Repair Of Complete Tears Research Articles

Arthroscopic management of isolated partial-thickness rotator cuff tears.

The aim of the present study is to provide a comprehensive review on the surgical outcomes following arthroscopic treatments of partial-thickness rotator cuff tears (PT-RCTs) and to compare the postoperative American Shoulder and Elbow Surgeons(ASES)score following in situ transtendon repair and tear completion, followed by repair. Medline, EMBASE, Scopus, CINAHL and CENTRAL bibliographic databases were searched. Papers including patients with PT-RCTs of any grade who underwent treatment using debridement, in situ transtendon repair, tear completion and repair or bioinductive collagen implants were reviewed. Primary PT-RCTs were the sole indication for surgery. Primary postoperative outcomes assessed included the ASESscore,the Absolute Constant-Murley score, the Simple Shoulder Test, the Visual Analogue Scale, the University of California-Los Angeles Shoulder Scale, the Western Ontario Rotator Cuff Score, range of motion, complications and revisions. A meta-analysis of comparative studies compared the postoperative ASES score between patients treated with in situ transtendon repair versus tear completion repair. Twenty-eight studies were included. The ASES score was reported by four comparative studies with contrasting results. The heterogeneity was high (I2 = 86%), and effect sizes ranged from -0.49 in favour of the tear completion and repair technique to an effect size of +1.07 favouring in situ transtendon repair. The overall effect size of 0.02 suggests an equivalence between the two techniques in terms of the ASES score. Two studies with a total sample size of 111 patients reported on debridement, and four studies with a total sample size of 155 patients reported on bioinductive collagen implants. Debridement alone is suitable for Ellman grades I-II PT-RCTs. In situ transtendon and tear completion repair techniques yield similar postoperative outcomes. Bioinductive collagen implants hold promise but lack long-term efficacy data. High-quality comparative studies are needed to determine the best treatment for PT-RCTs. Level IV.

Similar outcomes between transtendon repair and tear completion repair techniques for partial articular-sided supraspinatus tendon avulsion lesions: a systematic review and meta-analysis.

This study aimed to review studies comparing transtendon repair (TTR) with tear completion repair (TCR) techniques for partial articular-sided supraspinatus tendon avulsion (PASTA) lesions according to postoperative patient-reported outcomes and complications. Databases, including PubMed, Embase, Scopus, and Cochrane, were searched for studies published between 2008 and 2022 that directly compared the postoperative patient-reported outcomes and complications of the TTR and TCR techniques for PASTA lesions. Odds ratios (ORs) were calculated for dichotomous outcomes, while mean differences (MDs) were calculated for continuous outcomes. A total of seven studies (497 shoulders) were analysed. No statistically significant differences in the postoperative clinical outcomes at the final follow-up were observed between the TTR and TCR techniques for PASTA lesions. The overall retear rates of the TTR and TCR techniques were 7.7% and 11.6%, respectively (corresponding healing rates were 92.3% and 88.4%), whereas the overall occurrence rates of adhesive capsulitis were 4.7% and 3.3%, respectively. Furthermore, no significant difference was observed in postoperative range of motion (forward flexion, MD = - 1.22, 95% confidence interval (95%CI) - 5.28 to 3.34, n.s.; external rotation, MD = - 1.39, 95% CI - 3.19 to 0.42, n.s.), overall retear rate (OR 0.72, 95% CI 0.29-1.08, n.s.), and occurrence rate of adhesive capsulitis (OR 1.11, 95% CI 0.35-3.52, n.s.) between the two techniques. Both techniques improve clinical outcomes while having a low complication rate and a high rate of healing. No significant difference in clinical outcomes was observed between the two techniques. III.

