Outcomes Of Rotator Cuff Repair Research Articles

Long-term functional and structural outcome of rotator cuff repair in patients 60 years old or less.

The long-term outcomes of rotator cuff repair (RCR) have not been well studied. The purpose of this study was to evaluate long-term functional and structural outcomes after RCR in younger patients. A total of 49 patients (34 [69%] male) with a mean age of 51±6 years were evaluated preoperatively, and at short- and long-term follow-ups (minimum 15 years). There were 13 (27%) small, 17 (35%) medium, 14 (29%) large, and 5 (10%) massive tears. 15 (31%) had an acute repair of a traumatic tear. Long-term evaluation included physical examination, plain radiographs, ultrasound, and patient reported outcome measures (PROMs) (visual analog scale pain, Disability of Arm, Shoulder and Hand, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, and Short Form-36). Statistical analysis was performed to determine associations between preoperative and intraoperative factors and long-term functional and structural outcome. There were significant improvements in the mean short- and long-term PROMs compared to preoperatively that exceeded reported minimal clinically important differences and substantial clinical benefits. There was a slight decrease in the PROMs from the short-term to long-term follow-up. Male sex and traumatic rotator cuff tears were associated with better long-term outcomes. The number of medical co-morbidities was associated with worse long-term outcomes. Smaller initial tear size was associated with better long-term outcomes. There were 15 (31%) full thickness and 9 (18%) partial thickness recurrent rotator cuff tears, 17 (35%) had rotator cuff tear arthropathy (2 Hamada grade 1, 15 Hamada grade 2), 5 (10%) had revision surgery (2 revision RCR, 2 anatomic total shoulder, and 1 reverse total shoulder), and 13 (26%) had subsequent contralateral RCR. There were weak correlations between the presence of arthropathy and DASH (r=0.34; P=.02) and visual analog scale pain (r=0.29; P=.049). There were no significant correlations between the structural outcomes (recurrent rotator cuff tear, recurrent full thickness tear, acromiohumeral space, and critical shoulder angle,) and the PROMs. Long-term follow-up of RCR in this relatively young patient cohort demonstrated substantial and durable patient reported functional outcome and improvement despite considerable structural deterioration. This suggests that while RCR does not arrest the progression of rotator cuff disease it may delay this progression and that patients adapt to the structural changes as they age.

Equivalent Functional Outcomes of Rotator Cuff Repair in Patients Above 70yrs in an Appropriately Selected Cohort Can Be Achieved: An Observational Case-Control Comparative Study

Equivalent Functional Outcomes of Rotator Cuff Repair in Patients Above 70yrs in an Appropriately Selected Cohort Can Be Achieved: An Observational Case-Control Comparative Study

Effect of Quality of Repair on Clinical and Structural Outcomes of Rotator Cuff Repair

Background: Anatomic repair of a torn rotator cuff tendon on the greater tuberosity (GT) is an important surgical goal in rotator cuff repair. However, few studies have investigated whether the efforts made to maximize coverage of the GT are associated with the clinical and structural outcomes after rotator cuff repair surgery. Purpose: To investigate whether the quality of repair at the time of surgery is associated with clinical and structural outcomes after surgery and to identify factors influencing the quality of repair. Study design: Cohort study; Level of evidence, 3. Methods: Data were retrospectively collected from 141 patients who underwent arthroscopic rotator cuff repair between 2008 and 2016. All repairs were classified according to the amount of postoperative GT coverage: A, complete coverage of the GT (n = 96); B, incomplete coverage, comprising more than half of GT (n = 27); C, incomplete coverage, comprising less than half of the GT (n = 16); and D, exposure of the glenohumeral joint (n = 2). All patients underwent magnetic resonance imaging 1 year after surgery. Clinical outcomes and structural integrity based on Sugaya classification were assessed 2 years and 1 year after surgery, respectively. Preoperative factors associated with the postoperative GT coverage (measured at the close of surgery) were identified using a multivariable proportional odds cumulative logit model. Results: The forward flexion strength in group A (10.3 ± 4.6 lb) was significantly greater than that in group C (6.5 ± 3.7 lb) (P = .003) 2 years after surgery. The postoperative Constant score in group A (76.6 ± 11.5) was greater than that in group C (66.7 ± 15.6) (P = .018). The number of cases that showed retearing of the repaired tendon was as follows: group A (5/96; 5.2%), group B (7/27; 25.9%), and group C (10/16; 62.5%). There was no significant difference in the changes of pain visual analog scale scores among groups 2 years after surgery (all P > .05). Also, there was no significant difference in the changes of range of motion in all directions among groups 2 years after surgery (all P > .05). Patients with preoperative GT coverage B included in the postoperative GT coverage groups through surgery were as follows: group A (23/45; 51.1%), group B (17/45; 37.8%), and group C (5/45; 11.1%). Preoperative GT coverage was the only independent factor that was associated with GT coverage in multivariable analysis. Conclusion: Quality of repair, measured as the extent of postoperative GT coverage at the time of surgery, was associated with clinical and structural outcomes after rotator cuff repair surgery.

