Outcomes Of Rotator Cuff Repair Research Articles

Preoperative IDEAL (Iterative Decomposition of Echoes of Asymmetrical Length) magnetic resonance imaging rotator cuff muscle fat fractions are associated with rotator cuff repair outcomes

IDEAL (Iterative Decomposition of Echoes of Asymmetrical Length) imaging is amagnetic resonance imaging sequence that precisely measures rotator cuff muscle fatty infiltration. The influence of lower levels of fatty infiltration on outcomes after rotator cuff repair remains unclear. We hypothesized that increased preoperative fat fractions would be associated with inferior clinical outcomes after rotator cuff repair. We retrospectively identified patients who underwent arthroscopic rotator cuff repair with preoperative IDEAL imaging. Patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity computer adaptive survey at a minimum of 2 years after repair. Muscle segmentation was performed on 4 consecutive slices. Correlations between intramuscular fat fractions and PROMIS scores were determined. Patients were grouped by PROMIS scores of 50 or greater and scores lower than 50 for comparison of fat fractions. Multivariate linear regression was performed to model PROMIS scores as a function of demographic characteristics, tear size, and fat fractions. Significance was defined as P < .05. Eighty patients were included (mean follow-up, 42.5 ± 10.7 months). Postoperative PROMIS scores were significantly inversely correlated with the infraspinatus (ρ = -0.25, P = .02) and subscapularis (ρ = -0.29, P = .009) fat fractions. The infraspinatus (7.2% ± 4.9% vs. 5.2% ± 3.0%, P = .046) and subscapularis (10.4% ± 5.1% vs. 8.2% ± 5.0%, P = .001) fat fractions were significantly higher for patients with low PROMIS scores vs. those with PROMIS scores of 50 or greater. In multivariate modeling, the infraspinatus fat fraction (β = -0.68, P = .029) was the only significant independent predictor of postoperative PROMIS score. Intramuscular fat as determined by quantitative magnetic resonance imaging is an important factor in postoperative outcomes even in patients with lower levels of preoperative fatty infiltration.

Post-operative non-steroidal anti-inflammatory drugs do not affect clinical outcomes of rotator cuff repair

BackgroundThe administration of non-steroidal anti-inflammatory drugs (NSAIDs) to patients is thought to impair rotator cuff healing and clinical outcomes. Methods36 patients who underwent rotator cuff repair were divided into 3 groups based on their post-operative analgesia regimes. ResultsAt 4.4 years postoperative, there was significant improvement in SST and UCLA scores (p < 0.001). There were no significant differences in post-operative clinical outcome scores between the groups (p > 0.05). Administration of NSAIDs and duration of their use did not influence outcomes of rotator cuff repair (p = 0.151). ConclusionNSAIDs has no significant influence on clinical outcomes of rotator cuff repair.

Inferior outcome of rotator cuff repair in chronic hemodialytic patients

BackgroundRepair of rotator cuff tears has yielded excellent functional outcomes in recent decades; however, poor outcomes and dissatisfaction have been noted in specific groups. Spontaneous tendon rupture has been reported in patients receiving long-term hemodialysis owing to alteration of tendon structure, which might impede functional recovery after rotator cuff repair. The purpose of the present study was to compare the clinical outcomes between hemodialysis and non-hemodialysis patients after rotator cuff repair.MethodsWe retrospectively reviewed patients who underwent mini-open rotator cuff repair from Jan 2013 to Jan 2017. A total of 14 patients under chronic hemodialysis (HD) were matched to non-hemodialysis (NHD) patients at a 1:2 ratio according to age, gender, tear size, severity of fatty infiltration and history of diabetes. Pre- and post-operative functional outcome was assessed using the simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES), Shoulder Rating Scale of the University of California at Los Angeles (UCLA) and visual analog scale (VAS) scores. Clinical functional outcome at the last follow-up was adopted for comparison of the HD and NHD groups.ResultsA total of 42 patients were enrolled in this comparative study, with a mean age of 66.64 ± 1.68 years in the HD group and 65.71 ± 5.40 years in the NHD group. At the final clinical assessment, the post-operative functional outcome was significantly improved in both groups (p < 0.001). However, the functional outcome of the HD group was significantly inferior to that of the NHD group in terms of the SST score (6.50 ± 2.24 vs 9.39 ± 1.87, p < 0.001), ASES score (63.17 ± 15.93 vs 86.96 ± 11.43, p < 0.001), UCLA score (20.14 ± 7.71 vs 29.82 ± 5.08, p < 0.001) and VAS score (3.00 ± 0.96 vs 1.21 ± 1.03, p < 0.001).ConclusionThe improvement of pain and functional improvement of long-term hemodialysis patients were inferior to those of patients without hemodialysis after mini-open rotator cuff repair.

