Retear Rate Research Articles

Factors affecting healing of rotator cuff repairs: microfracture of the greater tuberosity.

This study aimed to investigate the impact of microfractures generated within the footprint of the greater tuberosity (GT) on postoperative cuff healing following arthroscopic rotator cuff repair (ARCR). A retrospective analysis was conducted on patients who underwent ARCR for full-thickness rotator cuff tear (FTRCT) between April 2020 and October 2023 at our institution. A total of 73 patients was categorized into two groups based on the presence of microfractures: a microfracture group (group M, n=33) and a non-microfracture group (group N, n=40). Six months post-surgery, magnetic resonance imaging was performed to assess cuff healing and retear rates between the two groups. Furthermore, patients were stratified into retear and healing groups based on cuff integrity to analyze the factors influencing retear. Statistical analyses were performed to assess the associations between various demographic data (e.g., age) and radiologic parameters (tear size mediolateral [ML], anteroposterior [AP], and fatty infiltration [FI] of the rotator cuff muscle), including microfracture, with retear. There was no significant difference in retear rates between groups M and N (18.2% vs. 10.0%, P=0.332). Among demographic factors, age showed a significant difference between the retear and healing groups (67.4±8.5 vs. 61.6±6.1, P=0.044). ML tear size (3.1±1.7 vs. 2.0±1.1, P=0.015), AP tear size (2.4±1.2 vs. 1.6±1.0, P=0.332), FI of the supraspinatus (2.3±1.3 vs. 1.4±1.0, P=0.029), and FI of the infraspinatus (1.6±1.3 vs. 0.9±0.8, P=0.015) exhibited significant differences between the retear and healing groups. Multivariate logistic regression analysis identified age (odds ratio [OR], 1.153; 95% CI, 1.026-1.295; P=0.016) and tear size (OR, 1.988; 95% CI, 1.103-3.582; P=0.022) as independent risk factors for retear. ARCR with concurrent microfracture of the GT footprint did not significantly impact cuff healing in patients with FTRCT. However, older age and larger ML tear size were associated with an increased risk of retear. Level of evidence: III.

Concomitant Arthroscopic Superior Labral and Rotator Cuff Repair: A Systematic Review.

The aim of this study was to systematically review the literature on concomitant repair of superior labral and rotator cuff tears, in light of the paucity of published clinical evidence. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses compliant search of PubMed, Embase, and Cochrane Library databases was performed for clinical studies of patients undergoing combined repairs of the rotator cuff and superior labrum. Ten studies comprising 241 shoulders were included, with a mean age of 52.6 years and mean follow-up of 29.0 months; 67.9% were male patients. Functional outcomes included the mean postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Score of 88.6, University of California at Los Angeles Shoulder Score of 30.6, constant score of 90.4, Simple Shoulder Test score of 8.6, and visual analog scale score of 1.1. Range of motion outcomes demonstrated mean postoperative forward flexion of 159°, external rotation of 68°, and internal rotation of 17°. The overall return-to-play rate was 76.8%, with 67.9% returning to preinjury level. The overall complication rate was 4.1% with an 18.9% rate of rotator cuff retear and 2.4% reoperation rate. Arthroscopic concomitant repair of superior labral and rotator cuff tears results in good functional outcomes and range of motion, along with a low reoperation rate. Among athletes, there are moderate rates of return but lower rates of return to the same level of play. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Biologic Augmentation of Rotator Cuff Repair: Current Concepts Review.

Rotator cuff tears are common in an aging population. Thus far, primary repairs have shown high re-tear rates suggesting the need for improved healing modalities. Current augmentations of rotator cuff repairs include synthetic and biological scaffolds, surgical bone marrow venting, and infusing the repair with a variety of stem cells and growth factors aimed at restoring the native cellular structure and function of the repaired tissue. This current concepts review discusses the anatomy, physical presentation, diagnosis, and treatment of rotator cuff tears; biological adjuvants for rotator cuff repairs; and the current literature on outcomes after biologically augmented rotator cuff repairs. [Orthopedics. 202x;4x(x):xx-xx.].

Platelet-Rich Plasma for Arthroscopic Rotator Cuff Repair: A 3-Arm Randomized Controlled Trial.

