Tendon Avulsion Lesions Research Articles

Effects of Arthroscopic Atelocollagen Insertion in High-Grade Partial Articular Supraspinatus Tendon Avulsion Lesions: A Retrospective Cohort Study With Propensity Score Matching.

This study sought to evaluate the effect of atelocollagen insertion into the bone-tendon interface of the repaired tendon after arthroscopic rotator cuff repair for high-grade partial articular supraspinatus tendon avulsion (PASTA) lesions. To compare clinical and radiological outcomes of atelocollagen-inserted rotator cuff repair and atelocollagen-noninserted rotator cuff repair in the high-grade PASTA lesions. Cohort study; Level of evidence, 3. The data from 301 consecutive patients who underwent arthroscopic rotator cuff repair of PASTA lesions between January 2017 and June 2020 were retrospectively reviewed. Patients with minimum 2-year follow-up data were included and divided into 2 groups: those treated with transtendon suture-bridge repair without additional augmentation (group 1) and those with atelocollagen-inserted transtendon suture-bridge repair (group 2). Patients in group 2 were matched 1:1 to patients in group 1 using propensity score matching (n = 68 per group); and pain visual analog scale, American Shoulder and Elbow Surgeons, University of California, Los Angeles, Korean Shoulder Scoring System, Simple Shoulder Test, and range of motion scores were compared between these groups. Also, repaired tendon integrity and thickness were compared immediately, 6 months, and 1 year after surgery on magnetic resonance imaging (MRI) using the vertical distance from the midpoint footprint of the greater tuberosity. In most comparisons, there were no significant differences in outcome measures and range of motion between groups. However, less residual discomfort at the final follow-up was also documented in group 2 (P = .043). Also, the difference in forward flexion was 3.7° at 1 year and 5.4° at final follow-up, and the difference in abduction was 2.2° at final follow-up, which were all significantly greater in the experimental group. Group 2 showed significant greater tendon thickness of the repaired tendon immediately, 6 months, and 1 year after surgery on MRI (P≤ .001). Addition of atelocollagen did not improve outcome scores. However, there was slightly greater flexion and abduction at final follow-up. Also, there was less residual discomfort at final follow-up.

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.

Efficacy of threading lasso fixation in repairing partial articular supraspinatus tendon avulsion lesions: a retrospective study

BackgroundThe partial articular supraspinatus tendon avulsion (PASTA) lesion repair remains a topic of debate. We have performed in situ repair of PASTA lesions using a potentially viable threading lasso fixation technique. This retrospective case series aimed to evaluate the clinical outcomes of PASTA lesion repair using threading lasso fixation. To the best of our knowledge, this is the first study to review this technique and its outcomes in terms of pain and upper extremity function.MethodsTwenty-five patients with PASTA lesions who were treated with threading lasso fixation were reviewed. All patients were followed up for at least 1 year. Preoperative and follow-up data were retrospectively collected and reviewed. Clinical outcomes were assessed to evaluate the efficacy of the surgery.ResultsThere were no postoperative complications. The average follow-up period was 25.7 (22–27) months. At the last follow-up, all patients underwent follow-up magnetic resonance imaging; only two cases showed a partially healed tendon and no case converted to full-thickness tear. Furthermore, shoulder pain decreased and mobility was recovered, with statistically significant differences in all scoring measures. Specifically, the mean visual analog scale score decreased from 5.4 ± 1.2 before surgery to 1.1 ± 0.8 at the last follow-up (t = 14.908, P < 0.01), and the mean American Shoulder and Elbow Surgeons Shoulder Assessment Form score improved significantly from 51.6 ± 6.4 to 89.3 ± 5.2 (t = 22.859, P < 0.01). Additionally, the mean University of California Los Angeles score improved from 17.8 ± 3.5 preoperatively to 32.3 ± 1.4 (t = 19.233, P < 0.01).ConclusionsArthroscopic repair using threading lasso fixation is a novel transtendinous technique for patients with partial articular supraspinatus tendon avulsion. Tendon integrity is preserved with this method, which may result in improved function. Overall, threading lasso fixation technique is an effective treatment.

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.

Insufficient integrity of partial articular surface tendon avulsion lesions after arthroscopic trans-tendon repair: Comparison with integrity after arthroscopic repair after conversion to a full thickness tear

