Outcomes Of Rotator Cuff Repair Research Articles

Clinical Outcomes of Rotator Cuff Repair With Arthroscopic Capsular Release and Manipulation for Rotator Cuff Tear With Stiffness: A Matched-Pair Comparative Study Between Patients With and Without Stiffness

To compare clinical outcomes after surgical treatment between rotator cuff tears with and without shoulder stiffness and evaluate the serial changes in pain intensity, functional scores, and range of motion (ROM). The study comprised 26 patients with preoperative stiffness (stiff group) and 26 patients without stiffness (non-stiff group). The stiff group underwent arthroscopic or mini-open rotator cuff repair with arthroscopic capsular release and manipulation. The non-stiff group with rotator cuff repair only was matched for age and sex with the stiff group. The visual analog scale (VAS) pain score; University of California, Los Angeles (UCLA) score; American Shoulder and Elbow Surgeons (ASES) score; and ROM were evaluated preoperatively; 3, 6, and 12 months after surgery; and at final follow-up. Both groups had significant improvements in the VAS pain score, UCLA score, ASES score, and ROM at final follow-up. There were no significant differences between the 2 groups regarding VAS pain score, UCLA score, and ASES score at any period after surgery. In the stiff group, mean forward flexion was significantly lower than that in the non-stiff group at 3 months after surgery (143.1° v 154.2°, P = .003). Mean external rotation and internal rotation were significantly lower than those in the non-stiff group at 3 months after surgery (37.9° v 44.2°, P = .043, and 15.8 v 13.9, P < .001, respectively) and 6 months after surgery (49.1° v 57.3°, P = .002, and 13.2 v 12.0, P = .033, respectively). Overall satisfactory clinical outcomes could be achieved in both the stiff and non-stiff groups, although the stiff group had slower postoperative recovery of ROM until 6 months after surgery. Level III, retrospective comparative study, prognosis study.

The Effect of Smoking on Rotator Cuff and Glenoid Labrum Surgery

Background: Several orthopaedic conditions have been reported to be adversely affected by smoking. Only a few studies have looked at outcomes related to smoking in shoulder surgery. Purpose/Hypothesis: To determine whether smoking has a negative influence on tendinous, ligamentous, and cartilaginous shoulder surgery. The hypothesis was that smoking has a negative influence from both a basic science and clinical outcomes perspective on soft tissue shoulder surgery. Study Design: Systematic review. Methods: A systematic review of multiple medical databases was performed evaluating clinical outcomes and basic science studies to determine the effects of smoking on tendinous, ligamentous, and cartilaginous shoulder surgery. The search strategy was based on “shoulder AND [smoke OR smoking OR nicotine OR tobacco].” English language clinical outcomes or basic science studies following soft tissue surgery of the shoulder were included. Studies excluded consisted of those with evidence level 5, partial or total shoulder arthroplasty, fracture reduction and fixation, oncologic mass excision, and osteotomy around the shoulder. Results: Ten studies were identified for inclusion and analysis. Eight of these studies, which included 1 basic science study, investigated the relationship between smoking and outcomes of rotator cuff repair (RCR), and 2 examined the effects of smoking on outcomes of glenoid labrum repair. No studies were found that specifically explored the effects of smoking on cartilaginous shoulder surgery. The basic science study and 3 of the 7 clinical outcomes studies investigating smoking and rotator cuff (RTC) surgery outcomes found a statistically significant negative association resulting in decreased RTC tendon repair quality, decreased biomechanics, poorer clinical outcomes, and impaired healing of small-medium RTC tears as assessed by magnetic resonance imaging. In addition, 1 of 2 clinical outcomes studies examining smoking and glenoid labrum repair reported an increased need for surgical revision of superior labral anterior to posterior (SLAP) tears in smokers. No basic science studies were found that investigated the effects of smoking on glenoid labrum surgery. Conclusion: Smoking has a negative influence on RCR clinical outcomes and is associated with decreased healing of small-medium RTC tears after repair. The current literature suggests a negative influence of nicotine and smoking on RCR from both a basic science and clinical outcomes perspective. Smoking cessation would benefit patients undergoing RCR and improve clinical outcomes. The relationship of smoking and labral/SLAP repair or articular cartilage is less clear. Further research is needed to evaluate associations with these surgeries and outcomes. Clinical Relevance: Smoking has a negative influence on RCR clinical outcomes and is associated with decreased healing of small-medium RTC tears after repair.