Rotator Cuff Repair With Patch Augmentation: What Do We Know?

Repair of massive rotator cuff tears remains a challenging process with mixed success. There is a growing interest in the use of patches to augment the repair construct and the potential to enhance the strength, healing, and associated clinical outcomes. Such patches may be synthetic, xenograft, or autograft/allograft, and a variety of techniques have been tried to biologically enhance their integration and performance. The materials used are rapidly advancing, as is our understanding of their effects on rotator cuff tissue. This article aims to evaluate what we currently know about patch augmentation through a comprehensive review of the available literature. We explore the results of existing clinical trials for each graft type, new manufacturing methods, novel techniques for biological enhancement, and the histological and biomechanical impact of patch augmentation. There are promising results in short-term studies, which suggest that patch augmentation has great potential to improve the success rate. In particular, this appears to be true for human dermal allograft, while porcine dermal grafts and some synthetic grafts have also had promising results. However, there remains a need for high-quality, prospective clinical trials directly comparing each type of graft and the effect that they have on the clinical and radiological outcomes of rotator cuff repair.

Manufacture of Soft-Hard Implants from Electrospun Filaments Embedded in 3D Printed Structures.

Rotator cuff tendon tears are common injuries of the musculoskeletal system that often require surgical repair. However, re-tearing following repair is a significant clinical problem, with a failure rate of up to 40%, notably at the transition from bone to tendon. The development of biphasic materials consisting of soft and hard components, which can mimic this interface, is therefore promising. Here, a simple manufacturing approach is proposed that combines electrospun filaments and 3D printing to achieve scaffolds made of a soft polydioxanone cuff embedded in a porous polycaprolactone block. The insertion area of the cuff is based on the supraspinatus tendon footprint and the size of the cuff is scaled up from 9 to 270 electrospun filaments to reach a clinically relevant strength of 227N on average. The biological evaluation shows that the biphasic scaffold components are noncytotoxic, and that tendon and bone cells can be grown on the cuff and block, respectively. Overall, these results indicate that combining electrospinning and 3D printing is a feasible and promising approach to create soft-to-hard biphasic scaffolds that can improve the outcomes of rotator cuff repair.

Do Age, Demographics, and Tear Characteristics Affect Outcomes After Rotator Cuff Repair? Results of Over 2000 Rotator Cuff Repairs at 5-Year Follow-up.