BackgroundFor the surgical treatment of severe partial articular surface tendon avulsion (PASTA) lesions, 2 repair techniques, i.e., arthroscopic trans-tendon repair and arthroscopic repair after conversion to a full thickness tear, are widely used, and a satisfactory clinical outcome with both has been reported. The purpose of this study was to investigate integrity of the repaired rotator cuff based on second-look arthroscopy and to compare the above two repair techniques. MethodsThirty-seven shoulders underwent PASTA lesion repair arthroscopically, with 20 shoulders receiving second-look arthroscopy. According to the repair technique, the shoulders were divided into 2 groups, which were 10 shoulders with trans-tendon repair (group P) and 10 shoulders with repair after conversion to a full thickness tear (group C). Second-look arthroscopy was done at a minimum of 3 months after initial surgery, with the mean interval until second-look arthroscopy being 5.6 months (3–13) in group P and 5.1 months (3–9) in group C. The reasons for second-look arthroscopy were pain with contracture in 15 patients, as well as pain in 4 patients and muscle weakness at abduction in one patient. ResultsIn group P, there was complete rotator cuff continuity in 3 shoulders, partial continuity in 4, and failure in 3, while group C had complete continuity in 8 shoulders, partial continuity in 1, and failure in 1. Adhesions of the subacromial bursa were seen in all shoulders, while contracture of the posterior capsule was noted in 5 shoulders from group P and 9 shoulders from group C, and contracture of the rotator interval was identified in 7 shoulders from group P and 9 shoulders from group C. ConclusionsSecond-look arthroscopy revealed that the integrity of the rotator cuff after trans-tendon repair of severe PASTA lesions was often unsatisfactory in patients with symptomatic shoulder. On the other hand, complete continuity was seen in most shoulders underwent repair after conversion to a full thickness tear.

Partial articular supraspinatus tendon avulsion: Should we repair? A systematic review of the evidence.

Partial articular sided rotator cuff tears are described as being a common cause of shoulder pain and to have a significant impact of patient quality of life. The natural history of partial articular supraspinatus tendon avulsion lesions is not clearly defined and there is limited evidence to determine optimal management. To perform a systematic review of the literature regarding the evidence for partial articular supraspinatus tendon avulsion repair and to determine whether there is any difference between operative and non-operatively managed patients. Conventional and grey literature were searched with defined terms to identify studies in human adults concerning management of partial articular sided supraspinatus avulsions. Out of 86 papers identified by the search terms, 28 were deemed eligible for review including 1966 shoulders. 4/28 papers were of level I-II evidence but all were comparing techniques. 4/28 papers were biomechanical cadaveric studies, assessing strength of repair and effect on stability. The remaining 20 studies were level IV-V evidence and consisted of case series and technical notes identifying varying techniques of repair and their outcomes. Current literature suggests that all techniques used to repair partial articular supraspinatus tendon avulsion lesions give increased functional scores and reduced pain. However, this represents a heterogeneous group of patients with variable degrees of tear and is not reproducible. There are limited controlled studies to determine whether partial articular supraspinatus tendon avulsion lesions require repair. Current classification systems represent a single plane and are open to user variation. No evidence exists to determine which tears are stable and which may progress.

Advantages and techniques of utilizing anterolateral portal in delaminated rotator cuff repair.

Typically, rotator cuff repair is performed two-dimensionally while visualizing the subacromial space. To achieve a more complete repair, sutures can be retrieved from inside the joint utilizing a penetrating suture device through the anterolateral portal, which permits visualization of the articular side and bursal side of the rotator cuff tear. Utilizing other portals can leave the sutures out of sight and reach. The anterolateral portal helps capture both leaves of a delaminated tear and places the sutures in the center of the field for retrieval and tying. The anterolateral portal is located with a spinal needle just off the anterolateral corner of the acromion, and the suture anchor is inserted into the greater tuberosity through this portal. The sutures are passed into the joint through the tear in the rotator cuff with a suture grasper. The scope is redirected intraarticularly, and the suture is visualized. The sutures are positioned, and the penetrator is passed through the tendon. The scope is placed back in the bursa for tying sutures and capturing both leaves of a delaminated tear. It works equally well for simple complete tears and partial articular-sided supraspinatus tendon avulsion lesions.

Lesions of the rotator cuff footprint: diagnostic performance of MR arthrography compared with arthroscopy

To evaluate the diagnostic performance of magnetic resonance arthrography (MR-A) of the shoulder in the diagnosis of rotator cuff tears involving the humeral insertion of the supraspinatus and infraspinatus tendon (footprint), using arthroscopy as the reference standard. The study population included 90 consecutive patients with history and clinical diagnosis of instability of the shoulder, rotator cuff tear or posterosuperior glenoid impingement. A total of 108 MR arthrograms were performed, since 18 patients had undergone a bilateral procedure. Arthroscopy, which was performed within 45 days after MR-A, was used as the reference standard. Sensitivity, specificity, accuracy, positive and negative predictive values were then calculated. Magnetic resonance arthrography showed a sensitivity of 92 % and a specificity of 78 % for the overall detection of tears involving the rotator cuff footprint. The diagnostic accuracy was 90 %, and the positive and negative predictive values were 95 and 64 %, respectively. Ten lesions were non-classifiable on surgery, of which eight were non-classifiable on MR-A also. Magnetic resonance arthrography is extremely accurate for the detection and classification of rotator cuff footprint tears. Most of these lesions are articular-sided (partial articular-sided supraspinatus tendon avulsion lesions) with predominance in younger patients and concealed type of tear (concealed interstitial delamination lesions).