Supraspinatus Repair Research Articles

A “Comma Sign”–Directed Subscapularis Repair in Anterosuperior Rotator Cuff Tears Yields Biomechanical Advantages in a Cadaveric Model

Background: Additional stabilization of the “comma sign” in anterosuperior rotator cuff repair has been proposed to provide biomechanical benefits regarding stability of the repair. Purpose: This in vitro investigation aimed to investigate the influence of a comma sign–directed reconstruction technique for anterosuperior rotator cuff tears on the primary stability of the subscapularis tendon repair. Study Design: Controlled laboratory study. Methods: A total of 18 fresh-frozen cadaveric shoulders were used in this study. Anterosuperior rotator cuff tears (complete full-thickness tear of the supraspinatus and subscapularis tendons) were created, and supraspinatus repair was performed with a standard suture bridge technique. The subscapularis was repaired with either a (1) single-row or (2) comma sign technique. A high-resolution 3D camera system was used to analyze 3-mm and 5-mm gap formation at the subscapularis tendon-bone interface upon incremental cyclic loading. Moreover, the ultimate failure load of the repair was recorded. A Mann-Whitney test was used to assess significant differences between the 2 groups. Results: The comma sign repair withstood significantly more loading cycles than the single-row repair until 3-mm and 5-mm gap formation occurred (P≤ .047). The ultimate failure load did not reveal any significant differences when the 2 techniques were compared (P = .596). Conclusion: The results of this study show that additional stabilization of the comma sign enhanced the primary stability of subscapularis tendon repair in anterosuperior rotator cuff tears. Although this stabilization did not seem to influence the ultimate failure load, it effectively decreased the micromotion at the tendon-bone interface during cyclic loading. Clinical Relevance: The proposed technique for stabilization of the comma sign has shown superior biomechanical properties in comparison with a single-row repair and might thus improve tendon healing. Further clinical research will be necessary to determine its influence on the functional outcome.

Superior Capsular Reconstruction of the Shoulder

For irreparable rotator cuff tears, superior capsular reconstruction (SCR) has become an option for restoring glenohumeral joint stability and reversing proximal humeral migration. Signs of irreparable rotator cuff tears include pain from subacromial impingement, muscle weakness, and pseudoparalysis. In biomechanical studies, Mihata etal. showed SCR with fascia lata graft and side-to-side suturing to remaining infraspinatus tendon restored superior stability of the shoulder joint. Adding acromioplasty decreased the subacromial contact area without altering the humeral head position, superior translation, or subacromial peak contact pressure. The same research group showed that using an 8-mm thick fascia lata graft attached at 15° to 45° of shoulder abduction optimized superior stability of the shoulder joint. Adams etal. performed SCR using a dermal allograft and found that greater glenohumeral abduction angle (60°) decreased applied deltoid force. SCR can be performed with the patient in the lateral decubitus or beach chair position. Arthroscopic exploration, debridement, and infraspinatus and supraspinatus repair attempt is completed before proceeding with SCR. To restore the superior capsule of the shoulder, the graft (fascia lata autograft, dermal allograft) can be attached to the superior glenoid medially and the rotator cuff footprint on the greater tuberosity of the humerus laterally, after debriding bone to enhance healing. SCR with side-to-side suturing to the remnant rotator cuff yields promising clinical results. Using a fascia lata autograft, Mihata etal. showed a reversal of pseudoparalysis in 93% to 96% of patients and mean active elevation, external rotation, and acromiohumeral distance on radiography all improved. Using a dermal allograft and a unique graft delivery technique, Burkhart etal. reversed pseudoparalysis in 9 of 10 patients and 70% of patients had completely intact grafts. Recommendations for rehabilitation and return to activity vary, but adequate time for graft healing is recommended.

Failure rates and clinical outcomes after treatment for long-head biceps brachii tendon pathology: a comparison of three treatment types.

