Rotator Cuff Repair Surgery Research Articles

Continuous Peripheral Nerve Blocks Are Associated With Increased Rates of Emergency Department Visits After Arthroscopic Rotator Cuff Repair Surgery.

The purpose of this study was to assess trends in the use of perioperative single and continuous peripheral nerve blocks (PNBs) and their associations with emergency department (ED) visits after arthroscopic rotator cuff repair (RCR) surgery. The authors used a large database from a private insurer to identify patients who received perioperative PNBs for arthroscopic RCR surgeries from 2007 to 2015. They analyzed patient demographics as well as trends in perioperative PNB use. They also assessed rates of single shot vs continuous PNB use and compared rates of postoperative ED visits according to PNB type. The rate of perioperative PNB for arthroscopic RCR was higher than previously reported (65.9%) and increased over time (52.8% in 2007 to 64.6% in 2015; P=.029). Single shot PNBs were more common than continuous, catheter-mediated PNBs (60.0% vs 6.6%; P<.001), although the use of continuous blocks increased at a greater rate during the study period. Patients who received a perioperative continuous PNB were significantly more likely to visit an ED within 7 days of their surgery than those who received a single shot PNB or no PNB (6.71% vs 4.78% vs 4.74%; P<.02). The rates of ED visits within each group did not change significantly over time. Continuous PNBs are increasingly common for patients undergoing arthroscopic RCR surgery but are associated with increased rates of postoperative ED visits. Studies are needed to identify the reasons for this increased rate of ED visits and strategies to decrease ED use. [Orthopedics. 2020; 43(2): 127-131.].

Surgery for rotator cuff tears

Surgery for rotator cuff tears

The effectiveness of prolotherapy on failed rotator cuff repair surgery

The effectiveness of prolotherapy on failed rotator cuff repair surgery

Depression increases the risk of rotator cuff tear and rotator cuff repair surgery: A nationwide population-based study.

BackgroundChronic inflammation is known to be associated with both rotator cuff tears (RCTs) and depression. However, no epidemiological studies with a longitudinal follow-up have been performed to prove this association. We aimed to investigate whether depressed patients had an elevated risk of RCT and subsequent repair surgery compared with those without depression.MethodsThis retrospective cohort study comprised of patients diagnosed with depression between 2000 and 2010 (depression cohort) and patients without depression (non-depression cohort, 1:2 age and sex matched). The risk of RCT and rotator cuff repair surgery were determined during a 13-year follow-up (2000–2013) between these two cohorts.ResultsThis study included 26,868 patients with depression and 53,736 patients without depression. The incidence of RCT was 648 and 438 per 100,000 person-years in the depression and non-depression cohorts, respectively. The adjusted hazard ratio (HR) was 1.46 (95% confidence interval [CI], 1.36–1.57) for depressed patients. The incidence of rotator cuff repair surgery was 28 and 18 per 100,000 person-years in the depression and non-depression cohorts, respectively. Depressed patients also had a significantly increased risk of subsequent rotator cuff repair surgery (adjusted HR = 1.46; 95% CI, 1.04–2.06).ConclusionThe present study showed that depression was associated with an increased risk of rotator cuff tear and rotator cuff repair surgery.

