Short-term results (1 year) of vented versus solid polyetheretherketone anchors in treatment of rotator cuff tears

Background: Due to the rotator cuff retear after being surgically repaired, some strategies have been developed. The authors verified that the possibility of polyetheretherketone (PEEK) vented anchors promoted a better clinical and healing process than PEEK solid anchors. Methods: A prospective and randomized study was designed with 38 patients treated with PEEK anchors, 18 of whom with vented anchors and 20 with solid ones. Demographic, clinical and radiologic data were collected before and during surgery (time 0) and at 12 months of follow-up. Results: In the final follow-up (12 months), there was no difference in the visual analogic scale (VAS) scale between groups (1.7 points vs 1.9 points; p = 0.731), neither in the DASH score (34.2 points vs 23.9 points; p = 0.268), nor in absolute Constant score (76.9 points vs 77.3 points; p = 0.910). In MRI, 10 patients had their cuff tear healed in the vented group and 15 in the solid group (p = 0.173). Conclusion: The new designed vented anchors do not add any advantage when compared to solids ones, at least within the first year after surgery.

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Comparison of Superior Capsular Reconstruction and Partial Infraspinatus Repair: A Matched-Pair Analysis of Irreparable Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120984264 ◽

2021 ◽

Vol 9 (2) ◽

pp. 232596712098426

Author(s):

Stefan Greiner ◽

Max Kaeaeb ◽

Andreas Voss ◽

Robert Lawton ◽

Pushkar Bhide ◽

...

Keyword(s):

Rotator Cuff ◽

Constant Score ◽

Rotator Cuff Tears ◽

Matched Pair ◽

Dash Score ◽

Western Ontario Rotator Cuff ◽

Superior Capsular Reconstruction ◽

Patient Reported ◽

The Mean

Background: Superior capsular reconstruction (SCR) represents a new option for the treatment of irreparable rotator cuff tears. Purpose/Hypothesis: This study aimed to evaluate the clinical and radiologic outcomes of SCR and compare them with the outcomes of partial repair (PR) of the infraspinatus tendon. The hypothesis was that there would be no significant differences between the clinical and radiologic outcome parameters of SCR and PR after a minimum follow-up of 2 years. Study Design: Cohort study; Level of evidence, 3. Methods: Of 21 patients who underwent SCR, 20 patients were matched in a 1:1 ratio according to sex, age, and tear configuration with 20 of 60 patients who had undergone PR; all patients were prospectively evaluated for a minimum follow-up of 2 years. The investigated outcome measures included the Constant score; Western Ontario Rotator Cuff (WORC) index; Disabilities of the Arm, Shoulder and Hand (DASH) score; and radiologic analysis of acromiohumeral distance (AHD) and humeral head centralization (HHC). Results: There were no differences in the demographic data between the SCR and PR groups. The mean age of both groups was 62.3 years (range, 47-79 years), the mean tear configuration was Bateman 3.0 and Patte 2.8, and the mean follow-up period was 29.4 months (range, 24-53 months). At final follow-up, no significant differences were seen between the SCR and PR groups with regard to Constant score (77.1 vs 82.7), age- and sex-adapted Constant score (85.5% vs 91.4%), DASH score (15.6 vs 7.8), or WORC index (81.1 vs 90.4). No significant differences in the AHD or HHC were seen between the groups. The reoperation rate was 4.8% (1/21) in the SCR cohort and 15% (9/60) in the PR cohort. Conclusion: Both SCR and PR resulted in significant improvements in patient-reported outcomes at 2-year follow-up, with no significant differences in clinical outcomes between the 2 techniques. Further follow-up is needed to determine whether there are long-term differences in HHC and development of cuff tear arthropathy. Further investigations should also focus on the cost-effectiveness of the respective procedures.