Rotator Cuff Repair

Background: Rotator cuff tears are common, and rotator cuff repair represents a major health care expense. While patients often benefit from rotator cuff repair, anatomic failure of the repair is not unusual. Purpose: To identify the published evidence on the factors associated with retears and with suboptimal clinical outcomes of rotator cuff repairs. Study Design: Systematic review and meta-analysis of articles with evidence levels 1-4. Methods: A total of 2383 articles on rotator cuff repairs published between 1980 and 2012 were identified. Only 108 of these articles, reporting on over 8011 shoulders, met the inclusion criteria of reporting quantitative data on both imaging and clinical outcomes after rotator cuff repair. Factors related to the patients, their shoulders, the procedures, and the results were systematically categorized and submitted for meta-analysis. Results: While the number of relevant articles published per year increased dramatically over the period of the study, the clinical and anatomic results did not show improvement over this period. The weighted mean retear rate was 26.6% at a mean of 23.7 months after surgery. Retears were associated with more fatty infiltration, larger tear size, advanced age, and double-row repairs. Clinical improvement averaged 72% of the maximum possible improvement. Patient-reported outcomes were generally improved whether or not the repair restored the integrity of the rotator cuff. The inconsistent and incomplete data in the published articles limited the meta-analysis of factors affecting the outcome of rotator cuff repair. Conclusion: In spite of a dramatic increase in the number of publications per year, there is little evidence that the results of rotator cuff repair are improving. The information needed to guide the management of this commonly treated and costly condition is seriously deficient. To accumulate the evidence necessary to inform practice, future clinical studies on the outcome of rotator cuff repair must report important data relating to each patient’s condition, the surgical technique, the outcome in terms of integrity, and the change in patient self-assessed comfort and function.

Does Footprint Preparation Influence Tendon-to-Bone Healing After Rotator Cuff Repair in an Animal Model?

The aim of this study was to investigate the influence of footprint spongialization and radiofrequency ablation on rotator cuff repair outcomes compared with an untreated group in a rat model. We randomly assigned 189 Sprague-Dawley rats to either a spongialization, radiofrequency ablation, or untreated group. After separation of the supraspinatus tendon from the greater tubercle, the footprint was prepared by removing the cortical bone with a burr (spongialization), was prepared by ablating soft tissue with a radiofrequency ablation device, or was left unaltered (untreated). Biomechanical testing (after 7 weeks, n = 165) and histologic analysis after 1 and 7 weeks (n = 24) followed reinsertion. The mean load to failure was 17.51 ± 4.46 N/mm(2) in the spongialization group, 15.56 ± 4.85 N/mm(2) in the radiofrequency ablation group, and 19.21 ± 5.19 N/mm(2) in the untreated group. A significant difference was found between the spongialization and radiofrequency ablation groups (P = .0409), as well as between the untreated and radiofrequency ablation groups (P = .0014). There was no significant difference between the spongialization and untreated groups (P = .2456). The mean area of fibrocartilage transition, characterized by the presence of type II collagen, was larger after 1 and 7 weeks in the spongialization group (0.57 ± 0.1 mm(2) and 0.58 ± 0.1 mm(2), respectively) and untreated group (0.51 ± 0.1 mm(2) and 0.51 ± 0.2 mm(2), respectively) than in the radiofrequency ablation group (0.11 ± 0.1 mm(2) and 0.4 ± 0.1 mm(2), respectively) with P < .05 and P < .01. The results of this study show that radiofrequency ablation of the footprint results in a poor biomechanical and histologic outcome in an animal model. No preparation of the footprint has the same effect as spongialization. Different techniques of footprint preparation in rotator cuff repair may influence tendon-to-bone healing.

