Repair Of Massive Rotator Cuff Tears Research Articles

Arthroscopic-assisted versus all-arthroscopic massive rotator-cuff repair: a cohort study of postoperative return to work

ObjectiveTo evaluate arthroscopic-assisted versus all-arthroscopic suture-anchor repair of massive rotator-cuff tears (RCTs), especially regarding postoperative patient's return to work.BackgroundMassive RCTs represent a challenging problem for shoulder surgeons. Management of RCT aims at pain relief, movement restoration, and improvement of the shoulder function.Patients and methodsA prospective study of 38 patients having massive RCT, conducted at Menoufia University Hospital and Neurosurgery Hospital between September 2019 and March 2021. Patients were divided into group A, which included 19 patients who were managed by arthroscopic-assisted technique. Group B included 19 patients who were managed by all-arthroscopic technique. Full history taking with complete clinical examination. All patients have completed 6-month postoperative follow-up.Primary outcomePostoperative patient's time to return to work.ResultsOur results found that postoperatively, there was statistically highly significant improvement in range of motion and University of California, Los Angles score in each group with a statistically nonsignificant difference between both groups. Comparison between both groups in time to return to work: postoperatively, there was a statistically nonsignificant difference between both groups in time to return to work, but in the all-arthroscopic group (group B), the patient returned to work slightly earlier.ConclusionBoth arthroscopic-assisted and all-arthroscopic procedures are effective in management of massive RCTs and result in significant improvement in clinical, functional outcomes, and patients' return to preinjury level of activity and work with a statistically nonsignificant difference between them, and both procedures could be used as an alternative repair method for massive RCTs.

Long-Term Outcomes of Massive Rotator Cuff Tear Repair: A Systematic Review.

With an increase in the treatment options available for massive rotator cuff tears, understanding the long-term outcomes of the chosen modality is important. The purpose of this study was to systematically review the available literature on repair of massive rotator cuff repairs and learn the longevity of outcomes, the failure rate, outcomes after failure, and any contributing factors to poor outcomes or failure. We conducted a systematic review of the MEDLINE, Cochrane, and Embase databases to find studies that investigated the long-term results of repair of massive rotator cuff repairs. Studies were excluded if they did not stratify results of massive tears, provide a definition for a massive rotator cuff tear, or report isolate patients with long-term follow-up. Six studies met the inclusion criteria, for a total of 472 shoulders; average patient age was 57.6 years. Follow-up ranged from 119 to 240 months. Outcome scores improved significantly following repair and were maintained throughout follow-up. The repair failure rate across studies was 39.2%. Patients who suffered retear had significantly worse outcome scores than patients with intact tendons at long-term follow-up. The existing literature on long-term follow-up after massive rotator cuff repair is scarce and not of high level of evidence. This review found repair of massive rotator cuff tears leads to long-term maintained improvements in outcome measures. Failure of repair is quite common, but results following failure are superior to preoperative outcomes.

Preoperative Radiographic Risk Factors for Incomplete Arthroscopic Supraspinatus Tendon Repair in Massive Rotator Cuff Tears

To determine if preoperative imaging findings of massive rotator cuff (RC) tears were associated with (1) incomplete arthroscopic repair and (2) the use of advanced mobilization techniques (interval slides) and/or the use of a load-sharing rip stop repair construct. Eighty-six consecutive patients who underwent arthroscopic repair for massive RC tears performed by a single surgeon between July 2013 and July 2015 were retrospectively evaluated. Previously proposed radiographic risk factors for irreparability (acromiohumeral distances, tangent sign, and the Goutallier stage of fatty infiltration for the supraspinatus) were analyzed. Associations between preoperative imaging characteristics and intraoperative results of RC surgery were determined using binary logistic regressions and Fisher's exact tests. The interobserver reliability of imaging characteristics was determined using intraclass correlation coefficients (ICCs). Seventy-six massive RC tears were fully reparable (88%). In the case of 10 RC tears (12%), a complete repair was not obtained. Inability to obtain a complete repair of the supraspinatus was associated with a positive tangent sign (30% irreparable) versus a negative tangent sign (6.3% irreparable, odds ratio [OR]= 6.3, P= .0102) and with Goutallier grade 3-4 fatty infiltration of the supraspinatus (42.9% irreparable) versus grade 0-2 fatty infiltration (5.7% irreparable, OR= 11.8, P= .001). Advanced arthroscopic techniques (interval slides or load-sharing rip stop) for dealing with poor-quality or retracted tendon were used in 62% of cases; however, no associations were found between preoperative imaging characteristics and these techniques. Interobserver reliability was moderate (ICC= 0.75-0.90) for the tangent sign (ICC= 0.78) and high-grade (Goutallier 3-4) fatty infiltration of the supraspinatus (ICC= 0.74). A positive tangent sign and/or high-grade fatty infiltration (Goutallier 3-4) of the supraspinatus were risk factors for incomplete RC repair. However, these were not completely predictive of reparability because the majority of massive RC tears with these imaging characteristics were still fully reparable. Level IV, therapeutic case series.

