Postoperative Cuff Integrity Research Articles

Tendon patch grafting using the long head of the biceps for irreparable massive rotator cuff tears

BackgroundSurgical treatment of massive rotator cuff tears is challenging for shoulder surgeons. The purpose of this study was to investigate both clinical outcomes and cuff integrity after tendon patch grafting using the long head of the biceps (LHB) tendon for irreparable massive rotator cuff tears. MethodsA short deltoid splitting approach was used to expose the torn cuff tendon stump. After tenodesis of the LHB tendon, its intraarticular portion was resected. If the size of the harvested tendon was smaller than that of the cuff defect, it was split into two layers. Then, the LHB tendon was sutured to the remnant cuff tendons and fi xed to the footprint using the transosseous suture technique. A total of 14 patients (12 men, 2 women; average age 64 years) underwent this procedure. The average postoperative follow-up period was 28 months (range 12–51 months). Active elevation angle of the shoulder as well as the Japanese Orthopaedic Association (JOA) score were assessed before surgery and at the time of follow-up. Postoperative cuff integrity was assessed using T2-weighted magnetic resonance imaging (MRI). ResultsAll cuff defects were successfully closed with this echnique. Average active elevation angle improved from 69° to 149°. Total JOA score also improved from 54.7 points to 83.1 points. Thirteen shoulders showed no re-tearing on T2-weighted MRI; a minor discontinuity of the repaired cuff tendon was observed in the other shoulder. ConclusionsThe LHB tendon is available in case tenodesis or tenotomy is needed. The resected tendon may be used as a graft for rotator cuff repair without any additional skin incision, which could reduce both the surgical invasion and the risk of infection. The LHB tendon patch grafting may be one of the useful options for surgical treatment of irreparable massive rotator cuff tears.

Procollagen Production at the Edge of a Ruptured Rotator Cuff Tendon is Correlated with Postoperative Cuff Integrity

Procollagen Production at the Edge of a Ruptured Rotator Cuff Tendon is Correlated with Postoperative Cuff Integrity

회전근 개 파열에 대한 관절경적 교량형 봉합술의 결과: 지방 변성이 중등도 이하인 전층 파열에 대한 단기 추시 임상적 결과

29 (male:17, female:12) consecutive shoulders treated with this index proce-dure and early rehabilitation were enrolled. Mean age was 56.4 years (range, 34~73 years) and mean fol-low-up period was 13 months (range, 12-15 months). Clinical outcomes were evaluated by using the Uni-versity of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and VisualAnalogue Scale (VAS). Postoperative cuff integrity was evaluated through magnetic resonance imaging(MRI) and categorized by Sugaya classification.

Isokinetic Muscle Performance Test Can Predict the Status of Rotator Cuff Muscle

The isokinetic muscle performance test (IMPT) is a validated and objective method used to evaluate muscle function but it is unknown whether it correlates with severity of rotator cuff tears. We asked whether peak torque and total work deficit on the IMPT correlated with the preoperative manual muscle test (MMT), tear size, fatty degeneration (FD) of cuff, and postoperative cuff integrity in patients after rotator cuff surgery. We evaluated 221 patients who had undergone rotator cuff repair; of these 86 had the IMPT and a CT arthrogram (CTA) 1 year after surgery. We found a correlation (r = 0.125 approximately 0.464) between the preoperative IMPT and MMT. The IMPT deficit was greater in rotator cuff muscles with larger tears and greater degree of FD. Preoperative external and internal rotation deficits on the IMPT were related to the risk of cuff detachment on the postoperative CTA (r = 0.290, 0.319), and the postoperative abduction deficit was greater than 40% of the contralateral side indicating cuff detachment. The IMPT provides objective and quantitative data for estimating the preoperative status of rotator cuff tear and can provide baseline data for postoperative anatomic assessment in patients with rotator cuff disorders. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Does an Arthroscopic Suture Bridge Technique Maintain Repair Integrity?: A Serial Evaluation by Ultrasonography

