroplasty in Management of Massive Irreparable Rotator Cuff Tear: A Systematic Review and Meta-analysis

Abstract Background rotator cuff pathology is one of the most common sources of shoulder disability and among the prevalent conditions treated by orthopaedic surgeons. Irreparable rotator cuff tear is generally large tear (in both anterior-posterior and medial-lateral dimensions) and retracted with poor attenuated tissue quality, muscular atrophy and fatty infiltiration. Aim of the Work to conduct a systematic review about superior capsular reconstruction Versus reversed total shoulder arthroplasty in treatment of massive irreparable rotator cuff tears aiming to reach a conclusion regarding superiority of one technique over the other. We may then present recommendations to orthopaedic surgeons to facilitate decision-making when approaching such cases. Patients and Methods this systematic review will be performed following the preferred reporting items for systematic reviews meta-analysis (Prisma). Six guided items and check list to answer the question of: comparison study between superior capsular reconstruction and reversed total shoulder arthroplasty in treatment of massive irreparable rotator cuff tears. Patients with irreparable rotator cuff tear of both gender and patients older than 18 years. Results all outcomes showed improvement in all studies either clinically and radiologically, also all studies had low complications rate as the following with variation of significance and heterogenicity between each group of studies. The mean age of patients underwent SCR was 64.7 ± 5.89 years, while for patients underwent RTSA; the mean age was 68.1 ± 22.18 years with metanalysis between the two groups; showing significant difference between them (p- value:0.0001) as the SCR operation was decided for age group younger than patients underwent RTSA with mean difference 5.24 (95% CI [ 2.57, 7.9]) years. Both SCR and RTSA showed significant improvement post operatively with functional scores and in active range of motion with no significant difference between the two operations except with JOA score and Constant score; both showed difference between the two groups favoring SCR over RTSA, (p-value:0.001) with JOA and (p-value:0.04) with constant score. Conclusion based on the evidence presented, both SCR and RTSA showed significant improvement in post-operative outcome measures in management of MIRCTs. All outcome measures showed comparable results with both SCR and RTSA except in JOA score and constant score, both showed significant improvement favoring RTSA. RTSA was the preferred choice for elderly patients with higher grade of glenohumeral arthritis and it was the most common revision surgery after failed SCR. It is preferred to mention SCR as the joint preserving surgical technique and that is why it would be the preferred technique in young age patients with relative lower grades of glenohumeral arthritis.

Intraoperative Management of Iatrogenic Durotomy in Endoscopic Spine Surgery: A Systematic Review.

This review aims to systematically evaluate the incidence, management strategies, and clinical outcomes of iatrogenic durotomy (ID) in endoscopic spine surgery and to propose a management flowchart based on the tear size and associated complications. A comprehensive literature search was conducted, focusing on studies involving endoscopic spinal procedures and incidental durotomy. The selected studies were analyzed for management techniques and outcomes, particularly in relation to the size of the dural tear and the presence of nerve root herniation. Based on these findings, a flowchart for intraoperative management was developed. A total of 14 studies were included, encompassing 68,546 patients. Varying incidences of ID, with management strategies largely dependent on the size of the dural tear, were found. Small tears (less than 5 mm) were often left untreated or managed with absorbable hemostatic agents, while medium (5-10 mm) and large tears (greater than 10 mm) required more complex approaches like endoscopic patch repair or open surgery. The presence of nerve root herniation necessitated immediate action, often influencing the decision to convert to open repair. Effective management of ID in endoscopic spine surgery requires a nuanced approach tailored to the size of the tear and specific intraoperative challenges, such as nerve root herniation. The proposed flowchart offers a structured approach to these complexities, potentially enhancing clinical outcomes and reducing complication rates. Future research with more rigorous methodologies is necessary to refine these management strategies further and broaden the applications of endoscopic spine surgery.