Patch-Augmentation in der Re-Insertionschirurgie der Rotatorenmanschette bei älteren Patienten

Background: Massive rotator cuff tendon tears have a poor clinical prognosis. This holds especially true in older patients and after revision surgery. In order to reduce tears and increase long term shoulder parameters, patches made of a variety of materials have been applied to reinforce sutures in current orthopaedic practice. Material and Methods: In a clinical study on rotator cuff surgery from 2005 to 2011 (date of surgical intervention), we tested the efficacy of three different commercial patches, with 89 patients (63 m/26 w) enrolled with a mean age of over 60. Graft Jacket, a regenerative stable human tissue scaffold, Artelon, a slow-resorbable polyurethane-urea patch and Restore, an orthobiological degradable graft, were arthroscopically implanted in order to augment the fragile tendon-bone interface after massive tears of 2 to 3 tendons (supraspinatus and/or infraspinatus and/or subscapularis). Results: An overall repair integrity score of 75 % was achieved in primary rotator cuff surgery and of 65 % in revision surgery with either non- or slowly resorbable patches outperforming the degradable material. This effect is more marked after primary surgery. CS values indicate overall patient recovery at 6 months of 81.43 vs. 47.29 for Graft Jacket, 81.34 vs. 46.18 for Artelon and 78.45 vs. 41.93 for Restore. Subjective shoulder value (SSV) at 3 years increased to 9.11 vs. 4.32 for Graft Jacket, 9.31 vs. 3.53 for Artelon and 9.45 vs. 2.9 for Restore. No severe adverse affects were encountered. Conclusions: Tendons with reduced mechanical characteristics can greatly profit from patch augmentation. This holds especially true for older patients and in revision surgery. The success rate of our patch studies was up to 87 % for Graft Jacket in primary rotator cuff surgery and a minimum of 58.3 % for Restore in pure revision surgery (comparable studies/metastudies on massive rotator cuff tear repair success rates range from 43 to 59 %). This paves the way for a continued search for better and more intelligent materials. Yield load, stiffness and ultimate load will probably improve further in the very near future.

Ultrasonography Technique in the Evaluation of Massive Rotator Cuff Tears Repaired using a Porcine Acellular Dermal Matrix Xenograft through a Mini-open Approach

ABSTRACT Purpose Massive rotator cuff tears (RCT) have been notoriously difficult to treat, but recently the novel use of interposition biologic scaffold grafts in repair of massive RCT has had promising results. However, there are no published guidelines regarding postoperative imaging evaluation of massive RCT repaired with xenograft. The purpose of this study was to (1) describe how to use ultrasound to evaluate a porcine acellular dermal matrix xenograft after repair of massive RCT and (2) evaluate healing of a xenograft using high-resolution ultrasound. Materials and methods A total of 37 consecutive patients underwent ultrasound evaluation of a repaired RCT at a mean of 33 months follow-up (23–48). Postoperative ultrasound findings were correlated to preoperative and postoperative functional (visual analog scale, Short-form 12, and Modified American shoulder and elbow score) and clinical outcomes (active range of motion and strength). Results Of the 37 patients, ultrasound showed that 33 (89.2%) of the cuff repairs were fully intact, 3 (8.1%) had partial thickness tears, and 1 (2.7%) had a full thickness tear. In this study, the integrity of the repair based on high-resolution ultrasound correlates with functional and clinical outcomes. Conclusion Ultrasound is an effective method to evaluate xenograft interposition grafts used in rotator cuff repair. Neumann JA, Rickert KD, Toth AP, Boggess BR. Ultrasonography Technique in the Evaluation of Massive Rotator Cuff Tears Repaired using a Porcine Acellular Dermal Matrix Xenograft through a Mini-open Approach. The Duke Orthop J 2016;6(1):26-34.

Outcome of open massive rotator cuff repairs with double-row suture knotless anchors: case series.

The aim of the present study was to evaluate functional and quality of life outcomes after transosseous equivalent (TOE) double row suture technique for massive rotator cuff (RTC) tear repair using validated subjective and objective measures. This technique has shown promising preliminary results in RTC repair; however, a paucity of evidence regarding these outcomes in massive RTC (MRTC) tear repair exists. Patients were identified using the Hospital Inpatient Enquiry Scheme. Pre-operative MRI and medical records were reviewed. A massive RTC tear was defined as the detachment of two or more tendons from their point of insertion on the humeral head. The Constant and Oxford Shoulder Scores (OSS) and SF-12 questionnaire were used for evaluation. Twenty-two patients were studied (72.7 % male; mean age at surgery, 62.6 years). Mean follow up was 14 (range six to 30) months. At six weeks postoperatively, 68 % achieved good or excellent shoulder function as measured by the OSS and Constant score. The cohort's mean SF-12 physical and emotional scores were significantly lower (p = 0.0002 and 0.037) and the vitality and mental health scores were higher (p = 0.005 and 0.006) than the reference norm scores. The TOE double row surgical repair for MRTC tears provides good to excellent functional outcomes and is associated with high vitality and mental health scores at a mean of 14 months. Physical and emotional scores were lower than reference norm. These results suggest this repair technique is appropriate for massive rotator cuff tears, and future randomised control studies are warranted.