Hypothesis/BackgroundTreatment options for the biceps brachii tendon include tenotomy, arthroscopic tenodesis, and open tenodesis. Few studies to date have compared all treatment options in the context of a rotator cuff repair.MethodsA retrospective review of 100 patients who underwent arthroscopic supraspinatus repair between 2013 and 2018 with a minimum of one-year follow-up was performed. Patients were separated into the following 4 groups: (1) 57 had isolated supraspinatus repair with no biceps tendon surgery (SSP); (2) 16 had supraspinatus repair and biceps tenotomy; (3) 18 had supraspinatus repair and arthroscopic biceps tenodesis; (4) 9 had supraspinatus repair and an open biceps tenodesis (SSP + OT). The primary outcome was operative time. The secondary outcomes were cost analysis, complications, patient-reported outcome measures, range of motion, and strength testing.ResultsThe operative time for the SSP + OT group was significantly longer than that of the SSP group (P < .05) but was not significantly longer than that of the other groups. The cost for the SSP group was significantly less than the cost for the SSP + OT and supraspinatus repair and arthroscopic biceps tenodesis groups (P < .05 for both), whereas the cost for the supraspinatus repair and biceps tenotomy group was significantly less than the cost for the SSP + OT group (P < .05). There were no significant differences between groups for complications, all patient-reported outcome measues, all range of motion, and all strength parameters.Discussion/ConclusionOperative time is the longest in open biceps tenodesis and is significantly longer than that of isolated supraspinatus repair. No significant differences in operative times or costs were identified in patients undergoing arthroscopic vs. open biceps tenodesis. All patients, irrespective of the type of biceps tendon procedure, had excellent clinical and functional outcomes at least one year after surgery. There was no difference in clinical or functional outcomes, or complications, among the 4 groups.

Repair of high-grade partial thickness supraspinatus tears after surgical completion of the tear have a lower retear rate when compared to full-thickness tear repair.

High-grade partial thickness rotator cuff tears (i.e., those involving at least 50% of the tendon thickness) are especially challenging to treat and various treatment strategies have been described. Prior studies have demonstrated equivalent outcomes between in situ tear fixation and tear completion repair techniques. However, it is unknown how repair of completed high-grade partial thickness tears to full tears compares to repair of full-thickness tears. The purpose of this study was to compare clinical outcome measures at least 1year postoperatively between patients who had completion of a high-grade partial thickness supraspinatus tear to a full-thickness tear (PT) and those who had an isolated full-thickness supraspinatus tear (FT). The hypothesis of this study was equivalent retear rates as well as equivalent clinical and patient-reported outcomes between the two groups. A retrospective review of 100 patients who underwent isolated arthroscopic supraspinatus repair between 2013 and 2018 with a minimum of 1year follow-up was performed. Patients were separated into two groups based on their treatment: 56 had completion of a partial thickness supraspinatus tear to full-thickness tear with repair (PT) and 44 had isolated full-thickness supraspinatus repairs (FT). The primary outcome was rotator cuff retear, which was defined as a supraspinatus retear requiring revision repair. Secondary outcomes were patient-reported outcome measures (PROs) including visual analog pain scale (VAS) and subjective shoulder value (SSV), range of motion (ROM) and strength in forward flexion (FF), external rotation (ER), and internal rotation (IR). There was a significantly lower rate of retear between the PT versus FT groups (3.6% vs. 16.3%, p=0.040). There were no significant differences between groups for all PROs, all ROM parameters, and all strength parameters (all n.s.). The data from this study demonstrated that the PT group had a significantly lower retear rate at 1year follow-up than the FT group, while PROs, ROM, and strength were similar between the two groups. Patients with PT supraspinatus tears can have excellent outcomes, equivalent to FT tears, after completion of the tear, and subsequent repair with low retear rates. These findings may aid the treating surgeon when choosing between in situ fixation of the PT supraspinatus tear or completion of the tear and subsequent repair, as it allows the treating surgeon to choose the procedure based on comfort and experience level. Level III.

