Rotator Cuff Repair Surgery Research Articles

Editorial review: American Journal of Sports Medicine “Evaluation of the Risk Factors for a Rotator Cuff Retear After Repair Surgery”

With reported retear rates of 17–19% in recent large cohorts following arthroscopic rotator cuff repair surgery, identification of risk factors leading to retears is of significant prognostic value (1,2).

Subacromial corticosteroid injections transiently decrease suture anchor pullout strength: biomechanical studies in rats

Arthroscopic rotator cuff (RC) repair incorporates suture anchors to secure torn RC tendons to the greater tuberosity (GT) bone. RC repair strength depends on the anchor-bone interface and on the quality of the GT. We evaluated the effect of single and multiple corticosteroid injections on the pullout strength of suture anchors. Fifty rats were divided into those receiving saline solution injection (control group), a single methylprednisolone acetate (MTA) injection (MTA1 group), or 3 once-weekly MTA injections (MTA3 group). Rats were killed humanely at 1 or 4 weeks after the last injection. A mini-suture anchor was inserted into the humeral head through the GT. Specimens were tested biomechanically. At 1 week after the last injection, the mean maximal pullout strength was significantly reduced in the MTA1 group (63.5%) and MTA3 group (56%) compared with the control group (P < .05 for both). Mean stiffness decreased significantly in both treatment groups compared with controls (P < .05). At 4 weeks after the last injection, there was a significant increase in the mean maximal pullout strength after single and triple MTA injections compared with values recorded at the 1-week time point (P < .05). At 4 weeks, the mean maximal pullout strength after a single MTA injection was 92.8% of the pullout strength measured in the control group. We showed a significant detrimental effect of corticosteroid exposure on the pullout strength of a suture anchor at 1 week. However, this effect was transient and resolved within a relatively short period. These findings indicate that a waiting period is required between subacromial corticosteroid injection and RC repair surgery that involves the use of suture anchors.

Patient self-assessed shoulder comfort and function and active motion are not closely related to surgically documented rotator cuff tear integrity

The rationale for rotator cuff repair surgery is that better integrity of the cuff should be associated with better comfort and function. However, in patients with cuff disease, there is not good evidence that the degree of rotator cuff integrity is closely associated with the shoulder's comfort, function, or active motion. The goal of this study was to explore these relationships in shoulders with surgically documented cuff disease. In 55 shoulders having surgery for cuff-related symptoms, we correlated the preoperative Simple Shoulder Test score with the objectively measured preoperative active shoulder motion and with the integrity of the cuff observed at surgery. The 16 shoulders with tendinosis or partial-thickness tears had an average Simple Shoulder Test score of 3.7 ± 3.3, active abduction of 111° ± 38°, and active flexion of 115° ± 36°. The corresponding values were 3.6 ± 2.8, 94° ± 47°, and 94° ± 52° for the 22 full-thickness supraspinatus tears and 3.9 ± 2.7, 89° ± 39°, and 100° ± 39° for the 17 supraspinatus and infraspinatus tears. In this study, surgically observed cuff integrity was not strongly associated with the shoulder's comfort or function. Whereas surgeons often seek to improve the integrity of the rotator cuff, the management of patients with rotator cuff disorders needs to be informed by a better understanding of the factors other than cuff integrity that influence the comfort and functioning of shoulders with cuff disease.

Functional Recovery After Rotator Cuff Repair: The Role of Biceps Surgery.