Repair of Rotator Cuff Tears in the Elderly: Does It Make Sense? A Systematic Review

Background: The indications and outcomes for rotator cuff repair (RCR) among patients ≥70 years old are not widely reported. Many active patients in this age range desire a joint-preserving option, and several small series reported successful clinical outcomes after RCR among patients aged ≥70 years. Purpose: To systematically review the literature on the outcomes of RCR among patients ≥70 years old. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The electronic databases of PubMed and Cochrane were used for the literature search. The quality of the included studies was evaluated according to the Coleman Methodology Score. Studies in English evaluating repair of full-thickness rotator cuff tears among patients aged ≥70 years were included. Results: Eleven studies were reviewed, including 680 patients (694 shoulders) who were treated with arthroscopic and/or open RCR with a mean follow-up of 24.2 months (range, 12-40.8 months). Forty patients were lost to follow-up, leaving 654 shoulders with outcome data. This age group demonstrated a significant increase in clinical and functional outcomes after RCR with high satisfaction. American Shoulder and Elbow Surgeons scores showed an improvement from 44.2 (range, 35.4-56) preoperatively to 87.9 (range, 84-90.3) postoperatively, while Constant scores improved from 41.7 (range, 22.6-53.6) to 70.8 (range, 58.6-76). Postoperative imaging evaluation was performed on 513 shoulders, revealing a retear rate of 27.1% (139 shoulders). There were 45 retears after open repair and 94 after arthroscopic repair. The difference in retear rate among patients receiving arthroscopic repairs was not significantly different than open repairs (P = .831). Pain according to a visual analog scale improved from 5.5 (range, 4.6-6.4) preoperatively to 1.3 (range, 0.5-2.3) postoperatively. Conclusion: RCR among patients ≥70 years old shows high clinical success rates with good outcomes and overall excellent pain relief. Although patients in this age group have a high potential for retear or persistent defects on imaging studies, RCR offers a joint-preserving option with significant functional and clinical improvement for the appropriately indicated patient.

Unsupported in a changing landscape: Learning Technologies in Complementary Medicine Education Provision: Results of an International Survey of Faculty

Rotator cuff tears are among the most common disorders of the shoulder girdle requiring surgical intervention, and it is no surprise that orthopaedic surgeons have searched far and wide for means to improve on rotator cuff repair outcomes. Radiological parameters such as the critical shoulder angle have recently emerged and have been associated with the presence of degenerative rotator cuff tears. However, their true impact on postoperative outcomes are still unclear. Although radiological parameters, because of their objectivity, will always remain a critical part of a surgeon's preoperative assessment, we must remember that ultimately we are treating patients and not radiographs.

Clinical and Radiographic Outcomes After Arthroscopic Lamina-Specific Double-Row Repair of Large Delaminated Rotator Cuff Tears in Active Patients.

Background:The presence of delamination and a larger rotator cuff tear (RCT) size have been associated with poorer outcomes in rotator cuff repair. Therefore, we developed a new surgical procedure, arthroscopic lamina-specific double-row fixation (ALSDR), for the repair of large delaminated RCTs.Purpose:To investigate the clinical outcomes, magnetic resonance imaging findings, and satisfaction with several variables after ALSDR for large delaminated RCTs.Study Design:Case series; Level of evidence, 4.Methods:A total of 30 active patients (mean age, 59.1 years) undergoing ALSDR were assessed by a numeric rating scale (NRS; 0-10) for pain, surgery, work, and exercise as well as American Shoulder and Elbow Surgeons (ASES), Constant, and Simple Shoulder Test (SST) scores at a mean of 65.9 months postoperatively. Rotator cuff integrity was determined by magnetic resonance imaging. The Spearman correlation coefficient (ρ) was used to determine the correlation between clinical and NRS scores.Results:Five patients (16.7%) had a retear. Each of the postoperative functional and NRS scores except the NRS work score was significantly better in the healed shoulders than in the shoulders with a retear (P < .001). The NRS pain score showed a significant negative correlation with ASES, Constant, and SST scores (ρ = −0.775, −0.668, and −0.742, respectively; P < .001 for all). The NRS surgery score had a positive correlation with Constant and SST scores (ρ = 0.393 [P = .032] and ρ = 0.456 [P = .011], respectively). The NRS work score had a positive correlation with ASES, Constant, and SST scores (ρ = 0.382 [P = .037], ρ = 0.386 [P = .035], and ρ = 0.414 [P = .023], respectively). The NRS exercise score had a positive correlation with ASES, Constant, and SST scores (ρ = 0.567 [P = .001], ρ = 0.511 [P = .004], and ρ = 0.639 [P < .001], respectively).Conclusion:Our results showed that there was a significant correlation between clinical and NRS scores. The results indicate that ALSDR can provide a high degree of functionality and can be a useful alternative treatment for active patients with large delaminated RCTs.

