Repair Of Tears Research Articles

Arthroscopic management of isolated partial-thickness rotator cuff tears.

The aim of the present study is to provide a comprehensive review on the surgical outcomes following arthroscopic treatments of partial-thickness rotator cuff tears (PT-RCTs) and to compare the postoperative American Shoulder and Elbow Surgeons(ASES)score following in situ transtendon repair and tear completion, followed by repair. Medline, EMBASE, Scopus, CINAHL and CENTRAL bibliographic databases were searched. Papers including patients with PT-RCTs of any grade who underwent treatment using debridement, in situ transtendon repair, tear completion and repair or bioinductive collagen implants were reviewed. Primary PT-RCTs were the sole indication for surgery. Primary postoperative outcomes assessed included the ASESscore,the Absolute Constant-Murley score, the Simple Shoulder Test, the Visual Analogue Scale, the University of California-Los Angeles Shoulder Scale, the Western Ontario Rotator Cuff Score, range of motion, complications and revisions. A meta-analysis of comparative studies compared the postoperative ASES score between patients treated with in situ transtendon repair versus tear completion repair. Twenty-eight studies were included. The ASES score was reported by four comparative studies with contrasting results. The heterogeneity was high (I2 = 86%), and effect sizes ranged from -0.49 in favour of the tear completion and repair technique to an effect size of +1.07 favouring in situ transtendon repair. The overall effect size of 0.02 suggests an equivalence between the two techniques in terms of the ASES score. Two studies with a total sample size of 111 patients reported on debridement, and four studies with a total sample size of 155 patients reported on bioinductive collagen implants. Debridement alone is suitable for Ellman grades I-II PT-RCTs. In situ transtendon and tear completion repair techniques yield similar postoperative outcomes. Bioinductive collagen implants hold promise but lack long-term efficacy data. High-quality comparative studies are needed to determine the best treatment for PT-RCTs. Level IV.

Synthesis, Characterization and Application of Advanced Antimicrobial Electrospun Polymers.

The aim of this work was to synthesize, characterize and apply advanced antimicrobial biocompatible electrospun polymers suitable for medical implants for surgical repairs. Injuries to the musculoskeletal system often necessitate surgical repair, but current treatments can still lead to high failure rates, such as 40% for the repair of rotator cuff tears. Therefore, there is an urgent need for the development of new biocompatible materials that can effectively support the repair of damaged tissues. Additionally, infections acquired during hospitalization, particularly those caused by antibiotic-resistant bacteria, result in more fatalities than AIDS, tuberculosis, and viral hepatitis combined. This underscores the critical necessity for the advancement of antimicrobial implants with specialized coatings capable of combating Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA), two strains notoriously known for their antibiotic resistance. Therefore, we developed an antimicrobial coating incorporating nanoparticle mixtures using the sol-gel process and applied it to electrospun polycaprolactone (PCL) filaments, followed by thorough characterization by using spectroscopic (FTIR, Raman, NMR) microscopic (SEM and SEM-EDX), and tensile test. The results have shown that the integration of electro-spinning technology for yarn production, coupled with surface modification techniques, holds significant potential for creating antimicrobial materials suitable for medical implants for surgical repairs.

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.

Shoulder balloon spacer for massive irreparable rotator cuff tears results in significant improvements.

The aim of the present study was to assess the effectiveness of balloon implantation in patients with irreparable supraspinatus tears alone or in combination withother rotator cuff (RC) tendon tearsand the effect of several covariables, such as age, gender, status of the long head biceps, with or without tendon repair and regardless the number of tendon involved. Patients enrolled from 'San Carlo' Hospital of Potenza (Italy, IT), from January 2012 to September 2014, underwent arthroscopic implantation of shoulder balloon by a single surgeon, and followed for 3 years. The American Shoulder and Elbow Surgeons (ASES) and Constant score (CS) were administered pre-, post-operatively at 12 months, and then annually. Patients were classified on the basis of the number of tendons involved in the tears and treatment performed, considering the reparability of the tendons themselves. Gleno-humeral joint osteoarthrosis (OA) was evaluated through shoulder radiographs and classified according to the Samilson-Prieto classification, at the first examination and at the final follow-up. Statistical improvements were evaluated using a variance model (least-squares means)and a T distribution test for the evaluation between different treatment groups. A total of 61 procedures were performed, and eight patients were lost during follow-up. The mean baseline CS was 30.2 ± 15.4 with statistically significant improvement, respectively, at 1-, 2- and 3-year follow-up to 69.3 ± 4.2, 74.6 ± 3.6 and 69.7 ± 5.1 respectively. ASES score at baseline was 22.5 ± 10.9, with a statistically significant improvement to 69.7 ± 9.2, 68 ± 17.8 and 71.2 ± 16.6 at 1-, 2- and 3-year follow-up, respectively. Tenotomy or absence of long head biceps at presentation did not influence results (n.s.), with no difference according to gender and age. At final follow-up, 24 patients (43.9%) showed progression of glenohumeral OA. One patient required secondary surgery for shoulder replacement after 18 months for persistent pain and one patient required implant removal following post-operative laser treatment. Arthroscopic rotator cuff tears repair with subacromial spacer balloon implantation showed statistically significant clinical and functional improvement at 3-year follow-up. Patients treated with combined partial repair and subacromial spacer balloon implantation experienced good results independent of gender, age, type of tear and long-head biceps tendon status. The risks related to this procedure appear to be minimal. Level IV.