Background:The New Zealand Rotator Cuff Registry represents the largest prospective cohort of rotator cuff repairs. Despite this, there are limited medium- to long-term data of rotator cuff repair outcomes.Purpose:To (1) analyze the pain and functional outcomes of a large cohort of primary rotator cuff repairs and (2) evaluate the effect of patient factors and tear characteristics on medium-term outcomes.Study Design:Cohort study; Level of evidence, 2.Methods:This was a multicenter, multisurgeon prospective cohort study of rotator cuff repairs from March 2009 until December 2010. Surgical data were collected by the operating surgeon. Primary outcome measures were the Flexilevel Scale of Shoulder Function (FLEX-SF) and a pain score, collected at baseline, 6, 12, and 24 months, and 5 years. Univariate and multivariate analyses were carried out.Results:Overall, 2533 primary rotator cuff repairs were analyzed with 81% follow-up at 5 years. The mean age of the cohort was 56 years. In the 2052 patients with final follow-up data, improvement on the FLEX-SF continued until 24 months postoperatively and remained high at 5 years. Mean improvement in FLEX-SF from baseline to 5 years was 15 points. Patients aged >70 years had lower FLEX-SF scores but no significant difference in improvement compared with patients ≤70 years. The mean anteroposterior tear size was 2.2 cm, and on multivariate analysis, tears >4 cm had worse 5-year FLEX-SF scores. If the affected tendon was easily reducible, there was no difference in FLEX-SF score for retracted or larger tears compared with smaller tears. The reoperation rate was 6.2%.Conclusion:Results indicated that rotator cuff repairs provide a sustained clinical improvement out past 5 years. Most functional improvement and pain relief occurred within the first 6 months, but improvement continued out to 24 months. Most population groups did well after rotator cuff repairs, including those >70 years. Tear size >4 cm and tendon reducibility correlated with outcome. Even patients with large tear sizes had clinically significant improvement in FLEX-SF scores after repair.

Outcomes after arthroscopic repair of rotator cuff tears in the setting of mild to moderate glenohumeral osteoarthritis.

BACKGROUNDRotator cuff pathology is a very common source of shoulder pain. Similarly, osteoarthritis of the glenohumeral joint can cause shoulder pain and produce similar symptoms. Surgical management can be indicated for both pathologies, however, outcomes data is limited when examining rotator cuff repair (RCR) in the setting of glenohumeral arthritis (GHOA). Thus, this study sought to determine outcomes for patients who undergo RCR in the setting of GHOA.AIMTo evaluate if a relationship exists between outcomes of RCR in the setting of GHOA.METHODSThis was a retrospective analysis of patients who underwent arthroscopic rotator cuff repair with concurrent glenohumeral osteoarthritis between 2010-2017. Patients were stratified based on rotator cuff tear size and glenohumeral osteoarthritis severity. Cohorts were paired 1:1 with patients without glenohumeral osteoarthritis. Patients included had a minimum two year follow-up. Rate of conversion to total shoulder arthroplasty, complication rates following initial surgery, and patient-reported outcome measures were collected.RESULTSA total of 142 patients were included. The number of patients that required total shoulder arthroplasty within two years after index surgery was low. 2/71 (2.8%) patients with GHOA, and 1/71 (1.4%) without GHOA. Following rotator cuff repair, both groups showed favorable patient-reported outcomes.CONCLUSIONPatients with glenohumeral osteoarthritis who underwent arthroscopic rotator cuff repair showed comparable outcomes to patients without glenohumeral osteoarthritis.

Mini-open Rotator Cuff Repair Can Still Be a Good Surgical Technique to Repair a Rotator Cuff

Background: The clinical outcomes of rotator cuff repair (RCR) surgeries vary because each method has its own advantages and limitations. Objectives: This study aimed to compare the short-term outcomes of arthroscopic RCR (ARCR) and mini-open RCR (MRCR). Methods: In this study, we included 49 patients with a diagnosis of full rotator cuff tear who had undergone ARCR and MRCR at Poursina Hospital of Rasht and Akhtar Hospital of Tehran from 20 March 2017 to 20 March 2020. The patients were divided into ARCR (n = 24) and MRCR (n = 25) groups. The two surgical procedures were compared with each other before surgery and three and six months after surgery in terms of shoulder function based on UCLA, disability based on QUICKDASH, range of motion (ROM), and pain based on Visual Analogue Scale (VAS). Data were analyzed by chi-square, independent t-test, and repeated measures analysis of variance (ANOVA). Results: There were no differences between the groups in terms of demographic details. The mean duration of surgery was significantly higher in the ARCR group compared to MRCR group (125.5 vs. 70.42 minutes). The short-term outcomes in the two groups on three measurement occasions showed a significant improvement in shoulder function, disability, and ROM in both groups along with a reduction in pain severity (P < 0.05); however, there was no significant difference between the two groups on any of the three occasions (P > 0.05). Conclusions: Shoulder function, disability, ROM, and pain were not different between the two groups, but duration of surgery was less in MRCR group. Therefore, under the same conditions, MRCR is a better choice than ARCR due to its short duration of surgery.