Correlation of Handgrip Strength to Postoperative Outcomes in Rotator Cuff Repair: A Preliminary Report

Background. Recovery of strength, range of motion and function are considered major determinants of success following rotator cuff repair. The strength of the distal limb measured as handgrip strength is a simple predictor of proximal muscle function. Moreover, grip strength is used to prognosticate outcomes in several conditions. This study investigated whether preoperative handgrip strength can be used as an indicator of outcomes in patients undergoing rotator cuff repair. Methods. A cross sectional study was performed on 21 patients (13 males and 8 females; mean age 55.14 ± 8.88 years) undergoing rotator cuff repair. Grip strength on the affected side was assessed preoperatively, and correlated with postoperative outcomes measured at fourth month follow up, which included isometric shoulder internal and external rotator strength, active Range of Motion (ROM) of the shoulder, pain assessed using the Numerical Pain Rating Scale (NPRS), and a performance-based shoulder function test, consisting of three activities. Results. Handgrip strength did not correlate with shoulder strength, ROM and pain. However, there was a moderate correlation (p = 0.505, r = 0.020) between pre-operative grip strength and shoulder function. Conclusion. Handgrip strength did not correlate with any of the outcomes of rotator cuff repair. Although a relationship between grip strength and shoulder function was shown, the correlation was moderate, indicating that multiple factors could contribute to the outcomes in individuals undergoing rotator cuff repair.

Delamination Does Not Affect Outcomes After Arthroscopic Rotator Cuff Repair as Compared With Nondelaminated Rotator Cuff Tears: A Study of 1043 Consecutive Cases

Background: Limited information is available regarding the characteristics of delaminated rotator cuff tears as compared with nondelaminated tears. Furthermore, there is conflicting information regarding the effects of delamination on the anatomic healing of repaired cuffs. Purpose: To evaluate the characteristics and anatomic outcomes of delaminated rotator cuff tears in comparison with nondelaminated tears to determine whether delamination is a negative prognostic factor affecting rotator cuff repair outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2010 and 2014, 1043 patients were enrolled in the study to assess the prevalence of delamination. Among them, the findings from 531 patients who underwent magnetic resonance imaging or computed tomographic arthrography at least 1 year after surgery were included to determine whether delamination was a negative prognostic factor affecting the anatomic outcomes of arthroscopic rotator cuff repair. Delamination was assessed intraoperatively and defined by distinguishable edge cleavage tearing or interstitial horizontal gap between the articular and bursal surfaces of the torn tendon. One of 3 repair techniques (modified Mason Allen, single row, or double row) was used according to tear configuration and tendon mobilization. The authors evaluated visual analog scale scores for pain and satisfaction and American Shoulder and Elbow Surgeons scores to quantify clinical outcomes. Results: The incidence of delamination was 42.9% (447 of 1043). As compared with those with nondelaminated tears, patients with delaminated tears were older (P < .001) and had longer symptom duration (P = .019), larger tear sizes and retractions (P < .001 for both), higher grades of fatty infiltration of the rotator cuff muscles (all P < .001), and poorer tendon quality (P < .001). The overall healing failure rate was 19.0% (101 of 531). In univariate analysis, the rate of healing failure for the repaired cuffs was significantly higher in the delaminated group (delaminated tears, 60 of 238, 25.2%; nondelaminated tears, 41 of 293, 14.0%; P = .001). However, results of subgroup and multivariate analyses showed that the presence of delamination was ultimately not an independent risk factor for the failure of cuff healing. Between the delaminated and nondelaminated groups, there was no significant difference in postoperative functional outcomes. Conclusion: The results suggest that delaminated rotator cuff tears might represent chronic degenerative tears of longer symptom duration, with larger tear sizes and higher grades of fatty infiltration in older patients. It appears that delamination could be a confounding factor, not an independent prognostic factor, affecting rotator cuff healing.