Surgical cuff repair is recommended in a full-thickness rotator cuff tear when nonoperative treatment fails. Surgical cuff repair can include surgery of the long head of the biceps when concomitant biceps pathology is present. However, the studies executed up till now have not yet clearly defined if additional biceps surgery affects the shoulder functionality in patients who underwent rotator cuff repair. To verify if the concomitant biceps surgery prejudices shoulder functionality during the short-term period in rotator cuff repair patients. Prospective and observational study. Outpatient service for rehabilitation. Ninety-three consecutive patients who had undergone surgery for full-thickness symptomatic rotator cuff tear were enrolled for rehabilitation; 25 underwent rotator cuff repair and tendon biceps surgery (ABS), while 68 underwent rotator cuff repair only (RCR). Motor rehabilitation after surgical treatment of rotator cuff repair. Final Constant score was used as primary outcome measure, and efficiency and effectiveness in Constant score were evaluated both at the end of the last cycle of rehabilitation and 6mo postsurgery. Patients with rotator cuff repair and tendon biceps surgery had lower final scores (36.5 ± 12.0 vs 49.3 ± 13.0, P < .001), effectiveness (40.6 ± 18.0 vs 60.3 ± 20.0, P < .001), and efficiency (0.80 ± 0.5 vs 1.19 ± 0.6, P = .010) in Constant score than those with rotator cuff repair only at the end of rehabilitation. Moreover, they had a lower final score (53.3 ± 14.0 vs 64.5 ± 10.0, P < .001) and effectiveness (66.9 ± 21.0 vs 84.0 ± 16, P < .001) in Constant score 6mo postsurgery. Gender was a determinant of final score, efficiency, and effectiveness in Constant score at the end of the rehabilitation period, while tendon biceps surgery was a determinant of final score and effectiveness in Constant score at the end of the rehabilitation period and at 6mo postsurgery. This study highlights that concomitant tendon biceps surgery negatively affects functional outcome of patients who underwent rotator cuff repair and is an important determinant of shoulder functionality in the first 6mo postsurgery.

Gout Can Increase the Risk of Receiving Rotator Cuff Tear Repair Surgery

Background: Gout commonly involves joint inflammation, and clinical epidemiological studies on involved tendons are scant. Rotator cuff tears are the most common cause of shoulder disability, and surgery is one of the choices often adopted to regain previous function. Purpose: To investigate the risk of receiving rotator cuff repair surgery among patients with gout and to analyze possible risk factors to design an effective prevention strategy. Study Design: Cohort study; Level of evidence, 3. Methods: The authors studied a 7-year longitudinal follow-up of patients from the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005). This included a cohort of patients who received a diagnosis of gout during 2004-2008 (gout cohort) and a cohort matched by propensity scores (control cohort). A 2-stage approach that used the National Health Interview Survey 2005 was used to obtain missing confounding variables from the LHID2005. The crude hazard ratio (HR) and adjusted HR were estimated between the gout and control cohorts. Results: The gout and control cohorts comprised 32,723 patients with gout and 65,446 people matched at a ratio of 1:2. The incidence of rotator cuff repair was 31 and 18 per 100,000 person-years in the gout and control cohorts, respectively. The crude HR for rotator cuff repair in the gout cohort was 1.73 (95% confidence interval [CI], 1.23-2.44; P < .01) during the 7-year follow-up period. After adjustment for covariates by use of the 2-stage approach, the propensity score calibration-adjusted HR was 1.60 (95% CI, 1.12-2.29; P < .01) in the gout cohort. Further analysis revealed that the adjusted HR was 1.73 (95% CI, 1.20-2.50; P < .001) among patients with gout who did not take hypouricemic medication and 2.70 (95% CI, 1.31-5.59; P < .01) for patients with gout aged 50 years or younger. Conclusion: Patients with gout, particularly those aged 50 years or younger and without hypouricemic medication control, are at a relatively higher risk of receiving rotator cuff repair surgery. Strict control of uric acid levels with hypouricemic medication may effectively reduce the risk of rotator cuff repair.