Clinical Outcomes After Mini-Open Subpectoral Biceps Tenodesis

Background Long head of the biceps tendon pathology is a common cause of shoulder pain. Current surgical treatment options for long head of the biceps tendon disorders include tenotomy and tenodesis. Younger and high-demand patients are usually treated with tenodesis since tenotomy is associated with increased biceps pain and cramping, cosmetic deformity and patient dissatisfaction. Previous studies have shown biomechanical advantages of subpectoral open approach over arthroscopic suprapectoral approach, with less biceps over tension and increased ultimate load to failure. Despite this, there is a lack of consensus in the literature regarding the management of biceps-related pathology. Methods We retrospectively reviewed all patients who underwent subpectoral biceps tenodesis with unicortical endo-button fixation between January 2015 and December 2019. Only patients who had a minimum of 24 months follow-up were included in the study. We reviewed patient demographics. The American Shoulder and Elbow Surgeons and Visual Analogue score were assessed and complications were recorded. Results A total of thirty-two patients were enrolled in this study. 15 were young patients and sports athletes with SLAP (Superior Labrum from Anterior to Posterior) lesions or isolated biceps instability and the remaining 17 were middle-age patients with degenerative biceps disease and concomitant pathology. The mean follow-up time was 36 months. SLAP lesions group average age was 24,3 and degenerative group average age was 53,8. The ASES score and the VAS score and were statically significative better in the isolated subpectoral tenodesis due to SLAP lesions 99,8 and 0,1 respectively in comparison with the degenerative group, 85,7 and 1,5 respectively. We recorded two complications. One case of superficial infection and one case of a patient that was concomitant submitted to arthroscopic rotator cuff tear repair with persisting shoulder pain. There was no case of failure of fixation or associated Popeye deformity. Conclusions Subpectoral biceps tenodesis with unicortical endo-button fixation is a viable treatment option for patients with symptomatic biceps disease. Anterior shoulder pain and biceps symptoms were resolved with this technique. Patients with coexistent rotator cuff lesion may have less favorable outcomes.

Critical shoulder angle and acromial index do not influence functional outcomes after repair of massive rotator cuff tears

ObjectivesCritical shoulder angle (CSA) and acromial index (AI) are two radiographic signs that can influence the risk of rotator cuff tears and the outcomes of repair. The purpose of this study was to determine the influence of CSA and AI on massive cuff tears and on the functional outcomes after repair. The hypothesis was that CSA and AI would be higher in posterosuperior compared to anterosuperior tears. MethodsCSA and AI were retrospectively measured on radiographs of patients who underwent repair of two rotator cuff tendons. Functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score and Simple Shoulder Test (SST) at least six months postoperatively. Patients were divided according to the tendons repaired into anterosuperior group and posterosuperior group. Radiographic measurements and functional outcomes were compared. Patients in the posterosuperior group were subdivided into low or high CSA (cut-off value ​= ​39), and into low or high AI (cut-off value ​= ​0.75). All available preoperative magnetic resonance images were reviewed and graded according to Goutallier classification. Multivariate analysis was used to determine the influence of CSA, AI and Goutallier grade on functional outcomes. ResultsEighty six patients were included. Both CSA and AI were statistically significantly higher in the posterosuperior group (p ​= ​0.0143 and 0.0052, respectively). After a mean follow-up of 33 months, ASES and SST were significantly better in patients with Goutallier grades 0–1 than grades>1 (multivariate p ​= ​0.03 and 0.009, respectively). No statistically significant differences were found between low and high CSA and AI groups in terms of functional outcomes of the posterosuperior group after repair (multivariate p ​= ​0.9). ConclusionHigher CSA and AI seem to increase the risk of posterosuperior more than anterosuperior rotator cuff tears. Neither of these radiographic parameters influenced the functional outcomes of massive posterosuperior tears after repair. Level of evidenceLevel III.