The effect of glenohumeral osteoarthritis on the outcome of isolated operatively treated supraspinatus tears

BackgroundRotator cuff tear is considered to be a common source of shoulder pain and dysfunction. Osteoarthritis of the glenohumeral joint (OAG) may coexist with rotator cuff tear, especially in elderly patients. The aim of the study was to evaluate the effect of associated OAG on the treatment outcome of rotator cuff repair. MethodsA total of 85 consecutive shoulders with an arthroscopically repaired isolated full-thickness supraspinatus tendon tear in males were included in this study. The grade of OAG was estimated preoperatively from shoulder radiographs using the Kellgren–Lawrence (K–L) classification, and peroperatively using the Outerbridge classification. Supraspinatus tendon tear was re-inserted anatomically to the native footprint in all cases. The Constant score was used as an outcome measure and was measured preoperatively and 1year after the operation. The effect of OAG on the Constant score was analyzed statistically. Results82 shoulders (96.5%) were available for the 1-year follow-up. Preoperative OAG was detected in 22/82 patients (26.8%). Any OAG above K–L grade 0 was associated with a lower Constant score preoperatively [49.9 (SD 17.6) vs. 60.1 (SD 16.7) (p=0.0185)] and also at the 1-year follow-up [73.9 (SD 17.5) vs. 82.8 (SD 10.9) (p=0.0074)]. 16/60 patients (26.7%) with K–L grade 0 radiographs had peroperatively detected OAG. Furthermore, any peroperatively detected OAG was associated with a lower Constant score preoperatively [53.2 (SD 19.0) vs. 60.9 (SD 15.2) (p=0.0445)] and at the 1-year follow-up 76.8 [(SD 14.8) vs. 83.5 (SD 11.4) (p=0.0223)]. ConclusionOAG is a relatively common finding in operated supraspinatus tear patients. Pre- and peroperatively detected OAG during rotator cuff reconstruction is predictive for lower pre- and postoperative Constant scores.

Outcome of arthroscopic rotator cuff repair in different age groups

Background There are numerous reports on the outcome of rotator cuff repair, but few have considered age as a factor affecting functional outcome. Hypothesis Age does not affect the anatomical and functional outcomes of rotator cuff repair. Patients and methods Twenty-eight patients with arthroscopic rotator cuff repair belonging to three different age groups were prospectively enrolled in the study and were followed up for at least 18 months after surgery. Various clinical features according to age were evaluated. The correlation was assessed between age and outcome, with adjustment for the preoperative score. Results The patient mean age was 61.6 years. There was marked improvement in postoperative pain (from 8.2 to 2.3) (P Conclusion There was marked improvement after arthroscopic rotator cuff repair in all age groups. Multivariate regression revealed that age was not correlated with postoperative pain, satisfaction, or functional outcome.

The science of rotator cuff tears: translating animal models to clinical recommendations using simulation analysis

The purpose of this article is to review basic science studies using various animal models for rotator cuff research and to describe structural, biomechanical, and functional changes to muscle following rotator cuff tears. The use of computational simulations to translate the findings from animal models to human scale is further detailed. A comprehensive review was performed of the basic science literature describing the use of animal models and simulation analysis to examine muscle function following rotator cuff injury and repair in the ageing population. The findings from various studies of rotator cuff pathology emphasize the importance of preventing permanent muscular changes with detrimental results. In vivo muscle function, electromyography, and passive muscle-tendon unit properties were studied before and after supraspinatus tenotomy in a rodent rotator cuff injury model (acute vs chronic). Then, a series of simulation experiments were conducted using a validated computational human musculoskeletal shoulder model to assess both passive and active tension of rotator cuff repairs based on surgical positioning. Outcomes of rotator cuff repair may be improved by earlier surgical intervention, with lower surgical repair tensions and fewer electromyographic neuromuscular changes. An integrated approach of animal experiments, computer simulation analyses, and clinical studies may allow us to gain a fundamental understanding of the underlying pathology and interpret the results for clinical translation.