FUNCTIONAL OUTCOME OF ARTHROSCOPIC REPAIR OF ISOLATED SUPRASPINATUS TEAR – A PROSPECTIVE OBSERVATIONAL STUDY

Background: Rotator cuff lesions are one of the more common conditions affecting the shoulder joint. The management of rotator cuff tears has changed dramatically from open procedures to less invasive procedures like arthroscopy. The results of arthroscopic rotator cuff repair have not been studied as extensively as open repair. The purpose of this study is to evaluate functional outcome of arthroscopic repair of isolated supraspinatus tear. Methods: A prospective observational study conducted on twenty patients with supraspinatus tendon tear who underwent arthroscopic supraspinatus repair between September 2017 and June 2018. Patients with tear of supraspinatus tendon, age between 45 and 70 years, repair performed solely with arthroscopic technique, consent to participate and follow up in post-operative rehabilitation were included. Patients with associated superior labrum anterior to posterior lesion, cuff tear arthropathy, acromioclavicular arthritis, tears involving other rotator cuff tendons and revision of rotator cuff repair were excluded. There were 15 female and 5 male with average mean age of 56.4 years. After assessing the tear pattern and subacromial decompression, the tear was repaired by either single row or double row techniques. All patients were assessed by University of California, Los Angles scoring system preoperatively, postoperatively 6 months and 1 year. Results: 10% patients had excellent results, 85% had good results and 5% had poor results. Mean University of California, Los Angles score increased from 6.55 preoperatively to 31.15 at the end of one year. Arthros Conclusion: copic repair for isolated Supraspinatus tendon tears gave good to excellent functional results in large percentage of patients.

Proximal Biceps Tenodesis Incorporated into Supraspinatus Repair: A Case Series and Technical Description.

Background:Biceps tendon pathology is commonly associated with rotator cuff tears. A multitude of different biceps tenodesis techniques have been studied, with limited clinical data on arthroscopic biceps tenodesis techniques incorporated into rotator cuff repairs.Purpose:To evaluate the outcomes of an arthroscopic biceps tenodesis incorporated into a supraspinatus tendon repair.Study Design:Case series; Level of evidence, 4.Methods:Patients undergoing surgical treatment of supraspinatus tendon tears with concomitant biceps tendon pathology were prospectively enrolled from 2014 to 2015. A total of 32 patients underwent combined biceps tenodesis and rotator cuff repair; of these, 19 patients were evaluated for a mean of 2.0 years. The primary outcome measures were the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES; patient self-report and physician assessment sections), visual analog scale (VAS) pain score, responses to specific biceps-related assessments, and biceps specific physical exam findings.Results:Patient-reported ASES scores improved from 45.9 preoperatively to 91.6 at the 2-year follow-up (P < .001). Pain VAS scores improved from 5.2 preoperatively to 0.7 at the 2-year follow-up (P < .001). Preoperatively, 18 patients had a positive Speed test; all were negative at 5 months postoperatively, and 21 patients had bicipital groove tenderness preoperatively, which resolved in all 21 patients at 5 months postoperatively. At the 2-year follow-up, 2 patients had cramping arm pain and 4 patients noticed a change in arm contour. There were no reoperations. No complications occurred in the study group.Conclusion:Arthroscopic biceps tenodesis incorporated into a supraspinatus tendon repair was a safe and reliable option for biceps pathology with a concomitant rotator cuff tear.

Biomechanical and Clinical Evaluation of the Optimal Arm Position After Rotator Cuff Surgery With an Adjustable Abduction Brace.

Abduction braces are used with the intention of relieving tension on the supraspinatus, thereby protecting an operative repair. It is not known, however, whether patients wearing a brace do deposit the weight of the arm on the brace effectively or actively stabilize the arm despite the brace. It is further unknown what position of the arm is most effective to relax the shoulder and is considered most comfortable. Twenty-two patients who had undergone an arthroscopic supraspinatus repair were postoperatively fitted with a standard abduction brace equipped with a torque sensor to measure the weight of the arm on the brace on the first and second postoperative days. The most comfortable arm position, tear size, and degenerative muscular changes on magnetic resonance imaging were assessed. Most patients (15 vs 5) preferred a low angle of abduction with the brace in the scapular rather than the true frontal plane irrespective of tear location or size. While loads applied to the brace were slightly higher at high abduction angles (70° and 90°) under regional anesthesia (day 1), they were significantly higher at low abduction angles (30° and 50°) with the arm fully awake (day 2). The most comfortable brace position-which is at low angles of abduction (30° to 50°) in the scapular plane-is associated with the highest load transfer to the brace in the unanesthetized arm. The authors therefore conclude that if an abduction brace is used, it should be fitted in the scapular plane with an abduction angle between 30° and 50°. [Orthopedics. 2021;44(1):e1-e6.].