Although there has been some amount of research into the use of platelet-rich plasma (PRP) after arthroscopic rotator cuff repair, most studies have not fully demonstrated its benefits. In addition, PRP formulations containing different concentrations of leukocytes have not been directly compared for rotator cuff repair. The purpose of this article was to determine whether arthroscopic rotator cuff repair combined with PRP injection, either leukocyte-rich PRP (LR-PRP) or leukocyte-poor PRP (LP-PRP), is superior to the control. The null hypothesis was that the addition of any PRP formulation would not result in outcomes superior to the control group. Randomized controlled trial; Level of evidence, 1. Patients with full-thickness rotator cuff tears who underwent arthroscopic repair were assessed for eligibility. The included patients were randomized to 3 treatment groups: the LR-PRP, LP-PRP, and standard-care control groups. After the rotator cuff suture was fixed firmly, different groups of liquid PRP preparations prepared by centrifugation were injected into the tendon-to-bone interface. The functional outcomes were assessed using the University of California, Los Angeles (UCLA) score, the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, the visual analog scale for pain during sleep and activity, and active range of motion at 3, 6, and 12 months after surgery. In addition, the visual analog scale score was obtained at weeks 2 and 6. Postoperative structural integrity was assessed by magnetic resonance imaging at 12 months using the Sugaya classification. Type III was considered partial retear, and types IV and V were considered complete retears. The safety of surgery was compared by the incidence of complications. The main analyses were performed in accordance with the intention-to-treat principle. Of 150 patients initially randomized, the functional outcomes in 142 (46 LR-PRP, 47 LP-PRP, 49 control) and the structural integrity in 133 (40 LR-PRP, 46 LP-PRP, 47 control) were analyzed. There was no significant difference in the primary outcome of the UCLA score among the 3 groups (P = .169). The trends in functional outcomes and range of motion were similar for the 3 groups, with no significant differences among the groups at 12 months. However, within 6 months after surgery, the ASES score was better in the LR-PRP group than in the control group (3 months: 85.8 ± 4.1 vs 81.6 ± 8.7; P = .011; 6 months: 90.0 ± 5.4 vs 86.2 ± 6.8; P = .003). At 12 months after surgery, the overall retear rate, including partial and complete retears, was 8%. There were no significant differences in the rates of overall retear (P = .755) or complete retear (P = .633) among the 3 groups. The only surgical complication was postoperative stiffness, which occurred in 3% of patients, and the incidence did not significantly differ among the groups (P = .790). The study did not reveal that shoulders treated with the LR-PRP or LP-PRP formulations had any superior functional or structural outcomes at 12 months compared with those of the control group. However, LR-PRP may offer better ASES scores than the control group up to 6 months after surgery, and its clinical benefit remains to be proven. ChiCTR2100045039 (Chinese Clinical Trial Register).

Evaluation of retear rates following transtibial anterior cruciate ligament reconstruction: Functional outcomes and GNRB assessment with a mean 6.3-year follow-up

The method of reconstruction of the anterior cruciate ligament (ACL) using the tibia-dependent femoral tunnel technique is highly criticized. It would not allow anatomical placement of the graft and would therefore lead to a high rate of retear. This retrospective study aimed to evaluate the rate of retear in ACL reconstructions using the transtibial tunnel (TT) technique and assess functional outcomes. The study included 148 patients (153 knees) who underwent ACL reconstruction with a minimum two-year follow-up period. Patients underwent clinical examinations, completed functional questionnaires (KOOS, Lysholm, ACL-RSI), and underwent laximetry measurements with GNRB at 134 N and 200 N. Two patients had retears detected on MRI and underwent revision surgery prior to the study, leaving 151 knees for evaluation. The retear rate was 6.6 %, with an overall rate of 7.8 % when including revision cases. Laxity measurements obtained with GNRB showed a strong correlation with functional scores, indicating worse scores with greater laxity differences (p < 0.0001). The retear rate observed in this study was at the higher end of those reported in the literature. The study indications for TT ACL reconstructions must be defined more specifically to reduce failure rates.Level of evidence: III (retrospective cohort study).