Efficacy of Marrow-Stimulating Technique in Arthroscopic Rotator Cuff Repair: A Prospective Randomized Study (SS-14)

To evaluate the efficacy of marrow-stimulating technique by microfracturing greater tuberosity during arthroscopic rotator cuff repair. The hypothesis of the study was that microfractures can improve outcome of rotator cuff repair. Eighty patients with a full-thickness tear of the posterior-superior rotator cuff underwent an arthroscopic repair. All procedures were performed by using single-row repair technique with metal suture anchors alone or combined with side-to-side repair. Patients were divided in two groups of 40 cases each. In group 1, standard repair was performed; in group 2, microfractures of the greater tuberosity were performed to enhance tendon repair. Exclusion criteria were: partial-thickness and irreparable cuff tears, subscapularis tears, labral pathology, os acromiale, degenerative arthritis of glenohumeral joint, symptomatic arthritis of acromioclavicular joint, rotator cuff arthropathy, previous surgery to the same shoulder, and workers' compensation claims. Sample size was calculate in order to achieve power equal to 0.80. Results were evaluated at minimum two-year follow-up. Clinical outcome was assessed using the DASH self-administered questionnaire (primary outcome) and the Constant score normalized for age and gender. Structural integrity of repaired tendons was evaluated with MRI. The following independent variables were considered: age, gender, dominance, type of work, timing of symptoms, size, shape and retraction of the cuff tear, fatty degeneration of rotator cuff muscles, treatment of the biceps tendon, repair technique (anchors or anchors and side to side), and number of anchors. Matched-pair comparison was performed for each independent variable. Comparisons between groups for clinical outcomes were adjusted for baseline values. Multivariate linear and logistic regression analysis was performed to determine which variables were independently associated with the outcome. Significance was set at p < .05. Mean follow-up was 28 months. Seven patients were lost at follow-up (2 patients in group 1, and 5 in group 2, respectively). Comparison between groups did not show significant differences for each independent variable. Mean DASH score was 28.6 points in group 1 and 23.3 points in group 2. Mean normalized Constant score was 92.7 points in group 1 and 94.5 points in group 2. Differences between groups were not significant. Tendon healing rate assessed by MRI was 52.6% (20/38) in group 1 and 65.7% in group 2, without significant difference between groups. However, stratified analysis for size of cuff tear showed that group 2 had significantly greater healing rate than group 1 for large tears (p = 0.040). Multivariate analysis showed that age, gender, timing of symptoms, tendon retraction and fatty degeneration significantly and independently affected clinical outcomes. Influence of microfractures on healing rate of repaired tendons approximated to significance (p = 0.07). Marrow-stimulating technique by microfracturing greater tuberosity during arthroscopic rotator cuff repair did not influence clinical outcome, but significantly improved healing rate of large rotator cuff tears.

Does Augmentation with a Reinforced Fascia Patch Improve Rotator Cuff Repair Outcomes?

Scaffold devices are used to augment rotator cuff repairs in humans. While the strength of a novel poly-L-lactic acid-reinforced (human) fascia patch has been documented, it is unclear whether such patches will enhance the strength or likelihood of healing of rotator cuff repairs. In a canine shoulder model, we asked: Do tendon repairs augmented with a reinforced fascia patch have (1) increased biomechanical properties at Time 0 and (2) less tendon retraction and increased cross-sectional area and biomechanical properties after 12 weeks of healing compared to repairs without augmentation? (3) Do the biomechanical properties of tendon repairs reach normal values by 12 weeks of healing? And (4) is the host response associated with use of the reinforced fascia patch biocompatible? Eleven dogs underwent bilateral shoulder surgery with partial release and acute repair of the infraspinatus tendon, one shoulder with augmentation and one without augmentation. Repair retraction, cross-sectional area, biomechanical properties, and biocompatibility were assessed at 12 weeks. At Time 0, the mean ± SD ultimate load of augmented repairs was 296 ± 130 N (46% ± 25%) more than nonaugmented repairs, with no difference in stiffness between groups. At 12 weeks, the ultimate load of augmented repairs averaged 192 ± 213 N (15% ± 16%) less than nonaugmented repairs, with no difference in stiffness between groups. At the tendon repair site at 12 weeks, the fascia patch showed a biocompatible host tissue response. The biomechanical properties of repairs augmented with a reinforced fascia patch demonstrated greater ultimate load at Time 0 than nonaugmented repairs but remained essentially unchanged after 12 weeks of healing, despite improvements in the ultimate load of nonaugmented controls in the same time frame.