Supraspinatus tendon transosseous vs anchor repair surgery: a comparative study of mechanical recovery in the rabbit

BackgroundSupraspinatus (SSP) tendon ruptures requiring surgical repair are common. Arthroscopic suture anchor fixation has gradually replaced transosseous repair in supraspinatus tendon tear. Our objective was to compare mechanical properties between transosseous and anchor supraspinatus repair in the first 6 postoperative weeks in a rabbit model.MethodsOne hundred and fifty-two rabbits had one supraspinatus tendon repaired either with an anchor suture 1 week after detachment or with transosseous sutures. Rabbits were euthanized at 0, 1, 2, 4 or 6 postoperative weeks. Experimental and contralateral tendons (304 tendons) were mechanically tested to failure. Data are expressed as percent of contralateral.ResultsAnchor repair had higher loads to failure compared to transosseous repair, at immediate repair (week 0, 52 ± 21% vs 25 ± 17%, respectively; p = 0.004) and at 1 postoperative week (64 ± 32% vs 28 ± 10%; p = 0.003) with no difference after 2 weeks. There was no difference in stiffness. Transosseous repairs showed higher rates of midsubstance failures compared to anchor repairs at 1 (p = 0.004) and 2 postoperative weeks (p < 0.001). Both transosseous and anchor repairs restored supraspinatus mechanical properties after 4 postoperative weeks.ConclusionAnchor repair provided better initial tensile strength while transosseous repair led to a faster normalization (namely, midsubstance) of the mode of failure. Research to optimize supraspinatus repair may need to consider the advantages from both surgical approaches.

Supraspinatus repair and biceps tenodesis in competitive CrossFit athletes allow for a 100% of return to sport.

The shoulder is the most commonly injured body part in CrossFit training. The aim of this study is to report the clinical and MRI results of an arthroscopic repair of supraspinatus tear associated with SLAP lesion in competitive CrossFit athletes. Competitive CrossFit athletes affected by a full-thickness supraspinatus tear associated with SLAP lesion secondary to training injury were prospectively enrolled in the study. Clinical diagnosis was confirmed with MRI (> 1.5T). Functional evaluation was done using the Constant Score (CS) and ASES score (ASES). All lesions were treated with single-row repair and biceps tenodesis. Minimum follow-up (clinical, MRI) was 24months. Nineteen patients were available at the final follow-up. The average age was 43-year-old (range 28-52, SD 8), 12 were males and 7 females. Pre-operative CS and ASES were 67 (range 61-77, SD 7) and 71 (range 62-79, SD 5), respectively. At the 24-month follow-up, 19/19 athletes resumed intensive training and 17/19 returned to competitions. CS and ASES rose to 90 (p = 0.039) and 93 (p = 0.04), respectively. At the final follow-up, MRI indicated complete healing of the tendon in 15 (79%) cases and 4 (21%) cases with type II Sugaya repair integrity. Two of the patients of the latter group did not return to their usual training level and showed type II (Kibler) scapular dyskinesis. Arthroscopic repair of the supraspinatus tendon associated with biceps tenodesis led to a 100% of return-to-CrossFit training and 90% rate of individuals resuming competitions at 24months of follow-up. MRI showed 15 (79%) cases of complete healing and 4 (21%) cases with type II Sugaya repair integrity; biceps tenodesis clinically failed only in 1 case and the athlete complained of a decrease in the competitions scores and opted to discontinue CrossFit competitions. IV.

Prospective study of tendon healing and functional gain after arthroscopic repair of isolated supraspinatus tear