Latissimus dorsi tendon transfer versus open complete repair for symptomatic massive rotator cuff tear

BackgroundSymptomatic massive rotator cuff tear (MRCT) treatment is challenging, and there is no clear treatment strategy. In our study, we aimed to compare latissimus dorsi tendon transfer (LDTT) and open complete repair (OCR) surgical techniques for the treatment of MRCT. MethodsCases of symptomatic MRCT treated surgically with LDTT and OCR techniques between 2014 and 2021 were included in the study. The study was conducted in two centers: 1) one surgeon performed LDTT in first center and 2) the other surgeon performed OCR in second center. This study included 18 cases of LDTT and 15 cases of OCR. The patients were evaluated preoperatively and postoperatively in terms of demographic, radiological and functional scores. The American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley (CM) score, and visual analog scale (VAS) were used for functional evaluation. Symptom duration was defined as less than 6 months after onset, longer than 6 months and less than one year (<1Y)after onset, and longer than one year (>1Y) after onset. ResultsThe functional scores and range of motion improved significantly in both groups. No statistically significant differences were found between the symptom duration subgroups in the LDTT group. However, there was a significant difference in functional scores between <1Y and >1Y (P < 0.001) in the OCR group. Re-tear was seen in 5 (33.3 %) cases in the OCR group, and failure was seen in 3 (16.6 %) cases in the LDDT group. The failure rate was significantly higher in the OCR group than in the LDTT group (P < 0.05). ConclusionsLDTT technique is good option in the treatment of MRCT. However, in acute-subacute MRCT cases, open complete repair is a simpler, successful and safe technique. In chronic cases of >1Y, re-tear rates with OCR were high, and functional outcomes were low. We recommend that LDTT treatment for chronic cases (>1Y).

Engineered Tendon-Fibrocartilage-Bone Composite With Mechanical Stimulation for Augmentation of Rotator Cuff Repair: A Study Using an In Vivo Canine Model With a 6-Month Follow-up

Background: Rotator cuff repair augmentation using biological materials has become popular in clinical practice to reduce the high retear rates associated with traditional repair techniques. Tissue engineering approaches, such as engineered tendon-fibrocartilage-bone composite (TFBC), have shown promise in enhancing the biological healing of rotator cuff tears in animals. However, previous studies have provided limited long-term data on TFBC repair outcomes. The effect of mechanical stimulation on TFBC has not been explored extensively. Purpose: To evaluate functional outcomes after rotator cuff repair with engineered TFBC subjected to mechanical stimulation in a 6-month follow-up using a canine in vivo model. Study Design: Controlled laboratory study. Methods: A total of 40 canines with an acute infraspinatus (ISP) tendon transection model were randomly allocated to 4 groups (n =10): (1) unilateral ISP tendon undergoing suture repair only (control surgery); (2) augmentation with engineered TFBC alone (TFBC); (3) augmentation with engineered TFBC and bone marrow-derived stem cells (BMSCs) (TFBC+C); and (4) augmentation with engineered TFBC and BMSCs, as well as mechanical stimulation (TFBC+C+M). Outcome measures—including biomechanical evaluations such as failure strength, stiffness, failure mode, gross appearance, ISP tendon and muscle morphological assessment, and histological analysis—were performed 6 months after surgery. Results: As shown in the mechanical test, the TFBC+C+M group exhibited higher failure strength compared with other repair techniques. The most common failure mode was avulsion fracture in the TFBC+C+M group, but tendon-bone junction rupture was observed predominantly in different groups. Engineered TFBC with mechanical stimulation showed over 70% relative failure strength compared with normal ISP, and the other groups showed about 50% relative failure strength. Histological analysis revealed less fat infiltration and closer-to-normal muscle fiber structure in the mechanical stimulation group. Conclusion: This study provides evidence that mechanical stimulation of engineered TFBC promotes rotator cuff regeneration, thus supporting its potential for rotator cuff repair augmentation. Clinical Relevance: This study provides valuable evidence supporting the use of a novel tissue-engineered material (TFBC) in rotator cuff repair and paves the way for advancements in the field of rotator cuff regeneration.

Comparison of Mediolateral (V-shaped) versus Anteroposterior Dominant Rotator Cuff Tears: The Anteroposterior Tear Width Contributes More to Postoperative Retears than Mediolateral Length when the Tear Size Area is Similar