Effects of Operative Time on Outcomes of Rotator Cuff Repair

This study aimed to ascertain whether: (1) the newer technology for rotator cuff repair (RCR) has improved operative time; (2) operative time independently affects the outcomes of RCR; and (3) there are any cost savings associated with performing the procedure in a more expeditious manner. We investigated operative time, retear rate, patient-derived and examiner-derived outcomes, and reviewed costs, for 4 groups of shoulder patients who received open RCR or 1 of 3 arthroscopic RCR techniques using Mitek (knotted) anchors or Opus Magnum (knotless) anchors repaired either from the bursal side or the undersurface. The operative time lengths were: open RCR, 58 minutes; Mitek RCR, 53 minutes; Opus bursal side RCR, 38 minutes; and Opus undersurface RCR, 22 minutes (P

Quality of Life After Arthroscopic Rotator Cuff Repair

Background: Despite its importance, few studies regarding health-related quality of life (HRQOL) after rotator cuff repair have been reported. Purpose: To evaluate the outcomes of rotator cuff repair in terms of HRQOL using SF-36 and to analyze factors affecting postoperative HRQOL. Study Design: Case series; Level of evidence, 4. Methods: We included 309 patients who were followed-up for a mean 26.3 months (range, 12-48 months) after arthroscopic rotator cuff repair, between November 2004 and August 2008, and who underwent periodic measurement of HRQOL using SF-36 preoperatively, 1 year postoperatively, and at the final follow-up. The correlation between SF-36 and shoulder-specific functional outcome measures (American Shoulder and Elbow Surgeons [ASES], Simple Shoulder Test [SST], and Constant score) was evaluated using correlation analysis, and the relationship between various clinical factors, including rotator cuff healing and HRQOL, was assessed using univariate and multivariate analyses. Results: The SF-36 scores for physical HRQOL and mental HRQOL showed significant improvement, from 40.40 to 47.53 and from 44.45 to 50.55 at 12 months after surgery, respectively (all P < .001), and improvement was maintained with 48.24 and 50.45, respectively, at the final follow-up (all P < .001). Scores also showed improvement according to all clinical variables, even after stratification of each variable. The correlation between SF-36 and shoulder-specific functional outcome measures was fair to moderate (Pearson correlation coefficients, 0.199-0.528). Various factors had significant effects on preoperative physical and mental HRQOL; however, postoperatively (at 12 months and final follow-up, respectively), only older age (P = .008 and .013), female sex (P = .036 and .043), presence of diabetes (P = .026 and .027), and low level of sports activity (P = .049 at final follow-up) had a negative effect on postoperative physical HRQOL in multivariate analysis, and female sex (P = .010 and .001) was the only factor leading to worse postoperative mental HRQOL. Conclusion: Arthroscopic rotator cuff repair significantly improved the patients’ HRQOL both physically and mentally. Older age, female sex, diabetes, and low level of sports activity were related to low postoperative physical HRQOL, and female sex was also related to low postoperative mental HRQOL.

Initial Fixation Strength of Transosseous-Equivalent Suture Bridge Rotator Cuff Repair Is Comparable With Transosseous Repair

