Management Of Rotator Cuff Repair Research Articles

Evaluation of Functional Outcome of Arthroscopic Rotator Cuff Repair Using Southern California Orthopedic Institute Technique.

Background:The number of anchors and modality of fixation to be used has been a point of debate in the arthroscopic management of rotator cuff repair. Southern California Orthopedic Institute (SCOI) technique has shown better anatomical healing of tendons using single-row anchors. In this study, we evaluated the functional outcomes of arthroscopic rotator cuff repair using the SCOI technique, in Indian population.Materials and Methods:Thirty two patients (16 males and 16 females) were included in the study, and underwent an arthroscopic repair of small-to-medium-sized rotator cuff tear, at a single institution, for 12 months. Postoperatively, patients were evaluated using UCLA score and Constant-Murley score, and range of motion was analyzed and documented using photographs.Results:Mean age was 57.06 years, and the most common cause of cuff tear was a traumatic degeneration. Mean UCLA score improved from preoperative 8.75 to postoperative 31.79, at 12 months, with the P < 0.001. Similarly, mean Constant-Murley score improved from preoperative 20.66 to postoperative 81.31, at 12 months, with P < 0.001.Conclusion:We conclude that the SCOI single-row technique proves to be a good and effective modality of treatment in the arthroscopic management of small-to-medium-sized rotator cuff tears. In Indian population, considering cost-effectiveness, single-row repair of rotator cuff tears using SCOI technique can be an interesting option in its management.

Systematic review of the surgical management of rotator cuff repair with an augmentative patch: a feasibility study protocol

BackgroundShoulder pain is a common problem in the general population and is responsible for prolonged periods of disability, loss of productivity, absence from work and inability to carry out household activities. Rotator cuff problems account for up to 70% of shoulder pain problems and are the third most prevalent musculoskeletal disorder after those occurring in the lower back and neck. Rotator cuff surgery has high failure rates (25–50% within 12 months), and as a result, there is a pressing need to improve the outcome of rotator cuff surgery. Patch augmented surgery for rotator cuff repairs has recently been developed and is increasingly being used within the UK National Health Service. Patch augmented surgery could lead to a dramatic improvement in patient and surgical outcomes, but its clinical and cost effectiveness needs rigorous evaluation. The existing evidence on the use of patches may be at risk of bias as currently only a small number of single-centre comparative studies appear to have been carried out. Additionally, it is unclear for which patches a clinical study (comparative and non-comparative) has been conducted. This paper outlines the protocol for a systematic review intended to summarise the best available clinical evidence and will indicate what further research is required.MethodsElectronic databases (Medline, Embase and Cochrane) will be systematically searched between April 2006 and the present day for relevant publications using a specified search strategy, which can be adapted for the use in multiple electronic databases, and inclusion criteria. Screening of both titles and abstracts will be done by two independent reviewers with any discrepancies resolved by a third independent reviewer. Data extraction will include information regarding the type of participants, type of intervention and outcomes including but not limited to shoulder-specific function and pain scores, patch-related adverse events and type of study. The results will be summarised in a narrative review where qualitative analysis is not possible.DiscussionThis review aims to collate the current evidence base regarding the use of patches to augment rotator cuff repair. The results of this review will help to develop, using consensus methods, the design of a definitive randomised trial assessing the clinical and cost-effectiveness of a patch to augment surgical repair of the rotator cuff that is both acceptable to stakeholders and is feasible.Systematic review registrationCRD42017057908

Are We Getting Any Better? A Study on Repair Integrity in 1600 Consecutive Arthroscopic Rotator Cuff Repairs

Objectives:Post-operative retear is the most common surgical complication following rotator cuff repair with reported rates ranging from 11% to 94%. There have been a number of advancements in the technology and management of rotator cuff repair which may have improved retear rates. The aim of this study was to determine if there has been any improvements in rotator cuff repair integrity in our centre and, to identify any changes in the management of rotator cuff tears that may have impacted post-operative re tear rate.Methods:This observational single cohort study used running average analysis to examine 1600 consecutive patients who underwent primary arthroscopic rotator cuff repair by a single surgeon, and had cuff integrity assessed by ultrasound six months post operation. Exclusion criteria included revision rotator cuff repairs, isolated subscapularis repairs, and irreparable tears.Results:Retear rates over the course of our study ranged from 3% to 34%, with the mean retear rate being 15%. The retear rate at the commencement of our study was 18% and decreased to 5% by the end. Reductions in retear were associated with; more passive rehabilitation, more attention to post-operative abduction sling use, increased surgical team experience. Increases in retear rates were associated with; increased false positives with a more sensitive ultrasound machine and, learning curves with new equipment for surgeon and sonographer.Conclusion:A significant decrease in retear rate following arthroscopic rotator cuff repair was observed over the course of our study with the re-tear rate at the end of the study being 5%. While the study design does not allow us to directly attribute changes in retear rate to changes in management, our results suggest that less aggressive rehabilitation, abduction sling use and increased surgeon experience decrease postoperative retear.

Systematic Review of All-Arthroscopic Versus Mini-Open Repair of Rotator Cuff Tears: A Meta-Analysis

The objective of this study was to compare outcomes in patients with rotator cuff tears undergoing all-arthroscopic versus mini-open rotator cuff repair. A systematic review and meta-analysis of outcomes of all-arthroscopic repair versus mini-open repair in patients with rotator cuff repair was conducted. Studies meeting the inclusion criteria were screened and included from systematic literature search for electronic databases including Medline, Embase, Cochrane CENTRAL, and CINAHL library was conducted from 1969 and 2015. A total of 18 comparative studies including 4 randomized clinical trials (RCTs) were included. Pooled results indicate that there was no difference in the functional outcomes, range of motion, visual analog scale (VAS) score, and short-form 36 (SF-36) subscales. However, Constant-Murley functional score was found to be significantly better in patients with mini-open repair. However, the results of the review should be interpreted with caution due to small size and small number of studies contributing to analysis in some of the outcomes. All-arthroscopic and mini-open repair surgical techniques for the management of rotator cuff repair are associated with similar outcomes and can be used interchangeably based on the patient and rotator tear characteristics.