Supraspinatus Repair Research Articles

The Destiny of the Subscapularis Tendon after Arthroscopic Supraspinatus Repair.

The purpose of this study was to identify the changes in untreated subscapularis in patients who underwent supraspinatus repair and to evaluate the factors related to the changes in the subscapularis. A cohort of patients who underwent isolated supraspinatus repair with preservation of the subscapularis was reviewed. Changes in the subscapularis, including any newly formed lesion and aggravation of an existing lesion, were evaluated 12 months postoperatively on magnetic resonance imaging along with an examination to identify causative factors after supraspinatus repair. Clinical scores were compared between patients with and without subscapularis changes. A total of 528 patients were reviewed. Changes in the subscapularis, including newly formed lesions and aggravation of an existing lesion, were shown in 90 patients (17.0%). Upon regression analysis, changes in the subscapularis were associated with the initial existence of a subscapularis lesion (grade I: p = 0.042, grade II: p = 0.025), an accompanying biceps lesion (p = 0.038), and a retear of the repaired supraspinatus (p = 0.024). No significant differences were shown in clinical scores between patients with and without subscapularis changes after supraspinatus repair. Untreated asymptomatic subscapularis may undergo morphological changes even after repair of the torn supraspinatus. Preoperative subscapularis lesions, biceps long head pathology, and retears of the repaired supraspinatus were associated with subscapularis pathology in patients who underwent supraspinatus repair.

Range of motion at 6 weeks is an independent risk factor for non-healing at 6 months after arthroscopic supraspinatus repair.

PURPOSE: This study aimed to analyze the effect of the range of motion (ROM) progression pattern on healing after supraspinatus (SSN) repair. HYPOTHESIS: We hypothesized that a faster ROM recovery in the immediate postoperative period would be detrimental for tendon healing. Methods: This was a retrospective study of prospective collected data. All primary arthroscopic SSN repairs for full-thickness tears, with retraction Patte grade < 2, fatty infiltration Goutallier grade < 3 and no glenohumeral osteoarthritis were eligible. Patients who did not attend all follow-ups were excluded. One surgeon performed all arthroscopic repairs using a double-row technique. All patients followed the same rehabilitation protocol with an abduction pillow and passive ROM for 6 weeks. One observer assessed all patients preoperatively and at 1.5, 3 and 6 months postoperatively. Collected outcome measures included: ROM, Visual Analogue Scale (VAS) for pain and Constant Score (CS). Repair integrity was evaluated at 6 months by ultrasound. 2 groups were established based on repair integrity (healed/non-healed). A multivariable analysis was performed to assess potential confounding factors and ROC curve analysis was used to identify predictive thresholds for non-healing. Results: Of 1397 consecutive SSN repairs, 169 were excluded and 1207 were finally included. The overall healing rate was 87.3%. All preoperative outcome measures were similar between groups. Non-healed repairs at 6 months were slightly younger (57.8±7.9 vs 61.6±8.8, p < 0.001) and had a faster postoperative ROM recovery pattern. This difference was most distinct at 6 weeks in passive anterior elevation (AE) (143±22 vs 128±26, p < 0.001) and external rotation (ER) (32±17 vs 23±17,p < 0.001) but was fully compensated by 6 months. VAS pain and CS at each follow-up were similar between groups. Multivariable analysis confirmed 6-weeks passive EA (OR:1.36) and ER (OR:1.16) as independent risk factors for non-healing. The non-healing rate increased when 6-weeks passive EA >140° (20.4 vs 7.9%) and ER > 30° (18.4 vs 8.8%). Conclusions: In a large cohort of isolated arthroscopic SSN repairs treated with the same surgical technique and rehabilitation protocol, a faster postoperative ROM progression pattern, reflected by higher 6-weeks AE and ER, was associated with an increased rate of non-healing. This study illustrates the benefit of a conservative rehabilitation protocol on tendon healing without affecting ROM at 6 months.