Background: The outcome of rotator cuff repair correlates with tendon healing. Early studies of arthroscopic rotator cuff repair demonstrate lower healing rates than traditional open techniques. Transosseous-equivalent repair techniques (suture bridge) were developed to improve the initial fixation strength. Purpose: To compare the initial in vitro tensile fixation strength of a transosseous-equivalent suture bridge (TOE-SB) rotator cuff repair construct to a traditional transosseous (TO) suture construct. Study Design: Controlled laboratory study. Methods: Identical simulated rotator cuff tears were created on 8 matched pairs of humeri. Each matched pair underwent repair with 4 sutures using either the TOE-SB or TO technique. Initial fixation strength was tested in a custom testing jig. Each shoulder underwent 1000 cycles each of low and then high load testing. Gap displacement was measured at anterior and posterior sites of the repair with digital video tracking of paired reflective markers and recorded at predetermined cycle intervals. Results: There were no statistically significant differences in gap formation at the repair sites under low or high load conditions between TOE-SB and TO techniques. The mean maximal gap formation of the repairs during low load testing in the TOE-SB and TO constructs was 0.93 ± 0.88 mm and 0.55 ± 0.22 mm, respectively (P = .505). The mean maximal gap formation during high load testing in the TOE-SB and TO constructs was 2.04 ± 1.10 mm and 2.28 ± 1.62 mm, respectively (P = .517). The most significant increase in gap distance occurred at the transition from low load to high load in both constructs. Most of the incremental displacement occurred within the first 100 cycles for both high and low load testing (P < .001). Conclusion: The arthroscopic TOE-SB technique is comparable in initial fixation strength to the traditional TO simple suture repair technique. Clinical Relevance: Arthroscopic techniques can achieve initial fixation strength comparable with traditional TO techniques performed without suture anchors.

Arthroscopic Rotator Cuff Repair in Patients with Concomitant Moderate to Severe Stiffness (SS-14)

Introduction The results of arthroscopic rotator cuff repair have been excellent and reproducible in several studies. Some patients with full thickness rotator cuff tears also present with, or subsequently develop significant shoulder stiffness preoperatively. While resolution of shoulder stiffness prior to rotator cuff repair would seem a desirable goal, some patients remain very stiff despite extensive nonoperative intervention. The treatment of rotator cuff tears in the face of persistent moderate to severe stiffness is controversial. Few articles have evaluated the outcomes of rotator cuff repair in patients with concomitant stiffness. Some authors have even recommended staged surgical procedures, first addressing the stiffness and then subsequently reoperating and repairing the rotator cuff tear. The purpose of this study is to evaluate the results of a consecutive group of patients who underwent both arthroscopic rotator cuff repair and arthroscopic capsular release due to persistent shoulder stiffness. Methods A prospective case series was conducted of patients who underwent both arthroscopic capsular release and arthroscopic rotator cuff repair in the same setting between January 1, 2004, and December 31, 2008. Forty-one patients were identified and a retrospective review of these medical records was performed. Data was collected including pre- and postoperative range of motion, strength, size of cuff tear, and pre- and post operative UCLA shoulder scores. Inclusion criterion included passive forward flexion Results Forty-one patients underwent both arthroscopic capsular release and arthroscopic rotator cuff repair in the same setting. 5 of these patients were excluded due to lack of follow up. Of the 36 patients, 23 were female and 13 were male. The average age was 59.5 (37-81). The mean duration of non-operative treatment prior to surgical intervention was 5.5 months (2-24 months). Average forward flexion improved from 106 degrees (10-120°) to 159 degrees (110-180°). Average external rotation improved from 4.34 degrees (−10-10°) to 65° (45-90°). The mean preoperative UCLA Score was 14.8 (6-21). These improved postoperatively to a mean of 32.2 (20-35) (p Conclusion Patients in this study who have combined moderate to severe shoulder stiffness and a documented rotator cuff tear demonstrated an improvement in range of motion comparable to other published results for isolated capsular release. Additionally, the improvement in UCLA scores mirrors other authors' results for the treatment of isolated rotator cuff tear without concurrent stiffness. Therefore, the authors feel that this combined approach can be used to effectively treat patients with resistant moderate to severe stiffness and concomitant rotator cuff tears.