Patient Understanding, Expectations, and Satisfaction Regarding Rotator Cuff Injuries and Surgical Management

Rotator cuff injuries are among the most common in orthopaedics, with rotator cuff repair surgery consistently reported as one of the most commonly performed orthopaedic procedures. Patient satisfaction is becoming an increasingly important outcome metric as health care continues to evolve with regard to quality measures affecting physician reimbursement. Evidence supports that postoperative patient satisfaction, an important quality outcome metric, is highly influenced by preoperative patient expectations, which are in turn governed by patient knowledge and understanding. Many authors have delineated patient-, injury-, and surgery-specific variables associated with high preoperative expectations and satisfaction after rotator cuff surgery. Specifically, large rotator cuff tears, subscapularis tears, persistence of postoperative pain and dysfunction, worker's compensation cases, lower education level, and preoperative disability have been seen more frequently in patients reporting poor satisfaction. Others have reported variables associated with higher patient satisfaction such as being married, employed, and of older age at the time of surgery (>55 years old) predictive of higher satisfaction. Patient education preoperatively regarding details about the surgery and the postoperative plan both immediately after the procedure and for rehabilitation are critical in helping set patients' preoperative expectations that have a known effect on patients' subjective clinical outcomes.

Effect of sodium hyaluronate/carboxymethyl cellulose (Guardix-sol) on retear rate and postoperative stiffness in arthroscopic rotator cuff repair patients: A prospective cohort study.

Hyaluronate-based anti-adhesive agents are expected to enhance rotator cuff healing; however, their effect on the incidence and extent of postoperative complications such as stiffness and retears has not been investigated. From July 2012 to February 2013, 80 patients undergoing arthroscopic rotator cuff repair surgery were prospectively enrolled. Forty patients were assigned to the control group, while the other 40 were assigned to the injection group and received a Guardix-sol injection immediately after surgery. Passive range of motion, pain visual analog scale, and functional score were assessed at 8 weeks, 6 months, and 24 months postoperatively. Gliding motion between the deltoid muscle and the greater tuberosity of the proximal humerus was evaluated using ultrasonography at 2 and 8 weeks postoperatively, and tendon integrity was evaluated using magnetic resonance imaging at 6 months postoperatively. We found no significant difference between the groups regarding gliding motion at 2 weeks postoperatively. However, at 8 weeks, the incidence of poor gliding motion was 2.5% and 15% for the injected patients and control group, respectively, which was statistically significant. At 6 months after surgery, the retear rate between the two groups was not statistically significant. We found no statistically significant difference between the two groups regarding retear rate and clinical score throughout the follow-up period. We noted no complications related to the use of Guardix-sol. Patients who received the Guardix-sol injection showed improved gliding motion between the deltoid muscle and the greater tuberosity in the early postoperative period.

Paper #24 - Factors influencing direct clinical costs of outpatient arthroscopic rotator cuff repair surgery