Intraoperative Incidental Internal Carotid Artery Injury in Extended Endoscopic Endonasal Approaches—Causes, Prevention, and Management: A Technical Note

AbstractIn spite of good anatomical awareness, the position of internal carotid artery (ICA) can be tricky in an intraoperative setup with disease causing very significant distortion of anatomy and shift of carotid artery and its branches. A 45-year-old gentleman presented with complaints of left hemicranial headache and painless progressive vision loss in both eyes (left more than right) for 8 months. A probable clinico-radiological diagnosis of meningioma was reached. Intraoperatively, bleeding occurred from left side ICA, control of which was achieved using a long gauze piece used as conventional nasal pack with crushed muscle beneath the gauze piece along with abdominal fat, which was further reinforced with Surgicel. The parasellar ICA is the most common segment injured. Dehiscent or bulging canal of ICA, presence of pseudoaneurysm, attachment of sphenoid septae to the canal, displacement by the lesion, nonenlarged sella because of small size of lesion or vertically oriented lesions, and vessel wall abnormalities increase the risk of injury. It is very essential to have a preoperative discussion involving the skull base surgeons (neurosurgeons and otorhinolaryngologists), neuroradiologists, and neuroanesthetists regarding the complications expected in the case. In case of ICA bleed, the target should be to achieve a temporary hemostasis. In small tears, cottonoids for pressure and bipolar for cauterization will help stop the bleeding, while in larger tears, giving moderate pressure using crushed muscle and cottonoids to achieve intra-operative hemostasis should be tried. After intraoperative hemostasis, the patient needs to be shifted to angiography suite for endovascular stent placement.

AUTOLOGOUS OR ALLOGENIC BLOOD PLEURODESIS AS TREATMENT FOR PNEUMOCOELOM IN FOUR SEA TURTLES (LEPIDOCHELYS KEMPII, CARETTA CARETTA).

Pneumocoelom secondary to primary pulmonary disease was diagnosed via CT (three cases) or radiographs and coelioscopy (one case) in one Kemp's ridley (Lepidochelys kempii) and three loggerhead (Caretta caretta) sea turtles. All cases were suspected to be caused by trauma to the lung, and all exhibited positive buoyancy disorders. Coelomocentesis alone was ineffective at resolving each pneumocoelom, suggesting a large and persistent tear in the pulmonary parenchyma. An autologous (in three cases) or allogenic (in one case) blood patch pleurodesis was performed. The pneumocoelom was resolved in all four cases with no noted postoperative complications. Follow-up diagnostic imaging confirmed resolution of the pneumocoelom in three cases, and all four patients were successfully rehabilitated and had normal buoyancy at the time of release. One rehabilitated loggerhead was satellite tagged, and the tracking data demonstrated that the animal was still alive and moving normally 126 d postrelease, when the tag stopped transmitting. In sea turtles, an autologous or allogenic blood patch pleurodesis can be safely performed in cases of persistent pneumocoelom secondary to traumatic primary pulmonary disease.

Comparison of Subsequent Surgery After Repair in Bucket-Handle Meniscal Tears and Meniscectomy Analysis of a Large, Contained Cohort Study.