Clinical outcomes of rotator cuff repair in patients with concomitant glenohumeral osteoarthritis.

Glenohumeral osteoarthritis (OA) is a common comorbidity in patients with rotator cuff tears. However, the efficacy of rotator cuff repair in patients with concomitant glenohumeral OA is still heavily debated. Thus, the purpose of this study was to compare the clinical and functional outcome measures following arthroscopic rotator cuff repairs in patients with concomitant glenohumeral OA vs. those without glenohumeral OA. A retrospective review of 206 consecutive patients who underwent arthroscopic supraspinatus repairs (both isolated and with accompanying infraspinatus and/or subscapularis involvement) between 2013 and 2018 with a minimum of 1-year follow-up was performed. Patients were separated into 2 groups based on the presence or absence of concomitant glenohumeral OA. The primary outcome was failure of repair, defined as the need for revision repair or a retear confirmed on postoperative magnetic resonance imaging. The secondary outcomes were patient-reported outcome measures including the visual analog scale pain score, Subjective Shoulder Value, and American Shoulder and Elbow Surgeons score; active range of motion (ROM); and strength testing. Within the OA cohort, a subgroup analysis was conducted to compare outcomes between patients with mild OA and patients with moderate to severe OA. There were 91 patients in the glenohumeral OA group and 115 patients in the control group. Significant differences in postoperative forward flexion (FF) ROM (153.55° ± 21.07° vs. 160.14° ± 17.26°, P = .001) and external rotation (ER) ROM (46.91° ± 11.95° vs. 52.25° ± 11.60°, P = .001) were observed between the glenohumeral OA and control groups. There were no significant differences between groups in revision repairs, retears, postoperative internal rotation ROM, all preoperative ROMs, all patient-reported outcome measures, and all strength parameters (all P > .05). For the subgroup analysis, there were 70 patients in the mild OA group and 21 patients in the moderate to severe OA group. We found a significant difference in postoperative FF strength (88.4% vs. 61.9% with 5 of 5 strength, P = .010) and ER strength (89.9% vs. 71.4% with 5 of 5 strength, P = .046) between the mild OA group and moderate to severe OA group. There were no significant differences between the groups in all other outcome measures. Rotator cuff repair remains an excellent treatment option in patients with concomitant glenohumeral OA. The data in this study demonstrate that rotator cuff repairs in patients with concomitant glenohumeral OA have similar clinical and functional outcomes to repairs in patients without OA with the exception of slightly decreased postoperative FF and ER ROM. Patients with moderate to severe OA may have slightly decreased FF and ER strength outcomes compared with patients with mild OA.

Role of Delay Between Injury and Surgery on the Outcomes of Rotator Cuff Repair: A Systematic Review and Meta-analysis

