Increased Glenohumeral Joint Loads Due to a Supraspinatus Tear Can be Reversed with Rotator Cuff Repair: A Biomechanical Investigation

Rotator cuff tears are a common condition that adversely affect function and quality of life. Altered glenohumeral joint (GHJ) motion is believed to contribute to the development of rotator cuff tears. Previous research has demonstrated relationships between in-vivo joint motion and bony morphology (particularly in the knee [e.g., 1]), and similar relationships have been reported in cadaveric shoulder studies [2, 3]. However, the extent to which these relationships exist under in-vivo conditions or if these relationships are altered in shoulders with pathologic conditions is not known. Thus, the objective of this study was to assess the relationship between glenoid/humerus morphology and in-vivo GHJ motion in healthy control shoulders and rotator cuff repair patients. We hypothesized that a relationship exists between glenoid/humerus morphology and GHJ motion in healthy control shoulders, but that this relationship is altered in rotator cuff patients.

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Risk factors for the development of degenerative changes among patients undergoing rotator cuff repair: A systematic review

Shoulder & Elbow ◽

10.1177/17585732211047225 ◽

2021 ◽

pp. 175857322110472

Author(s):

Matthew Macciacchera ◽

Salwa Siddiqui ◽

Kajeandra Ravichandiran ◽

Moin Khan ◽

Ujash Sheth ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Glenohumeral Joint ◽

Degenerative Changes ◽

Increased Risk ◽

Cuff Repair

Background Osteoarthritis (OA) of the glenohumeral joint results in significant pain and functional limitations. It is unclear which risk factors increase the risk of developing glenohumeral OA amongst Rotator Cuff Repair (RCR) patients. The purpose of this systematic review was to examine the risk factors which may contribute to the development of osteoarthritic changes post-operatively. Methods MEDLINE, Embase, and PubMed databases were searched to identify studies reporting on demographics of patients who develop OA following RCR. Results Seventeen articles were identified investigating a total of 1292 patients. The overall quality of evidence was low. Pooled assessment of OA incidence following RCR at minimum 5 years follow-up found 26% of patients developed OA. Patients requiring revision surgery following retears developed OA at a rate of 29%. Surgical technique and patient demographics may also contribute to degenerative changes. Discussion This review found correlations between the aforementioned risk factors and glenohumeral joint degeneration at long-term follow-up after RCR. These findings suggest that future long-term studies should aim to identify prognostic factors that may place a patient at increased risk of developing OA. Such data can be used to counsel patients with respect to long-term outcomes following surgical intervention.

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The range of glenohumeral joint motion in activities of daily living after rotator cuff repair: A cadaveric biomechanical study

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2008.02.015 ◽

2008 ◽

Vol 17 (5) ◽

pp. 802-807 ◽

Cited By ~ 2

Author(s):

Takayuki Muraki ◽

Mitsuhiro Aoki ◽

Sadanori Ohsiro ◽

Hitoshi Miyamoto ◽

Eiichi Uchiyama ◽

...

Keyword(s):

Rotator Cuff ◽

Activities Of Daily Living ◽

Rotator Cuff Repair ◽

Daily Living ◽

Glenohumeral Joint ◽

Biomechanical Study ◽

Joint Motion ◽

Cuff Repair

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Effect of Suture Absorbability on Rotator Cuff Healing in a Rabbit Rotator Cuff Repair Model

The American Journal of Sports Medicine ◽

10.1177/0363546518787181 ◽

2018 ◽

Vol 46 (11) ◽

pp. 2743-2754 ◽

Cited By ~ 8

Author(s):

Wei Su ◽

Wenxiao Qi ◽

Xiaoxi Li ◽

Song Zhao ◽

Jia Jiang ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Biomechanical Testing ◽