Tear size is a significant prognostic factor following rotator cuff repair. However, no study has investigated which dimension of the tear, the mediolateral or anteroposterior, more significantly influences the outcome when the product of the two dimensions, the tear size area, is similar. A retrospective cohort study was conducted with patients who underwent arthroscopic FTRCT repair. Two contrasting groups were derived from preoperative tear dimensions. The mediolateral dominant (MLD) group consisted of 45 FTRCTs with the mediolateral tear dimension at least 1.5 times larger than the anteroposterior, and retraction exceeding the humeral head apex. The anteroposterior dominant (APD) group included 35 FTRCTs with an inverse proportion of the dimensions and retraction short of the humeral head apex. Demographic data, pre- and postoperative magnetic resonance imaging (MRI), clinical scores, and strength were compared between the groups. The mean follow-up was 26.7 and 32.2 months in the MLD and APD groups, respectively. The tear size in area (MLD vs. APD, 521.0 vs. 523.4 mm2, P=.960) and the discrepancy between ML and AP dimensions (2.0 vs. 1.9, P=.597) were similar. However, the MLD group demonstrated significant female predominance (P=.003), dominant arm involvement (P=.007), a higher incidence of pathologic subacromial spurs (P=.016), narrower acromiohumeral distance (P<.001), shorter residual tendon (P<.001), and advanced supraspinatus muscle atrophy (P=.005). Other baseline parameters were comparable between the groups. At the one-year postoperative MRI, the MLD group demonstrated a significantly lower retear rate (4.4% vs. 31.4%, P=.001). Nevertheless, clinical scores and strength at the last follow-up did not significantly differ. In a similar tear size area, the greater AP width contributes more than the ML length in causing a retear. Female predominance, dominant arm involvement, subacromial spurs, shorter residual tendon, and supraspinatus muscle atrophy were more demonstrated in MLD tears. Surgeons should be aware that healing may be poor in APD tears despite less retraction.

Long head of biceps tendon autograft is effective in the management of large to massive rotator cuff tear: a systematic review.

The aim of this systematic review is to review the functional, clinical and radiological outcomes of patients undergoing large to massive rotator cuff repair with long head of biceps tendon (LHBT) autograft, as well as compare these to standard arthroscopic cuff repair. A review of the online Medline database was conducted on 20 October 2022 according to PRISMA guidelines and registered prospectively on the PROSPERO database. Clinical studies assessing patients with large to massive rotator cuff tears undergoing LHBT autograft repair were included. All studies reported on functional outcomes, range of movement (ROM) and radiological re-tear rates. The Methodological Index for Non-Randomised Studies (MINORS) tool was used to appraise all studies. The search strategy identified ten studies for inclusion including a total of 594 patients. Five studies were comparable (346 patients), assessing LHBT autograft repair against arthroscopic rotator cuff repair without autograft. A variety of techniques of LHBT autograft were used across all studies, including bridging and augmentation styles. Radiographic comparison showed lower re-tear rates in the LHBT autograft group with two studies demonstrating statistically significant results. Pain scores, functional outcomes and ROM were significantly improved post-operatively in all studies for LHBT autograft patients, with no significant difference when compared to standard arthroscopic repair. LHBT autograft looks to significantly improve functional scoring and range of motion in patients with large to massive rotator cuff tears. When compared to standard arthroscopic cuff repair, LHBT autograft appears to significantly reduce the re-tear rate. Further randomised studies are needed to assess the efficacy of this technique.

The effectiveness of intravenous zoledronic acid in elderly patients with osteoporosis after rotator cuff repair: a retrospective study

The aim of this study was to investigate the effect of zoledronic acid (ZA) on postoperative healing and functional rehabilitation in osteoporotic patients with rotator cuff (RC) injury. 96 Patients were divided into three groups according to bone mineral density and ZA use (Group A: normal BMD; Group B: osteoporosis and intravenous ZA use; Group C: osteoporosis, without ZA use). Radiologic, functional and Serological outcomes were evaluated 6 months after surgery. The functional scores in all groups exhibited significant improvement 6 months after surgery. Inter-group comparison showed that Constant Shoulder joint function Score (CSS) of group A not significantly differing from that of group B, the other indicators were significantly better than those of group B and C. There were no significant differences in shoulder forward flexion, abductive Range of Motion between group B and C. Other indicators of group B were significantly improved compared to group C. The retear rate in group C (30.3%, 10/33) was higher than group A (6.1%, 2/33) and group B (13.3%, 4/30). In conclusion, the application of ZA can significantly reduce the rate of RC retear in elderly patients with osteoporosis after surgery, which is significant for postoperative shoulder joint functional rehabilitation.

Influence of statin use on progression of postoperative fatty infiltration in the arthroscopic rotator cuff repair.