Background: Outcomes of rotator cuff repair (RCR) are influenced by several well-described factors, but the role of delay from injury to surgery on the outcomes is not clear. Purpose: To assess the role of delay to surgery on the outcomes of RCR in the literature. Study Design: Systematic review with meta-analysis; Level of evidence, 4. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. All studies assessing outcomes after RCR—either retear rates or patient-reported outcome measures (PROMs)—and reporting delay to surgery were identified through June 2021 in PubMed, Embase, and Cochrane. Inclusion criteria consisted of traumatic injuries, mean age <65 years, minimum 6-month follow-up, and assessment of retear rates with radiologic examination or reporting of PROMs. Random-effect models were used to assess outcomes, reported in odds ratio (OR) or mean difference (MD) with 95% CIs. Results: A total of 8118 patients were included from 33 studies, with a mean age of 59 years (range, 53-64) and mean follow-up of 3.0 years (range, 0.5-8.2), among whom 53% were male and 74% had dominant-side injury. Patients undergoing surgery >3 months after injury did not have significantly higher retear rates (OR, 1.1 [95% CI, 0.5 to 3.1]; P = .700), lower Constant-Murley score (MD, −6.2 [95% CI, −16.4 to 4.1]; P = .240), or lower ASES score (American Shoulder and Elbow Surgeons; MD, –12.9 [95% CI, −26.0 to −0.2]; P = .050) compared with those having surgery within 3 months. Similarly, delaying surgery for 6 months did not result in higher retear rates (OR, 1.7 [95% CI, 0.8 to 3.7]; P = .190) or lower PROMs. Delaying surgery for 1 year, however, led to an increased likelihood of retear when compared with <1 year (OR, 2.9 [95% CI, 2.1 to 4.0]; P < .001), and this was similar for the 2-year cutoff (OR, 5.9 [95% CI, 1.1 to 32.1]; P = .040). It was also noted that patients with an intact cuff at follow-up had a mean 3.9 months’ shorter time from injury to surgery than patients with retear (95% CI, 1.0-6.8 months; P = .009). Conclusion: This systematic review with meta-analysis found that delaying rotator cuff surgery for 3 to 6 months did not lead to higher retear rates or inferior PROMs as compared with undergoing earlier surgery. However, delaying surgery for ≥1 year clearly resulted in higher retear rates after RCR. This study is limited by relying on retrospective studies, and larger prospective studies are needed to confirm these findings. Registration: CRD42021240720 (PROSPERO).

PROMIS Milestones in Patients Undergoing Rotator Cuff Repair (233)

Objectives:Patient Reported Outcome Measurement Information System (PROMIS) has emerged as an effective tool in assessing post-operative outcomes in rotator cuff repair. PROMIS employs computer adaptive testing (CAT) in order to select specific items from a standard question bank based on previous patient responses. In turn, domain-specific PROMIS forms allow optimal tracking of outcomes in specific areas of patient recovery, such as upper extremity function (PROMIS-UE) for rotator cuff repair patients. The objective of this investigation is to analyze the PROMIS-UE CAT question bank to determine the point in recovery at which a patient is able to reach certain milestones and to elucidate the number of days – in increments of 30 (i.e., monthly) – it takes for patients who undergo rotator cuff repair to answer “with some difficulty” or “without any difficulty” for the five most frequently asked questions in the PROMIS-UE CAT questionnaire. Understanding these timepoints will improve clinical monitoring and counseling following surgery and provide standardized measures for appropriate activity progression and restriction.Methods:All patients who underwent rotator cuff repair by one of two sports medicine fellowship-trained orthopedic surgeons between 2/16/17 and 7/13/19 were included in this study. Post-operative PROMIS-UE CAT scores were reviewed with respect to individual item, response, and timing of response (with respect to number of days following surgery using 30-day increments). For each PROMIS-UE CAT item, the following five answer choices were available: “Without any difficulty”, “With a little difficulty”, “With some difficulty”, “With much difficulty”, and “Unable to do”. A task was considered achievable if the patient answered any answer with “Without any difficulty” or “With a little difficulty”. The percentage of patients in each 30-day group who answered with either of these responses was recorded. Chi-square tests were run between the number of days postoperatively the surveys were administered and patient responses to determine whether or not there were statistically significant differences between groups.Results:A total of 1,143 patient responses were included in the final analysis. The five most frequently asked questions in the PROMIS-UE CAT item bank, which were as follows: “Are you able to carry a heavy object (over 10 pounds /5 kg)?” (n=1143), “Are you able to put on and take off a coat or jacket?” (n=932), “Are you able to carry a shopping bag or briefcase?” (n=453), “Are you able to pour liquid from a bottle into a glass?” (n=675), and “Are you able to put on a shirt or blouse?” (n=578). The times at which greater than 50% of respondents answered either “Without any difficulty” or “With a little difficulty” are shown in Table 1. All five questions showed statistically significant associations between number of days postoperatively and patient responses (p<.0005).Conclusions:On average, patients undergoing rotator cuff repair achieved milestones measured by the five most commonly asked questions on the PROMIS-UE CAT by 1-4 months postoperatively. Patients also showed significant improvements in upper extremity function in the same time period. These findings can be utilized in post-operative monitoring, and patients who do not meet these milestones in the appropriate timepoints may require additional supportive care or treatment.