Bucket-handle meniscal tears are large longitudinal vertical meniscal tears that have an attached fragment flipped into the intercondylar notch. Meniscal repair attempts to restore the function of the meniscus and aims to preserve joint mechanics. Alternatively, meniscectomy results in quicker recovery but may lead to future degeneration. To evaluate the long-term risk of subsequent ipsilateral knee surgery in patients who underwent a bucket-handle meniscal repair (BHMR) versus meniscectomy/bucket-handle meniscal debridement (BHMD) and assess risk factors associated with subsequent knee surgical intervention. Cohort study; Level of evidence, 3. An electronic health records search for all patients who underwent arthroscopic knee meniscal surgery (repair and meniscectomy) between 2011 and 2018 was performed. Natural language processing was used to search for terms of interest in the long operative notes to determine whether these surgeries were performed for bucket-handle meniscal tears. These patients comprised our initial cohort. Study patients were followed for at least 1 year and for up to 5 years (until December 31, 2019), with censoring at death or membership disenrollment. Baseline patient characteristics and outcomes were evaluated via a database review. The primary outcome was subsequent ipsilateral knee surgeries and secondary outcomes included contralateral knee surgeries, deep surgical site infections, and venous thrombotic events. Multivariable logistic regression analyses were used to model for subsequent surgical treatment of the ipsilateral knee. A subset analysis for patients aged 30 to 50 years was then performed. The median follow-up time was 52.4 months (interquartile range [IQR], 33.5-60 months). A total of 1359 patients underwent BHMR and 1537 patients underwent BHMD. The median age was 24 years (IQR, 17-34 years) for the BHMR versus 38 years (IQR, 27-47 years) for the BHMD group (P < .001). Body mass index (BMI) was significantly lower in the BHMR group compared with the BHMD group (P < .001). BHMR was significantly more likely to be performed during a concomitant ipsilateral anterior cruciate ligament reconstruction (ACLR) than a BHMD (44.2% vs 30.1%, P < .001). During the follow-up period, a total of 656 subsequent ipsilateral procedures were performed in 393 (13.6%) patients. Patients who underwent initial BHMR were at a significantly higher risk of undergoing subsequent meniscal repair (4.3% vs 1%, P < .001), meniscectomy (12.1% vs 3.3%, P < .001), and ACLR (7.4% vs 2.9%, P < .001) compared with those who underwent BHMD. Multivariable analysis showed that BHMR, younger age, and lower BMI were risk factors for subsequent ipsilateral surgery. After adjusting for patient demographic and clinical characteristics, subset analysis showed that for patients aged 30 to 50 years, undergoing a BHMR versus a BHMD led to a 2.3-fold higher risk of subsequent surgery, a 5.3-fold higher risk of subsequent meniscal repair and a 3.2-fold higher risk of subsequent meniscectomy. BHMR was more often performed in younger patients with a lower BMI, especially during a concomitant ACLR. Patients treated with BHMR were more likely to undergo subsequent surgeries, with the likelihood decreasing with increasing age. Subset analyses showed increasing risk for subsequent surgeries with BHMR versus BHMD in the cohort consisting of patients aged 30 to 50 years.

Patch Augmentation in Arthroscopic Rotator Cuff Surgery-Review of Current Evidence and Newest Trends.

Background: Rotator cuff tears are a common and debilitating condition requiring surgical intervention. Arthroscopic rotator cuff repair is essential for restoring shoulder function and alleviating pain. Tear classification by size and tendon retraction, along with the grade for fatty infiltration, influence postoperative outcomes, with large tears and higher fatty infiltration grades linked to higher retear rates. Managing complex tears is challenging, with failure rates ranging from 20 to 94%. Patch augmentation has emerged as a promising strategy, using biological or synthetic materials to reinforce tendon repairs, enhancing structural integrity and reducing retear risk. Methods: A review of the recent literature from January 2018 to March 2024 was conducted using PubMed/MEDLINE, Embase, and Web of Science. Keywords included "rotator cuff tear", "rotator cuff augmentation", "rotator cuff patch", "tendon augmentation", "massive rotator cuff tear", "patch augmentation", and "grafts". Relevant articles were selected based on their abstracts for a comprehensive review. Results: Initial methods used autograft tissues, but advances in biomaterials have led to standardized, biocompatible synthetic patches. Studies show reduced retear rates with patch augmentation, ranging from 17 to 45%. Conclusions: Patch augmentation reduces the retear rates and improves tendon repair, but complications like immune responses and infections persist. Cost-effectiveness analyses indicate that while initial costs are higher, long-term savings from reduced rehabilitation, revision surgeries, and increased productivity can make patch augmentation economically beneficial.

Reduced retear rates yet similar clinical outcomes following arthroscopic partial repair of large and massive irreparable rotator cuff tears with biceps augmentation compared to repairs without biceps augmentation: A systematic review and meta-analysis.