Comparative Analysis of Mini Open versus Arthroscopic Repair of Supraspinatus Tears

Background and Aim: Among all the rotator cuff tendon injuries, supraspinatus tear is very common and it is mostcommon in older individuals. Before the arthroscopy came into high demand, the open repair of supraspinatustear was the preferred method of surgery. Recently, the miniopen technique of repair has also gained popularitybecause of certain factors like better repair strength, requires less expertise and facilitates early active mobilization.Present stud was performed to compare functional and clinical outcomes of arthroscopic and mini-open repair.Material and Methods: The present analysis is the randomized control study done on the patients diagnosedwith rotator cuff tears and was planned with supraspinatus repair with the use of arthroscopic and mini opentechnique. As per the inclusion and exclusion criteria total of 128 patients were included in the study. The includedpatients were equally divided into two groups: 64 patients who underwent mini-open repair and 64 patientswho underwent arthroscopic repair. Follow up was done after 12 months postoperatively and the results wereevaluated using University of California Los Angeles (UCLA) shoulder score.Results: For arthroscopic repair group, UCLA shoulder score were: 26 patients got excellent result, 30 patients gotgood result and only 8 patients got fair result. In the other group UCLA shoulder score were: 22 patients in whomexcellent results were obtained good results were obtained in 32 patients and in 10 patients we got fair results.Conclusion: The arthroscopic procedure decreased postoperative pain, faster regains normal ROM and quickerreturn to function and in turn early return to work compared to mini-open procedure. The arthroscopic procedurebetter in addressing intra-articular and other associated problems than mini-open technique.

Lower Trapezius Tendon Transfer With Achilles Tendon Allograft: A Technique Video

Background: While small to medium rotator cuff tears demonstrate good outcomes with primary repair, large, irreparable cuff tears pose a significant clinical challenge with high re-tear rates and lower patient satisfaction. Tendon transfers are procedures that can restore motion and strength in the shoulder in the case of irreparable rotator cuff tears. Trapezius tendon transfers are suitable for large posterosuperior cuff tears as the lower trapezius has a vector of pull similar to that of the infraspinatus. Indications: Lower trapezius tendon transfers are indicated for young and active patients with irreparable posterior and posterosuperior rotator cuff tears causing significant weakness and loss of external rotation. Contraindications to the procedure include advanced osteoarthritis of the glenohumeral joint, advanced age, and deficiency of the subscapularis, deltoid, or trapezius muscles. Technique Description: Using a scapular incision, the trapezius muscle body and tendon are dissected from the scapular spine and mobilized. The plane of the infraspinatus into the glenohumeral joint is tunneled using blunt dissection, and the prepared allograft is passed through under arthroscopic visualization. The allograft insertion is stabilized with 3 knotless anchors and reinforced using medial row sutures from a concomitant supraspinatus repair. The proximal graft origin is fixed to the trapezius tendon using a Pulvertaft weave morphology to reconstruct the muscle-tendon unit. Results: Outcomes data from the literature demonstrate improvement in symptoms and patient satisfaction following the procedure. In a retrospective analysis of 41 patients, Elhassan et al demonstrated that 90% of patients experienced significant improvement in visual analog scale (VAS), Subjective Shoulder Value (SSV), and Disabilities of the Arm, Shoulder, and Hand (DASH) score at mean follow-up time of 14 months. Discussion/Conclusion: In appropriately indicated patients, the lower trapezius tendon transfer offers restoration of external rotation strength and range of motion, pain relief, low risk of complications, and reduced risk of revision compared with alternative procedures. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Longitudinal Analysis of the ASES and Constant-Murley Scores, and the Internal Rotation/Shift and Jobe Tests Following Arthroscopic Repair of Supraspinatus Lesions.

It is essential to investigate patients post-surgery using functional surveys like the American Shoulder and Elbow Surgeons Shoulder (ASES) and the Constant-Murley shoulder (CMS) scores, as well as clinical tests, such as the Internal Rotation and Shift (IRO/Shift) and Jobe tests. In this study, 51 out of an initial 87 patients underwent an arthroscopic supraspinatus repair (22 single-row, 16 double-row, 13 debridement). Testing occurred pre-surgery, and 3 and 6 months post-surgery. Both surveys showed significant improvements over time among all 87 patients, but there were no differences between groups (lesion/no lesion) (p > 0.815) or time × group (p > 0.895). The IRO/Shift test showed a stronger ability to distinguish between both groups (positive vs. negative) with respect to the ASES and CMS scores over time, but the Jobe test did not (p > 0.100). Improvements in the CMS scores and the Jobe test were lower following repair compared to the ASES and IRO/Shift test. Most patients returned to adequate levels of functional abilities at 6 months post-surgery. The time required to return to activities of daily living and negative clinical tests was longer for the double-row repair patients compared to the single-row and debridement groups. In conclusion, both the functional surveys and the clinical tests demonstrated improvements following surgery.