Do patients receiving workers' compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case-control study.

We compared preoperative and postoperative measures among workers' compensation board (WCB) recipients and non-recipients and determined the impact of WCB receipt on the 1- and 2-year outcomes of rotator cuff repair. We retrospectively reviewed patients with full-thickness rotator cuff tears who underwent arthroscopic repair between September 2011 and September 2014. Patients were divided into two groups based on WCB status: WCB recipients and non-recipients. All patients returned for follow-up functional evaluations at 1 and 2 years after the operation. Four outcome measures were evaluated: visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA), and range of motion (ROM). Seventy patients (38 males, 32 females) were evaluated, 20 of whom were WCB recipients. At 1 year after the operation, ASES, UCLA, and VAS scores as well as abduction ROM (Abd-ROM) had improved significantly in both groups. However, non-recipients showed significantly greater improvement than did WCB recipients in ASES, UCLA, and VAS scores and in forward flexion ROM and Abd-ROM ( p = 0.000, 0.009, 0.002, 0.046, and 0.020, respectively). However, at 2 years after the operation (after the end of WCB), there were no significant differences in any clinical outcome between WCB recipients and non-recipients ( p = 0.057, 0.106, 0.075, 0.724, and 0.787, respectively). Although workers' compensation recipients who underwent arthroscopic rotator cuff repair had worse outcomes while receiving WCB benefits, the outcomes were similar after WCB benefits ended.

Long-term clinical and radiographic outcome of rotator cuff repair with a synthetic interposition graft: a consecutive case series with 17 to 20 years of follow-up

Treatment options for irreparable cuff tears include synthetic interposition grafts, but whether such grafts can maintain acceptable shoulder function and prevent cuff tear arthropathy in the long-term is unknown. This was a retrospective case series of 13 consecutive patients treated with a synthetic interposition graft made of Dacron (DuPont, Wilmington, DE, USA). Patients were examined with bilateral ultrasonography, bilateral x-ray imaging, Constant-Murley score, and Western Ontario Rotator Cuff score. After a mean of 18 years (range, 17-20 years), 1 patient had died, and 12 were available for x-ray imaging and 10 also for ultrasonography and clinical scores. Cuff tear arthropathy (Hamada grade ≥2) had developed in 9 of 12 (75%; 95% confidence interval, 43%-95%), including 3 patients operated on with arthroplasty in the follow-up period. The mean absolute Constant-Murley score was 46 (standard deviation, 26), and the mean Western Ontario Rotator Cuff score was 59 (standard deviation, 20). In 7 of 10 patients (70%) with available ultrasonography, the graft was interpreted as not intact. All patients had a contralateral full-thickness tear, and 7 of 12 patients (58 %; 95% confidence interval, 28%-85%) had contralateral cuff tear arthropathy. The number of patients with cuff tear arthropathy was not significantly different between the shoulder repaired with a Dacron graft and the contralateral shoulder (P = .667). These results indicate that a synthetic interposition graft with screw fixation could not prevent cuff tear arthropathy and preserve cuff integrity in a long-term perspective.

Does bicep pathology affect rotator cuff repair outcomes?

Rotator cuff (RC) tears are common and a frequent cause of dysfunction in the shoulder, especially with progression of age. Biceps pathology occurs concomitantly and its relationship with RC tears has been well described. However, the study of biceps intervention affecting outcomes of RC repair is limited. We aim to study the effect of biceps tenotomy in RC repair after matching for cuff tear size. We collected data of 24 consecutive patients undergoing RC repair and biceps tenotomy and matched them with patients undergoing RC repair only ( n = 24). The groups were matched for age, RC tear size, and presence of subscapularis tears. All patients of this study underwent RC repair under a single surgeon. Patient demographics and outcome measures in the form of range of motion (ROM) pain scores and validated shoulder scores (Constant shoulder score, Oxford score, and University of California Los Angeles shoulder score) were collected preoperative and at predetermined fixed intervals up to 2 years postoperatively. We then compared the two groups using a mixed analysis of variance design so as to identify any possible differences. Patients from both groups demonstrated significant improvement in ROM, lower pain scores, and improvement in functional outcomes ( p < 0.05). Patients with biceps intervention demonstrated equivalent outcomes postoperatively up to 2 years with no statistical differences ( p > 0.05). Arthoscopic RC repair is an effective intervention for improving ROM, reducing pain, and improving function. Concomitant biceps procedure did not negatively impede recovery or affect outcomes.