Outcome of Rotator Cuff Repair in Large-to-Massive Tear With Pseudoparalysis

Background: Active range of motion deficit is one of the alleged negative influencing factors of rotator cuff repair. Recently, with the popularity of reverse total shoulder arthroplasty (RTSA), there is a tendency toward performing RTSA in cases of nonarthritic large-to-massive tears with pseudoparalysis. Hypothesis: Rotator cuff repair in patients with active motion deficit may yield inferior outcome. Study Design: Cohort study; Level of evidence, 3. Methods: Among 195 complete repairs of large-to-massive rotator cuff tears, 35 patients experienced painful pseudoparalysis preoperatively. Propensity score matching (1-to-1) was performed between pseudoparalytic and nonpseudoparalytic groups. Finally, 29 patients in each group were matched using the following variables: age, gender, dominance, onset period, aggravation period, number of tendons involved, retraction, operation method (arthroscopic or mini-open), rows of repair (single or double), number of anchors, and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis. At least 1 year after surgery (mean, 30.5 months), range of motion, visual analog scale for pain and satisfaction, Constant score, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, and University of California, Los Angeles shoulder rating scale (UCLA score) were evaluated. Healing of repaired cuffs was evaluated by computed tomography arthrography. Results: Range of motion was improved in both groups after rotator cuff repair. Active forward elevation had significantly improved postoperatively in the pseudoparalytic group (P < .001). All functional outcome scores improved at the final follow-up visit compared with preoperative values (all P < .05). Preoperative Constant, ASES, and UCLA scores were significantly inferior in the pseudoparalytic group, but all except the Constant score showed no differences between the 2 groups at the final follow-up (P = .04). Postoperatively, 7 patients (24.1%) in the pseudoparalytic and 1 (3.4%) in the nonpseudoparalytic group showed pseudoparalysis (P = .03). Among 37 patients who underwent postoperative computed tomography arthrography, cuff healing was achieved in 6 of 18 (33.3%) in the pseudoparalytic and 9 of 19 (47.4%) in the nonpseudoparalytic group (P = .385). Conclusion: Recovery from pseudoparalysis after rotator cuff repair was evident in a large portion of the study group, and postoperative function and cuff healing were not different according to the presence of pseudoparalysis. Considering possible complications and longevity of RTSA, rotator cuff repair should be the first-line treatment option for large-to-massive tears.

A comparative study of arthroscopic and open rotator cuff repair outcomes of 400 patients followed for two years or longer

A comparative study of arthroscopic and open rotator cuff repair outcomes of 400 patients followed for two years or longer

Results of concomitant rotator cuff and SLAP repair are not affected by unhealed SLAP lesion

To verify the anatomic results of combined repair of a full-thickness rotator cuff tear and superior labral anterior and posterior (SLAP) lesion. In addition, we compared the anatomic and functional outcomes according to the status of the repaired SLAP lesion. We enrolled 61 patients who underwent cuff repair with concomitant SLAP repair and were available for both functional and radiologic outcome evaluation at least 1 year after the operation. There were 40 male and 21 female patients with a mean age of 57.4 years (range, 39-70 years). We measured various clinical outcomes and evaluated the structural outcomes of the rotator cuff and the superior labrum and rotator cuff using computed tomography arthrography at the final follow-up visit. We also evaluated the functional outcome according to anatomic healing of the superior labrum. Labral healing to the bony glenoid was achieved in 49 patients (80.3%), and anatomic healing of the rotator cuff was observed in 44 patients (72.1%). The retear rate of the rotator cuff was not statistically different with respect to labral healing status. All functional outcomes improved significantly (P < .001), and there were no statistical differences in functional outcome with respect to postoperative healing of the superior labrum. An unhealed SLAP lesion did not preclude the successful outcome of concomitant rotator cuff repair. Therefore, repair of a concomitant SLAP lesion may not be an essential procedure for a successful outcome of a rotator cuff repair.

Does obesity affect early outcome of rotator cuff repair?

Obesity is linked to major health conditions and poor surgical outcomes. The impact of obesity on self-perceived outcome after rotator cuff repair (RCR) is unclear. We studied 154 patients who underwent RCR. Obesity was considered a body mass index (BMI) greater than 30. Preoperative and postoperative evaluations included the Disabilities of the Arm, Shoulder and Hand (DASH), Simple Shoulder Test, and visual analog scales for pain, function, and quality of life. Obese and control patients were compared for baseline demographics, surgical findings, and postoperative outcomes. Our overall population had a mean BMI of 28.4 (95% confidence interval, 27.7-29.1). There were 57 obese patients (BMI >30) and 97 nonobese patients with 1- or 2-tendon rotator cuff tears. Mean follow-up was 54.8 weeks (range, 52.0-88.7 weeks). Preoperative DASH score was 45.2 for obese patients and 43.4 for control patients (P = .524). The mean improvement in DASH score was 30.7 for obese patients and 26.1 for nonobese patients (P = .152). There were no significant differences in the Simple Shoulder Test and visual analog scale scores. Worse follow-up DASH scores in both groups were associated with worker's compensation status (P = .003) and total comorbidities (P < .001). Multiple linear regression analysis showed that BMI (continuous) and obesity (dichotomous) were not significantly related to outcome after we controlled for confounding variables. Although obesity is considered a risk factor for poor postoperative outcomes after some surgical procedures, in our experience, obesity does not have an independent, significant effect on self-reported early outcomes after RCR.