IntroductionIn case of failure of non-operative treatment of isolated supraspinatus tear, tendon surgery can improve shoulder function and alleviate pain. The present study hypothesis was that isolated supraspinatus repair shows good healing, with improved clinical results. Materials and methodsA prospective multicentre study followed up 199 patients (mean age, 57 years) for one year. Inclusion criteria comprised: isolated full-thickness supraspinatus tear, retraction grade<3, with the same double-row arthroscopic technique. Clinical assessment used Constant score at 6 weeks and 3, 6 and 12 months. Ultrasound control checked tendon repair quality on the Sugaya criteria, types I-II-III being considered as healed. ResultsAt one year, mean Constant score had increased by 26 points (p<0.001). Healing rate was 94% (n=187): Sugaya type I, 46% (n=92); type II, 41% (n=81); type III, 7% (n=14). Mean Constant score was significantly higher in case of healing: 81 vs. 70 points (p=0.002). Constant score progression was identical in both healing groups throughout follow-up. Univariate analysis showed no correlation between epidemiological or tear-related factors and tendon healing. ConclusionArthroscopic repair of isolated small supraspinatus tear provided 94% healing. Clinical results were better when healing was achieved. Level of evidenceI, prospective cohort study.

Benefits of distal clavicle resection during rotator cuff repair: Prospective randomized single-blind study

IntroductionRotator cuff tears often occur in combination with acromioclavicular (AC) arthropathy. But it can be difficult to separate pain caused by the rotator cuff tear from pain caused by the AC joint, despite clinical and other examinations. Distal clavicle resection (DCR) is increasingly being done at the same time as arthroscopic rotator cuff repair. The aim of this study was to compare the functional outcomes 1 year after arthroscopic rotator cuff repair between patients who simultaneously undergo DCR and patients who do not. The primary hypothesis was that DCR improves the clinical outcomes. Material and methodsThis was a prospective, multicenter, randomized, single-blind study of 200 patients who underwent isolated supraspinatus repair using the same technique. The patients were randomized into two groups: 97 patients who also underwent DCR and 103 patients who did not. The patients were followed until 1 year postoperative according to a standardized radiological and clinical review protocol. ResultsAt 1 year postoperative, all the clinical outcomes were worse in the DCR group, although only external rotation with elbow at side (53° vs. 59°, p=0.04) and the SSV (86.5 vs. 90.1, p=0.04) were statistically different. Overall shoulder pain was higher in the DCR group during the first 3 months postoperative (p=0.04). At 1 year, the DCR group had more residual pain; this pain was mainly located on the superior side of the shoulder (p=0.03), especially when more than 11 mm was resected (p=0.01). More of the shoulders in the DCR group had failures in rotator cuff healing based on ultrasonography (p=0.5). ConclusionOur hypothesis was not confirmed. We do not recommend doing routine DCR with arthroscopic rotator cuff repair. Level of evidenceI, prospective randomized simple blind study.

Arthroscopic knotless repair: an effective technique for small-sized supraspinatus tendon tears.

The purpose was to evaluate the clinical and radiological results of knotless repair with flat-braided suture in full small-sized supraspinatus tendon tears (< 1cm). A consecutive series of 54 patients with isolated small supraspinatus tendon tear (< 1cm and Goutallier index < 2) was evaluated in the study. Patients underwent a knotless arthroscopic repair using flat-braided suture (2mm wide). Minimal follow-up required was 5years. Changes in Murley-Constant score, ASES score, strength, and pain relief were assessed. The Sugaya score was used to confirm the tendon repair on MRI. Data were analyzed in two subgroups: technique with additional U point for dog ear deformity (group 1) and technique without additional U point (group 2). The immobilization period was 3weeks long. Passive mobilization was immediate. Fifty-four patients were included. Mean age was 57 ± 4years. The average follow-up was 68 ± 10months. Average preoperative score of Constant was 51.2 ± 8.5 and 83.1 ± 14.6 at the end of the follow-up (p < 0.001). Mean VAS went from 5.8 ± 1.8 to 1.9 ± 2.1 (p < 0.001). Average forward elevation of the shoulder went from 86.3° ± 9 preoperatively to 169.6° ± 15.9 at the end of the follow-up (p < 0.001). The strength score was significantly higher post-operatively (18.4 vs. 8.3, p < 0.001.). The ASES score was significantly improved 49.1 ± 13.1 vs. 88.6 ± 15.8, p < 0.001). The MRI assessment revealed 94% of Sugaya 1-2. No significant difference was observed between group 1 and 2 regarding all clinical outcomes. Two complex regional pain syndromes were described with a favorable evolution. Three patients presented a retear requiring an iterative arthroscopic repair. The use of a knotless arthroscopic construct with flat-braided suture for small supraspinatus repair achieved excellent structural and clinical results. This technique is fully adequate for the arthroscopic treatment of such tears, enabling early mobilization. Level III.