The purpose of this study was to determine the influence of hyperlipidemia and statin (hydroxyl-methylglutaryl-coenzyme-A reductase inhibitors) use on fatty infiltration (FI) of the rotator cuff muscle after arthroscopic rotator cuff repair (ARCR). The presence or absence of statin use and type of statins used (type 1 naturally derived statins and type 2 synthetic statins) were examined. This was a retrospective review of 620 cases (620 shoulders) who underwent arthroscopic rotator cuff repair. Total cholesterol (TC), low-density lipoprotein (LDL), triglycerides (TG) levels, and statin use were reviewed with the medical records. FI of the cuff muscles and repair integrity were assessed by MRI. A generalized linear model was used to analyze the progression of fatty infiltration. Repair integrity was determined according to the Sugaya classification, with types 4 and 5 as retears. The mean age was 66.9 years (272, females). The overall retear rate was 16.1%. There was no significant difference in retears between statin use and non-use with a trend toward higher retear rates in the type 2 statins. FI progressed postoperatively, and multivariate regression showed that type 2 statin use was a significant risk factor (p = 0.006). Other significant risk factor were large-to-massive tear (p = 0.02) and retear (p < .0001). The progression of FI after ARCR was observed. The new generation of strong statins (type 2 statins) was a significant risk factor for the progression of postoperative fatty infiltration, while neither serum lipid level (TC, LDL, and TG) was significant.

Muscle Advancement During Arthroscopic Rotator Cuff Repair as a Treatment Option for Irreparable Rotator Cuff Tears.

The management of irreparable rotator cuff tears presents a surgical dilemma. However, supraspinatus muscle advancement (MA) could be used to convert irreparable to reparable tears without requiring a graft. To compare the outcomes of patients with an irreparable tear who underwent rotator cuff repair with MA with those with a reparable large to massive cuff tear who underwent rotator cuff repair. Cohort study; Level of evidence, 3. We enrolled 62 patients who underwent rotator cuff repair for a large to massive tear between January 2020 and May 2022. Among them, 29 patients underwent an MA procedure due to an inability to repair despite releases (MA group), whereas the other 33 patients did not require the procedure (NMA group). At 1 year postoperatively, follow-up assessments including magnetic resonance imaging were performed to evaluate group outcomes. Despite there being more revision surgery cases and a poorer potential for cuff healing in the MA group, the retear rates in the MA and NMA groups were similar (31.0% vs 21.2%, respectively; P = .401), as were clinical outcomes, including the visual analog scale for pain (2.9 vs 1.9; P = .076), University of California, Los Angeles (27.0 vs 29.1; P = .185), Constant (70.1 vs 74.9; P = .063), and American Shoulder and Elbow Surgeons (74.5 vs 81.8; P = .168) scores. Postoperative muscle power during forward elevation was weaker in the MA group than in the NMA group (35.1 vs 45.8 N; P = .052), but external rotation power was comparable (49.3 vs 59.0 N; P = .121). Progress in fatty degeneration of the supraspinatus was not significantly different in the 2 groups (P = .43), although the MA group showed a nonsignificant decrease in supraspinatus atrophy (P = .092) due to the lateral shift produced by the procedure. The MA procedure for irreparable tears produced outcomes comparable with reparable tears, offering a valuable perspective on the efficiency of the procedure. The comparable but relatively high retear rates emphasize the need for further studies to compare with other treatment options for irreparable tears.

Preoperative Nutrition Impacts Retear Rate After Arthroscopic Rotator Cuff Repair.

A rotator cuff retear following arthroscopic rotator cuff repair (ARCR) is a concern in older patients. However, only a few of its risk factors are amenable to preoperative intervention. We aimed to elucidate the relationship between preoperative nutritional status and rotator cuff retears after ARCR. This single-center retrospective study included patients aged ≥65 years with rotator cuff tears who underwent ARCR. The Geriatric Nutritional Risk Index (GNRI) was used to assess preoperative nutritional status. Data collection encompassed patient demographics, clinical assessments, and surgical specifics. Patients were divided into healed and retear groups based on 2-year post-ARCR magnetic resonance imaging results. Logistic regression analysis was conducted to adjust for confounding factors and detect independent risk factors for retears. The GNRI cutoff value for retear prediction was determined by a stratum-specific likelihood ratio; clinical outcomes were compared based on the cutoff values obtained. Overall, 143 patients were included. The retear rate was 20.3%. The albumin level, GNRI, postoperative shoulder strength of abduction and external rotation, and postoperative Japanese Orthopaedic Association and Constant scores in the retear group were significantly lower than those in the healed group. The logistic regression analysis showed that low risk of morbidity and mortality (compared with no risk) based on the GNRI (odds ratio [OR], 3.39) and medial-lateral tear size per mm (OR = 1.10) were independent risk factors for a retear 2 years after ARCR. Stratum-specific likelihood ratio analysis identified data-driven strata as GNRI < 103, 103 ≤ GNRI < 109, and GNRI ≥ 109. Univariate analysis showed that patients with GNRI < 103 had a significantly higher retear risk than those with 103 ≤ GNRI < 109 and those with GNRI ≥ 109. Logistic regression analysis showed that GNRI < 103 compared with 103 ≤ GNRI < 109 (OR = 3.88) and GNRI < 103 compared with GNRI ≥ 109 (OR = 5.62), along with the medial-lateral tear size per mm (OR = 1.10), were independent risk factors for a retear at 2 years after ARCR. When assessing the risk of a retear after ARCR, GNRI ≥ 103 may indicate good preoperative nutritional status. However, more data are essential to ascertain the importance of this finding. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The effect of preemptive middle glenohumeral ligament release, following release of the rotator interval and coracohumeral ligament, in arthroscopic rotator cuff repair of small- to medium-sized tears to prevent postoperative stiffness: a retrospective comparative study