Translation of the humeral head scale is associated with success of rotator cuff repair for large-massive tears

BackgroundAlthough 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.MethodsOne 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.ResultsThe 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.ConclusionsWe 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.

Does Concomitant Biceps Surgery Affect the Outcome of Rotator Cuff Repair?

Does Concomitant Biceps Surgery Affect the Outcome of Rotator Cuff Repair?

Rotator cuff surgery in patients with rheumatoid arthritis: clinical outcome comparable to age, sex and tear size matched non-rheumatoid patients.

Aims This study aimed to compare the clinical outcomes of rotator cuff repair in patients with rheumatoid arthritis with those of patients who have no known history of the disease. We hypothesised that the functional outcomes are comparable between patients and without rheumatoid arthritis and may be affected by the level of disease activity, as assessed from C-reactive protein (CRP) level and history of systemic steroid intake. Patients and methods We conducted a retrospective review of the institutional surgical database from May 1995 to April 2012. Twenty-nine patients with rheumatoid arthritis who had rotator cuff repair were enrolled as the study group. Age, sex, and tear size matched patients with no disease who were selected as the control group. The mean duration of follow-up was 46 months (range 24-92 months). Clinical outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) questionnaire, Constant score and visual analogue scale (VAS). All data were recorded preoperatively and at regular postoperative follow-up visits. CRP was measured preoperatively as the disease activity marker for rheumatoid arthritis. Medication history was thoroughly reviewed in the study group. Results In patients with rheumatoid arthritis, all shoulder functional scores improved after surgery (ASES 56.1-78.1, Constant 50.8-70.5 and VAS 5.2-2.5; P<0.001). The functional outcome of surgery in patients with rheumatoid arthritis was comparable to that of the control group (difference with control: ASES 78.1 vs. 85.5, P=0.093; Constant 70.5 vs. 75.9, P=0.366; VAS 2.5 vs. 1.8, P=0.108). Patients with rheumatoid arthritis who had an elevated CRP level (>1 mg/dl) showed inferior clinical outcomes than those with normal CRP levels. Patients with a history of systemic steroid intake showed inferior functional outcomes than those who had not taken steroids. Conclusions Surgical intervention for rotator cuff tear in patients with rheumatoid arthritis improved the shoulder functional outcome comparable to that in matched patients without rheumatoid arthritis. Elevated preoperative CRP level and history of systemic steroid intake portend inferior functional outcome in patients with rheumatoid arthritis.

What is the role of systemic conditions and options for manipulation of bone formation and bone resorption in rotator cuff tendon healing and repair?

Rotator cuff pathology is a significant cause of shoulder pain. Operative repair of rotator cuff is an established standard of care for these patient, however, failure of the procedure is common. Systemic conditions such as diabetes mellitus, hypocholesteremia, thyroid disease, and smoking significantly affect the outcomes of rotator cuff repair and have significant implications for the management of these patients. Diabetes mellitus has been proposed to damage tendons through non-enzymatic glycosylation of collagen with advanced glycation end product formation and impaired microcirculation. Hypocholesteremia may lead to fatty infiltration and subsequent pro-inflammatory degenerative enzymatic degeneration. Thyroid disease may disrupt tendon homeostasis through the alteration of collagen production and the accumulation of glycosaminoglycans. Lastly, smoking inhibits tendon healing through the induction of hypovascularity and hypoperfusion. Understanding of the implications these systemic conditions have on the outcomes is important in the management of rotator cuff disease.

Ten-Year Multicenter Clinical and MRI Evaluation of Isolated Supraspinatus Repairs.

