Interposition of Human Amnion Membrane at the Bone-Tendon Interface of a Full-Thickness Rotator Cuff Repair.

Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears.Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI), and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively and 2 years after repair.Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (P<0.001). Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (P<0.001). MRI studies showed 24 cases of tear after repair (29%). Only 8 cases were a full-thickness tear.Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity.

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Epidemiological Analysis of Changes in Clinical Practice for Full-Thickness Rotator Cuff Tears From 2010 to 2015

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119845912 ◽

2019 ◽

Vol 7 (5) ◽

pp. 232596711984591 ◽

Cited By ~ 4

Author(s):

Avinesh Agarwalla ◽

Gregory L. Cvetanovich ◽

Anirudh K. Gowd ◽

Anthony A. Romeo ◽

Brian J. Cole ◽

...

Keyword(s):

Clinical Practice ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Management Practices ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Biceps Tenodesis ◽

Rotator Cuff Injuries ◽

Cuff Repair ◽

Corticosteroid Injections

Background: Rotator cuff injuries are a leading cause of shoulder disability among adults. Surgical intervention is a common treatment modality; however, conservative management has been described for the treatment of rotator cuff tears. As the cost of health care increases, the industry has shifted to optimizing patient outcomes, reducing readmissions, and reducing expenditure. In 2010, the American Academy of Orthopaedic Surgeons created clinical practice guidelines (CPGs) to guide the management of rotator cuff injuries. Since their publication, there have been several randomized controlled trials assessing the management of rotator cuff injuries. Purpose: To quantitatively describe changes in the management of full-thickness rotator cuff tears over time with regard to the publication of the CPGs and prospective clinical trials. Study Design: Cohort study; Level of evidence, 3. Methods: Included in the study were Humana-insured patients in the PearlDiver database with the diagnosis of a full-thickness rotator cuff tear from 2010 to 2015. Patients undergoing rotator cuff repair (CPT-29827, CPT-23410, CPT-23412, CPT-23420) and patients undergoing nonoperative management in the queried years were identified. The incidence of physical therapy (PT), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections was assessed. Results: In 2015, patients with full-thickness rotator cuff tears were less likely to receive a corticosteroid injection (16.5% vs 23.9%, respectively; odds ratio [OR], 0.6; P < .001) or undergo PT (7.8% vs 12.1%, respectively; OR, 0.6; P < .001) before rotator cuff repair in comparison with 2010. Additionally, patients were no more likely to be prescribed NSAIDs before rotator cuff repair in 2015 in comparison with 2010 (OR, 1.0; P = .6). Patients with full-thickness rotator cuff tears were less likely to undergo acromioplasty in 2015 in comparison with 2010 (48.2% vs 76.9%, respectively; OR, 0.4; P < .001); however, the rate of concomitant biceps tenodesis slightly increased (14.8% vs 14.6%, respectively; OR, 1.1; P = .01). Conclusion: From 2010 to 2015, there were changes in the management of full-thickness rotator cuff tears, including decreased preoperative utilization of corticosteroid injections and PT as well as a decrease in concomitant acromioplasty, and the rate of biceps tenodesis slightly increased. As CPGs and prospective investigations continue to proliferate, management practices of patients with full-thickness rotator cuff tears continue to evolve.

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Type 2 Superior Labral Anterior Posterior (SLAP) Tear in 55-Year-Old Male with Concomitant Full-Thickness Rotator Cuff Tear Treated with Long Head of the Biceps Tenodesis and Rotator Cuff Repair

The Biceps and Superior Labrum Complex ◽

10.1007/978-3-319-54934-7_12 ◽

2017 ◽

pp. 159-172

Author(s):

Robert A. Duerr ◽

Darren A. Frank

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Full Thickness ◽

Biceps Tenodesis ◽

Cuff Tear ◽

Long Head ◽

Slap Tear ◽

Cuff Repair ◽

Anterior Posterior

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Clinical outcomes and repair integrity after arthroscopic full-thickness rotator cuff repair: suture-bridge versus double-row modified Mason-Allen technique

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2018.04.005 ◽

2018 ◽

Vol 27 (11) ◽

pp. 1953-1959 ◽

Cited By ~ 7

Author(s):

Kwang Won Lee ◽

Dae Suk Yang ◽

Gyu Sang Lee ◽

Chang Hyun Ma ◽

Won Sik Choy

Keyword(s):

Rotator Cuff ◽

Clinical Outcomes ◽

Rotator Cuff Repair ◽

Full Thickness ◽

Double Row ◽

Suture Bridge ◽

Cuff Repair

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Why Do Patients Decide to Have Surgery for Their Symptomatic Rotator Cuff Tear? A Prospective Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00083 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0008

Author(s):

Danielle Weekes ◽

Weilong Jeffrey Shi ◽

Christopher Hadley ◽

Kevin B. Freedman ◽

Matthew D. Pepe ◽

...