Midterm Clinical Outcomes After Arthroscopic Rotator Cuff Repair in Olympic Volleyball Players: Return to Sports and Return to Performance.

The decision-making process and predicting the time to return to sport (RTS) and return to performance (RTP) after arthroscopic rotator cuff repair (ARCR) in elite volleyball players are difficult issues to address, even among experienced shoulder surgeons. The purpose of the study was to evaluate the results in Olympic-level volleyball players treated with arthroscopic supraspinatus repair and to report the RTS and the RTP. It was hypothesized that these athletes had higher RTS and faster RTP. Case series; Level of evidence, 4. This study included 17 elite volleyball athletes (11 male, 6 female; mean age, 26.2 years) who underwent ARCR for partial- and full-thickness supraspinatus tears that did not improve despite nonoperative treatment. The clinical results were evaluated at 12 months postoperatively. The authors compared the athletes' preoperative, 6-month, and 12-month Kerlan-Jobe Orthopaedic Clinic (KJOC) scores and the visual analog scale (VAS) for pain after competition and conducted 6- and 12-month isometric strength analyses. The athletes' RTS and RTP times were recorded. All tears were on the dominant side (15 right, 2 left), and 82% were partial tears (14 partial thickness, 3 full thickness). The mean time from the onset of symptoms to surgery was 11.3 ± 6.7 months. While the mean Kerlan-Jobe Orthopaedic Clinic score was 31 preoperatively, it was 89 after 6 months (P < .001 vs preoperative) and 96 after 12 months (P = .003 vs 6 months). The mean VAS for pain was 7.9 preoperatively, 0.4 at 6 months (P < .001 vs preoperative), and 0.1 at 12 months (P = .02 vs 6 months). All athletes were able to reach their preinjury level, with RTS at a mean of 6.9 months and RTP at a mean of 12.4 months. ARCR appears to be an effective option for Olympic-level volleyball players who do not benefit from nonoperative treatment. All athletes returned to their preinjury level of sports. The surgeon and athlete can plan surgical decision-making and timing based on the mean RTS time of 6.9 months and mean RTP time of 12.4 months.

The effect of biceps tenotomy on superior humeral migration in arthroscopic repaired full-thickness supraspinatus tears

Lesions of the long head of the biceps (LHB) tendon are a prevalent injury that frequently coexists with rotator cuff injuries. This study aimed to assess the effect of supraspinatus (SST) repair with concurrent LHB tenotomy on superior migration of the humeral head. The acromiohumeral distance (AHD) was determined via ultrasound to evaluate the superior migration of the humeral head. The study population was retrospectively recruited from patients who underwent unilateral arthroscopic repair of isolated degenerative full-thickness SST tears between January 2017 and December 2019. Patients were divided into 2 subgroups based on whether they underwent LHB tenotomies during arthroscopy. While 37 patients underwent arthroscopic single-row SST repair, the other 33 patients underwent arthroscopic single-row SST repair with LHB tenotomy. The subject group consisted of people who had undergone arthroscopic shoulder surgery. Contralateral shoulders without rotator cuff injuries were included in the control group. The AHD and SST thicknesses of patients were examined via the ultrasound in both groups and subgroups. The mean age in the SST repair group was 55.52±4.58 years (range, 46-63 years), whereas it was 58.24±3.98 (range, 52-73 years) in the SST repair+LHB tenotomy group. In the SST repair group, 57.6% of patients were female and 42.4% were male, whereas 56.8% and 43.2% were in the SST repair+LHB tenotomy group, respectively. The mean body mass index was 28.06±1.31 kg/m2 (range, 25.7-31.2 kg/m2) in the SST repair group and 28.95±1.79 kg/m2 in the SST repair+LHB tenotomy group. Groups were not different for sex, surgery side, dominant side, tear size, and follow-up time; however, the SST repair+LHB tenotomy group had significantly higher mean age and body mass index than the SST repaired group. The mean AHD value and SST thickness were significantly less in both the rotator cuff repair group and the rotator cuff repair+LHB tenotomy group compared to the healthy shoulder. The mean AHD value was significantly lower in the SST repaired+LHB tenotomy group than in the SST repair group (P=.02). The AHD was narrowed in patients who underwent LHB tenotomy and radiologically demonstrated the depressor effect of the LHB tendon on the humeral head. As a secondary outcome, we demonstrated that regardless of tenotomy, AHD could not be restored in patients who underwent arthroscopic single-row SST repair.