Bone Tendon Interface: A New Perspective on Rotator Cuff Healing

During rotator cuff repair surgery, fixation and incorporation of ruptured rotator cuff tendon into the bone is a major concern. Many studies have report the limitations in the healing potential of the bone-tendon interface. The structure and composition of the native direct bone-tendon interface cannot be restored after primary repair, resulting in a poor mechanical and structural interface and leading to a high rate of re-tear (95%) especially after in larger or massive tear (Figure 1). If the native bone-tendon junction cannot be regenerated after primary repair, a bone-tendon composite graft, which preserves the native bone-tendon junction, can be a valuable option. Thus, we have adopted the concept of bone to bone and tendon to tendon healing by using autogenous bone-tendon composite graft. The Achilles-calcaneus composite autograft group showed significantly better biomechanical characteristics at 3 and 6 weeks in terms of maximum load, maximum stress, stiffness, and Young’s modulus. Tissue histology demonstrated an organized extracellular matrix, a clear tide mark, and distinct fibrocartilage layers in the composite graft group, similar to those of the native bone-tendon interface (Figure 2). Additionally, clear bone to bone healing and tendon to tendon healing were observed. By contrast, the conventional primary repair could not regenerate the structure of the native bone-tendon interface, although bone-tendon interface healing progressed. Bone-tendon autograft for chronic rotator cuff reconstruction is superior to the primary repair regarding biomechanical property and histological structure.Figure 1.Rat model showing (Left) Native bone tendon interface showing distinct layer of tendon – unmineralized fibrocartilage – mineralized fibrocartilage – lamellar bone. (Right) Bone tendon interface following primary repair for chronic rotator cuff tear.Figure 2.Rat model of primary repair and composite graft rotator cuff repair.

Effects of arthroscopic vs. mini-open rotator cuff repair on function, pain & range of motion. A systematic review and meta-analysis.

ObjectiveTo assess the effectiveness of arthroscopic versus mini-open rotator cuff repair on function, pain and range of motion at 3-, 6- and 12-month follow ups.DesignSystematic review and meta-analysis of randomized controlled trials.SettingClinical setting.ParticipantsPatients 18 years and older with a rotator cuff tear.Intervention/ComparisonArthroscopic/mini-open rotator cuff repair surgery followed by post operative rehabilitation.Main outcome measuresFunction and pain.ResultsSix RCTs (n = 670) were included. The pooled results, demonstrated no significant difference between arthroscopic and mini open approach to rotator cuff repair on function (very low quality, 4 RCTs, 495 patients, SMD 0.00, 3-month; very low quality, 4 RCTs, 495 patients, SMD -0.01, 6-month; very low quality, 3 RCTs, 462 patients, SMD -0.09, 12-months). For pain, the pooled results, were not statistically different between groups (very low quality, 3 RCTs, 254 patients, MD -0.21, 3-month; very low quality, 3 RCTs, 254 patients, MD -0.03, 6-month; very low quality, 2 RCTs, 194 patients, MD -0.35, 12-months).ConclusionThe effects of arthroscopic compared to mini-open rotator cuff repair, on function, pain and range of motion are too small to be clinically important at 3-, 6- and 12-month follow ups.

Timing and Risk Factors for Venous Thromboembolism After Rotator Cuff Repair in the 30-Day Perioperative Period

To analyze the American College of Surgeons National Surgical Quality Improvement Program database to evaluate the incidence of deep venous thrombosis and pulmonary embolism in patients undergoing rotator cuff repair surgery. In addition, we aim to identify risk factors associated with the development of thromboembolic events following rotator cuff repair. A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database was performed. Current Procedural Terminology codes were used to identify patients who underwent rotator cuff repair between 2005 and 2017. The presence of deep venous thrombosis or pulmonary embolism during the 30-day perioperative period were the primary outcomes assessed. Logistic regression analysis was performed to identify risk factors for postoperative venous thromboembolic events (VTEs). In total, 39,825 rotator cuff repairs (RCRs) were performed and 117 (0.3%) VTE events occurred. VTE was identified at a mean of 11.5 ± 7.4days. A total of 31,615 RCRs were performed arthroscopically. There was no significant difference of VTE between groups comparing arthroscopic RCR VTE 0.3% (94) with open RCR 0.3% (23) (P= .81). RCR in patients with an American Society of Anesthesiologists classification of III or IV was associated with >1.5-fold increase risk of VTE (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.14-2.45). Increased risks of VTE included surgery >80minutes (OR 2.10, 95% CI 1.42-3.15), performed under general anesthesia (OR 4.38, 95% CI 1.18-36.6), and in the outpatient setting (OR 6.09, 95% CI 1.06-243.7), male sex (OR 1.53, 95% CI 1.01-2.33), bleeding disorders (OR 2.87, 95% CI 1.17-7.05), or dyspnea (OR 1.51, 95% CI 1.02-2.23). The biggest risk for VTE was unplanned reoperation OR 16.6 (95% CI 5.13-53.5). Venous thromboembolism is a rare complication following rotator cuff repair 0.3%. Understanding the risk factors: duration of surgery >80minutes, male sex, body mass index >30kg/m2, ASA III or IV, RCR as an inpatient under general anesthesia, bleeding disorder, or dyspnea may be useful in guiding treatment to prevent VTE. The largest risk for VTE is a patient with unplanned reoperation. RCR surgery performed in an outpatient setting resulted in a significantly lower incidence of VTE. III Retrospective Comparative Study.