Impact of smoking on pain and function in rotator cuff repair: a prospective 5-year cohort follow-up of 1383 patients.

This multicentre cohort study investigates the effect of smoking on the outcome of rotator cuff repair (RCR), with attention to age at presentation for surgery, pre-operative and post-operative pain and function and intra-operative findings. Patient information was collected pre-operatively, including Flex Shoulder Function (Flex SF) and visual analogue scale pain, then at 6months, 1, 2 and 5 years post-operatively. Intra-operative technical data were collected by the operating surgeon. Current smokers were classified by daily cigarette consumption. A total of 1383 RCRs in as many patients were included with an 84% 5-year follow-up. Smokers were on average 6.7 years younger than non-smokers (51.8 vs. 58.5, P < 0.001). There was no difference in intra-operatively assessed tear size both in anteroposterior dimension (P=0.5) and retraction (P=0.9). Pre-operative Flex SF score in smokers was below that of non-smokers (23.0 vs. 24.5, P=0.002) and at 6months (P=0.02) but no different at 5 years (P=0.7). Pain scores were higher in smokers than non-smokers both pre-operatively (5.34 vs. 4.67, P < 0.001) and up to 2 years (P < 0.001) but not at 5 years (P=0.073). Smokers undergoing RCR were younger than non-smokers, and had worse pre-operative pain scores and shoulder function. Poorer post-operative function persisted to 6months, and with higher reported pain to 2 years in smokers. However, at 5-year follow-up, patient-reported outcomes were not affected by smoking status.

Outcomes of rotator cuff repair with concurrent microfracture of focal glenohumeral osteoarthritis

The benefit of rotator cuff repair (RCR) in patients with concurrent osteoarthritic changes remains unclear. RCR has the theoretical potential to increase the compressive force across the glenohumeral joint, further exacerbating osteoarthritis pain. The purpose of this study is to investigate pain relief and patient-reported outcomes of patients undergoing simultaneous RCR and microfracture of focal glenohumeral osteoarthritis. Thirty-four patients undergoing simultaneous RCR and microfracture were retrospectively reviewed at a minimum 1-year follow-up. Patient demographics, preoperative range of motion, functional outcomes (visual analog scale [VAS], Single Assessment Numeric Evaluation [SANE], American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], and Simple Shoulder Test [SST]), and operative metrics were recorded. The patients were then contacted to obtain postoperative functional outcome scores (VAS, SANE, ASES, and SST). Twenty-seven patients (11 male/16 female [79%]) were evaluated at a mean follow-up of 25.8 months (range, 12-46). The average age at surgery was 64.9 years (range, 56-78). Chronic tears were more common than acute tears (57.7% vs. 42.3%). The majority of patients had a full rotator cuff tear (89%) involving a mean 1.7 ± 0.8 tendons (range, 1-3). Eighty-eight percent of the humeral lesions were Outerbridge 4 compared with 84% on the glenoid. The mean estimated involvement between the 2 groups with 38.4% ± 18.4% of the humeral head involved and 34.6% ± 18.4% of the glenoid involved. PRO scores improved postoperatively with a reduction in mean VAS (6.6-2.0, P < .01), SANE (33.8-79.8, P < .01), ASES (38.0-80.9, P < .01), and SST (3.07-9.70, P < .01) scores. Cumulatively, only 52% (14/27) of the patients improved, however, by the MCID for all collected PROs. Our results demonstrate modest improvements in postoperative pain and functional scores at a minimum of 1-year follow-up in a cohort of patients who have undergone RCR and glenohumeral microfracture. In cases of small focal lesions of full-thickness cartilage loss, RCR with microfracture is a reasonable treatment option; however, patients should be counseled on expectations accordingly.

Arthroscopic Linked Triple Row Repair for Large and Massive Rotator Cuff Tears

Recently, many arthroscopic techniques have been described to improve the outcomes in rotator cuff repair of large and massive tears; these include conventional double-row, suture bridge, and triple-row techniques, in an effort to optimally reconstruct the rotator cuff footprint and improve fixation. This report describes a modified triple-row repair technique that links the double-row and suture-bridge techniques in one construct, merging the advantages of both to maximize the footprint contact area and contact pressure, which may lead to better healing and faster rehabilitation.