Biceps Augmentation Outperforms Tear Completion Repair or In Situ Repair for Bursal-Sided Partial-Thickness Rotator Cuff Tears in a Rabbit Model

Background: There is an ongoing debate on the treatment of bursal-sided partial-thickness rotator cuff tears (PTRCTs), including ideal repair techniques. Augmentation using a collagen patch has been introduced as a new surgical approach to treat PTRCTs, while the effect of autogenous biceps augmentation (BA) has not been investigated. Purpose: To analyze the effects of BA on bursal-sided PTRCTs and compare its histological and biomechanical results with those of tear completion followed by repair and in situ repair (ISR). Study Design: Controlled laboratory study. Methods: Unilateral chronic PTRCTs were created in 96 mature New Zealand White rabbits, which were randomly divided into 4 groups: no repair, tear completion repair (TCR), ISR, and BA. A new bicipital groove was fabricated in BA for the biceps tendon that was transferred to augment the bursal-sided PTRCT repair. In each group, we sacrificed 6 rabbits for biomechanical testing of the whole tendon-to-bone complex (WTBC) and 6 for histological evaluation of bursal- and articular-sided layers at 6 and 12 weeks postoperatively. Healing responses between the biceps and new bicipital groove in the BA group were determined using histological analysis, and final groove morphologies were evaluated using micro–computed tomography. Results: The remaining tendon and enthesis in bursal-sided PTRCTs progressively degenerated over time. WTBCs of ISR exhibited a larger failure load than those of TCR, although better healing properties in the bursal-sided repaired site were achieved using TCR based on histological scores and superior articular-sided histological scores were observed using ISR. However, WTBCs of BA displayed the best biomechanical results and superior histological scores for bursal- and articular-sided regions. The new bicipital groove in BA remodeled over time and formed similar morphologies to a native groove, which provided a mature bone bed for transferred biceps tendon healing to augment bursal-sided PTRCTs. Conclusion: BA achieved better biomechanical and histological results for repairing bursal-sided PTRCTs as compared with TCR and ISR. When compared with that of TCR, the WTBC of ISR exhibited a higher failure load, showing histological superiority in the articular-sided repair and inferiority in the bursal-sided repair. Clinical Relevance: BA may be an approach to improve bursal-sided PTRCT repair in humans, which warrants further clinical investigation.

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.

Mid-Term Outcomes after Arthroscopic "Tear Completion Repair" of Partial Thickness Rotator Cuff Tears.

Background and Objectives: Different arthroscopic procedures are used for partial-thickness rotator cuff tears (PT-RCTs), but there is still no evidence on the superiority of one procedure over the other. The aim of this study was to evaluate the clinical outcomes and the rate of complications of a tear completion repair (TCR) technique. Materials and Methods: Patients who had undergone arthroscopic TCR technique for PT-RCTs with a follow-up of at least 2-years after surgery were included. The TCR technique involved the removal of the “critical zone” and creating microfractures to biologically support tendon healing. Functional outcomes were assessed prospectively by the Constant score (CS) and active and passive range of movement (ROM). Pain and patient satisfaction were measured using a visual analog scale (VAS). Complication rates were recorded, and tendon integrity was assessed with magnetic resonance imaging (MRI) or ultrasound performed at least 2-years after surgery. Results: Eighty-seven patients with a median age of 57 years were followed-up for a median of 5 years. The CS score improved from 53.5 preoperatively to 94.0 postoperatively (p < 0.001). Median VAS score decreased from 8.6 to 1.0 (p < 0.0001). Median patient satisfaction was 9.3. The overall complication rate was 14.9%. Conclusions: Patients with PT-RCTs of the supraspinatus tendon treated by the TCR technique with “critical zone” removal and biological stimulation by microfractures showed good functional results with excellent strength recovery, a high degree of patient satisfaction, and resolution of painful symptoms at mid-term follow-up.

Arthroscopic repair of partial articular supraspinatus tendon avulsion lesions by conversion to full-thickness tears through a small incision