Comparison of Knotless Versus Knot-Tying Suture Anchors for Arthroscopic Repair of Hip Labral Tears.

Both knotless and knot-tying anchors are commonly employed in the arthroscopic repair of hip labral tears. To compare the midterm clinical results of arthroscopic hip labral repair using knot-tying versus knotless suture anchors. Cohort study; Level of evidence, 3. Patients who underwent arthroscopic hip labral repair between January 2017 and January 2021 and who had at least 2 years of follow-up were included. The patients were divided into 2 groups based on the suture anchor type: a 2.9-mm knotless suture anchor (knotless group) or a 1.8-mm knot-tying suture anchor (knot-tying group). All patients underwent femoroplasty for cam lesions and acetabular rim trimming for pincer lesions. The modified Harris Hip Score (mHHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain were administered both preoperatively and postoperatively. The consistency of the outcome scores was assessed using the minimal clinically important difference and Patient Acceptable Symptom State. The statistical significance between groups was evaluated using the Mann-Whitney test and quantile-based analysis of variance. A total of 413 patients were included: 256 patients in the knotless group (median age, 35 years [interquartile range, 31-38 years]; median follow-up, 34 months) and 157 patients in the knot-tying group (median age, 34 years [interquartile range, 30-38 years]; median follow-up, 25 months). There were no significant differences in postoperative mHHS, HOS-ADL, or iHOT-12 scores between the 2 groups. However, there were significant differences, favoring the knotless group over the knot-tying group, in postoperative HOS-SSS (87 ± 2 vs 86 ± 1, respectively) and VAS pain (1 vs 2, respectively) scores (P < .0001 for both). Postoperative synovitis was found in significantly more patients in the knot-tying group than in the knotless group (17 vs 5, respectively; P = .01). In this study, patients who underwent arthroscopic hip labral repair with knotless suture anchors had slightly better postoperative HOS-SSS and VAS pain scores and a lower incidence of postoperative synovitis compared with patients who underwent repair with knot-tying suture anchors.

Restoring the Anteroposterior Shoulder Force Couple: Arthroscopic-Assisted Lower Trapezius Tendon Transfer With Partially Augmented Rotator Cuff Repair for Irreparable Massive Rotator Cuff Tears

Lower trapezius transfer presents a highly encouraging therapeutic approach for addressing posterosuperior irreparable massive rotator cuff tears. Based on studies on the balance of force couples of the rotator cuff, more scholars believe that attention should be paid to the reconstruction of the force couples of the rotator cuff. This study proposes a modified surgical approach that integrates an arthroscopic-assisted lower trapezius transfer with autologous hamstring tendon and partially augmented rotator cuff repair for irreparable massive rotator cuff tears, with a focus on restoring the anterior-posterior shoulder force couple.

Repair of Isolated Subscapularis Tears With Concurrent Biceps Tenodesis Using a Single Anchor Results in Satisfactory Clinical Outcomes: Minimum 2-Year Follow-Up

PurposeThe aim of the present study was to investigate the clinical outcomes of patients treated with isolated subscapularis tear repair and biceps tenodesis using a single anchor. MethodsPatients diagnosed with subscapularis tear and underwent arthroscopic surgery by a single surgeon between February 2017 and January 2022 were retrospectively evaluated. Inclusion criteria were patients who underwent repair of isolated subscapularis tear along with tenodesis for LHBT pathologies such as superior labrum anterior posterior (SLAP) lesion, instability, partial tear or tenosynovitis, with a minimum follow-up of 24 months. Assessment included active and passive range of motion (ROM), single-assessment numeric evaluation (SANE), visual analog scale (VAS),Constant-Murley score (CMS), and specific subscapularis and biceps tests. Improvements were analyzed using Minimum Clinically Important Difference (MCID) values. ResultsA total of 20 patients were included. The mean age was 48.5±7 years, and the follow-up period was 43.1±12.7 months. Significant improvements were observed at the final follow-up in active forward flexion, active abduction, active internal rotation, as well as VAS, SANE, and CMS (p< 0.001). The MCID analysis showed that 100% of patients met the MCID for CMS, 90% for SANE, and 100% for VAS. ConclusionIn the presence of an isolated subscapularis tear associated with LHBT pathologies, favorableclinical outcomes could be achieved by performing both tear repair and biceps tenodesis with a double-loaded single anchor. A majority of patients (>90%) achieved the MCID for the CMS, SANE and VAS, indicating significant clinical improvement and satisfactory patient outcomes. Level of EvidenceLevel IV, Case series