BackgroundThis study aimed to evaluate the efficacy of preemptive middle glenohumeral ligament (MGHL) release during arthroscopic rotator cuff repair (ARCR) of small- to medium-sized tears to prevent postoperative stiffness. MethodsPatients who underwent ARCR of small- to medium-sized tears were enrolled and allocated into two groups retrospectively: the preemptive MGHL release group (MGHL+ group, n=34) and preemptive MGHL non-release group (MGHL- group, n=32). The rotator interval and coracohumeral ligament release were performed in all patients with or without MGHL release in both groups. Clinical outcomes including the range of motion (ROM), Constant Shoulder (CS) score, and University of California, Los Angeles (UCLA) score preoperatively and at 3 months, 6 months, and 12 months postoperatively and complications were assessed and compared between the two groups. The integrity of the repaired tendon was assessed at the 12-month follow-up using magnetic resonance imaging. ResultsThe MGHL+ group showed a significantly higher external rotation, CS score, and UCLA score than the MGHL- group at 6 months postoperatively (P=.03, <.001, .01, respectively). The ROM and functional scores were not significantly different between the groups at 3 and 12 months postoperatively (P>.05). The retear rate, postoperative stiffness, and postoperative instability were not significantly different between the groups (all, P>.05). ConclusionsPreemptive MGHL release in ARCR of small- to medium-sized tears could be an effective method to prevent early postoperative shoulder stiffness but does not significantly change the overall clinical outcome after ARCR.

Reduced retear rates yet similar clinical outcomes following arthroscopic partial repair of large and massive irreparable rotator cuff tears with biceps augmentation compared to repairs without biceps augmentation: A systematic review and meta-analysis.

To compare the clinical outcomes between arthroscopic partial rotator cuff repair with biceps augmentation(BA) and partial repair (PR) without BA. This systematic review included studies comparing outcomes of arthroscopic repair for large to massive irreparable rotator cuff tears with and without the BA. The focus was on postoperative clinical results and retear rates. Mean differences were used to express continuous outcomes, while odds ratios (ORs) were employed for dichotomous outcomes. Ten studies (733 shoulders, all level 3 evidence) were included. The BA group showed a significant reduction in retear rates (OR = 0.40, 95% confidence interval [CI]: 0.20-0.77, P = 0.007) and comparable postoperative outcomes across various measures: American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale for pain, University of California-Los Angeles shoulder score, active forward flexion motionand active external rotation at the arm-at-side position compared to the PR group. Subgroup analysis of two BA techniques-rerouting and supplementation following supraglenoid tenotomy-showed no significant differences in ASES score for either technique versus PR. However, rerouting significantly lowered retear rates (OR = 0.21, 95% CI: 0.12-0.36, p < 0.001), while supplementation showed similar retear rates to PR (OR = 0.87, 95% CI: 0.37-2.02, n.s.). Arthroscopic partial rotator cuff repair with BA for large to massive irreparable rotator cuff tears is a reliable technique, resulting in improved postoperative outcomes. BA using supplementation following supraglenoid tenotomy showed similar clinical outcomes and range of motion but with lower retear rates compared to the PR group. Level III.

Patch Augmentation in Arthroscopic Rotator Cuff Surgery-Review of Current Evidence and Newest Trends.