To compare the clinical outcomes between arthroscopic partial rotator cuff repair with biceps augmentation(BA) and partial repair (PR) without BA. This systematic review included studies comparing outcomes of arthroscopic repair for large to massive irreparable rotator cuff tears with and without the BA. The focus was on postoperative clinical results and retear rates. Mean differences were used to express continuous outcomes, while odds ratios (ORs) were employed for dichotomous outcomes. Ten studies (733 shoulders, all level 3 evidence) were included. The BA group showed a significant reduction in retear rates (OR = 0.40, 95% confidence interval [CI]: 0.20-0.77, P = 0.007) and comparable postoperative outcomes across various measures: American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale for pain, University of California-Los Angeles shoulder score, active forward flexion motionand active external rotation at the arm-at-side position compared to the PR group. Subgroup analysis of two BA techniques-rerouting and supplementation following supraglenoid tenotomy-showed no significant differences in ASES score for either technique versus PR. However, rerouting significantly lowered retear rates (OR = 0.21, 95% CI: 0.12-0.36, p < 0.001), while supplementation showed similar retear rates to PR (OR = 0.87, 95% CI: 0.37-2.02, n.s.). Arthroscopic partial rotator cuff repair with BA for large to massive irreparable rotator cuff tears is a reliable technique, resulting in improved postoperative outcomes. BA using supplementation following supraglenoid tenotomy showed similar clinical outcomes and range of motion but with lower retear rates compared to the PR group. Level III.

Effect of Preoperative Lipidemic Control on Retear Rates After Rotator Cuff Repair in Patients With Hyperlipidemia

Background: In patients with hyperlipidemia, the risk of retear increases after rotator cuff repair (RCR). In particular, it has been reported that preoperative low-density lipoprotein cholesterol (LDL-C) level affects cuff integrity. However, there are no studies assessing whether lipidemic control affects cuff healing. Purpose: To evaluate the effect of preoperative lipidemic control on cuff integrity after arthroscopic RCR across cardiovascular disease risk groups in patients with hyperlipidemia. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively reviewed the charts of patients with hyperlipidemia who underwent arthroscopic double-row suture bridge RCR between 2014 and 2019. The included patients had LDL-C tested within 1 month before surgery. Magnetic resonance imaging was conducted 6 months after surgery to evaluate the integrity of the repaired cuff tendon. Patients were divided into groups of low, moderate, high, and very high risk according to the 4th Korean Dyslipidemia Guidelines. On the basis of the target LDL-C set in each risk group, patients were categorized into 2 groups: group C (controlled hyperlipidemia, less than target LDL-C) and group U (uncontrolled hyperlipidemia, target LDL-C or greater). The correlation between serum lipid profile, lipidemic control, and post-RCR integrity was evaluated. Results: A total of 148 patients were analyzed, 51 in group U and 97 in group C. The retear rate was significantly higher in group U than in group C (23/51 [45.1%] vs 18/97 [18.6%], respectively; P = .001). The proportion of group U was significantly higher in the retear group than in the healing group (56.1% vs 26.2%; P = .001). In addition, the proportions of patients with uncontrolled diabetes mellitus (DM) (19.5% vs 3.7%; P = .002) and mediolateral (2.6 ± 1.2 cm vs 1.7 ± 1.1 cm; P < .001) and anteroposterior (2.2 ± 1.1 cm vs 1.6 ± 0.8 cm; P = .003) tear sizes were significantly different between the retear and healing groups, respectively. No significant difference in serum lipid profile, including LDL-C level (119.6 ± 31.3 vs 116.7 ± 37.2; P = .650), was observed between the retear and healing groups. Multivariate regression analysis identified uncontrolled hyperlipidemia (OR, 4.005; P = .001), uncontrolled DM (OR, 5.096; P = .022), and mediolateral tear size (OR, 1.764; P = .002) as independent risk factors for retear. The 2.0-cm mediolateral size cutoff and the 3 independent risk factors had significant associations with retear. Conclusion: Poor preoperative lipidemic control was significantly associated with poor healing after RCR. In addition to large mediolateral tear size, uncontrolled hyperlipidemia and DM were significant risk factors for retear. Moreover, poor lipidemic control compared with the recommended target level before surgery was more correlated with an increased retear rate than a preoperative LDL-C level.