A Slower Recovery Of Range Of Motion after Arthroscopic Supraspinatus Repair Is Associated With a Higher Healing Rate

A Slower Recovery Of Range Of Motion after Arthroscopic Supraspinatus Repair Is Associated With a Higher Healing Rate

Menstrual Blood–Derived Mesenchymal Stem Cells Encapsulated in Autologous Platelet-Rich Gel Facilitate Rotator Cuff Healing in a Rabbit Model of Chronic Tears

Background: Successful management of chronic rotator cuff (RC) tears remains a challenge owing to its limited intrinsic healing capacity and unsatisfactory failure rate. Menstrual blood–derived mesenchymal stem cells (MenSCs) have the potential to differentiate into the chondrogenic or osteogenic lineage. Autologous platelet-rich gel (APG), a gel material derived from platelet-rich plasma (PRP), can be applied as a carrier system for cell delivery and also as a releasing system for endogenous growth factors. Purpose: To investigate the effect of human MenSCs encapsulated in APG (MenSCs@APG) on the healing of chronic RC tears in a rabbit model. Study Design: Controlled laboratory study. Methods: After evaluation of the effect of PRP on MenSC proliferation or differentiation, the stem cells were encapsulated in APG for in vivo injection. Supraspinatus tenotomy from the right greater tuberosity was performed on 45 New Zealand White rabbits. After 6 weeks, these rabbits were randomly allocated to 3 supplemental treatments during supraspinatus repair: saline injection (control [CTL] group), APG injection (APG group), and MenSCs@APG injection (MenSCs@APG group). At week 18, these rabbits were sacrificed to harvest the humerus–supraspinatus tendon complexes for micro–computed tomography (CT), histological evaluation, tensile test, and MenSC tracking. Results: In vitro results showed that APG can stimulate MenSC proliferation and enhance chondrogenic or osteogenic differentiation. In vivo results showed that APG can act as a carrier for delivering MenSCs into the healing site, and also as a stimulator for enhancing the in vivo performance of MenSCs. Micro-CT showed that bone volume/total volume and trabecular thickness of the new bone in the MenSCs@APG group presented significantly larger values than those of the APG or CTL group (P < .05 for all). Histologically, compared with the CTL or APG group, significantly more mature fibrocartilage regenerated at the healing site in the MenSCs@APG group. A large number of human nuclei–stained cells were observed in the MenSCs@APG group, presenting a similar appearance to fibrochondrocytes or osteocytes. Biomechanically, the MenSCs@APG group showed significantly higher failure load and stiffness than the APG or CTL group (P < .05 for all). Conclusion: Human MenSCs@APG facilitated RC healing in a rabbit model of chronic tears. Clinical Relevance: Autogenous MenSCs@APG may be a new stem cell–based therapy for augmenting RC healing in the clinic.

Increased operative time has a negative impact on clinical outcome in arthroscopic rotator cuff repair.

Few data are available about the impact of operative time on outcome of rotator cuff repair. The aim of this study was to evaluate the impact of operative time on clinical outcome and tendon healing after arthroscopic rotator cuff repair. Patients operated on for distal supraspinatus tear in our institution between 2012 and 2018 were included retrospectively. Operative time, from skin incision until skin closure, was extracted from medical files. For statistical analysis, operative time was treated as a quantitative variable. Endpoints were clinical outcome (Constant score, range of motion), tendon healing (on CT or MRI) and complications at 1year. The significance threshold was set at p = 0.05. A total of 219 Patients, with a mean age of 54.6years (range 40-70years), were included. Mean operative time 44.9min (range 14-140min). Significant correlations (p < 0.05) were found for Constant score and external rotation at 1year: increasing operative time by 1min led to a decrease in Constant score of 0.115 points, or 6.9 points for a 60-min increase (p = 0.0167) and a decrease in external rotation of 0.134°, or 8.04° for a 60-min increase (p = 0.0214). No significant correlations were found for anterior elevation at 1year (p = 0.2577), tendon healing at 1year (p = 0.295) or onset of complications during follow-up (p = 0.193). The minimal clinically important difference in Constant score in patients undergoing rotator cuff surgery is between 6 and 10 points. An increase of more than 60min in operative time significantly impacted clinical outcome of arthroscopic distal supraspinatus repair, but not tendon healing. Level III: Retrospective Cohort Design. Therapeutic Study.