Background: Rotator cuff tears are a common and debilitating condition requiring surgical intervention. Arthroscopic rotator cuff repair is essential for restoring shoulder function and alleviating pain. Tear classification by size and tendon retraction, along with the grade for fatty infiltration, influence postoperative outcomes, with large tears and higher fatty infiltration grades linked to higher retear rates. Managing complex tears is challenging, with failure rates ranging from 20 to 94%. Patch augmentation has emerged as a promising strategy, using biological or synthetic materials to reinforce tendon repairs, enhancing structural integrity and reducing retear risk. Methods: A review of the recent literature from January 2018 to March 2024 was conducted using PubMed/MEDLINE, Embase, and Web of Science. Keywords included "rotator cuff tear", "rotator cuff augmentation", "rotator cuff patch", "tendon augmentation", "massive rotator cuff tear", "patch augmentation", and "grafts". Relevant articles were selected based on their abstracts for a comprehensive review. Results: Initial methods used autograft tissues, but advances in biomaterials have led to standardized, biocompatible synthetic patches. Studies show reduced retear rates with patch augmentation, ranging from 17 to 45%. Conclusions: Patch augmentation reduces the retear rates and improves tendon repair, but complications like immune responses and infections persist. Cost-effectiveness analyses indicate that while initial costs are higher, long-term savings from reduced rehabilitation, revision surgeries, and increased productivity can make patch augmentation economically beneficial.

The Current Role of Collagen Patch Augmentation in Rotator Cuff Pathology: A Narrative Review

Rotator cuff repair is a common orthopaedic procedure. Despite advancements in the mechanics of rotator cuff repair, the re-tear rate post repair remains significant. This review assesses the available literature on usage of collagen bio-inductive scaffolds for rotator cuff repairs. Augmentation of biology is a key strategy to improving success of rotator cuff repair. Current evidence suggests that augmentation of rotator cuff repairs with a collagen bio-inductive scaffold improves the thickness of the rotator cuff. There is a favourable safety profile, and its usage may improve re-tear rates. However, there is currently no consensus on whether clinical outcomes are improved by the usage of collagen bio-inductive scaffolds. Further research is necessary to increase our understanding of the clinical effects of using collagen bio-inductive scaffolds and to determine which patient profiles will best benefit from its usage.

Effect of Preoperative Lipidemic Control on Retear Rates After Rotator Cuff Repair in Patients With Hyperlipidemia

Background: In patients with hyperlipidemia, the risk of retear increases after rotator cuff repair (RCR). In particular, it has been reported that preoperative low-density lipoprotein cholesterol (LDL-C) level affects cuff integrity. However, there are no studies assessing whether lipidemic control affects cuff healing. Purpose: To evaluate the effect of preoperative lipidemic control on cuff integrity after arthroscopic RCR across cardiovascular disease risk groups in patients with hyperlipidemia. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively reviewed the charts of patients with hyperlipidemia who underwent arthroscopic double-row suture bridge RCR between 2014 and 2019. The included patients had LDL-C tested within 1 month before surgery. Magnetic resonance imaging was conducted 6 months after surgery to evaluate the integrity of the repaired cuff tendon. Patients were divided into groups of low, moderate, high, and very high risk according to the 4th Korean Dyslipidemia Guidelines. On the basis of the target LDL-C set in each risk group, patients were categorized into 2 groups: group C (controlled hyperlipidemia, less than target LDL-C) and group U (uncontrolled hyperlipidemia, target LDL-C or greater). The correlation between serum lipid profile, lipidemic control, and post-RCR integrity was evaluated. Results: A total of 148 patients were analyzed, 51 in group U and 97 in group C. The retear rate was significantly higher in group U than in group C (23/51 [45.1%] vs 18/97 [18.6%], respectively; P = .001). The proportion of group U was significantly higher in the retear group than in the healing group (56.1% vs 26.2%; P = .001). In addition, the proportions of patients with uncontrolled diabetes mellitus (DM) (19.5% vs 3.7%; P = .002) and mediolateral (2.6 ± 1.2 cm vs 1.7 ± 1.1 cm; P < .001) and anteroposterior (2.2 ± 1.1 cm vs 1.6 ± 0.8 cm; P = .003) tear sizes were significantly different between the retear and healing groups, respectively. No significant difference in serum lipid profile, including LDL-C level (119.6 ± 31.3 vs 116.7 ± 37.2; P = .650), was observed between the retear and healing groups. Multivariate regression analysis identified uncontrolled hyperlipidemia (OR, 4.005; P = .001), uncontrolled DM (OR, 5.096; P = .022), and mediolateral tear size (OR, 1.764; P = .002) as independent risk factors for retear. The 2.0-cm mediolateral size cutoff and the 3 independent risk factors had significant associations with retear. Conclusion: Poor preoperative lipidemic control was significantly associated with poor healing after RCR. In addition to large mediolateral tear size, uncontrolled hyperlipidemia and DM were significant risk factors for retear. Moreover, poor lipidemic control compared with the recommended target level before surgery was more correlated with an increased retear rate than a preoperative LDL-C level.