A comprehensive analysis of the acromial morphology and etiological factors of partial rotator cuff tears

BackgroundRotator cuff tears are divided into complete and partial tears, and partial rotator cuff tears include articular-sided tears and bursal-sided tears. Tears are caused by extrinsic, intrinsic, or traumatic factors; however, the mechanisms by which partial tears occur remain unknown. Recent reports have described the correlation between acromial morphology and rotator cuff tears. To date, no reports have investigated acromial morphology in partial tears. The purpose of this study is to evaluate the incidence of abnormal acromial morphology in both partial articular-sided and bursal-sided rotator cuff tears. MethodsPatients with supraspinatus tendons that had articular-sided tears were categorized into Group A, and patients who had bursal-sided tears were categorized into Group B. Patients who underwent arthroscopic rotator cuff repair for rotator cuff tears were assessed based on their diagnosis of Group A or Group B according to arthroscopic findings. The following items were examined: age, sex, presence of diabetes mellitus, acromiohumeral distance (AHD), critical shoulder angle (CSA), lateral acromial angle (LAA), sagittal and coronal morphologies of the acromion, and traumatic shoulder tears. ResultsThere were 39 patients in Group A and 95 patients in Group B. A significantly greater rate of presence of diabetic was found in the JST group. There were no significant differences in age, sex, or frequency of traumatic shoulder tears. The mean AHD, CSA, and LAA in Group A and Group B were as follows: AHD, 9.4±1.5 and 9.3±1.4 mm; CSA, 32.1±4.6 and 35.3±4.4 degrees; LAA, 82.2±7.2 and 79.9±7.0 degrees. There were no significant differences between the groups. Although the CSA was significantly greater in Group B, there was no significant difference in the AHD or LAA. There was no significant difference in sagittal acromial morphology; however, Group B had significantly more inferior osteophytes of the acromial center in the coronal plane. ConclusionsGroup B was found to have a significantly larger mean CSA compared to group A. Group B occurred more often in patients with inferior osteophytes of the acromial center on the acromion, suggesting the involvement of extrinsic factors.

Arthroscopic Assessment of the Incidence of Biceps Pulley Lesions Associated With Rotator Cuff Tears: An Observational Study.

The shoulder joint houses a stabilizing structure called the biceps pulley. Biceps pulley lesions can trigger anterior shoulder pain and frequently coincide with rotator cuff tears, whose prevalence rises with age. In our study, we aim to assess the incidence of biceps pulley lesions associated with rotator cuff tears in patients undergoing arthroscopic repair, the possible associated factors, and whether MRI findings were correlated with them. This study was a prospective observational one conducted at Al-Hadra University Hospital. The patients aged 40 to 65 years were indicated for arthroscopic repair of a rotator cuff tear. We used IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. to conduct the analysis. A total of 60 patients were enrolled in the study. The mean age was 50.97 ± 6.90. The overall incidence of biceps pulley lesions was 85%. Older age was found to be significantly associated with increased incidence. On the other hand, gender, and the mode of injury (cuff tear) had no significant associations with the incidence. Also, formal MR had no significance in diagnosing biceps pulley lesions. The overall incidence of biceps pulley lesions in the current study was 85%. The older the patient with a cuff tear, the greater the incidence of finding a pulley lesion arthroscopically. Moreover, MRI did not have a significant role in diagnosing the biceps pulley lesions.

The addition of mesenchymal stem cells in a bioabsorbable scaffold does not enhance tendon healing after a repair of rotator cuff tear.

The purpose of the study is to evaluate the healing potential of a full-thickness tendon defect in the rotator cuff of rabbits using a bioabsorbable scaffold impregnated with bone marrow-mesenchymal stem cells (BM-MSCs) or rotator cuff-derived mesenchymal stem cells (RC-MSCs). Sixteen adult rabbits were subjected to a full-thickness rotator cuff deficit. Rabbits were randomly assigned to four groups of four animals. In Group 0 (control), the deficit was left untreated. In Group 1, the deficit was treated with a single synthetic scaffold alone. In Group 2, the deficit was treated with the previous scaffold loaded with allogeneic BM-MSCs. In Group 3, the deficit was treated with the previous scaffold loaded with allogenic RC-MSCs. After animal sacrifice, tissue samples were subjected to histological and immunohistochemical analysis. Group 1 showed the highest mean tendon maturing score (15.3 ± 0.9) postoperatively, being significantly higher, in comparison to groups 0, 2 and 3 (p = 0.01, 0.02 and 0.01, respectively). Group 1 showed the highest mean collagen I/collagen III ratio (1.4 ± 0.8) postoperatively but without any statistical significance. The utilization of MSCs in rotator cuff repair in a rabbit model has not been associated with an enhancement in tendon healing in 16 weeks postoperatively, in comparison to controls and bioabsorbable scaffolds. The addition of MSCs does not result in better rotator cuff healing. Not applicable. This is an animal study.