Background: Understanding the cost of healthcare delivered is critical to understanding the overall value provided. Billing charges are often confused with the cost of delivering care and are often inaccurate estimates of the actual costs incurred. Overall, there is limited information on the “true cost” of care delivered or direct clinical care costs. Very limited information exists as to what variables affect the direct clinical care costs of rotator cuff repair surgery. The purpose of this study was to determine the direct clinical care cost of outpatient arthroscopic rotator cuff repair surgery utilizing a unique Value-Driven Outcomes (VDO) tool which was designed to identify and track direct costs of all aspects of clinical care; and to identify various patient and treatment-related variables affecting cost. Methods: Arthroscopic rotator cuff repairs performed at an outpatient academic medical center by three surgeons were included in the analysis from 3/2014 to 6/2015. Cost data was derived for all cases during this period using the VDO tool developed and validated at our institution. Cost data included overall total cost, and was further broken down to identify facility utilization costs, indirect costs, medication costs, supply costs and other ancillary costs. Patient and surgical data collected included attending surgeon, smoking status, BMI, ASA health status, tear severity (partial thickness versus full thickness), repair construct (single row versus double row), if a subscapularis repair was performed, if a subacromial decompression was performed, if a distal clavicle excision was performed, if a biceps tenodesis was performed, the overall numbers of anchors utilized per case, anteroposterior size of the tear (mm), tear retraction (mm) and supraspinatus and infraspinatus muscle quality (Goutallier grade). Univariate and multivariate regressions were performed to determine the affect of various factors on cost. P < .05 was considered statistically significant. Results: 170 arthroscopic rotator cuff repairs were performed during the study period. There were 17 active smokers. 31 patients were considered to have severe systemic disease based upon their ASA classification. 138 full thickness tears and 32 partial thickness tears were repaired. A single row repair was performed on 128 patients and double-row repair on 42 patients. The average total number of anchors used per case overall was 3. The average tear size was 21 mm. The average tear retraction was 18 mm.The average Goutallier grade for the supraspinatus and infraspinatus were 0.9 and 0.4 respectively. Subscapularis repair and subacromial decompression were performed in 37 cases and 106 cases respectively. Distal clavicle excision was performed in 19 cases. A biceps tenodesis was performed in 66 cases and a tenotomy in 26 cases. In the univariate analysis, higher overall total cost was correlated with the presence of subscapularis repair being performed (P < .0001), a bicep tenodesis being performed (P = .043) and a greater total number of anchors used per case (P < .0001). Multivariate analysis results showed continued significant correlations between higher total cost and the presence of a subscapularis repair being performed (P = .015) and total number of anchors utilized (P < .0001). Smoking status, attending surgeon, BMI, ASA classifications, partial versus full-thickness tear, single row vs double row construct, the addition of a subacromial decompression or distal clavicle excision, tear size and retraction and muscle quality were not significantly associated with total cost. (P > .05) Discussion: Direct clinical care costs associated with arthroscopic rotator cuff repair are related to the overall number of suture anchors utilized and the addition of concomitant procedures (biceps tenodesis, subscapularis repair). Implementation of strategies to reduce overall costs should focus on reducing overall anchor quantity and/or potentially using alternative surgical techniques that may result in equivalent clinical results (biceps tenotomy vs. tenodesis; debridement of partial thickness upper border subscapularis tears vs. repair).

No evidence for the use of stem cell therapy for tendon disorders: a systematic review

IntroductionStem cells have emerged as a new treatment option for tendon disorders. We systematically reviewed the current evidence for stem cell therapy in tendon disorders.MethodsRandomised and non-randomised controlled trials, cohort...

Effectiveness of early compared with conservative rehabilitation for patients having rotator cuff repair surgery: an overview of systematic reviews

Aim/objectiveThe aim is to critically analyse and discuss the current literature and determine the effectiveness of rehabilitation for patients after surgical repair of rotator cuff tears for range of motion...

Magnetic resonance imaging without contrast as a diagnostic method for partial injury of the long head of the biceps tendon

ObjectiveTo evaluate the use of magnetic resonance imaging (MRI) without contrast as a diagnostic method of partial lesions of the long head of the biceps, using arthroscopic surgery as the gold standard. MethodsWe evaluated data from MRI and arthroscopic surgical findings of patients operated due to rotator cuff and SLAP injuries. MRI without contrast of at least 1.5T, with a radiologist report, was used as a criterion for the detection of long head of the biceps injury. All cases were operated by the same surgeon at this hospital. ResultsThis study evaluated data from 965 patients, 311 women (32%) and 654 men (68%), with a mean age of 45 years, who underwent arthroscopic surgery for rotator cuff and SLAP repair from September 2012 to September 2015. Overall, the sensitivity and specificity of MRI was 0.22 (CI: 0.17–0.26) and 0.98 (CI: 0.96–0.99), respectively. ConclusionsMRI has a low sensitivity and high specificity for detection of partial tears of the long head of the biceps tendon.

Is early mobilisation after rotator cuff repair surgery beneficial?

Is early mobilisation after rotator cuff repair surgery beneficial?