A modified arthroscopic en masse suture bridge repair is effective for delaminated rotator cuff tears.

This study aimed to clarify the characteristics of delaminated rotator cuff tears (RCTs) and evaluate the clinical outcomes of a modified arthroscopic en masse suture bridge repair for delaminated RCTs. Patients with full-thickness RCTs, who underwent arthroscopic suture bridge repair with a minimum 2-year follow-up, were retrospectively reviewed. Patients were categorized into two groups based on the presence of delamination. Delaminated RCTs were treated using a modified en masse suture bridge technique, while nondelaminated RCTs received a conventional suture bridge technique. Preoperative and postoperative Constant scores and American Shoulder and Elbow Surgeons (ASES) scores were determined to evaluate clinical outcomes. Postoperative magnetic resonance imaging (MRI) was carried out to identify the integrity and retear of the repaired rotator cuff. A total of 172 patients were included in our study cohort, in which 67 (39%) delaminated RCTs were confirmed intraoperatively. The prevalence of delamination was significantly higher in large tears (53/102, 52%) compared to medium tears (14/70, 20%) (p < 0.001). No significant differences in age (n.s.) or gender (n.s.) were observed between the two groups. Both groups showed significant improvements in Constant and ASES scores postoperatively (both p < 0.001), with no significant differences between the groups (n.s.). The retear rates were 2/67 (3.0%) in the delamination group and 3/105 (2.9%) in the nondelamination group, showing no significant difference (n.s.). The modified arthroscopic en masse suture bridge technique was effective for repairing delaminated RCTs, yielding favourable clinical outcomes comparable to those of nondelaminated tears. Level IV.

Effect of Different Screw Materials on ACL Reconstruction With the Tape Locking Screw Technique: A Retrospective Study From the FAST Cohort.

Screws for graft fixation are available in 3 different materials for anterior cruciate ligament reconstruction (ACLR) with the Tape Locking Screw (TLS) technique: titanium, poly-l-lactic acid bioabsorbable, and polyetheretherketone (PEEK). To compare the effect of the 3 different fixation materials on graft and implant survival after ACLR with the TLS technique. Cohort study; Level of evidence, 3. Included were 521 patients from the French Prospective ACL Study (FAST) cohort who underwent primary surgical ACLR with the TLS technique. Patients were divided into 3 groups depending on the type of screw material used: titanium (TLS-T group), poly-l-lactic acid bioabsorbable (TLS-B group), or PEEK (TLS-P group). The primary endpoint was a retear within 2 years after ACLR. The secondary endpoints were complication rate, return to sports rate, and functional scores. Objective and subjective functional scores-including the International Knee Documentation Committee, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Lysholm score-were evaluated preoperatively and at the 2-year follow-up. Pain was assessed with the KOOS-Pain subscore recorded pre- and postoperatively every 6 months up to 2 years. Patient satisfaction was recorded at the 2-year follow-up. No significant differences between the study groups were found in retear rates (4.4%, 4.5%, and 4.3% in the TLS-T, TLS-P, and TLS-B groups 2 years after surgery) or subjective and objective outcomes. The TLS-T group had the lowest rate of intraoperative implant-related complications (0.9%) compared with the TLS-P (4.3%) and TLS-B (7.7%) groups. Young age was a significant risk factor for retear in the TLS-T (P = .03) and TLS-B (P = .0001) groups, while a high level of sports was found to be a significant risk factor in the TLS-P (P = .04) group. All functional scores improved significantly at the 2-year follow-up (P < .0001), with no significant group difference. The KOOS-Pain subscore improved continuously with no significant group difference. The rate of return to preinjury sports was between 43.4% and 58.6%. The rate of highly satisfied patients at the final follow-up was between 86.2% and 91.8%. There was no difference in retear rate or objective and subjective functional scores between implant materials for TLS ACLR in this study.