Operative results for massive rotator cuff tear repair using hybrid type artificial ligament

Operative results for massive rotator cuff tear repair using hybrid type artificial ligament

Chronic massive rotator cuff tear in rats: in vivo evaluation of muscle force and three-dimensional histologic analysis

Massive rotator cuff tear repair is frequently complicated by unsatisfactory clinical results due to possible tendon retraction, muscle atrophy, and fatty degeneration. The objective of this study was the development of a chronic massive tear in a rat model and the evaluation of the muscle force invivo and of the histologic changes in a 3- dimensional manner. To simulate massive rotator cuff tears, both the supraspinatus (SS) and the infraspinatus (IS) tendons were surgically detached from the right humerus of 15 male adult Sprague-Dawley rats. Twelve weeks postoperatively, all animals underwent isometric tension recordings of both the SS and IS muscles. Histologic analysis and image deconvolution processing were performed to estimate the presence and the distribution of atrophy in 3 dimensions. An overall 30% and 35% reduction in muscle force of the SS and IS muscles, respectively, was observed compared with the left uninjured shoulder (P<.005). Histologic analysis revealed that the degeneration and the fatty infiltration were more evident near the tendon and at the dorsal side in both muscle groups. These results show that functional impairment of SS and IS muscles after chronic massive tendon tears could be attributed to the decrease in muscle force production during their repair on the greater tuberosity and, second, to the comparatively greater degeneration of their dorsal part.

Animal models and clinical outcomes of massive rotator cuff tears repaired at different timings

Objective To study the effect of operative timing on repairing massive rotator cuff tears (RCT) before fatty infiltration and atrophic degeneration in animal models and clinic as well.Methods Sixty New Zealand rabbits were used to set up models of massive RCT without fatty infiltration and atrophic degeneration and randomly divided into 2 equal groups.The operative repair was performed at one week after injury in group A and at 4 weeks in group B.At 2,4 and 8 weeks after operation,healing of tendon-bone interface was observed by H.E.staining,collagens were observed by Sirius Red F 3B (SR) in saturated carbazotic acid staining and areas of type Ⅰ and Ⅲ collagens were measured by imaging analysis software.Failure loads of supraspinatus on both sides were measured.All data were compared at the same time between the 2 groups.Clinically,from January 2008 to January 2011,51 patients with massive RCT without fatty infiltration and atrophic degeneration were arthroscopically repaired.They were divided into 3 groups according to different operative timings:an acute group (n =18) in which operation was conducted in less than 6 weeks,a subacute group (n =17) in which operation was conducted in 6 weeks to 3 months and a chronic group (n =16) in which operation was conducted in more than 3 months.All the shoulders were repaired using the double-row technique.The range of motion (ROM),visual analog scale (VAS) for pain,Constant-Murley score,University of California,Los Angeles (UCLA) score,simple shoulder test (SST) score were recorded and compared among the 3 groups at the last follow-up.Results The animal experiments showed no significant differences between the 2 groups at any time point histologically and biomechanically (P ＞ 0.05).The data showed significant differences in group A between 2 weeks and 4/8 weeks and in group B between 2/4weeks and 8 weeks (P ＜ 0.05).Clinically,follow-ups from 12 to 18 months (average,18 months) showed the 51 patients were cured with no complications.There were significant differences regarding the ROM,VAS,SST,UCLA and Constant-Murley scores between preoperation and postoperation in all the 3 groups (P ＜0.05) but there were no significant differences among the 3 groups regarding RM,functional recovery and pain score at the last follow-up (P ＞ 0.05).Conclusion Animal models and clinical outcomes indicate no effect of operative timing on the repair of massive RCT before fatty infiltration and atrophic degeneration. Key words: Shoulder joint; Wounds and injuries; Histology; Biomechanics; Controlled clinical trial

Use of Graft Jacket as an Augmentation for Massive Rotator Cuff Tears

Tendon healing and improved strength in the face of massive rotator cuff tear repair remains a daunting challenge. Seventeen consecutive patients with massive rotator cuff tears were treated with a standardized open repair technique and the repair augmented with Graft Jacket (Wright Medical, Memphis, Tennessee). Mean follow-up was 1.2 years (438 days). Pain scores improved with 11 patients (64%) reporting no pain or occasional and slight pain. Functional status improved with 12 patients (70%) reporting normal function or slight restriction only. Active forward flexion improved with 10 patients (59%) having greater than 150°. UCLA scores improved significantly from a mean 9.06 preoperatively to 26.12 ( P value

Tendon transfer for the management of irreparable rotator-cuff tears

Although clinical results after repair of massive rotator-cuff tears are frequently good, structural healing does notreliably occur after technically successful reconstruction. It has been recognized that massive rotator-cuff tears are commonly associated with a muscular disease characterized by atrophy and fatty degeneration of the corresponding muscles. As recovery of function and strength after rotator-cuff repair is an important requirement, especially for younger individuals, reconstruction of irreparable rotator-cuff lesions with transfer of healthy musculotendinous units should be considered as alternatives to direct repair.