A prospective comparative study of mini-open versus arthroscopic repair of supraspinatus tear

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Supraspinatus tear is very common and more frequent among older individuals. Before the arthroscopy came into high demand, the open repair of supraspinatus tear was the preferred method of surgery. Recently, the mini-open technique of repair has also gained popularity because of certain factors like better repair strength, requires less expertise and facilitates early active mobilization. Still, the gold standard modality of repair is yet to be determined as both modalities are associated with good clinical outcomes and both have their pros and cons. We decided to compare functional and clinical outcomes of arthroscopic and mini-open repair.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a randomised study with 32 patients in each group, aged between 18 and 60 years and all patients were cases of traumatic tear of Supraspinatus tendon. From January 2016 to March 2018, alternate patients were selected for mini-open and arthroscopic repair who fulfilled our criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Follow up was done after 12 months postoperatively and the results were evaluated using University of California Los Angeles (UCLA) shoulder score. None left the study. In arthroscopic group, out of 32 patients, 28 got excellent or good result whereas in mini open out of 32 patients 27 achieved excellent or good outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Arthroscopic method provides better visualization of shoulder anatomy whereas Mini-open method has better repair strength and is affordable. The necessity of an arthroscopy set up might not be required for supraspinatus repair as both the modalities show similar functional and clinical outcomes, reducing the economic burden on the patients.&lt;/p&gt;

Postoperative rotator cuff integrity: can we consider type 3 Sugaya classification as retear?

Sugaya classification is a widely accepted classification system that is used to analyze postoperative rotator cuff tendon integrity. However, there are inconsistencies in the literature as to whether type 3 Sugayashould be considered as a retear or healed tendon. We aimed to show that type 3 Sugaya is not a retear by comparing the long-term supraspinatus and infraspinatus muscle degenerationand the functional outcomes of type 3 with those of type 4 and 5 Sugaya. We hypothesized that the clinical course of type 3 Sugaya would be different from type 4 or 5 Sugaya. The study was a retrospective multicenter review of all the rotator cuff repair done in 2003-2004. We included all the patients who had undergone supraspinatus repair with 10-year follow-up (magnetic resonance imaging done with full functional assessment). Data collection included pre- and postoperative supraspinatus and infraspinatus fatty infiltration, supraspinatus muscle atrophy, and Constant score with a separate analysis of its Strength subsection. Supraspinatus tendon integrity at 10-year follow-up was determined according to Sugaya classification. The patients were divided into 2 groups: type 3 Sugaya and type 4 and 5 Sugaya. Statistical comparison was done between the groups. There was no significant difference in the preoperative fatty infiltration of the supraspinatus and infraspinatus, supraspinatus muscle atrophy, and Constant score between the 2 groups. However, type 3 Sugaya patients had significantly better scores in the preoperative Strength subsection. Postoperatively, type 3 Sugaya patients showed significantly lesser fatty infiltration of the supraspinatus and infraspinatus, lesser supraspinatus muscle atrophy, and higher Constant score compared with type 4 and 5 Sugaya(P < .001). Patients with type 3 Sugaya supraspinatus tendon exhibited lesser muscle degeneration in the supraspinatus and infraspinatusand performed better in functional assessment compared with type 4 and 5 Sugaya patients. We inferred that type 3 Sugaya should not be considered as a retear.

Footprint preparation with nanofractures in a supraspinatus repair cuts in half the retear rate at 1-year follow-up. A randomized controlled trial