Increased Expression of Pain-Related Factors in Structures Adjacent to Pathologic Biceps Long Head Tendons in Patients with Rotator Cuff Tears

Different levels of pain, with various symptoms, are present in patients with rotator cuff tears. The purpose of this study was to evaluate the expression of factors related to pain on the long head of the biceps tendon (LHBT) and structures adjacent to the LHBT in patients with supraspinatus tears and to compare the differences in order to verify whether the structures are affected by the condition of the LHBT. Forty patients who underwent arthroscopic supraspinatus repair were enrolled. Patients with an intact LHBT were allocated to group 1 and patients with pathologic LHBTs were allocated to group 2. With the acquisition of tissues from the LHBT, anterior capsule, rotator interval, and subacromial bursa, the expressions of protein gene product 9.5 (PGP9.5), growth-associated protein 43 (GAP43), calcitonin gene-related peptide (CGRP), substance P, P75, S100, and CD34 were analyzed using real-time reverse transcription polymerase chain reaction and immunohistochemistry. The gene expression levels of PGP9.5 (p = 0.02), GAP43 (p = 0.03), CGRP (p = 0.007), and CD34 (p = 0.03) from the LHBT were significantly higher in group 2. PGP9.5 (p = 0.04 and p = 0.01), GAP43 (p = 0.02 and p = 0.004), and P75 (p = 0.02 and p = 0.02) from the anterior capsule and rotator interval were also significantly higher in group 2. Immunohistochemistry revealed increased expression of pain-related factors in the anterior capsule and rotator interval of group 2. Enhanced expression of pain-related factors in the LHBT, anterior capsule, and rotator interval of patients with pathologic LHBTs suggests that a pathologic LHBT functions as a pain generator itself and adjacent structures can be influenced by the condition of the LHBT.

Effects of a graphene oxide-alginate sheet scaffold on rotator cuff tendon healing in a rat model

Natural polymer scaffolds used to promote rotator cuff healing have limitations in terms of their mechanical and biochemical properties. This animal study aimed to investigate the effects of combined graphene oxide (GO) and alginate scaffold and the toxicity of GO on rotator cuff healing in a rat model. First, the mechanical properties of a GO/alginate scaffold and a pure alginate scaffold were compared. The in vitro cytotoxicity of and proliferation of human tenocytes with the GO/alginate scaffold were evaluated by CCK-8 assay. For the in vivo experiment, 20 male rats were randomly divided into two groups (n = 10 each), and supraspinatus repair was performed: group 1 underwent supraspinatus repair alone, and group 2 underwent supraspinatus repair with the GO/alginate scaffold. Biomechanical and histological analyses were performed to evaluate the quality of tendon-to-bone healing 8weeks after rotator cuff repair. The GO/alginate scaffold exhibited an increased maximum load (p = .001) and tensile strength (p = .001). In the cytotoxicity test, the cell survival rate with the GO/alginate scaffold was 102.08%. The proliferation rate of human tenocytes was no significant difference between the GO/alginate and alginate groups for 1, 3, 5, and 7days. Biomechanically, group 2 exhibited a significantly greater ultimate failure load (p < .001), ultimate stress (p < .001), and stiffness (p < .001) than group 1. The histological analysis revealed that the tendon-to-bone interface in group 2 showed more collagen fibers bridging, tendon-to-bone integration, longitudinally oriented collagen fibers, and fibrocartilage formation than in group 1. A small amount of GO added to alginate improved the mechanical properties of the scaffold without evidence of cytotoxicity. At 8 weeks after rotator cuff repair, the GO/alginate scaffold improved tendon-to-bone healing without causing any signs of toxicity in a rat model.

Poster 130: Tendon-to-bone Healing in a CCR2 Knockout Mouse Model of Delayed Rotator Cuff Repair

Poster 130: Tendon-to-bone Healing in a CCR2 Knockout Mouse Model of Delayed Rotator Cuff Repair

How to Decrease Suture Tangling When Performing Supraspinatus Repair With a Single–Working Portal Technique

Arthroscopic rotator cuff repair is one of the most common procedures in shoulder surgery. Some complications occur related to portal incisions, such as infection, bleeding, increased surgical time, and surgical scar. By using 1 lateral working portal with decreased suture tangling, surgical complications can be reduced and rehabilitation and patient satisfaction can be enhanced.