Keyword(s):

Decision Making ◽

Chronic Pain ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Surgical Repair ◽

Full Thickness ◽

Younger Patients ◽

Cuff Tear ◽

Cuff Repair ◽

Time Point

Objectives: While rotator cuff pathology may be amenable to conservative therapy, patients with full thickness tears not improving with non-operative treatment are indicated for repair. The decision to undergo surgery is often multifactorial with pain, loss of function, and concern for progression all factoring in the decision-making process. The purpose of this investigation was to evaluate patients main determining factors in deciding to have surgery for their rotator cuff tear, correlate these factors with strength of surgeon recommendation and clinical outcomes. Methods: One hundred and fifty patients undergoing arthroscopic rotator cuff repair (ARCR) were enrolled prospectively. Patients received a questionnaire preoperatively to determine why they decided to proceed with surgical repair. This 13-question survey was developed based on evidence-based review of rotator cuff repair literature and the Delphi technique. Patients were asked to rate each factor with regard to importance in their decision to proceed with repair. Surgeons were given a similar Likert Scale and were queried on how strongly they would recommend surgery for their patients based upon various factors such as MRI findings, age, etc. Pre- and post-operative shoulder function was assessed with the American Shoulder and Elbow Society (ASES) Score. Descriptive statistics were used to evaluate the reasons to proceed with surgery and correlated with outcomes based on ASES scores. Results: The most influential patient reported factors for proceeding with surgical repair were: limited functionality of the shoulder (81%), surgeon recommendation (80%), and daily chronic pain (77%). Patients improved from 42.6 to 77.0 on the ASES from baseline to 6-months (p<0.001). Patients who listed that they were unable to play a favorite sport or hobby as their top reason for surgery demonstrated a significant increase in their ASES score relative to other factors at the 3 month time point (p=0.0014); otherwise, there was no significant difference in outcomes for any other time point based on category importance. Subgroup analysis of males and females and older v. younger patients demonstrated significant findings. Females were more likely to proceed with repair due to inability to sleep and daily, chronic pain (p<.005) relative to males. Younger patients were more likely to proceed with repair for the inability to play a sport/hobby and increased demands of work relative to older patients (p<.005). There was no correlation between any decision factor and final outcome of ASES scores. Younger patients and male patients both demonstrated higher baseline ASES scores (p<.05); however, there was no difference in outcome measures at final follow-up. Conclusion: Prior studies have shown that rotator cuff repair is best at alleviating pain for full thickness rotator cuff tears and may not be as impactful for improving function. Despite this evidence, the majority of patients undergoing rotator cuff repair in our study did so to improve function of their shoulder. While pain, inability to sleep, and inability to participate in ones favorite hobby/sport were important to our patient population, a strong surgeon recommendation had no correlation with our patients decision to proceed with repair. Surgeons should be mindful of these differences between gender and age when counseling patients pre-operatively. Outcomes of ARCR do not appear to be determined by pre-operative decision making on the part of the patient.

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The Effect of Time Interval from MRI to Rotator Cuff Repair on Tear Size: Imaged vs. Actual Tear Size

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00277 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0027

Author(s):

Amanda J. Naylor ◽

Michael D. Charles ◽

Allison Jamie Rao ◽

Gregory Louis Cvetanovich ◽

Michael C. O’Brien ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Critical Time ◽

T Test ◽

Rotator Cuff Tears ◽

Time Interval ◽

Consecutive Series ◽

Full Thickness ◽

Cuff Repair ◽

Tear Size

Objectives: Magnetic resonance imaging (MRI) is the advanced imaging modality of choice for the evaluation and diagnosis of full thickness rotator cuff tears (RCT). Tear size progression has been correlated with increasing pain. However, there is little data on tear size progression in symptomatic RCT with regard to time from MRI to actual rotator cuff repair (RCR). The purpose of the study was to evaluate the effect of time (from date of MRI measured tear dimensions to date of RCR measured intraoperative tear dimensions) on tear size progression. Methods: In the course of a study on physical examination manual muscle tests in patients with known full thickness RCT requiring repair, MRI was obtained for each patient undergoing RCR. Tears were measured intraoperatively in the Anterior-Posterior (A-P) and Medial-Lateral (M-L) dimensions with a graduated probe. Location (anterior, central, posterior in the supraspinatus tendon), area of the tear, and anterior band of supraspinatus status (intact/ not intact) were recorded.The preoperative MRI was evaluated by the same examiner blinded to the operative results at least 4 weeks after the RCR and the same parameters measured.There were 64 consecutive shoulders with 40 male, 24 female at an average age of 58 yrs (40-76) that had MRI and underwent RCR. The mean MRI dimensions were: A-P tear:16.53 mm (SD 9.70); M-L tear: 17.3 mm (SD 9.75); Tear area: 366.7 square mm. The average time from preoperative MRI to RCR was 107.3 days (range 12-399 days). Operative mean RCT dimensions were: A-P tear: 18.38 mm (SD 10.0); M-L tear: 14.06 mm (SD 8.15); Tear area: 307.7 square mm.Descriptive statistical analysis with two-sample T-test was performed to determine the temporal effect on tear size from date of MRI to the date of surgery, and whether there was a change.Patients were grouped in the following time cohorts based on the length of time elapsed between the preoperative MRI and date of RCR: ≤1 month, 1 month to 2 months, 2 months to 3 months, 3 months to 9 months, and ≥9 months. The delta, or difference between intraoperative measurements and preoperative MRI measurements, was calculated for each cohort. Results: The t-test revealed a significant time effect with regard to tear size between the MRI and the intraoperative measured tear requiring repair. This was significant for the A-P dimension (p<0.001), the Medial-Lateral dimension (p<0.001), and the total area of the tear (p=0.009). In an attempt to determine a “watershed” or critical time interval where MRI and RCT size correlated, an additional analysis was performed. The change in A-P tear dimension between MRI and RCR findings showed increasing delta with increasing time. Positive mean delta in A-P dimension was seen in the 2-3 month group (2.64), with larger differences seen in the 3 month to 9 month (5.89) and ≥9 month (7.3) groups. A similar trend was seen for mean delta values in the M-L dimension among the cohorts. Conclusion: In a consecutive series of RCTs undergoing repair, the measured MRI dimensions and the intraoperative dimensions were recorded and analyzed. A surgeon can have a level of confidence that the RCT size will correlate with MRI tear size within a certain time frame. There is a significant effect of time on tear size progression from MRI dimensions to actual RCT dimensions at time of repair.

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