Biomechanical studies suggest a suture bridge technique enhances rotator cuff tendon footprint contact area, holding strength, and mean contact pressure. Based on these studies, we asked whether (1) the suture bridge technique would provide a high rate of cuff integrity after surgery, (2) the status of the repaired cuff would change with time, (3) preoperative factors could predict postoperative cuff integrity, and (4) patients with retears had less favorable pain, functional scores, range of motion (ROM), and muscle strength compared with those with intact repairs. We prospectively followed 78 patients with arthroscopic repairs in whom we used the suture bridge technique. The integrity of the rotator cuff repair was determined using ultrasonographic evaluation at 4.5 and 12 months after surgery. Ultrasonography revealed intact cuffs in 91% at 4.5 months postoperatively, all of which were maintained at the 12-month followup. Failure rates were 17.6% (three of 17) for massive tears, 11.1% (two of 18) for large tears, 6.3% (two of 32) for medium tears, and no failures for small tears. Preoperative fatty degeneration of the supraspinatus muscle was a strong predictor of cuff integrity. We found no correlation between the integrity and clinical outcomes except for a temporary decrease of abduction strength at 6 months. Arthroscopic repair using suture bridge technique can achieve a low retear rate in shoulders treated for rotator cuff tears, but the occurrence of retear did not influence the outcome. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Prognostic Factors Affecting Anatomic Outcome of Rotator Cuff Repair and Correlation With Functional Outcome

To analyze the relationship between functional outcomes and postoperative cuff integrity (anatomic outcome), and to reveal the factors affecting outcomes of rotator cuff repair. Seventy-eight patients who had undergone repair of full-thickness rotator cuff tear received both computed tomographic arthrography (CTA) and functional evaluation a minimum of 1 year after surgery. The mean follow-up period was 19.6 months (range, 12 to 39 months). Anatomic outcome was evaluated by CTA. Functional outcomes were evaluated by visual analogue scale (VAS) for pain and satisfaction with the operation, Constant score, simple shoulder test (SST), and American Shoulder and Elbow Surgeons (ASES) score. Various clinical and structural factors were included for statistical analysis. All patients displayed significant improvement in all functional evaluations at the final visit. Functional outcome did not correlate with anatomic outcome (P > .05). A few variables did relate to functional outcome: female or old age statistically correlated with the score of SST, and the size of the tear correlated with the ASES score (P < .05). The retear was influenced by age, fatty degeneration of the cuff muscles, and the size of tear. Fatty degeneration of the infraspinatus was the most independent predictor of anatomic outcome on multivariate regression analysis. Rotator cuff repair brought significant functional improvement. However, the functional outcome did not correlate with the anatomic outcome. The fatty degeneration of the infraspinatus muscle served as an independent predictor of the postoperative integrity of the rotator cuff. Level IV, prognostic case series.

Moderate Preoperative Shoulder Stiffness Does Not Alter the Clinical Outcome of Rotator Cuff Repair With Arthroscopic Release and Manipulation

The purpose of this study was to determine whether moderate preoperative shoulder stiffness affects the clinical outcome of rotator cuff repair, and to evaluate the serial change in range of motion (ROM), functional scores, pain, and satisfaction after rotator cuff repair. Rotator cuff repair was performed in 125 consecutive patients (127 shoulders). Thirty patients had concomitant moderate shoulder stiffness at the time of the repair. There were no statistical differences in sex ratio, age, the size and retraction of the tear, or the associated pathologies and repair procedure between the stiffness and nonstiffness groups. Arthroscopic capsular release and manipulation were added to the stiffness group, and the same rehabilitation protocol was applied according to the size of the tear. Clinical outcomes were evaluated using ROM, American Shoulder and Elbow Surgeon (ASES) score, Constant score, Simple Shoulder Test (SST), and short form 36. Pain and postoperative patient satisfaction were measured by a visual analog scale. All clinical parameters were prospectively recorded on the day before surgery, and at 3, 6, and 9 months postoperatively, and at their last follow-up visit. Differences of ROM did not reach statistical significance after 6 months of operation. Other functional outcome instruments showed no statistical difference at any follow-up period. Postoperative cuff integrity after 1 year showed no statistical difference between 2 groups. This study suggests that moderate preoperative shoulder stiffness does not affect clinical outcomes of rotator cuff repair if arthroscopic capsular release with manipulation is added to the index procedure. Arthroscopic capsular release with manipulation and a well programmed rehabilitation program can avoid any delay of surgery and limitation of motion after cuff repair in patients with concomitant moderate shoulder stiffness. Level III, retrospective comparative study.