Histological Evaluation ◽

Suture Materials ◽

Greater Tuberosity ◽

Bone Interface ◽

Supraspinatus Tear ◽

Absorbable Sutures ◽

Cuff Repair

Background: Various suture materials can be clinically used for rotator cuff repair (RCR). RCR with high-strength nonabsorbable sutures may not be ideal, because it may cause stress shielding, which may hinder enthesis regeneration and maturation in the tendon-bone interface. RCR with strength-decreasing sutures (ie, absorbable sutures) may be a better choice. However, the effects of suture absorbability on enthesis regeneration and maturation have not been investigated. Hypothesis: The use of absorbable sutures in RCR would produce a better tendon-bone connection structure, which provides histological and biomechanical advantages over the use of nonabsorbable sutures. Study Design: Controlled laboratory study. Methods: A supraspinatus tear was created on the right shoulder in 108 of 120 skeletally mature male rabbits. The animals were randomly divided into 3 groups, with 36 rabbits in each group, to undergo RCR individually with total absorbable, partial absorbable, and nonabsorbable sutures (TAS, PAS, and NAS). Twelve animals in each group were sacrificed at 4, 8, and 12 weeks after surgery, with 6 operated shoulders used for histological evaluation to detect enthesis regeneration and maturation and the other 6 for biomechanical testing. The remaining 12 animals without supraspinatus tear were used as control. Results: At 12 weeks, in the tendon-bone interface, enthesis regeneration was detected in the TAS group but not in the NAS group. A mature enthesis appeared in the TAS group but not in the NAS group. In the PAS group, enthesis regeneration was also observed; however, the fibrocartilage was not abundant and the enthesis maturity not good as compared with the TAS group. Biomechanical testing showed that the rotator cuff–greater tuberosity connection structure in the TAS and PAS groups had greater values of ultimate load to failure, stiffness, and stress than the NAS group at all time points. Conclusion: In RCR in an acute rabbit rotator cuff tear model, the use of sutures with absorbability lead to enthesis regeneration, increased maturity of rotator cuff insertion, and enhanced rotator cuff–greater tuberosity connection. Clinical Relevance: Compared with the use of NAS, the use of TAS or PAS might be a better choice for RCR.

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Changes in Glenohumeral Joint Mechanics, Shoulder Strength, and Clinical Outcomes Over Two Years After Rotator Cuff Repair

ASME 2009 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2009-205584 ◽

2009 ◽

Author(s):

Michael J. Bey ◽

Stephanie K. Kline ◽

Jessica M. Deneweth ◽

Jeffrey R. Haladik ◽

Patricia A. Kolowich ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Glenohumeral Joint ◽

Rotator Cuff Tears ◽

Joint Mechanics ◽

Medical Care Costs ◽

Contact Patterns ◽

Shoulder Strength ◽

Cuff Repair

Rotator cuff tears are a common injury that have a major impact on function, comfort, and medical care costs. Treatment procedures rely implicitly on the belief that restoring normal glenohumeral joint (GHJ) mechanics is necessary to obtain a satisfactory clinical result. However, it is unknown if rotator cuff repair restores and maintains normal GHJ mechanics. Thus, the objective of this study was to compare in-vivo GHJ contact patterns between the repaired and contralateral shoulders of patients who underwent rotator cuff repair. We hypothesized that GHJ contact patterns would be significantly different between repaired and contralateral shoulders.

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A Novel, Fast, Safe, and Effective All-Inside Arthroscopic Rotator Cuff Repair Technique: Results of 1000 Consecutive Cases

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119864088 ◽

2019 ◽

Vol 7 (8) ◽

pp. 232596711986408

Author(s):

Ashleigh Elkins ◽

Patrick H. Lam ◽

George A.C. Murrell

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Glenohumeral Joint ◽

Case Series ◽

Arthroscopic Rotator Cuff Repair ◽

Repair Technique ◽

Ultrasound Evaluation ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair ◽

Retear Rate

Background: Arthroscopic rotator cuff repair is a common but technically difficult surgical technique. This study describes a novel arthroscopic rotator cuff repair technique where the repair was performed while visualized entirely from the glenohumeral joint. A single-row knotless tension band inverted mattress suture technique was utilized with fixation obtained via suture anchors. The technique was relatively easy to perform and demonstrated good repair strength and footprint compression in an ex vivo ovine model. Purpose: To evaluate the safety and efficacy of this technique in 1000 consecutive patients. Study Design: Case series; Level of evidence, 4. Methods: This study was a retrospective analysis of prospectively collected data in 1000 consecutive patients. Included patients underwent primary arthroscopic rotator cuff repair by a single surgeon performing the undersurface repair technique and attended 6-month follow-up with ultrasound evaluation to determine repair integrity. Exclusion criteria were irreparable tears, incomplete repairs, tendon reconstruction with a synthetic patch, and revision cases. Results: The only complication was retear. The overall retear rate at 6 months following repair with the undersurface technique was 8.5%. The mean ± SEM operative time for the technique was 16 ± 0.3 minutes (range, 4-75 minutes). There were no infections. Smaller tears were repaired faster and had better healing rates. Conclusion: The novel all-inside arthroscopic rotator cuff repair technique was safe and significantly faster and provided better healing rates than other repair techniques. The retear rate of 8.5% is, to the authors’ knowledge, the lowest reported rotator cuff retear rate in a large cohort of patients based on a single technique.

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