Utility of pig head model as an oculoplastic wet lab surgical training tool

ABSTRACT Purpose To assess the utility of pig head model as an oculoplastic surgical training tool. Methods Fresh pig head was availed for surgical workshop for entropion correction, eyelid margin repair, and evisceration with implant for oculoplastic surgery-naïve participants. Skill improvement, surgical understanding, and performance of the participants were evaluated both subjectively and objectively by trained oculoplastic surgeons. Subjective assessment was done by a standardized questionnaire based on Likert scale shared with the participants post training. Objective evaluation was done by the faculty based on a three-point scale and a competency-based surgical assessment rubric. Results There were 18 surgery-naïve participants in the workshop which comprised ophthalmology residents and comprehensive ophthalmologists. About 88.88% of the participants were able to perform the lid margin and sub-tarsal dissection in entropion surgery. While performing lid tear repair, 94.44% were correctly able to identify the grey line and anterior and posterior lamellae. About 83.33% of the participants were able to place an implant in the scleral shell or intraconal space. About 83.33% of the participants noted that texture and tissue maneuvering were similar to the human eye while performing surgical steps. About 94.44% of the participants reported better understanding, development of skill and additional confidence after training. The median score on objective assessment was 3. The performance on real patients resulted in a median score of 4 for entropion correction. Conclusion Porcine orbital dissection is an available, affordable, and useful tool for oculoplastic surgical training. Training on porcine model can improve anatomical understanding, clinical judgement, and surgical efficiency in trainees.

Case Report : Navigating the uncommon: Medicopsis romeroi-induced corneal ulcer

Abstract* This report details a rare case of corneal infection caused by Medicopsis romeroi, highlighting clinical presentation, diagnostic methods, treatment, and outcome. An early adolescence male, after recent corneal tear repair, presented acute eye pain, redness, and decreased vision for 1 day. He underwent corneal tear repair elsewhere post vegetative matter-related swimming injury. Ophthalmic examination revealed a 2.5*3.3mm ulcer around sutures. Corneal scrapings enabled microscopy and culture. With lesion worsening, tissue adhesive (TA) and bandage contact lens (BCL) were applied. Fungal culture identified Medicopsis romeroi. Patient's history, clinical course, and treatment were documented. Microscopy unveiled fungal hyphae, later confirmed as Medicopsis romeroi. Treatment included topical/systemic antifungals. Post-TA + BCL, significant improvement followed, with re-epithelialization, scarring. This report underscores the importance of considering rare fungal pathogens like Medicopsis romeroi in cases of corneal ulcers, especially in individuals with unusual risk factors. Timely diagnosis through microscopy and fungal culture, coupled with tailored antifungal treatment led to successful management and favorable patient outcomes. This case also emphasizes the significance of vigilant clinical observation, precise laboratory analysis, and multidisciplinary collaboration between ophthalmologists and microbiologists in managing atypical ocular infections.

Acromioplasty combined with arthroscopic rotator cuff repair can reduce the risk of reoperation: a systematic review and meta-analysis

ABSTRACT Background Whether to perform acromioplasty in arthroscopic rotator cuff repair (ARCR) is controversial, and the optimal surgical approach for rotator cuff tear repair is unknown. The purpose of this study was to compare the reoperation rate, retear rate and patient-reported outcomes (PROs) of ARCR with those of ARCR combined with acromioplasty (ARCR-A). Methods PubMed, Embase and Cochrane Library were searched for relevant literature dated between database inception and 4 December 2023. The primary outcomes of this study were the reoperation rate and the retear rate. The secondary outcomes were PROs, including the visual analogue scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the University of California-Los Angeles (UCLA) score, the Constant score and the Western Ontario Rotator Cuff (WORC) score. The quality of the included studies was evaluated by using the risk of bias assessment tool. RevMan 5.3 software was used for meta-analysis. Fixed (I2 <50%) or random (I2 ≥50%) effects models were applied to calculate the effect size. Results Meta-analysis revealed that ARCR-A had a lower reoperation rate (OR = 0.35, 95%CI: 0.15-0.85, p = 0.02), but the difference in the retear rate between ARCR-A and ARCR was not significant (p = 0.25). In type 2 acromion patients, the reoperation rate was not significantly different between ARCR and ARCR-A (p = 0.12), but, for type 3 acromion patients, the retear rate was lower for ARCR-A than for ARCR (OR = 0.12, 95%CI: 0.01-0.94, p = 0.04). There were statistically significant differences in the 6-month postoperative Constant scores (p < 0.001), VAS pain scores (p = 0.003) 12-month postoperative ASES scores (p = 0.02) and 24-month postoperative WORC scores (p = 0.04), but these differences were not clinically significant. Conclusions Combining ARCR with acromioplasty can reduce the rate of reoperation, especially in patients with type 3 acromion, but it provides no clinically important change in the retear rate and postoperative PRO compared with ARCR.