Selective Serotonin Reuptake Inhibitor Promotes Bone-Tendon Interface Healing in a Rotator Cuff Tear Rat Model.

Selective serotonin reuptake inhibitor (SSRI) is believed to accelerate wound healing, and thus expected to have a positive effect on rotator cuff repair. We hypothesized that SSRI has a positive effect on the healing of the bone-tendon interface (BTI), and improved rotator cuff tear healing would be confirmed by mechanical strength measurements and histological assessment of the restored tendon. The study used 40 adult male Sprague-Dawley wild-type rats. The animals were divided into two groups: group-SSRI, the supraspinatus repair with SSRI injection group, and group-C, conventional supraspinatus repair only without SSRI. Biomechanical and histological analyses were performed 8weeks after index rotator cuff surgery. The ultimate load (N) was significantly higher in group-SSRI than in group-C (54.8 ± 56.9 Vs 25.1 ± 11.1, p = .031). In the histological evaluation, the Bonar score confirmed significant differences in collagen fiber density (group-C: 0.6 ± 0.5, group-SSRI: 1.1 ± 0.6, p = .024), vascularity (group-C: 0.1 ± 0.2, group-SSRI: 0.3 ± 0.4, p = .024) and cellularity (group-C: 1.7 ± 0.4, group-SSRI: 2.0 ± 0.0, p = .023) between the groups. Based on the total score, group-SSRI was significantly better compared with group-C (6.3 ± 2.7 Vs 4.3 ± 1.9, p = .019). Our study demonstrated that SSRI could facilitate improved biomechanical and histological outcomes 8weeks after rotator cuff repair in a rat model. Consequently, SSRI may improve healing after rotator cuff repair.

Arthroscopic Rotator Cuff Repair with Biphasic Interpositional Allograft Augmentation

Rotator cuff repair in the setting of a chronic tear or poor tissue quality presents a surgical challenge because of the high risk of structural failure. Patients with an increased risk of retear may be candidates for enthesis augmentation with a novel, biphasic allograft, composed of a demineralized cancellous matrix with a layer of mineralized bone. This interpositional graft was designed with the intention to promote both soft-tissue and osseous integration into the matrix, thereby conferring greater stability and regeneration of the transitional zone of the rotator cuff enthesis. Here, we describe a technique for a transosseous-equivalent supraspinatus repair with placement of a biphasic interpositional allograft.

Rotator Cuff Repair Using Coracoacromial Ligament Autograft for Supraspinatus Footprint Augmentation

Failure of rotator cuff repair can be a disastrous clinical outcome. Although failure is a multifactorial issue, recent interest has piqued in understanding the biology of the insertional components of the supraspinatus and infraspinatus at the footprint. When the torn tendon is of poor quality, especially if it is diminutive or thin, rotator cuff repair augmentation should be considered to aid in long-term healing. Various allograft options have been described in the past, and more recently, xenografts and synthetics have become more commonly used. The use of autografts in the treatment of insertional footprint deficiency has great potential; however, few grafts have been described. This study describes the surgical technique for footprint augmentation in arthroscopic supraspinatus repair using harvested autologous coracoacromial ligament tissue.

Arthroscopic rotator cuff repair: Is healing enough?