Evaluate the Results at Minimum 2-Years of Treating Rotator Cuff Tear by Arthroscopic Surgery.

BACKGROUND:Rotator cuff tear (RCT) is a common injury of the shoulder, especially middle-aged people. Nonoperative treatment, cortisone injections are only effective at an early stage. Open surgery causes postoperative atrophy of the deltoid muscle, so results are limited. Arthroscopic rotator cuff repair surgery has been performed in Vietnam for about ten years, with many advantages such as the ability to accurately assess the lesions and less invasive procedure. In order to have a clearer view, we performed a mid-term assessment of the effectiveness of this surgery.AIM:Evaluate results over 2 years of patients with rotator cuff tears treated with arthroscopic surgery and their quality of life.METHOD:A group of 30 patients were diagnosed with RCT and surgery by arthroscopy to treat at Hanoi Medical University Hospital and Saint Paul Hospital between Jun 2015 and April 2017. The results of the surgeries were assessed by the degree of pain, muscle power, motion of the shoulder joint according to UCLA shoulder score. Evaluate the quality of life through the Rotator Cuff-Quality of Life (RC-QoL) index.RESULTS:The average age was 60.7 years. Female / male ratio was 1.3. Thirty-six months ± 6.41 was the average follow-up time (min 27 – max 50 months). The shoulder function is recorded according to UCLA has an average score of 30.9, therein good and excellent result were 90 %. The mean RC-QoL index was 91.5%.CONCLUSION:Treatment of RCT by arthroscopic surgery that has been evaluated for a minimum of 2 years follow-up showed good results and high quality of patient’s life.

Preoperative Mental Health Scores and Achieving Patient Acceptable Symptom State Are Predictive of Return to Work After Arthroscopic Rotator Cuff Repair.

Background:The incidence of rotator cuff repairs has risen dramatically over the past 10 years, most notably in the working-class population. Return to work (RTW) is a valuable outcome measure to set patient expectations before surgery.Purpose:To establish the rate of RTW after rotator cuff repair with respect to stratified levels of occupational demand (sedentary, light, moderate, and heavy) and to identify clinical factors significantly associated with postoperative RTW.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who received rotator cuff repair between 2014 and 2017 were queried from a prospectively maintained institutional registry. Work status was evaluated from clinical and physical therapy notes, and RTW was stratified based on duty level. The minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) values were calculated for American Shoulder and Elbow Surgeons (ASES) score and subjective Constant score through use of an anchor-based approach. Patient demographic factors, preoperative ASES scores, Constant scores, and health-related quality of life scores, as well as change in postoperative scores exceeding the thresholds for MCID, SCB, and PASS, were analyzed to determine significant associations with RTW without restriction.Results:In total, 89 patients with documented pre- and postoperative work status underwent surgery. Rates of RTW for sedentary, light, moderate, and heavy duties were 100%, 84.0%, 77.4%, and 63.3%, respectively, within return at less than 7 postoperative months on average. RTW was associated with achieving PASS (P = .004) but not achieving MCID and SCB (P = .429 and .452, respectively). Injury to a patient’s dominant side had reduced odds (0.057; 95% CI, 0.004-0.763; P = .030) for RTW at full duty. Tear characteristics and type of insurance were not associated with RTW. Preoperative Veterans RAND Mental Component Score (>53.3; area under the curve, 70.4%) was predictive of returning to work.Conclusion:A vast majority of patients undergoing rotator cuff repair can expect to return to work within 8 months of surgery. Preoperative mental health scores can predict future return to work, which supports the concept that mental health status plays an important role in the outcomes after rotator cuff repair surgery.