A modified arthroscopic en masse suture bridge repair is effective for delaminated rotator cuff tears.

This study aimed to clarify the characteristics of delaminated rotator cuff tears (RCTs) and evaluate the clinical outcomes of a modified arthroscopic en masse suture bridge repair for delaminated RCTs. Patients with full-thickness RCTs, who underwent arthroscopic suture bridge repair with a minimum 2-year follow-up, were retrospectively reviewed. Patients were categorized into two groups based on the presence of delamination. Delaminated RCTs were treated using a modified en masse suture bridge technique, while nondelaminated RCTs received a conventional suture bridge technique. Preoperative and postoperative Constant scores and American Shoulder and Elbow Surgeons (ASES) scores were determined to evaluate clinical outcomes. Postoperative magnetic resonance imaging (MRI) was carried out to identify the integrity and retear of the repaired rotator cuff. A total of 172 patients were included in our study cohort, in which 67 (39%) delaminated RCTs were confirmed intraoperatively. The prevalence of delamination was significantly higher in large tears (53/102, 52%) compared to medium tears (14/70, 20%) (p < 0.001). No significant differences in age (n.s.) or gender (n.s.) were observed between the two groups. Both groups showed significant improvements in Constant and ASES scores postoperatively (both p < 0.001), with no significant differences between the groups (n.s.). The retear rates were 2/67 (3.0%) in the delamination group and 3/105 (2.9%) in the nondelamination group, showing no significant difference (n.s.). The modified arthroscopic en masse suture bridge technique was effective for repairing delaminated RCTs, yielding favourable clinical outcomes comparable to those of nondelaminated tears. Level IV.

Return to Play After Arthroscopic Management of Rotator Cuff Tears in Professional Athletes of Contact Sports.

Rotator cuff tears are rare injuries in professional athletes who participate in contact sports, and limited data exist to guide players and team physicians regarding outcomes after surgical management. To report the outcomes and return-to-play rates of professional contact sport athletes who underwent arthroscopic management of rotator cuff tears. Case series; Level of evidence, 4. All professional athletes of contact sports who underwent arthroscopic management of a rotator cuff tear between 2002 and 2019 at the institution were identified. Patient information collected were age, sport, position, date of injury, date of surgery, and time to return to play; surgical data included tear size, acuity, pattern, and procedure performed. The primary outcome measure was the ability to return to play and the number of games played after surgery. Overall, 10 rotator cuff tears in 9 professional athletes (8 tears in football players and 2 tears in hockey players) were identified; 9 of the tears were full-thickness tears that underwent arthroscopic single-row repair, while 1 was a partial tear that was debrided. Of the 9 athletes, 8 were able to return to play at the same level, at a mean time of 9.5 ± 4.3 months. The mean playing time after surgery was 32 ± 25 games (2.7 ± 2 seasons) for the football players and 22 games (1 season) for the hockey player who returned. Postoperative imaging was available in 8 of the 10 tears, and 7 of 8 (88%) demonstrated a healed repair. One football player and 1 hockey player with large (>3 cm) full-thickness tears did not return to play. The mean age of these players was 34.5 years and both had >10 years of professional playing experience.≥. The study findings demonstrated that the majority (80%; n = 8) of the professional athletes in contact sports in this series were able to return to play at the same level after arthroscopic management of a symptomatic rotator cuff tear.