대형 및 광범위 회전근 개 파열의 개방적 봉합술 후 임상적 결과와 회전근 개 연속성(integrity)의 상관 관계

Purpose: To evaluate the relationship between the clinical outcome and the cuff integrity following open repair in large and massive rotator cuff tears using ultrasonography as an imaging modality. Material and Methods: From November 2001 to April 2005, 17 cases(16 patients) who had open repair of tear measuring more than 3cm were assessed with minimal follow-up of 12 months in this study. 6 cases had a large tear and 11 cases a massive tear. There were 6 men and 11 women with a mean age of 52 years at surgery (range, 33 to 72 years). The evaluation consisted of the preoperative and postoperative shoulder scores according to UCLA shoulder scoring system and Visual analogue scale (VAS). Ultrasonography was performed by a experienced musculoskeletal physician at a minimum of 12 months postoperatively to evaluate the postoperative cuff integrity. Results: Retear were detected in four of seventeen cases. Regardless of the presence of recurrent tear, 14 cases had UCLA score of more than 29 points (good grade). All 17 had an improvement in the functional score, which increased from an average of 15.1 to 31.2 points. All cases showed pain relief and five cases had no pain. Sixteen cases except one had the range of motion of forward elevation above . Conclusion: Open rotator cuff repair in large and massive tears showed low retear rate. At a minimum of twelve months follow-up, all cases had improvement on UCLA score, pain relief, increased range of motion of the shoulder regardless of retear. And the correlation between recurrent tear and function score was not statistically significant.

Functional and Structural Outcome after Arthroscopic Rotator Cuff Repair - Serial Assessment of Postoperative Cuff Integrity by Traction -MRI-

Functional and Structural Outcome after Arthroscopic Rotator Cuff Repair - Serial Assessment of Postoperative Cuff Integrity by Traction -MRI-

Cuff integrity after arthroscopic versus open rotator cuff repair: A prospective study

Arthroscopic rotator cuff repair (RCR) has been reported to have good clinical results but high retear rates by ultrasound. We prospectively assessed postoperative cuff integrity and outcome after arthroscopic RCR (40 patients) and compared these results with open RCR (32 patients). Evaluation preoperatively and at 1 year included a physical examination and magnetic resonance imaging. American Shoulder and Elbow Surgeons and Constant scores improved significantly in both groups (P < .0001). Overall, 69% of repairs in the open group and 53% in the arthroscopic group were intact by magnetic resonance imaging. Of tears less than 3 cm in size, 74% in the open group and 84% in the arthroscopic group were intact. Of tears greater than 3 cm in size, 62% in the open group and 24% in the arthroscopic group were intact (P < .036). In the arthroscopic group, patients with an intact cuff had significantly greater strength of elevation (P = .01) and external rotation (P = .02). We conclude that open and arthroscopic RCRs have similar clinical outcomes. Cuff integrity is comparable for small tears, but large tears have twice the retear rate after arthroscopic repair.

Functional and Structural Outcome After Arthroscopic Full-Thickness Rotator Cuff Repair: Single-Row Versus Dual-Row Fixation

The purpose of this study was to compare the functional as well as the structural outcomes of single-row and dual-row fixation after arthroscopic full-thickness rotator cuff repair. Retrospective cohort study. A consecutive series of 80 shoulders in 78 patients with full-thickness rotator cuff tears was evaluated using the rating scale of the University of California Los Angeles (UCLA) and the shoulder index of the American Shoulder and Elbow Surgeons (ASES) at an average of 35 months (range, 24 to 60 months) after arthroscopic rotator cuff repair. Thirty-nine shoulders were repaired using the single-row technique and 41 shoulders using the dual-row technique. Postoperative cuff integrity was determined through magnetic resonance imaging and was classified into 5 categories: type I, sufficient thickness with homogenously low intensity; type II, sufficient thickness with partial high intensity; type III, insufficient thickness without discontinuity; type IV, presence of a minor discontinuity; type V, presence of a major discontinuity. The average UCLA score improved significantly to 32.4 in the single-row and to 33.1 in the dual-row group. The ASES shoulder index improved significantly to 93.0 in the single-row group and to 94.6 in the dual-row group. However, there was no statistical difference between the groups in the postoperative scores. Postoperative MRI revealed 11 type I, 6 type II, 12 type III, 4 type IV, and 6 type V in the single-row group, and 22 type I, 8 type II, 7 type III, 4 type IV, and no type V in the dual-row group. A statistical difference was observed between the groups (P < .01). Arthroscopic rotator cuff repair yielded successful functional outcomes without significant difference between single and dual-row fixation techniques. However, dual-row repairs excelled in structural outcome over the single-row technique. Level III.