Practical use of transanal decompression tube following the repair of fourth-degree perineal tears associated with vaginal delivery

BackgroundFourth-degree perineal tears associated with vaginal delivery (PTAVD) occur in approximately 0.25 to 6% of vaginal deliveries. A persistent challenge in treating fourth-degree PTAVD is the high incidence of anastomotic leakage, leading to impaired quality of life, marked by incontinence, rectovaginal fistula, and painful sexual intercourse. Thus, effective interventions are necessary. Herein, we report our successful approach in repairing a fourth-degree PTAVD, involving the placement of a transanal decompression tube (TDT) during the early postoperative period.Case presentationFive patients underwent the repair of fourth-degree PTAVD by suturing the mucosal and muscular layers of the rectum, and the vaginal wall in layers. Subsequently, a TDT was placed in the rectum, positioned 10–15 cm from the anal verge. The TDT was allowed to drain spontaneously without suction. Gastrografin enema examination was performed through a TDT, followed by a computed tomographic scan on postoperative days 3–4. After unfavorable complications were ruled out, the TDT was removed and the patients were transitioned to a normal diet.ResultAll patients showed favorable outcomes with no occurrence of vaginal fistula or incontinence.ConclusionThis simple intervention demonstrates potential efficacy in reducing anastomotic leakage following the repair of fourth-degree PTAVD.

Poster 303: Outcomes Following Repair of Radial Meniscus Tears Compared to Bucket Handle Meniscus Tears

Objectives: Preserving the meniscus has become a priority in managing meniscal tears with advancement of meniscus repair techniques. Meniscal repair, as opposed to partial meniscectomy, reduces risk of development and progression of knee osteoarthritis. Radial meniscus tears have traditionally been associated with a poor prognosis because they occur perpendicular to circumferential meniscal fibers, compromising hoop tension. Advances in surgical technique and biologic augmentation have facilitated repair of these complex injuries. The purpose of this study was to compare post-operative complication and surgical revision rates in patients who underwent repair of a radial meniscus tear versus bucket-handle meniscus tear. We hypothesized the outcomes of repair of radial meniscus tear would be similar to a matched group of patients who underwent repair of a bucket handle meniscus tear. Methods: A retrospective study was performed to identify patients who underwent repair of radial meniscus tear. Chart review was performed for 1506 patients who underwent meniscus repair from 2012 to 2019, and demographic information, type of meniscus tear, concomitant ACL reconstruction, post-operative complications, repeat surgeries, and failure at the repair site were detailed in a database. Patients who underwent repair of a radial tear were matched with patients who underwent repair of a bucket-handle tear based on sex, age (within 5 years), BMI (within 5 kg/m2), meniscus laterality, and concomitant ACL reconstruction. Isolated meniscus repairs were augmented with platelet rich plasma (PRP). Results: Fifty patients (age, 31.8 ± 15.2 years; BMI, 30.2 ± 6.4 kg/m2) were identified who underwent a radial meniscus tear repair. Of these patients, 16 (32.0%) were female and 23 (46.0%) underwent concomitant ACL reconstruction. Complications including recurrent swelling, stiffness, persistent pain, and repeat injury were reported in 15 patients (30.0%). Six patients underwent repeat surgery (12.0%). Four repeat surgical patients, who had previously undergone meniscus repair and concomitant ACL reconstruction, were found to have an intact radial repair at the time of second surgery, and underwent repeat surgery for a reason unrelated to the radial tear repair (e.g. cyclops lesion, synovectomy, new meniscus tear). Two patients had a radial tear repair failure that required surgical revision (4.0%). Radial tear repair patients who underwent concomitant ACL reconstruction differed significantly from those who did not only in age (ACL group, 26.0 ± 10.9 y; non-ACL group, 36.6 ± 16.7 y; p = 0.03). There were no significant differences in post-operative complications, repeat surgeries, or failures between the radial and bucket-handle tear repair patients. Conclusions: Repair of radial meniscus tears with contemporary techniques and biological enhancement with either ACL reconstruction or PRP can be expected to have similar outcomes to repairs of bucket handle meniscus tears.