Repair of Rotator Cuff Tear With Delamination: Independent Repairs of the Infraspinatus and Articular Capsule

We propose a technique to repair delamination, which often occurs during rotator cuff repair surgery. We have reported that the infraspinatus occupies most of the greater tuberosity with the articular capsule attached to a very wide area, and that the superficial layer is mainly composed of the infraspinatus, and the deep layer is mainly composed of the articular capsule. To repair such delamination with consideration of the detailed anatomy, we developed the following repair method with independent repair of the superficial layer (infraspinatus) and the deep layer (articular capsule): (1) the deep layer is pulled laterally and joined to the medial margin of the greater tuberosity using 4 simple sutures from 2 anchors; (2) the paired limbs (same color) of 4 knots are passed over the posterior leaf of the superficial layer at intervals; (3) a push-in anchor loaded with 1 thread each of 4 knots is placed on the anterolateral corner of the greater tuberosity to pull the superficial layer anterolaterally; (4) another push-in anchor (remaining threads) is pushed on the posterior corner of the greater tuberosity. We believe that this technique can recover the function of both the articular capsule and rotator cuff, thereby facilitating better treatment outcomes after surgery.

Avaliação da ressonância magnética sem contraste como método para diagnóstico de lesões parciais do tendão da cabeça longa do bíceps

ObjectiveTo evaluate the use of magnetic resonance imaging (MRI) without contrast as a diagnostic method of partial lesions of the long head of the biceps, using arthroscopic surgery as the gold standard. MethodsWe evaluated data from MRI and arthroscopic surgical findings of patients operated due to rotator cuff and SLAP injuries. MRI without contrast of at least 1.5T, with a radiologist report, was used as a criterion for the detection of long head of the biceps injury. All cases were operated by the same surgeon at this hospital. ResultsThis study evaluated data from 965 patients, 311 women (32%) and 654 men (68%), with a mean age of 45 years, who underwent arthroscopic surgery for rotator cuff and SLAP repair from September 2012 to September 2015. Overall, the sensitivity and specificity of MRI was 0.22 (CI: 0.17 to 0.26) and 0.98 (CI: 0.96 to 0.99), respectively. ConclusionsMRI has a low sensitivity and high specificity for detection of partial tears of the long head of the biceps tendon.

Diabetes mellitus increases the risk of rotator cuff tear repair surgery: A population-based cohort study

BackgroundRotator cuff tears are the most common cause of shoulder disability in people older than 50years, and surgical intervention is usually required for restoring functioning. However, in patients undergoing rotator cuff repair surgery, patients with DM had poorer functional outcomes than those without DM, and hence, DM is one of the possible risks factor for rotator cut off tear. The aim of this population-based study was to investigate the relationship between DM and the risk of rotator cuff tear in patients receiving rotator cuff repair surgery. MethodsIn this retrospective longitudinal population-based 7-year cohort study, we investigated the risk of rotator cuff repair surgery in patients with DM. We performed a case–control matched analysis by using data from the Taiwan Longitudinal Health Insurance Database 2005. Patients were enrolled on the basis of the International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes for DM between January 1, 2004, and December 31, 2007. The prevalence and the adjusted hazard ratios (HRs) of a rotator cuff repair surgery in patients with and without DM were estimated according to the Cox proportional hazard regression analysis using the frailty model. ResultsThe DM and non-DM cohorts comprised 58,652 patients with DM and 117,304 (1:2) patients without DM after matching for age and sex. The incidence of rotator cuff repair surgery was 41 per 100,000 and 26 per 100,000 person-years in the DM and non-DM cohorts, respectively. The HR of rotator cuff repair surgery during the follow-up period was 1.56 (95% confidence interval [CI] 1.25–1.93, p<0.001) for patients with DM. After adjustment for covariates, the adjusted HR of rotator cuff repair surgery was 1.33 (95% CI, 1.05–1.68, p<0.001) in the DM cohort. ConclusionDM is an independent risk factor for rotator cuff tear repair surgery.