PurposeTo assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion (PASTA) lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon followed by repair. MethodsWe retrospectively analyzed 41 patients with Ellman grade 3 PASTA lesions and an average age of (54.7 ± 11.4) years from March 2013 to July 2017. Patients without regular conservative treatment and concomitant with other shoulder pathologies or previous shoulder surgery were excluded from the study. The tears were confirmed via arthroscopy, and a polydioxanone suture was placed to indicate the position of each tear. A small incision of approximately 6 mm was made using a plasma scalpel on the bursal-side supraspinatus tendon around the positioned suture to convert the partial tear into a full-thickness tear. The torn rotator cuff was sutured through the full thickness using a suture passer after inserting a 4.5-mm double-loaded suture anchor. Data were analyzed using a paired Student’s t-test with statistical significance defined as p <0.05. ResultsAt the final follow-up of 2 years, the pain-free shoulder joint range of motion and visual analog scale score were significantly improved compared to those before surgery (p < 0.001). The postoperative American Shoulder and Elbow Surgeons shoulder score was (90.6 ± 6.2), which was significantly higher than the preoperative score of (47.9 ± 8.3) (p < 0.001). The University of California at Los Angeles shoulder rating scale score increased from (14.7 ± 4.1) prior to surgery to (32.6 ± 3.4) points after surgery (p < 0.001). No patient had joint stiffness. ConclusionThis modified tear completion repair, by conversion to full-thickness tears through a small incision, has less damage to the supraspinatus tendon on the side of the bursa compared to traditional tear completion repair in the treatment of PASTA lesions. This surgical method is a simple and effective treatment that can effectively alleviate pain and improve shoulder joint function.

Does Time from Injury to Surgery Affect Outcomes Following Surgical Repair of Partial and Complete Proximal Hamstring Ruptures?

Objectives:The purpose of this study was to determine if time from injury to surgery affected postoperative outcomes after primary repair of partial and complete proximal hamstring ruptures. The secondary aim of the study was to assess patients’ experiences from initial evaluation to finding a treating surgeon to help increase awareness of the injury.Methods:Office records from 2008 to 2016 were reviewed from one orthopedic surgeon’s practice. A total of 124 partial and complete proximal hamstring repairs in 121 patients were identified. Ninety-two patients completed questionnaires including a custom survey in addition to validated outcome measures: Lower Extremity Outcome Score (LEFS), custom LEFS, Marx Activity Scale, custom Marx scale, and University of California at Los Angeles (UCLA) Activity Score. A chart review was performed to collect demographic, encounter, and operative information. Results were analyzed and compared for both partial and complete proximal hamstring repairs performed ≤ 3 weeks, ≤ 6 weeks, and > 6 weeks following injury.Results:Mean follow-up of study respondents was 43 months (range, 6-116 months). Of the 93 proximal hamstring repairs reviewed, 50.5% (9/28 partial, 38/65 complete), 78.5% (16/28 partial, 57/65 complete) and 21.5% (12/28 partial, 8/65 complete) were performed ≤ 3 weeks, ≤ 6 weeks, and > 6 weeks, respectively. At various injury-to-surgery time intervals, no statistical difference was found in the LEFS, custom LEFS, Marx Activity Scale, custom Marx Scale, and UCLA Activity Scores. Overall, partial proximal hamstring repairs had better outcome scores compared to complete tears although this was not statistically significant with the exception of leg pain at rest, which was higher after repair of complete tears (P = 0.021). Additionally, female gender and age were negative predictors of outcome scores. Increasing time from injury-to-surgery was associated with lower perceived strength of operative side compared to contralateral leg, most notable with surgery > 6 weeks after injury (% patients with perceived near or full strength of the contralateral limb: partial tears ≤ 6 weeks 93.8% versus > 6 weeks 75%; complete tears ≤ 6 weeks 75.4% versus > 6 weeks 50%). Patients who underwent repair > 6 weeks following injury for both partial and complete tears exhibited a greater sitting intolerance after one hour compared to those repaired ≤ 6 weeks (0% partial, 7.1% complete ≤ 6 weeks; 12.5% partial, 25% complete > 6 weeks). The majority of patients with complete ruptures (42%) were initially evaluated at a local emergency room while most partial tears were evaluated by their primary care physician (35.7%). Patients with repairs performed > 6 weeks following injury visited, on average, 2.6 practitioners prior to evaluation by the treating surgeon compared to 1.6 for those surgically treated ≤ 6 weeks following injury.Conclusion:Proximal hamstring ruptures performed in both the acute and chronic setting can expect overall successful outcomes but may experience lower perceived strength and difficulty with prolonged sitting with repair > 6 weeks following injury. Patients also faced challenges in correct diagnosis of the injury and referral to an appropriate treating surgeon. These findings emphasize the need for increased awareness of the injury not only within the orthopedic community, but also the emergency room and primary care settings.

Arthroscopic knotless single-row repair preserving full footprint versus tear completion repair for partial articular-sided rotator cuff tear.