Early repair of isolated supraspinatus tears could prevent further deterioration of the rotator cuff; however, there is no consensus on the management of such tears because of a lack of long-term outcome studies. The purposes of this study were to report the 10-year outcomes of isolated supraspinatus repairs and to investigate the factors that favor healing and recovery. We retrieved the records of all 511 patients who, in 2003, underwent repair of full-thickness isolated supraspinatus tears, performed by 15 surgeons at 15 centers. In 2014, the patients were asked to return for evaluation at a minimum follow-up of 10 years. One hundred and eighty-eight patients could not be reached, and 35 were excluded because they had a reoperation (17 had a retear, 7 had conversion to an arthroplasty, and 11 had other causes). A total of 288 patients (50% were men) who had a mean age (and standard deviation) at index surgery of 56.5 ± 8.3 years (range, 32 to 77 years) were evaluated clinically, and 210 of them were also evaluated using magnetic resonance imaging (MRI). Thirty shoulders (10.4%) had complications, including stiffness (20 shoulders), infection (1 shoulder), and other complications (9 shoulders). The total Constant score improved from a mean of 51.8 ± 13.6 points (range, 19 to 87 points) preoperatively to 77.7 ± 12.1 points (range, 37 to 100 points) at 10 years. At the 10-year follow-up evaluation, the mean Subjective Shoulder Value (SSV) was 84.9 ± 14.8 (range, 20 to 100), and the mean Simple Shoulder Test (SST) was 10.1 ± 2.2 (range, 3 to 12). Of the 210 shoulders evaluated using MRI, the repair integrity was Sugaya type I in 26 shoulders (12%), type II in 85 (41%), type III in 59 (28%), type IV in 27 (13%), and type V in 13 (6%). The total Constant score at the final follow-up was significantly associated with tendon healing (p < 0.005) and was inversely associated with preoperative fatty infiltration (p < 0.001). Neither the surgical approach nor the preoperative retraction influenced the outcomes. Repairs of isolated supraspinatus tears maintained considerable improvement in clinical and radiographic outcomes at 10 years. Preoperative fatty infiltration and postoperative retear have a significantly detrimental effect on the long-term functional outcome of rotator cuff repair. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Effect of Hand Dominance on Functional Outcome Following Single Row Rotator Cuff Repair

Introduction:Rotator cuff tears are a common cause of shoulder disability and pain. Excellent outcomes can be obtained with surgical treatment although this outcome is affected by several factors. We sought to investigate the effect of hand dominance on subjective functional outcome post rotator cuff repair.Methods:All patients who had rotator cuff repair over a calendar year were identified and followed up at 3 years post operatively. Patients were consented for inclusion in the study and demographic data, hand dominance and functional outcome data was collected. L’insalata shoulder questionnaire was used for outcome data collection. SPSS version 22 was used for statistical analysis where appropriate.Results:144 patients were included in this study. Mean age was 63 +/- 10.1 years in the dominant side group and 62 +/- 8.6 years in the non-dominant group. 92 patients had dominant side surgery and 52 had non-dominant side surgery. There was a statistically significant correlation between dominant hand and operated side (P=0.005). The mean overall outcome score was marginally higher in the dominant surgery group with a mean of 89.8 +/- 14.2 compared with a mean of 87.4 +/- 17.5 in the non-dominant group. Multi-variate linear regression analysis revealed this difference to be non-significant (p = 0.4).Conclusion:No difference was found in the functional outcome of rotator cuff repair between dominant and non-dominant side surgery. This information will help in counselling patients who are concerned about the potential impact of rotator cuff repair on the function of their dominant hand.

Murine Supraspinatus Tendon Detachment and Repair Model Augmented With Tendon-Derived, Activated Endothelial Cells: A New Concept in Biologic Enhancement of Tendon-to-Bone Healing