Delamination tearing of the rotator cuff: Prospective analysis of the influence of delamination tearing on the outcome of arthroscopically assisted mini open rotator cuff repair

Limited information regarding the effect of delamination tearing on the outcome of rotator cuff repair is available in the literature. Studies have reported equally good results for rotator cuff repair using an open, mini-open, and arthroscopic repair techniques. Negative results have been reported for arthroscopic rotator cuff repair when delamination is present. The purpose of this study was to assess the affect of delamination on the outcome of the arthroscopically assisted mini-open technique. Two-hundred sixty-three consecutive operations were followed prospectively in this study. All underwent arthroscopically assisted mini-open repairs by a single surgeon. Patient demographics, compensation status, and tear characteristics were investigated. Variables were compared using the Western Ontario Rotator Cuff Index (WORC) pre-operatively and at 1 and 2 years postoperative. The incidence of delamination was 71% of rotator cuff tears. Patient demographics did not affect the incidence of delamination. The presence of delamination did not affect the outcome of mini-open rotator cuff repair. We believe this technique is better able to produce reliable outcomes in the presence of delamination tearing.

Effect of Age on Functional and Structural Outcome after Rotator Cuff Repair

Background There are numerous reports on the outcome of rotator cuff repair according to age. However, the results are conflicting and driven by univariate analysis, which is not free of confounding factors. Hypothesis Age does not affect the anatomical and functional outcomes of rotator cuff repair. Study design Case series; Level of evidence, 4. Materials and Methods Eighty-one men and 96 women underwent rotator cuff repair at one institution and received computed tomography arthrography and functional evaluations at least 1 year after surgery. Various structural and clinical features according to age were evaluated. The correlation was assessed between age and outcomes, with adjustment for the preoperative score. Results Patient mean age was 60.0 ± 8.7 years. The mean ages were higher in women, nonsmokers, and those with positive paradoxical abduction, lower level of sports activity, the presence of biceps injury, higher fatty degeneration in cuff muscles, inferior isokinetic muscle performance, bigger tear size, more retraction of tear, and symptomatic acromioclavicular arthritis. For the integrity of the repair, the mean age was higher in the retear group (31.1%) than in the intact group (68.9%)—that is, 63.7 ± 7.5 and 58.4 ± 8.7 years, respectively (P < .001). Only the Constant score exhibited a positive correlation with age after adjustment (P = .009). Univariate regression analysis revealed that a 0.313-point increment of Constant score could be expected for each year of age. Conclusion On univariate analysis, older age was related with poor postoperative integrity and better functional improvement in Constant score. Multivariate regression revealed that age was not an independent determinant for anatomical or functional outcome whereas the tear retraction and fatty degeneration of the infraspinatus were independent factors for the integrity of repair and the presence of the paradoxical abduction and abduction torque of the unaffected shoulder for the Constant score.

Quantitative Evaluation of Fatty Infiltration of Rotator Cuff Muscles Using T2 Mapping (SS-08)

Fatty infiltration of rotator cuff muscles has been reported to affect outcome of rotator cuff repair. To date, many articles that evaluate fatty infiltration using computed tomography (CT) or magnetic resonance imaging (MRI) have been published. Qualitative methods, such as Goutallier's staging, have been commonly used for evaluation of fatty infiltration of rotator cuff muscles. There have been no published articles that evaluate fatty infiltration quantitatively. T2 mapping is an MRI technique that can evaluate objects quantitatively and has been mainly used for quantitative evaluation of articular cartilage in the area of musculoskeletal imaging.