Hypothesis/backgroundArthroscopic rotator cuff repair most commonly results in good clinical outcomes, however understanding of predictive factors influencing the final clinical outcome is limited. AimThe purpose of our study was to evaluate clinical outcomes of patients with healed supraspinatus tendon after arthroscopic rotator cuff repair and to identify its pre- and peri-operative predictive factors of good clinical results. MethodsA multi-center prospective study followed up 188 patients, who had a healed tendon after an arthroscopic repair of isolated supraspinatus tear. Inclusion criteria were: age under 70 years old, isolated supraspinatus tear, stage 0 or I of fatty infiltration, healed supraspinatus tendon at one year postoperatively and the same arthroscopic double row rotator cuff repair used in all patients. Clinical assessment used Constant Murley Score (CMS) and Subjective Shoulder Value (SSV) preoperatively and at one year postoperatively. Ultrasound (US) control checked tendon repair quality based on Sugaya classification. Types I-II-III were considered as healed. ResultsThe average age of our cohort was 57.57 (range; 41 to 70) years and the female to male ratio was 1.14 (range; 100 to 87). The average preoperative CMS was 53.75±13.50 (mean±SD; range; 16 to 83). At final follow up, the average postoperative CMS was 79.95±12.05 (mean±SD; range; 28 to 100). 12.22% (23/188) of patients, who had a CMS score below 70, had a clinically significant difference compared to the average CMS, due to the fact that the minimal clinically significant difference (MCID) in CMS is 10. A statistical analysis has shown that in patients with lower scores there was only a significant dominance of females (p-value=0.001). No difference was found in regards to age, preoperative CMS, fatty degeneration and other factors. ConclusionOur study showed that despite all patients had a healed repair of supraspinatus, not all of them experienced a good final clinical outcome. The only factor negatively influencing the final clinical outcome was a female gender. No other structural factors seemed to influence the final clinical results. Futures studies should focus more on analyzing which personality traits and other psychosocial factors play an important role in determining the final outcome after arthroscopic rotator cuff repair. Level of evidenceIII; retrospective cohort study.

Outcomes Following the Repair of Isolated Supraspinatus Repairs versus those with Concurrent Subscapularis Repairs (242)

Objectives:While rotator cuff tears often require repair of the supraspinatus, patients can also have a concurrent tear of the subscapularis requiring repair. Previous smaller studies have shown good clinical outcomes following the repair of the subscapularis and rotator cuff during the same procedure.1 The purpose of this study was to compare clinical outcome measures between patients who had isolated supraspinatus repairs versus those who had a supraspinatus tear with a concurrent subscapularis repair.Methods:A retrospective review of 166 patients who underwent arthroscopic supraspinatus repair with or without a concurrent subscapularis repair between 2013-2018 with a minimum of one-year follow up was performed. Patients were separated into two groups based on their treatment: 100 had an isolated supraspinatus repair (SP) and 66 had both a supraspinatus and subscapularis repair (SB). The primary outcome was revision rotator cuff repair. Secondary outcomes were objective measures such as range of motion (ROM) and strength testing, including flexion (FF), external rotation (ER), and internal rotation (IR), as well as patient-reported outcome measures (PROs) including visual analog pain scale (VAS) and subjective shoulder value (SSV). Outcomes were compared using the Mann- Whitney Test and Fisher’s Exact Test with p<0.05, as the data were not parametric (SPSS, IBM).Results:There was no significant difference in the rate of revision surgery required following isolated supraspinatus repair versus those with a subscapularis repair. Additionally, there were no significant differences between groups for all PROs, all ROM parameters, and all strength parameters (all p > 0.05) (Table 1).Conclusions:The data from this study demonstrated that patients who require a subscapularis repair at the time of their rotator cuff repair can expect similar short term outcomes to those patients who only required repair of their supraspinatus.

Comparing the outcomes of arthroscopic tenodesis versus tenotomy for the treatment of the long head of biceps tendon pathologies during supraspinatus tendon repair

Aim: Long head of the biceps tendon pathologies are frequently accompany full-thickness rotator cuff tear. The purpose of this study was to compare functional scores, complication rates, and time to return to work after tenotomy and tenodesis who underwent arthroscopic supraspinatus repair (ASR).Methods: Overall, 129 patients who underwent ASR surgery were divided into 2 groups. Group 1 consists of 62 patients underwent biceps tenodesis and group 2 consists of 67 patients underwent biceps tenotomy. We evaluated demographic data, clinical findings, complications and American Shoulder and Elbow Surgeons, Constant Murley, Visual analogue scale and 36-item Short Form subscale scores. Results: Mean follow-up time was 13.68±4.22 months. Mean postoperative and preoperative-postoperative differences of ASES, CM, VAS and SF-36 subscale scores were not significantly different between two groups. Popeye sign was positive for 13 (19.4%) patients in group 2, however, none of patients in group 1 was positive (p&amp;lt;0.001). Other complications were not significantly different between two groups.Conclusion: The results show that arthroscopic biceps tenotomy and tenodesis are both viable treatments for proximal biceps tendon pathology, yielding similar clinical outcomes in the context of concomitant rotator cuff repair. Tenotomy can be chosen instead of tenodesis which is technically more difficult and expensive.