Purpose To evaluate if adding nanofractures to the footprint of a supraspinatus tear repair would have any effect in the outcomes at one-year follow-up.Methods Multicentric, triple-blinded, randomized trial with 12-months follow-up. Subjects with isolated symptomatic reparable supraspinatus tears smaller than 3 cm and without grade 4 fatty infiltration were included. These were randomized to two groups: In the Control group an arthroscopic supraspinatus repair was performed; in the Nanofracture group the footprint was additionally prepared with nanofractures (1 mm wide, 9 mm deep microfractures). Clinical evaluation was done with Constant score, EQ-5D-3L, and Brief Pain Inventory. The primary outcome was the retear rate in MRI at 12-months follow-up. Secondary outcomes were: characteristics of the retear (at the footprint or at the musculotendinous junction) and clinical outcomes.ResultsSeventy-one subjects were randomized. Two were lost to follow-up, leaving 69 participants available for assessment at 12-months follow-up (33 in the Control group and 36 in the Nanofracture Group). The Nanofracture group had lower retear rates than the Control group (7/36 [19.4%] vs 14/33 [42.4%], differences significant, p = 0.038). Retear rates at the musculotendinous junction were similar but the Nanofracture group had better tendon healing rates to the bone (34/36 [94.4%] vs. 24/33 [66.71%], p = 0.014). Clinically both groups had significant improvements, but no differences were found between groups.Conclusion Adding nanofractures at the footprint during an isolated supraspinatus repair lowers in half the retear rate at 12-months follow-up. This is due to improved healing at the footprint.Level of evidenceLevel I.

Effect of human dermal allograft thickness on glenohumeral stability for superior capsular reconstruction in irreparable supraspinatus tears: A biomechanical analysis of the superior capsular reconstruction - A cadaveric study.

The objective of this study was to compare the biomechanics of using a double layered human dermal allograft to a single layered human dermal allograft in superior capsular reconstruction. Five cadaveric shoulders were tested. The superior translation of the humerus and the subacromial contact pressure were measured at 0°, 30° and 60° of glenohumeral abduction in the following six conditions: (1) intact rotator cuff, (2) irreparable supraspinatus tear, (3) superior capsular reconstruction using a double layered human dermal allograft with and (4) without posterior suturing, (5) superior capsular reconstruction using a single human dermal allograft with and (6) without posterior suturing. There was a significant increase in superior translation of the humerus and subacromial contact pressure when comparing torn supraspinatus to intact shoulder. All superior capsular reconstruction repairs lead to a reduction in superior translation and subacromial contact pressures compared to after the supraspinatus tear except for single layered superior capsular reconstruction repair without posterior suturing. There was no difference in superior translation and subacromial contact pressures comparing the intact shoulder to any of the superior capsular reconstruction constructs. Superior capsular reconstruction using a single or double layered human dermal allograft improves superior translation after supraspinatus repair. There is some biomechanical benefit of a double layered human dermal allograft technique over a single layered graft technique in superior capsular reconstruction. IV.

Small Subchondral Drill Holes Improve Marrow Stimulation of Rotator Cuff Repair in a Rabbit Model of Chronic Rotator Cuff Tear

Background: Microfracture of the greater tuberosity has been proved effective for enhancing tendon-to-bone healing after rotator cuff repair. However, no standard diameter for the microfracture has been established. Purpose/Hypothesis: This study aimed to assess treatment with large- and small-diameter microfractures to enhance healing during rotator cuff repair surgery in a rabbit model of chronic rotator cuff tear. It was hypothesized that a small-diameter microfracture had advantages in terms of tendon-to-bone integration, bone-tendon interface maturity, microfracture healing, and biomechanical properties compared with a large-diameter microfracture. Study Design: Controlled laboratory study. Methods: Bilateral supraspinatus tenotomy from the greater tuberosity was performed on 21 New Zealand White rabbits. Bilateral supraspinatus repair was performed 6 weeks later. Small-diameter (0.5 mm) microfracture and large-diameter microfracture (1 mm) were performed on the left side and right side, respectively, in 14 rabbits as a study group, and simple repair without microfracture was performed in 7 rabbits as a control group. At 12 weeks later, 7 of 14 rabbits in the study group were sacrificed for micro–computed tomography evaluation and biomechanical testing. Another 6 rabbits were sacrificed for histological evaluation. In the control group, 3 of the 7 rabbits were sacrificed for histological evaluation and the remaining rabbits were sacrificed for biomechanical testing. Results: Significantly better bone-to-tendon integration was observed in the small-diameter microfracture group. Better histological formation and maturity of the bone-tendon interface corresponding to better biomechanical results (maximum load to failure and stiffness) were obtained on the small-diameter microfracture side compared with the large-diameter side and the control group. The large-diameter microfracture showed worse radiographic and histological properties for healing of the microfracture holes on the greater tuberosity. Additionally, the large-diameter microfracture showed inferior biomechanical properties but similar histological results compared with the control group. Conclusion: Small-diameter microfracture showed advantages with enhanced rotator cuff healing for biomechanical, histological, and radiographic outcomes compared with large-diameter microfracture, and large-diameter microfracture may worsen the rotator cuff healing. Clinical Relevance: This animal study suggested that a smaller diameter microfracture may be a better choice to enhance healing in clinical rotator cuff repair surgery in humans.