Poster 154: Arthroscopic Rotator Cuff Repair With Side-to-Side Sutures for Full-Thickness Transtendinous Supraspinatus Tears Yields Excellent Outcomes and Low Retear Rates Similar to Traditional Tendon-to-Bone Fixation at Mean Follow Up of 4 Years

Objectives: Full-thickness transtendinous supraspinatus tears involve a large portion of the tendon that remains attached to the footprint that often leaves insufficient medial tissue for tension free footprint restoration with traditional suture anchor repair. The aim of this study was to compare outcomes and failure rates for arthroscopic side-to-side suture repair for transtendinous tears to traditional double-row repair for more common tendon avulsions. We hypothesized poorer objective and subjective outcomes as well as higher retear rates for side-to-side suture repair. Methods: This was a retrospective cohort study of 18 consecutive patients with full-thickness transtendinous supraspinatus tears repaired with arthroscopic side-to-side sutures (Group 1) compared to 36 matched controls with classic tendon avulsion from the footprint repaired with double-row knotless transosseous equivalent (TOE) repairs (Group 2). All procedures were performed by a single surgeon with a minimum of 2 years follow-up. Demographics and prospectively collected patient reported outcomes (PROs) were collected including postoperative active range of motion (AROM), American Shoulder and Elbow Surgeons (ASES) score, Visual analog scale (VAS) for pain, and Subjective Shoulder Value (SSV). Failure defined as a symptomatic re-tear diagnosed on magnetic resonance imaging (MRI) or need for revision surgery was also determined. Preoperative tear size and Goutallier stage were recorded from MRIs. Results: There were no significant differences between Group 1 and Group 2 regarding mean follow-up (49 months vs. 52.4 months, p = 0.640) and age (68.7 ± 6.8 vs. 67.1 ± 9.6, p = 0.550). With respect to clinical outcomes and PROs, there were no differences in postoperative VAS for pain score (1 ± 1.54 vs 1.5 ± 2.1, p = 0.537), SSV score (92.2 ± 9.1 vs 87.1 ± 10.9, p = 0.086), or ASES score (90.8 ± 9.9 vs 83.1 ± 23.9, p = 0.377). No differences were identified for postoperative AROM forward flexion (153 ± 14 vs 156 ± 16, p= 0.194), external rotation (53 ± 6 vs 51 ± 9, p= 0.498) and internal rotation score (6.4 ± 1.8 vs 7.2 ± 1.2, p=0.244). There was no statistically significant difference in failure rates between cohorts (11.1% vs. 2.7%, p = 0.255). Regarding preoperative tear characteristics, fatty infiltration of the supraspinatus (1.2 ± 1 vs 1.5 ± 0.7, p= 0.307) and anteroposterior tear size were similar (21.3 ± 9.3 vs 24 ± 8, p = 0.322), although lower grades of fatty infiltration in the infraspinatus was present in Group 1 (0.3 ± 0.6 vs 1.1 ± 0.7, p &lt; 0.001). Conclusions: Arthroscopic side-to-side suture repair for supraspinatus tears yields excellent outcomes with low failure rates comparable to tendon-to-bone double suture anchor repair for typical avulsion type tears. Retention of the large tendon stump on the greater tuberosity with side-to-side repair also allows restoration of anatomy without undue tension in this uncommon scenario.

Good mid- to long-term outcomes after meniscus bucket-handle tear repair: A comparative analysis with and without anterior cruciate ligament reconstruction.

To evaluate mid- to long-term clinical outcomes after arthroscopic bucket-handle meniscal tear (BHMT) repair and to assess the impact of concurrent anterior cruciate ligament reconstruction (ACLR). A comparative retrospective case series with blinded outcome assessment was conducted. All consecutive patients treated with arthroscopic BHMT repair with or without concurrent ACLR between 2001 and 2021 were eligible for inclusion. Fifty-five patients with an average follow-up of 7.3 ± 3.4 years were included in the analysis. Outcome measures comprised post-operative IKDC Subjective Knee Form, Lysholm Score, Tegner Activity Scale, KOOS, and visual analogue scale (VAS) for satisfaction. Additionally, failure and reoperation rates were assessed. The failure rate was 9%. Medial BHMT repair showed superior post-operative IKDC scores compared to lateral meniscus repair (p = 0.038). Concurrent ACLR did not demonstrate any impact on post-operative KOOS, IKDC, Tegner or patient satisfaction. The mean IKDC score at final follow-up across both groups was 80.4 ± 17.8. The mean Lysholm score was 86.9 ± 16.7. Mean KOOS scores were (i) symptoms: 83.6 ± 18.3, (ii) pain: 90.2 ± 14.4, (iii) activities of daily living: 93.6 ± 15.1, (iv) sports: 78.3 ± 26.0 and (v) quality of life: 70.5 ± 24.5. Mean patient satisfaction (VAS) was 7.9 ± 2.5. The mean Tegner score was 4.9 ± 1.9. A consistent positive correlation between the number of sutures used and post-operative outcome measures was observed but did not reach statistical significance for most items. Arthroscopic BHMT repair achieved good clinical outcomes and an acceptable failure rate of 9% at a mean follow-up of 7 years, supporting the clinical value of meniscal repair, including large BHMTs. Concurrent ACLR showed no impact on clinical outcomes. Level IV (retrospective case series).