Prognosis Driven Rehabilitation After Rotator Cuff Repair Surgery

Background:Rehabilitation after rotator cuff repair surgery has been the focus of several clinical trials in the past decade. Many illuminate new evidence with regard to the prognosis of structural and functional success after surgery. Methods:A selective literature search was performed and personal physiotherapeutic and surgical experiences are reported.Results:Post-operative rehabilitation parameters, namely the decision to delay or allow early range of motion after surgery, play a large role in the overall success after surgery. Using a prognosis driven rehabilitation program offers clinicians a means of prescribing optimal rehabilitation parameters while ensuring structural and functional success. This commentary aims to synthesize the evidence in a spectrum of prognostic factors to guide post-operative rehabilitation.Conclusion:The optimal rehabilitation program after rotator cuff repair surgery is debatable; therefore, we suggest using a spectrum of prognostic factors to determine a rehabilitation program suited to ensure structural and functional success, quickly and safely.

Vitamin D and the immunomodulation of rotator cuff injury.

Tendon-to-bone healing after rotator cuff repair surgery has a failure rate of 20%–94%. There has been a recent interest to determine the factors that act as determinants between successful and unsuccessful rotator cuff repair. Vitamin D level in patients is one of the factors that have been linked to bone and muscle proliferation and healing, and it may have an effect on tendon-to-bone healing. The purpose of this article is to critically review relevant published research that relates to the effect of vitamin D on rotator cuff tears and subsequent healing. A review of the literature was conducted to identify all studies that investigate the relationship between vitamin D and tendon healing, in addition to its mechanism of action. The data were then analyzed in order to summarize what is currently known about vitamin D, rotator cuff pathology, and tendon-to-bone healing. The activated metabolite of vitamin D, 1α,25-dihydroxyvitamin D3, affects osteoblast proliferation and differentiation. Likewise, vitamin D plays a significant role in the tendon-to-bone healing process by increasing the bone mineral density and strengthening the skeletal muscles. The 1α,25-dihydroxyvitamin D3 binds to vitamin D receptors on myocytes to stimulate growth and proliferation. The form of vitamin D produced by the liver, calcifediol, is a key initiator of the myocyte healing process by moving phosphate into myocytes, which improves function and metabolism. Investigation into the effect of vitamin D on tendons has been sparse, but limited studies have been promising. Matrix metalloproteinases play an active role in remodeling the extracellular matrix (ECM) of tendons, particularly deleterious remodeling of the collagen fibers. Also, the levels of transforming growth factor-β3 positively influence the success of the surgery for rotator cuff repair. In the tendon-to-bone healing process, vitamin D has been shown to successfully influence bone and muscle healing, but more research is needed to delve into the mechanisms of vitamin D as a factor in skeletal tendon health and healing.

Paper #40 - Effect of hypercholesterolemia on fatty infiltration and rotator cuff healing in a chronic rotator cuff tear model of rabbit