The fate of hypoechoic cleft

BackgroundHypoechoic clefts are small defects found on ultrasonographs in the intact rotator cuff tendon after rotator cuff repair. Little is known about the fate of these hypoechoic clefts, as to whether they will heal, persist, or develop into a retear.MethodsThis prospective study involved 24 patients who underwent arthroscopic rotator cuff repair surgery and were found to have a hypoechoic cleft at the 6-month postoperative ultrasonograph. A subsequent ultrasonography follow-up was performed at 9 months or later by the same ultrasonographer and the repair re-examined.ResultsAt an average postoperative follow-up of 21 months, 14 of the 25 hypoechoic clefts (56%) had healed; 5 (20%) had persistent clefts whereas 6 (24%) had progressed to a full-thickness rotator cuff retear. Patients with a hypoechoic cleft ≥36 mm2 were 5 times more likely to have a retear than patients with hypoechoic cleft <36 mm2 (relative risk = 5.1; P < .05). Patients with hypoechoic clefts ≥36 mm2 had a higher frequency of pain during activity and sleep and a lower level of satisfaction at the 21-month follow-up compared to those with small hypoechoic clefts (P = .05).ConclusionThis is the first study to evaluate the natural history of a hypoechoic cleft found at ultrasonography following rotator cuff repair. The study showed that clefts less than 36 mm2 are likely to heal, while those greater than 36 mm2 are at high risk of progressing to full-thickness retears.

Arthroscopic Rotator Cuff Repair in 2019: Linked, Double Row Repair for Achieving Higher Healing Rates and Optimal Clinical Outcomes

The primary aim of rotator cuff repair surgery is to restore the musculotendinous units by creating a complete, tension-free repair construct that optimizes conditions for tendon-to-bone healing. There are many factors outside the control of the surgeon that are capable of affecting the healing process; however, there are also a number of important technical considerations that the surgeon can control, including familiarity with methods to deal with immobile tissues and techniques to perform novel repair constructs. It is clear that linked double row repairs are more likely to heal, and healed rotator cuff repairs best restore shoulder strength, improve patients' satisfaction, and maximize functional outcomes.

Nonabsorbable Suture Knot on the Tendon Affects Rotator Cuff Healing: A Comparative Study of the Knots on Tendon and Bone in a Rat Model of Rotator Cuff Tear

Background: Nonabsorbable suture knots are usually used to link the tendon and bone during rotator cuff repair surgery. There are many variations in the arthroscopic knot-tying technique; however, the location of suture knot placement for rotator cuff healing has rarely been studied. Hypothesis: The authors compared the rotator cuff healing between knots tied on tendon and bone in a rotator cuff tear rat model. It has been hypothesized that knots can cause chronic inflammation and create the weakest link between tendon and bone, thus affecting rotator cuff healing. Study Design: Controlled laboratory study. Methods: Bilateral supraspinatus tenotomy and rotator cuff repair at the greater tuberosity were performed on 24 Wistar rats. Nonabsorbable surgical suture knots were made on the right supraspinatus tendon tissue and left humerus inferior to the greater tuberosity, respectively. Twelve rats each were sacrificed at 3 and 9 weeks. Six of the 12 rats were used for biomechanical testing and the remaining 6 for histologic evaluation. Results: The surgical knots placed on the bursal side of the tendon migrated to the articular side, as noted on gross observation in 22 of 24 samples. The knots on the tendon group showed significantly inferior tendon-bone integration and significantly inferior biomechanical results in terms of maximum load to failure and stiffness. An obvious chronic foreign body inflammatory reaction was found in the knots on the tendon group at 3 and 9 weeks. Furthermore, inferior bone-tendon interface regeneration and weakest link formation were obtained in the knots on the tendon group compared with those on the bone group. Conclusion: Nonabsorbable suture knots placed on the tendon migrate to the articular side, causing chronic inflammation and weakening tendon-bone healing, which may explain some retears after rotator cuff repair. Clinical Relevance: The present animal study suggests that it is not recommended in clinical practice to make several bulky nonabsorbable suture knots on the rotator cuff tendon during rotator cuff repair surgery. It may be better to tie the knots at the bone side or do knotless repair.

PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure-specific postoperative pain management recommendations.

SummaryRotator cuff repair can be associated with significant and difficult to treat postoperative pain. We aimed to evaluate the available literature and develop recommendations for optimal pain management after rotator cuff repair. A systematic review using procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in English from 1 January 2006 to 15 April 2019 assessing postoperative pain after rotator cuff repair using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. Out of 322 eligible studies identified, 59 randomised controlled trials and one systematic review met the inclusion criteria. Pre‐operative and intra‐operative interventions that improved postoperative pain were paracetamol, cyclo‐oxygenase‐2 inhibitors, intravenous dexamethasone, regional analgesia techniques including interscalene block or suprascapular nerve block (with or without axillary nerve block) and arthroscopic surgical technique. Limited evidence was found for pre‐operative gabapentin, perineural adjuncts (opioids, glucocorticoids, or α‐2‐adrenoceptor agonists added to the local anaesthetic solution) or postoperative transcutaneous electrical nerve stimulation. Inconsistent evidence was found for subacromial/intra‐articular injection, and for surgical technique‐linked interventions, such as platelet‐rich plasma. No evidence was found for stellate ganglion block, cervical epidural block, specific postoperative rehabilitation protocols or postoperative compressive cryotherapy. The analgesic regimen for rotator cuff repair should include an arthroscopic approach, paracetamol, non‐steroidal anti‐inflammatory drugs, dexamethasone and a regional analgesic technique (either interscalene block or suprascapular nerve block with or without axillary nerve block), with opioids as rescue analgesics. Further randomised controlled trials are required to confirm the influence of the recommended analgesic regimen on postoperative pain relief.

Group format rehabilitation is equally effective as individual therapy in patients with surgically repaired rotator cuff tears.

Does group physiotherapy methods produce different results when compared with individual physiotherapy in persons with surgically repaired rotator cuff tears? No studies to date have examined the feasibility or effectiveness of such therapy formats. Given the prevalence of rotator cuff tears, a study examining group format therapy is warranted and can produce evidence to transform care for rotator cuff tear rehabilitation. We analyzed the electronic medical records of persons that underwent rotator cuff repair surgery followed by the prescribedpost-surgical physiotherapy at Southlake Regional Health Centre. Both groups were provided standard physiotherapy intervention protocol for post-operative rotator cuff tear. Active range of motion (AROM), quick disabilities of the arm, shoulder and hand (Q-DASH) measures, and efficiency measures were examined for differences between groups. No significant differences between AROM (abduction p=.92, lateral rotation p=.64, and flexion p=1.00) and Q-DASH (p=.62) measures between groups were observed at discharge. Overall, group therapy participants required a greater number of visits (p=.000); however, when separated by age groups, only the 60- to 69-year-old participants significantly differed in number of visits between groups (p=.000), whereas no difference was observed in the 50- to 59-year-old participants (p=.14). Group format physiotherapy may be equally effective as individual formats in improving AROM and functional outcomes of participants with surgically repaired rotator cuff tears. Further research is needed to determine the optimal age range for group therapy interventions in this population.