Paper 29: Incidental Teres Minor Atrophy in Patients Undergoing Arthroscopic Rotator Cuff Repair of the Supraspinatus Occurs Frequently and is Associated with Worse Postoperative Outcomes Without Higher Failure Rates

Objectives: Fatty infiltration and rotator cuff atrophy has been associated with poor clinical outcomes during rotator cuff repairs. Compared to supraspinatus and infraspinatus atrophy there has been minimal research on the effect of teres minor atrophy on surgical outcomes and failure rates in rotator cuff repairs. The purpose of this study was to assess the incidence and outcomes of arthroscopic rotator cuff repairs (ARCR) for partial and full thickness supraspinatus tears in patients with incidentally identified teres minor fatty infiltration. Methods: A consecutive series of 272 shoulders from 256 patients who underwent arthroscopic, double row transosseous equivalent repairs by 3 fellowship trained surgeons with minimum 1 years follow up for partial and full thickness tears of the supraspinatus tendon was reviewed. Revision repairs and concomitant subscapularis repairs were excluded. Preoperative MRI was reviewed to classify teres minor fatty infiltration using the modified Goutallier classification. Preoperative and postoperative range of motion, strength, visual analog scale (VAS), subjective shoulder value (SSV), Patient-Reported Outcomes Measurement Information System (PROMIS) mental/physical health, American Shoulder and Elbow Surgeons Shoulder Score (ASES), and Brophy shoulder activity scores were collected. Failure defined as a symptomatic retear identified on postoperative MRI or need for revision surgery was also collected. Paired t-tests, Chi-squared, and Fisher’s exact tests were utilized for continuous and binary variables, respectively. Statistical significance was at p &lt; 0.05. Results: A total of 106 patients met the inclusion criteria with 47 partial thickness tears and 59 full thickness tears. The average age of 67 and average follow-up of 30 months (range 10-92) were included. Tear size (16.37 vs 13.62, p = 0.30), and Goutallier classification of supraspinatus (0.51 vs 0.62, p =0.41), and infraspinatus (0.42 vs 0.47, p = 0.81) did not differ between the two groups. Incidental teres minor fat infiltration was present in 53% of cases with an overall frequency in Goutallier stage as follows: 47% - Grade 0, 38% - Grade 1, 14% - Grade 2, 1% - Grade 3, and 0% - Grade 4. For partial tears, postoperative PROMIS mental and physical scores were significantly better in those without teres minor fatty infiltration versus in those without (16.7 vs 14.3, p=0.01; 15.5 vs 13.5, p=0.02), while ROM, strength, and PROs were not statistically significant. For full tears, those without fat infiltration had statistically significantly better PROs on PROMIS physical (16.25 vs 14.07, p=0.01), ASES (83 vs 63, p=0.02), Brophy (8.3 vs 5.2, p=0.02), and SSV scores (94 vs 83, p=0.046). No other differences in ROM, strength, and other PROs were identified. No differences were identified for retear and revision rates among patients regardless of fatty infiltration (partial: retear, 7.7% vs 9.5%, p = 0.59; revision, 7.7% vs 9.5%, p = 0.59; revision, 12.5% vs 5.7%, p = 0.18). Conclusions: Our study demonstrates that incidentally noted teres minor fatty infiltration occurs in over 50% of patients undergoing arthroscopic rotator cuff repair for full thickness supraspinatus tears and is associated with worse postoperative outcome scores without higher failure rates. Compared to full thickness tears, teres minor atrophy in partial thickness tears showed a lesser effect on outcome scores with only significantly worse post operative PROMIS mental and physical scores. Identification of these patients preoperatively with strategies to optimize may be necessary to improve outcomes.