Clinical outcome of rotator cuff repair in patients with mild to moderate glenohumeral osteoarthritis.

Osteoarthritis (OA) in the glenohumeral joint is a concomitant lesion with rotator cuff tear that commonly occurs in older patients. The authors aimed to evaluate the effect of associated OA on the treatment outcome of rotator cuff repair. A total of three hundred and forty-eight patients who underwent full-thickness arthroscopic rotator cuff repair were retrospectively reviewed, and the data were prospectively collected. The severity of OA was evaluated using the Samilson and Prieto method preoperatively and the Outerbridge classification intraoperatively. The patients were divided into the small-to-medium group and large-to-massive group according to rotator cuff tear size and were evaluated for presence or absence of OA. The postoperative clinical outcomes were assessed using the visual analog scale for pain, simple shoulder test (SST), University of California-Los Angeles, Constant, and American Shoulder and Elbow Surgeons (ASES) scoring systems at baseline and at final follow-up. Forty-five patients were diagnosed with glenohumeral OA (12.9%). Overall, no significant differences were observed in demographic and baseline data between the two groups according to the presence or absence of OA. The clinical symptoms of both groups significantly improved at the final follow-up. At the final follow-up, no significant differences were found in the VAS for pain, SST, UCLA, Constant, and ASES scores between the two groups. In the large-to-massive tear group, patients with OA had significantly inferior clinical results compared with those without OA. The clinical outcome scores improved after rotator cuff repair regardless of the presence of concomitant OA. However, glenohumeral OA should be considered as a potential negative prognostic factor in patients with large-to-massive rotator cuff tears. III.

Periimplant osteolysis does not affect the outcome of rotator cuff repair: a systematic review and meta-analysis.

The goal of this study was to perform a systematic review and meta-analysis to compare the clinical and radiologic outcomes of rotator cuff repair, depending on the presence of developed periimplant osteolysis (PIO) after using suture anchors. The electronic databases of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for articles published up until October 2019 to find relevant articles comparing the outcomes of rotator cuff repair between the periimplant osteolysis group and non-periimplant osteolysis group. Data searching, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines. The results are presented as risk ratio (RR) for binary outcomes and standardised mean difference (SMD) for continuous outcomes with 95% confidence intervals (CI). Six clinical studies were included. No significant differences were found between the group with periimplant osteolysis and the group without periimplant osteolysis regarding retear rate (RR = 1.34; 95% CI 0.93-1.94; I2 = 28%), postoperative clinical scores (SMD = 0.29; 95% CI - 0.26 to 0.83; I2 = 80%) and range of motion (ROM); forward flexion (SMD = 0.39; 95% CI - 0.16 to 0.93; I2 = 0%), external rotation (SMD = - 0.10; 95% CI - 0.64 to 0.45; I2 = 0%) and internal rotation (SMD = - 0.37; 95% CI - 0.92 to 0.17; I2 = 0%). The presence of periimplant osteolysis after rotator cuff repair with suture anchor does not affect the clinical outcomes such as retear rate, clinical scoring, and ROM. However, as there was no standard consensus on the criteria for evaluating periimplant osteolysis, this result may not fully reflect the effect of periimplant osteolysis depending on its severity. Level IV.

Clinical outcomes of rotator cuff repair in athletes

: Rotator cuff (RC) tears remain a relatively common and potentially debilitating problem for both the professional and recreational athlete. Initial conservative management is usually performed; however, athlete’s performance may decrease across this period of nonoperative treatment. Operative treatment has generally shown successful outcomes in contact and non-shoulder dependent athletes, as well as in the recreational population. Conversely, return to sport (RTS) after surgery in the overhead athlete and professional athlete has remained unpredictable, and these patients may have difficulty returning to preinjury level of sport. In this review we aim to provide the reader with a comprehensive overview of current literature on outcomes after RC repair (RCR) in athletes, beginning with anatomy and epidemiology, conservative and surgical management, and concluding with the rehabilitation of RC tears (RCTs).