The comparison of clinical outcomes of arthroscopic footprint-preserving knotless single-row repair with the tear completion repair technique for articular-sided partial-thickness rotator cuff tears (PTRCTs) remains unclear. A total of 68 patients diagnosed with articular-sided PTRCTs who underwent rotator cuff repair between December 2014 and June 2015 were included. Of the 68 patients, 30 received footprint-preserving knotless single-row repair (group 1) and 38 received the tear completion repair technique (group 2). Preoperative and postoperative assessments were compared. Both groups had significantly improved American Shoulder and Elbow Surgeons (ASES) scores (group 1: 48.2 preoperatively to 81.9 postoperatively, p < 0.001; group 2: 47.1 preoperatively to 84.9 postoperatively, p < 0.001) and visual analog scale (VAS) pain score (group 1: 6.0 preoperatively to 0.93 postoperatively, p < 0.001; group 2: 6.1 preoperatively to 1.1 postoperatively, p < 0.001), showing that the two procedures significantly improved postoperative shoulder function. No significant differences were shown in ASES score or VAS pain score between the two groups ( p > 0.05). The mean operation time was significantly shorter in group 1 with an average of 48.1 min than in group 2 with an average of 60.4 min ( p < 0.001). Footprint-preserving knotless single-row repair obtains similar clinical results compared to tear completion repair in the treatment of articular-sided PTRCTs. Footprint-preserving knotless single-row repair may be a convenient choice for the treatment of articular-sided PTRCTs. Randomized controlled studies are needed to investigate whether the footprint-preserving knotless single-row repair yields better long-term outcomes through the protection of the bursal cuff and restoration of the healthy footprint.

Outcome Comparison Between in Situ Repair Versus Tear Completion Repair for Partial Thickness Rotator Cuff Tears

To compare the clinical outcomes of arthroscopic in situ repair with the tear completion repair technique for partial-thickness rotator cuff tears (PT-RCTs). We prospectively enrolled 100 cases with articular-sided and bursal-sided PT-RCTs exceeding 50% of tendon thickness and allocated them randomly. An in situ repair was performed in group 1 (n= 50). Completion of the remaining cuff tissue and repair were performed in group 2 (n= 50). The medial row was knotted as transosseous repair (suture-bridge technique) in all cases. American Shoulder Elbow Society (ASES) score, Constant shoulder (CS) score, Simple shoulder (SS) score, and Korean shoulder (KS) score, and visual analog scale (VAS) for pain and range of motion were assessed at 3, 6, and 12 months and at the last visit. Repaired tendon integrity was determined at 6 to 12 months by magnetic resonance imaging. Eight cases were lost to follow-up. Ultimately, 92 cases were analyzed. The average follow-up was 19.1 months (range, 12 to 42 months). Significant improvements in the VAS for pain and functional outcomes were observed in both groups postoperatively (P=.001 for VAS; P < .001 for ASES score; P < .001 for CS score; P= .001 for SS score; P<.001 for KS score). No significant difference in the clinical results was observed at any time between the groups. No difference of retear rate on articular-sided PT-RCT was observed between the groups (P= .34). Retears on the bursal-sided PT-RCT were more frequent in group 2 (P= .02). Arthroscopic repair of PT-RCT exceeding 50% of the thickness provided functional improvements and pain relief regardless of the repair technique. The retear rate for bursal-sided PT-RCT was higher in group 2, although the retear rate for the articular-sided PT-RCT was not different. Level II, prospective comparative study.

TRANSPLANTATION OF LEVATOR MUSCLES IN REPAIR OF COMPLETE TEAR AND RECTO‐VAGINAL FISTULA

Australian and New Zealand Journal of SurgeryVolume 18, Issue 2 p. 154-154 TRANSPLANTATION OF LEVATOR MUSCLES IN REPAIR OF COMPLETE TEAR AND RECTO-VAGINAL FISTULA Francis J. Hayden, Francis J. HaydenSearch for more papers by this author Francis J. Hayden, Francis J. HaydenSearch for more papers by this author First published: October 1948 https://doi.org/10.1111/j.1445-2197.1948.tb06354.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume18, Issue2October 1948Pages 154-154 RelatedInformation