The primary cost drivers of arthroscopic rotator cuff repair surgery: a cost-minimization analysis of 40,618 cases

An estimated 250,000 rotator cuff repair (RCR) surgical procedures are performed every year in the United States. Although arthroscopic RCR has been shown to be a cost-effective operation, little is known about what specific factors affect the overall cost of surgery. This study examines the primary cost drivers of RCR surgery in the United States. Univariate analysis was performed to determine the patient- and surgeon-specific variables for a multiple linear regression model investigating the cost of RCR surgery. The 2014 State Ambulatory Surgery and Services Databases were used, yielding 40,618 cases with Current Procedural Terminology code 29827 ("arthroscopic shoulder rotator cuff repair"). The average cost of RCR surgery was $25,353. Patient-specific cost drivers that were significant under multiple linear regression included black race (P < .001), presence of at least 1 comorbidity (P < .001), income quartile (P < .001), male sex (P = .012), and Medicare insurance (P = .035). Surgical factors included operative time (P < .001), use of regional anesthesia (P < .001), quarter of the year (January to March, April to June, July to September, and October to December) (P < .001), concomitant subacromial decompression or distal clavicle excision (P < .001), and number of suture anchors used (P < .001). The largest cost driver was subacromial decompression, adding $4992 when performed alongside the RCR. There are several patient-specific variables that can affect the cost of RCR surgery. There are also surgeon-controllable factors that significantly increase cost, most notably subacromial decompression, distal clavicle excision, use of regional anesthesia, and number of suture anchors. Surgeons must consider these factors in an effort to minimize cost, particularly as bundled payments become more common.

Insurance status affects access to physical therapy following rotator cuff repair surgery: A comparison of privately insured and Medicaid patients.

Rotator cuff repair (RCR) is an effective procedure to relieve shoulder pain and dysfunction. Postoperative physical therapy (PT) plays an integral role in the overall success of RCR. Insurance status has been shown to be an important predictor of postoperative PT utilization. This study evaluated the effect of insurance status on access to PT services following RCR. One hundred thirty-eight PT clinics were contacted in the Greater Boston metropolitan area. Clinics were contacted on two separate occasions and presented with a fictitious acutely postoperative RCR patient in need of PT. Insurance status was reported as Medicaid or private insurance. Overall, 133 (96.4%) accepted private insurance, whereas only 71 (51.4%) accepted Medicaid (P=0.019). Medicaid patients were offered a first available appointment at a mean of 8.3 days (95% CI: 7.13-9.38, range: 0-31) versus a mean of 6.3 days (95% CI: 5.3-7.22, range: 0-19, P=0.001) for private patients. Clinic location was not associated with access to PT or time to first appointment. Insurance status affects access to PT services and time to first available appointment in patients following RCR surgery in a major metropolitan area.

Is there a relation between rotator cuff injury and core stability?

Strong core stabilization not only minimizes the load on the vertebral column, but also improves strength and endurance of peripheral joints, and enables the energy transfer to distal segments. Despite the current interest surrounding core stability, none of the studies investigated the effect of core stability on the formation of rotator cuff tear or healing after repair. To determine the relationship between core stability and upper extremity functional performance in patients who underwent rotator cuff repair surgery and to compare those with healthy subjects of similar age. Patients who underwent rotator cuff repair (RC repair group, n= 58 patient) and healthy subjects of the similar age group (control group, n= 114) were included in the study. The mean age was 55.03 ± 9.84 years in the RC repair group and 52.71 ± 6.31 years in the control group. The RC repair group took standardized rehabilitation. The rehabilitation program did not include core strength and stability exercise. Core endurance was assessed with Flexor Endurance, Prone Bridge and Supine bridge test. Disabilities of the Arm, Shoulder and Hand (DASH), Short Form-36 (SF-36) and the Close Kinetic Chain Upper Extremity Stability (CKCUES) test were used to evaluate the upper extremity functional performance. The core endurance (prone and supine bridge test) of the control group was statistically significantly better than the RC repair group (p⩽ 0.005). The DASH-T, SF-36 and CKCUES scores of the control group were also statistically significantly better. The neuromuscular system should be considered as a whole, and addition of the core stabilization exercises to an effective rehabilitation program after RC repair surgery may be beneficial.