Return to work following arthroscopic supraspinatus repair: a survey of UK practice

Return to work following arthroscopic supraspinatus repair: a survey of UK practice

CONSTANT MURLEY SCORE ON PATIENTS POST SUPRASPINATUS RECONSTRUCTION WITH MEMBRANE AMNION COMPOSITE AND FAT TISSUE ALLOGENIC MESENCHYMAL STEM CELL AUGMENTATION

Background: Rotator cuff tears are the most common cases in nontrauma upper extremities in group patient more than 50 years old. Incidence on rotator cuff can’t show the real population. New Approaches healing rotator cuff syndrome is tendon regeneration like mesenchymal stem cell injection and growth factor or tissue engineering that has been developed.Methods: Retrospective comparation study of 15 postsupraspinatus reparation patients who has been treated for more than 4 months at the Dr. Soetomo general hospital. Patients is divided into group undergone supraspinatus reparation and patient supraspinatus reparation with augmented by membrane amnion composite and mesenchymal stem cell. Its’ functional results were evaluated using constant murley score.Results: Pain score average on supraspinatus reparation patients which augmented by membrane amnion and mesenchymal stem cell and those without augmentation is 15 and 13.7 (p=0.036). Daily activity score average on patients with and without augmentation are 20 and 17 (p=0.037). Flexion score average on patients with and without augmentation are 10 and 8.6 (p=0.114). External rotation score average on patients with and without augmentation are 9.6 and 7.2 (p=0.004). Internal rotation score average on patients with and without augmentation are 9.2 and 7.2 (p=0.012).Conclusion: The constant murley score pain score, ADL score, external rotation score, and internal rotation score in the group with the addition of amniotic membrane and mesenchymal stem cells were significantly better than the group with supraspinatus repair only, but not significantly on the flexion score and lateral elevation score components.

Improved Rotator Cuff Footprint Contact Characteristics With an Augmented Repair Construct Using Lateral Edge Fixation

Background: The transosseous-equivalent (TOE) rotator cuff repair construct has become the gold standard for the repair of medium and large rotator cuff tears. Repair failure, however, continues to be a problem. One contributing factor may be the inability of the TOE repair to replicate the native footprint contact characteristics during shoulder movement, especially in rotation. This results in higher strain across the repair, which leads to gapping and predisposes the construct to failure. In an effort to better reproduce the native compression forces throughout the footprint, an augmented TOE construct supplemented with lateral edge fixation is proposed, and the contact characteristics were compared with those of the gold standard TOE construct. Hypothesis: The augmented TOE repair will demonstrate improved footprint contact characteristics when compared with the classic TOE repair. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen cadaveric shoulders underwent supraspinatus repair using both the classic TOE double-row construct and the augmented TOE repair. For the augmented repair, 2 luggage tag sutures were used to secure the lateral edge and incorporated into the lateral row anchors. A Tekscan pressure sensor (Tekscan Inc) placed under the repaired tendon was used to collect footprint contact area, force, peak pressure, and contact pressure data for each construct. Results: The augmented construct demonstrated significantly greater contact forces (average difference, 4.9 N) and significantly greater contact pressures (average difference, 23.1 kPa) at all degrees of abduction and all degrees of rotation. At 30° of internal and 30° of external rotation at both 0° and 30° of shoulder abduction, the augmented construct demonstrated significantly greater peak contact pressures. Conclusion: The augmented construct showed superior contact characteristics when compared with the classic TOE technique. The addition of lateral edge fixation to the classic TOE repair significantly improves bone-tendon contact characteristics with minimal additional surgical effort. Clinical Relevance: The results of this study indicate that lateral augmentation of the classic TOE repair produces a biomechanically superior construct that may optimize tendon healing.