Introduction: The purpose of this study is to verify the effect of hypercholesterolemia on fatty infiltration and rotator cuff healing in chronic rotator cuff tear model using a rabbit supraspinatus. We also aimed to investigate whether the control of hypercholesterolemia can help the improvement of fatty infiltration and healing after rotator cuff repair. Methods: Forty-eight rabbits were randomly allocated into 4 groups (12 rabbits per each group, 8 for the electromyographic (EMG) and mechanical tests in right shoulder and the histological test of fat proportion in both shoulders; additional 4 (bilateral shoulder) for the histology of tendon-to-bone healing): Group A (high-chol. + repair), Group B (high-chol.+statin+repair), Group C (repair), and Group D (control). Initial hypercholesterolemia was made by feeding rabbits of Group A and B with a high-cholesterol meal for 4 weeks, then the supraspinatus tendon was detached in Group A, B, and C. Six weeks after detachment, the supraspinatus tendon was repaired in a transosseous manner. Group A got the high-cholesterol diet persistently until final evaluation (6 weeks after repair), however, Group B changed the diet to general diet with an administration of cholesterol lowering agent (simvastatin) from the time of repair. The EMG test, mechanical test, and histological test of tendon-to-bone healing was performed at final evaluation, and the histological evaluation for the fat-to-muscle proportion was performed at two times at the time of repair and at final evaluation. Results: For EMG test, Group A showed significantly smaller area in compound muscle action potential (6.69 ± 2.23 ms⋅mV) compared with Group C and D (10.50 ± 2.96 ms⋅mV and 14.40 ± 2.79 ms⋅mV, P = .008 and <0.001). Group B (9.05 ± 3.23 ms⋅mV) showed larger area than group A without statistical significance (P = .112), almost to the level of group C. For mechanical test, Group A showed significantly lower load-to-failure and stiffness (42.01 ± 13.80N and 36.32 ± 14.70N/mm) compared with Group C (65.12 ± 22.81N and 65.31 ± 23.21N/mm, P = .020 and 0.006, respectively). The load-to-failure and stiffness of Group B (58.23 ± 22.39N and 47.22 ± 14.14N/mm) was higher than Group A without statistical differences (P = .103 and 0.153, respectively), but the stiffness of group B was still much less than group C (P = .065). The Group D (normal control) showed much higher load-to-failure (148.01 ± 26.12N) than any other groups (all P < .001), however, the stiffness of Group D (62.51 ± 14.29N/mm) was between that of Group B and C. For the histological test, Group A and B showed significantly higher fat-to-muscle proportion (59.26 ± 17.80% and 64.02 ± 11.87%) compared with Group C (44.26 ± 7.85%, P = .044 and 0.004, respectively) or D (8.02 ± 5.29%, all P < .001) at 6 weeks after detachment. At the final evaluation, the fat-to-muscle proportion (Fig. 1) of Group A was more increased to 78.23 ± 10.87% (P = .015), but that of Group B was decreased to 54.68 ± 10.47% (P = .146). Group A showed coarse and poorly organized collagen fibers with fat interposition in tendon-to-bone insertion area, but Group B and C showed better collagen fiber continuity and orientation with higher collagen density than group A (Fig. 2). Conclusions: The hypercholesterolemia resulted in the deleterious effect on the fatty infiltration and tendon-to-bone healing assessed by electromyographic, mechanical, and histological evaluation, and the control of hypercholesterolemia seemed to be able to reverse these harmful effects to some degree even after rotator cuff repair surgery.

Fibrin Scaffold as a Carrier for Mesenchymal Stem Cells and Growth Factors in Shoulder Rotator Cuff Repair

With an increase in the aging population, rotator cuff tears are becoming more common. High failure rates with shoulder rotator cuff repair surgery have been persistent, prompting the introduction of biologic methods to promote healing. The aim of the present technique is to deliver stem cells and growth factors to the footprint of the repair site. A platelet-rich plasma (PRP) fibrin clot is used as a scaffold for the delivery of stem cells, by using PRP, to provide a source of growth factors, and platelet-poor plasma (PPP) as a source for fibrinogen for the matrix for the scaffold. In the second step, bone marrow is harvested from the proximal humerus, concentrated, and combined with the PRP and PPP. Using a customized device, we then activate the clotting process and transfer the scaffold containing the stem cells using a suture anchor onto the shoulder rotator cuff footprint. In an effort to promote healing, this technique reimplants autologous stem cells and growth factors into the operative site. This technique may serve as an alternative for typically used scaffolds such as collagen matrices or decellularized human dermis patches.

Arthroscopic Medial Meniscus Posterior Root Fixation Using a Modified Mason-Allen Stitch

A complete radial tear of the meniscus posterior root, which can effectively cause a state of total meniscectomy via loss of hoop tension, requires that the torn root be repaired. Several methods have been used to repair medial meniscus posterior root tears, most of which are based on a simple stitch technique that is known to have stitch-holding strength. We applied a modified version of the Mason-Allen stitch technique, which is recognized as a method for rotator cuff repair surgery because its locking effect overcomes the potential weakness of simple stitches. This article introduces the medial meniscus posterior root tears repair procedure based on a modified Mason-Allen stitch technique in which 2 strands (i.e., 1 simple horizontal and 1 simple vertical stitch) are used.