Prospective Evaluation of the Effect of Rotator Cuff Integrity on the Outcome of Open Rotator Cuff Repairs

Background Open rotator cuff repairs have led to excellent clinical results; however, several studies have linked postoperative structural integrity to patient outcomes. The purpose of this study is to prospectively assess postoperative cuff integrity after open rotator cuff repair and assess its relationship to clinical outcome. Hypothesis Preoperative rotator cuff tear size and postoperative rotator cuff integrity are important factors in overall clinical outcomes. Study Design Prospective nonrandomized clinical outcomes study. Methods Forty-seven consecutive patients undergoing repair of full-thickness rotator cuff tears by a single surgeon were enrolled in this prospective study. A standardized evaluation was performed preoperatively and postoperatively at annual intervals. All patients underwent postoperative magnetic resonance imaging at least 1 year after surgery. Statistical evaluation was performed using paired and unpaired 2-tailed t tests for comparison. Results Thirty-two patients were available for evaluation. Overall, the patients experienced a significant (P < .05) improvement in their American Shoulder and Elbow Surgeons survey (40-85) and Constant (53-80) scores. The overall retear rate was 31%. Although patients with large tears preoperatively and retears postoperatively had lower overall outcomes scores, this was not significant. Conclusion These data support open rotator cuff repair as an effective technique that restores excellent shoulder function. The authors did not find postoperative cuff integrity to have a significant effect on outcomes when compared with those with an intact cuff. In fact, those with a retear still had a significant improvement in all clinical areas assessed, including strength.

Postoperative cuff integrity after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation (SS-06)

Postoperative cuff integrity after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation (SS-06)

Prospective evaluation of the effect of rotator cuff integrity on patient outcomes following arthroscopic rotator cuff repair (SS-75)

Arthroscopic rotator cuff repair (RCR) has been reported to have good clinical results but 70% to 90% retear rates by ultrasound. This study prospectively evaluates postoperative cuff integrity, as assessed by MRI, and patient outcomes following arthroscopic RCR. Methods: Fifty-two consecutive patients after arthroscopic RCR by a single surgeon were prospectively enrolled for evaluation preoperatively and at one year follow-up, including a postoperative MRI. Any tendon defect was graded a retear, even if smaller than the original tear. Results: Thirty-two patients had completed the arthroscopic RCR protocol and were evaluated. Overall ASES scores improved from 46 to 77, and Constant scores from 52 to71 (P < .05). Strength in forward elevation and external rotation improved significantly, from 5.9 to 9.8 lb, and 9.4 to 13.3 lb (P < .05). The average preoperative tear size was 3.1 cm; 15 tears were <3 cm and 17 >3 m. 47% of the rotator cuffs were intact by MRI. Of tears <3 cm, 80% were intact at follow-up; of tears >3 cm, 18% were intact at follow-up. 13% of massive tears (≥5 cm) were intact by MRI. There was a trend to better scores with an intact cuff (Constant 80, ASES 90, P = .06) than with a retear (Constant 72, ASES 78). Patients with intact cuffs had significantly greater strength of elevation (P < .005) and strength in external rotation (P < .02). Conclusion: Arthroscopic RCR yields excellent clinical outcomes which are better if the tendon is intact at follow-up. Repairs of small and medium tears of the rotator cuff have a high rate of cuff integrity (80%) while the large and massive tears have a higher retear rate. It should be noted that these results evaluate early arthroscopic methods. As techniques continue to evolve, e.g., current use of a double row of anchors, it is hoped that security of repairs of larger tears will improve.

Pre- and Postoperative Isokinetic Strength Test in Rotator Cuff Tear

PURPOSE: This study investigated whether (i) isokinetic muscle strength correlated with (ii) anatomical assessment of rotator cuff tear size, fatty degeneration of the supraspinatus muscle or postoperative cuff integrity.MATERIALS &amp; METHODS: Among patients who underwent arthroscopic rotator cuff repair, 32 patients in whom magnetic resonance imaging (MRI) and isokinetic muscle strength tests were performed preoperatively and, at an average of 10 months after repair, took part in this study. We measured the isokinetic strength (peak torque and total work) deficit in external rotation and internal rotation at a 60degrees/sec load.RESULTS: Preoperative isokinetic strength deficits correlated with tear size (p&lt;0.001) but correlated weakly with fatty degeneration of supraspinatus muscle (p&lt;0.001). In patients with healed rotator cuffs, preoperative peak torque and total work deficits were 39% and 62% for external rotation. At final follow up, they were decreased to 17% and 32%, respectively. In the re-tear group, preoperative peak torque and total work deficit were 44% and 61% in external rotation. At final follow up, they were decreased to 23% and 35%, respectively. But there was no significant difference between the two groups (p&gt;0.05).CONCLUSION: Preoperative isokinetic strength correlates with tear size but not fatty degeneration of the supraspintus muscle or postoperative cuff integrity. Postoperative cuff integrity did not have an effect on postoperative isokinetic strength.