Objectives:Biologic interventions are being increasingly used to improve outcome of rotator cuff repair. Individual growth factors and stem cell-based augmentations are among the most popular approaches. In this study we investigated a novel approach in which tendon-derived, activated endothelial cells (tAECs) are used as a source of tissue-specific growth factors to stimulate tendon intrinsic stem cell niche in our established murine model of microsurgical supraspinatus tendon (SST) detachment and repair.Methods:Study protocol was approved by the IACUC. In stage 1, 20 C57BL/6 mice underwent tendon harvest from fore- and hind limbs and endothelial cells isolation and transfection with adenoviral E4 ORF1 and red fluorescent protein labelling using a proprietary protocol. In stage 2, 158 C57BL/6 mice underwent the procedure with implantation of a 10μm fibrin glue bead (FGB) at the repair site and were randomly allocated to study group (SG) and control group (CG). Study mice received 100,000 tAECs suspended in the FGB. Control mice received the FGB only. 3 mice were sacrificed on post-operative day (POD) #3 and #7 for cell viability study. 96 mice were sacrificed at 1, 2, and 4 weeks, with 10 and 6 mice in each group and time point for biomechanical and histologic evaluations, respectively. 56 mice were sacrificed on POD 5, 10, 14, and 28 for gene expression analysis using qPCR, with 7 mice in each group and time point. Biomechanical evaluation consisted of determination of failure force and site. Histologic parameters were cell count (H&E), number of vessels (factor VIII-specific antibody), number of chondrocytes and proteoglycan content (Alcian Blue), and collagen organization (picrosirius red and polarized light microscopy). 12 evaluated genes were aggrecan (ACAN), collagen1α1 (COL1), collagen3α1 (COL3), MKX, MMP-3, 13, and 14, Runx2, scleraxis (Scx), SOX9, tenomodulin (TNM) and VEGFa.Results:Fluorescent microscopy revealed viable tAECs at the repair site on POD #3 with No fluorescent activity on POD #7. Failure force in the SG was 50% higher at 2 weeks (2.50 ± 0.55 N vs 1.86 ± 0.82 N, p = 0.012) with 65% of all failures occurring at SST mid-substance, whereas 90% of failures in the CG occurred at the repair site. There was no significant difference in failure force at 4 weeks. Cell count, number of vessels, and proteoglycan content (Figure 1) were significantly higher in the SG at all time points. The number of chondrocytes was higher in the SG at 1 week (Figure 1). Quantitative analysis showed significantly superior collagen organization in the SG (Figure 2). SCX, MKX, TNM and COL3 expression were up-regulated on POD #10 and decreased on day #28 in both groups. Expression of TNM and COL3 in the SG showed significance difference at 4 weeks. ACAN, SOX9, COL1, MMP14 expression exhibited an increase starting from POD 5, followed by a significant decline towards baseline by POD 28. In the SG, SOX9 peaked at day 14. Expression of VEGFa showed an uptrend at earlier time points (Figure 3).Conclusion:tAECs increased repair strength of SST. Histologic findings were suggestive of a more vigorous cellular and vascular response, higher proteoglycan content, and ultimately, superior collagen organization. A commensurate pattern was observed in expression of relevant genes. This approach opens a new avenue for cell-based biologic augmentation of SST repair with the goal of stimulating the intrinsic stem cell niche in tendon, as opposed to incorporating exogenous cell sources.

Comparison of clinical outcomes of rotator cuff repair for rotator cuff tears with stiffness or without stiffness

Comparison of clinical outcomes of rotator cuff repair for rotator cuff tears with stiffness or without stiffness

Differences of RNA Expression in the Tendon According to Anatomic Outcomes in Rotator Cuff Repair

Background: Despite increased understanding of the pathophysiology of rotator cuff tears and the evolution of rotator cuff repair, healing failure remains a substantial problem. The critical roles played by biological factors have been emphasized, but little is known of the implications of gene expression profile differences at the time of repair. Purpose: To document the relationship between the perioperative gene expression of healed and unhealed rotator cuffs by RNA microarray analysis. Study Design: Case-control study; Level of evidence, 3. Methods: Superior (supraspinatus involvement) and posterosuperior (supraspinatus and infraspinatus involvement) tears were included in the study. Samples of rotator cuff tendons were prospectively collected during rotator cuff surgery. Three samples were harvested at the tendon ends of tears from the anterior, middle (apex), and posterior parts using an arthroscopic punch. Seven patients with an unhealed rotator cuff were matched one-to-one with patients with a healed rotator cuff by sex, age, tear size, and fatty degeneration of rotator cuff muscles. mRNA microarray analysis was used to identify genetic differences between healed and unhealed rotator cuff tendons. Gene ontology and gene association files were obtained from the Gene Ontology Consortium, and the Gene Ontology system in DAVID was used to identify enhanced biological processes. Results: Microarray analyses identified 262 genes that were differentially expressed by at least 1.5-fold between the healed and unhealed groups. Overall, in the healed group, 103 genes were significantly downregulated, and 159 were significantly upregulated. DAVID Functional Annotation Cluster analysis showed that in the healed group, the genes most upregulated were related to the G protein–coupled receptor protein signaling pathway and to the neurological system. On the other hand, the genes most downregulated were related to immune and inflammatory responses. BMP5 was the gene most upregulated in the healed group, and the majority of downregulated genes were involved in the immune/inflammatory response. Conclusion: The downregulation of inflammatory response genes and the upregulation of cell differentiation genes in torn rotator cuffs at the time of surgery are related to rotator cuff healing. These results provide useful baseline information for future biological studies on rotator cuff healing.