Rotator cuff tear degeneration and the role of fibro-adipogenic progenitors.

The high prevalence of rotator cuff tears poses challenges to individual patients and the healthcare system at large. This orthopedic injury is complicated further by high rates of retear after surgical repair. Outcomes following repair are highly dependent upon the quality of the injured rotator cuff muscles, and it is, therefore, crucial that the pathophysiology of rotator cuff degeneration continues to be explored. Fibro-adipogenic progenitors, a major population of resident muscle stem cells, have emerged as the main source of intramuscular fibrosis and fatty infiltration, both of which are key features of rotator cuff muscle degeneration. Improvements to rotator cuff repair outcomes will likely require addressing the muscle pathology produced by these cells. The aim of this review is to summarize the current rotator cuff degeneration assessment tools, the effects of poor muscle quality on patient outcomes, the role of fibro-adipogenic progenitors in mediating muscle pathology, and how these cells could be leveraged for potential therapeutics to augment current rotator cuff surgical and rehabilitative strategies.

Arthroscopic Transosseous Repair of Rotator Cuff Tear and Greater Tuberosity Cysts

PurposeTo evaluate the short-term outcomes of rotator cuff repair in the presence of a greater tuberosity cyst (GTC) using a transosseous repair technique.MethodsThis study included patients who underwent arthroscopic rotator cuff tear repair with a transosseous technique and were evaluated clinically and by postoperative magnetic resonance imaging (MRI) after 1 year. The inclusion criteria were based on the results of preoperative MRI and were as follows: patients identified as having a repairable full-thickness rotator cuff tear associated with the presence of cystic changes at the tendon insertion site of the greater tuberosity, defined as a GTC involving the footprint area of the torn tendon (supraspinatus and/or infraspinatus tendons).ResultsWe evaluated 25 patients. The mean preoperative and postoperative American Shoulder and Elbow Surgeons scores were 39.48 (P = .530) and 84.64 (P = .035), respectively; Constant shoulder scores, 38.96 (P < .005) and 80.28 (P = .425), respectively; and University of California–Los Angeles shoulder rating scale scores, 10.6 (P = .045) and 29.04 (P = .315), respectively. The GTC mapping system was easily adopted in all the MRI examinations independently from the quality of the images. The GTCs were mostly located in the superficial anterolateral section of the humeral head and in both the posterolateral sections (superficial and deep).ConclusionsArthroscopic transosseous rotator cuff repair led to significant mid-term improvement and satisfactory subjective outcomes with low complication and failure rates in this study. The GTC mapping system could be useful to evaluate GTCs and to aid surgeons in the choice of the best surgical technique.Level of EvidenceLevel IV, therapeutic case series.

Genetic factors in rotator cuff pathology: potential influence of col 5A1 polymorphism in outcomes of rotator cuff repair

BackgroundInvestigations in genetics have provided valuable information about the correlation between gene variants and tendinopathy. Single Nucleotide Polymorphisms of COL5A1 gene are reported to be involved in Achilles tendinopathy, chronic degenerative tendon changes at the elbow, and other tendinopathies. The influence of Single Nucleotide Polymorphisms of COL5A1 was previously analyzed in rotator cuff disease with confounding results. Moreover, the rs12722 polymorphism in COL5A1 gene has been implicated in the aetiology of musculoskeletal soft tissue injuries in several association studies. This study aims to analyse the possible influence of rs12722 polymorphism in COL5A1 in the outcomes of rotator cuff repair.MethodsSeventy-nine patients were included in the study. DNA was extracted from 1.2 ml of venous blood and genotyped for COL5A1 SNPs rs12722. Rotator cuff muscle strength and range of motion (ROM) in anterior elevation, external and internal rotation of the shoulder were evaluated.ResultsPatients presenting COL5A1 SNP rs12722 CC showed a ROM of passive external rotation statistically significantly higher compared to patients with CT genotype and TT genotype.ConclusionsCOL5A1 SNP rs12722 may influence the functional outcomes of RCRs, even though further studies are required to confirm these preliminary results.