Bridging Reconstruction With Interpositional Dermal Allograft Has Superior Healing Than Does Maximal Repair for Treatment of Large to Massive, Irreparable Rotator Cuff Tears—Secondary Analysis of a Randomized Control Trial

PurposeThe purpose of this study was to compare the radiographic results of bridging rotator cuff reconstruction (BRR) with dermal allograft and maximal repair for large or massive, irreparable rotator cuff tears. MethodsThis was a secondary analysis of data from a single-center, blinded-observer, randomized controlled trial that examined clinical outcomes of BRR compared to maximal repair. A sample size of 30 patients with MRI-proven large or massive (>3 cm), retracted rotator cuff tears and/or involvement of 2 or more tendons were randomly allocated to 1 of 2 groups: maximal repair or BRR using dermal allograft. MRIs were obtained preoperatively and 1 year postoperatively. The primary outcome of this study was the retear rate on MRI. Secondary outcomes included progression of muscle atrophy and fatty infiltration. ResultsThere was no difference in age or preoperative tear size between the two groups. Patients treated with BRR had decreased retear rate (21%) compared with patients who received maximal repair alone (87%). There was no difference in the number of patients who had progression of muscle atrophy (p=0.088 for supraspinatus and p=0.738 for infraspinatus) or fatty infiltration (p=0.879 for supraspinatus and p=0.693 for infraspinatus) between the two groups. A significant increase in mean postoperative supraspinatus muscle atrophy was identified in the maximal repair group (p=0.034). ConclusionThe results of this secondary analysis of a randomized controlled trial comparing radiographic results of maximal repair vs BRR using dermal allograft in the treatment of large or massive rotator cuff tears show that BRR results in a significantly reduced structural failure rate and a trend towards better preservation of supraspinatus muscle mass compared to maximal repair.

Compression sutures: A rescue to failed intracameral gas injection in massive non-resolving corneal hydrops of long duration in advanced pellucid marginal corneal degeneration (PMCD)

To describe the application of full-thickness compression corneal sutures along with intracameral gas injection in a case of non-resolving long-duration hydrops of pellucid marginal corneal degeneration with a large Descemet membrane (DM) tear. Corneal hydrops is a complication of conditions such as keratoconus (KC), pellucid marginal corneal degeneration (PMCD), and keratoglobus. Intracameral gas injection in the form of sulfur hexafluoride (SF6) or perfluoro propane (C3F8) has been known to shorten the recovery period by tamponading the break. The application of corneal sutures to approximate the widely separated ends of the DM tear may also be performed. All these are management options described for acute hydrops. We report two cases of application of full-thickness compression corneal sutures along with intracameral gas injection in a case of non-resolving long-duration hydrops of more than 2 months duration in PMCD with a large DM tear. Full-thickness corneal compression sutures and intracameral gas injection can restore the imperviousness of posterior stroma after hydrops. This technique is safe and effective for faster resolution of corneal edema post hydrops and early visual rehabilitation.

ADIPOSE CELLULAR INJECTION IN THE TREATMENT OF AN INTRASUBSTANCE ACHILLES TENDON TEAR

Introduction: We describe a case report of a patient who presented with chronic right Achilles tendon pain and weakness. Without contrast, magnetic resonance imaging of the right Achilles tendon revealed significant expansion of the Achilles tendon in the traverse and anteroposterior dimension with extensive increased T2 signal consistent with large partial-thickness Achilles tendon tear. A musculoskeletal ultrasound using a linear transducer demonstrated an anechoic tendon defect measuring 0.97 cm in the longitudinal axis with a total tendon length measuring 1.53 cm, as well as a 0.9 cm defect in the transverse axis surrounded by homogenous tendon fibers consistent with a large defect involving the distal Achilles tendon proximal to the distal insertion. The patient underwent an ultrasound-guided adipose cellular procedure using micronized fat to fill in the defect and facilitate pain reduction and tissue healing.Conclusion: Ultrasound-guided injection of micro-fragmented adipose tissue of Achilles tendon defect can result in significant improvement in pain and function