The effectiveness of prolotherapy on failed rotator cuff repair surgery.

The aim of the present study was to investigate the effectiveness of prolotherapy injections in the treatment of failed rotator cuff repair surgery. Between May 2014 and March 2016, a total of 15 patients (5 males, 10 females; mean age 49.4±10.7 years; range, 33 to 71 years) with failed rotator cuff repair surgery who had at least six months of complaints and were refractory to at least of three months of conservative methods were included. Ultrasound-guided prolotherapy injections were performed under aseptic conditions, and the patients were instructed to carry out a home-based exercise program. Clinical assessment of shoulder function was performed using a visual analog scale (VAS) for pain, Shoulder Pain and Disability Index (SPADI), Western Ontario Rotator Cuff (WORC) Index, patient satisfaction and shoulder range of motion. All patients were examined at baseline, at Week 3, 6, and 12 and at the final follow-up visit. The intra-group comparison showed that the patients achieved significant improvements at all time points, compared to baseline as measured by VAS, SPADI, WORC index, and shoulder range of motion (p<0.001). Twelve patients (80%) reported excellent or good outcomes. Our study results show that prolotherapy is effective in the treatment of patients with failed rotator cuff repair surgery with significant improvements in the shoulder functions and pain relief.

Autoimmune Connective Tissue Diseases and the Risk of Rotator Cuff Repair Surgery: A Population-Based Retrospective Cohort Study

ObjectivesAutoimmune connective tissue diseases (ACTDs) commonly involve the shoulder joint; however, clinical epidemiological studies investigating their association with tendons are scant. Rotator cuff (RC) tears can cause shoulder disability, and...

Enhancement of rotator cuff tendon–bone healing using bone marrow–stimulating technique along with hyaluronic acid

ObjectiveThe purpose of this study was to investigate the effect of hyaluronic acid (HA) in the tendon–bone healing process after rotator cuff repair in a rabbit model. MethodsIn vitro, rat bone marrow stromal cells (rBMSCs) were cultured in media for cartilage-related and inflammation-related gene expression levels examination at 1.0 mg/mL of HA. In vivo, 48 New Zealand white rabbits underwent rotator cuff repair surgery, and they were randomly divided into three groups: (1) control group (n = 16), (2) microfracture (MF) group accepting MF treatment (n = 16) and (3) MF/HA group accepting MF with HA treatment (n = 16). Four rabbits from each group were sacrificed at 6 and 12 weeks postoperatively for histological evaluation and biomechanical testing. ResultsIn vitro experiments reveal that HA significantly decreased inflammation-related mRNA expression (IL-1, TNFα) compared with the control group. At 6 weeks after surgery, there was no significant difference of load-to-failure between groups. At 12 weeks after surgery, the mean failure load of the MF/HA group was significantly higher than that of the control group (100.5 ± 10.1 N vs. 68.0 ± 6.2 N; p = 0.0115). The mean failure load of the MF group appeared higher than that of the control group, whereas there was no significant difference (p > 0.05). Histologically, more chondrocytes were clustered at the tendon–bone interface, and more extracellular matrixes were produced in the MF/HA group. The interface of the MF/HA group appeared similar with the normal tendon–bone interface. ConclusionHA may play a crucial role in the acceleration of tendon-to-bone healing which might be through inhibiting inflammation. Rotator cuff repair using MF along with HA led to better tendon–bone healing and a subsequent increase of biomechanical strength at the repair site. The translational potential of this articleHA injection is very common for patients with rotator cuff disease because of its antiinflammatory action and adhesion prevention preoperatively. The HA injection during surgery provides an antiinflammatory effect during tendon–bone healing process and leads to better tendon–bone healing postoperatively.