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Two-year results of double row repair for medium sized rotator cuff tear in elderly patients

International Surgery Journal ◽

10.18203/2349-2902.isj20190043 ◽

2019 ◽

Vol 6 (2) ◽

pp. 423

Author(s):

Afsar T. Ozkut

Keyword(s):

Rotator Cuff ◽

Internal Rotation ◽

Rotator Cuff Tear ◽

External Rotation ◽

Constant Score ◽

Rotator Cuff Tears ◽

Double Row ◽

Cuff Tear ◽

Forward Flexion

Background: Rotator cuff tears are treated surgically when conservative treatment methods fail. Since osteoporosis is common and the cuff is degenerative in nature, it may be a challenge to treat the tears surgically in the elderly. The objective of this study was to evaluate the results rotator cuff repair with double row two anchors (one medial and one lateral) for middle sized tears in patients over 65years old.Methods: 18 patients who are over 65years old treated arthroscopically for medium sized rotator cuff tear were included in the study. Inclusion criteria were patients with MR findings and physical findings consistent with medium sized (1-3cm) rotator cuff tears, patients with follow up period of at least 2years. All of the patients were repaired using (two anchors, one medially and one laterally placed) double row technique arthroscopically. The patients were evaluated with constant Murley score and ASES scores. All these measurements (both ROM and functional tests) were performed preoperatively and at postoperative third sixth months, first year and after second year.Results: Mean age of the patients was 69.3 (±2.6). The mean follows up period was 34months (±4.1) Preoperative mean forward flexion and external rotation were 127.3±25.3º and 48.9±14.6º respectively. The preoperative mean internal rotation was 9.1±6.9º. Preoperative mean ASES score was 59.1º (±9.6) and mean constant score was 53.7º (±11.2). At the last follow up mean forward flexion was 158.3º (±17.9), external rotation was 63.2º (±11.4) and internal rotation was 9.3º (±7.3). Mean ASES score and constant score of the patients were 84.3 (±9.1) and 77.3 (±10.8) in the last follow up.Conclusions: It is possible to obtain good results in medium sized rotator cuff tears in patients over 65years old particularly if fatty degeneration over grade II has not prevailed.

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Rotátorköpeny-szakadás után kialakult zsíros degeneráció változása az ín rekonstrukcióját követően, 65 éves kor után

Orvosi Hetilap ◽

10.1556/650.2019.31326 ◽

2019 ◽

Vol 160 (14) ◽

pp. 533-539

Author(s):

Imre Sallai ◽

Márton Weidl ◽

Attila Szatmári ◽

Imre Antal ◽

Gábor Skaliczki

Keyword(s):

Rotator Cuff ◽

Muscle Atrophy ◽

Rotator Cuff Repair ◽

Constant Score ◽

Fatty Degeneration ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Before And After ◽

Cuff Repair

Abstract: Introduction: In the case of rotator cuff tears, the severity of the muscle atrophy and fatty degeneration has an effect on the success of the repair and on the functional outcome after surgery. Aim: The ability of regeneration reduces with ageing; therefore, the study examined the atrophy and the fatty degeneration after rotator cuff repair in patients over 65. Method: Eleven patients over 65 years of age were involved whose surgery was performed at the Department of Orthopaedics of Semmelweis University between 2012 and 2015. Their average age was 71.9 years and the average follow-up period was 39.9 months. Tear sizes were C1 in 3 cases, C2 in 3 cases, C3 in 4 cases, and C4 in 1 case. Each patient had magnetic resonance examination before and after the repair; the muscle atrophy and fatty degeneration were evaluated together with the type of the tear. Visual analogue scale and Constant score were used for the assessment of the pain and the shoulder function. Results: The average Constant score was 75 points. The occupancy ratio – referring to the severity of the atrophy – did not show significant improvement. The change in fatty degeneration and the atrophy were examined in different groups according to the size of the tears. In each group, the results showed progression. Conclusions: After rotator cuff repair in patients over 65, fatty degeneration and muscle atrophy also show progression. No significant relationship was found between the size of the tear and fatty degeneration or between the size of the tear and muscle atrophy. Orv Hetil. 2019; 160(14): 533–539.

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Clinical and functional outcomes of a novel transosseous device to treat rotator cuff tears: A minimum 2-year follow-up

Journal of Orthopaedic Surgery ◽

10.1177/2309499019875172 ◽

2019 ◽

Vol 27 (3) ◽

pp. 230949901987517 ◽

Cited By ~ 1

Author(s):

Mehmet Arican ◽

Yalçın Turhan ◽

Zekeriya Okan Karaduman ◽

Tacettin Ayanoğlu

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Functional Outcomes ◽

Dash Score ◽

Open Approach ◽

Full Thickness ◽

Gold Standard Method ◽

Cuff Tear ◽

The Mean

Purpose: Despite the improvements in the repair equipment techniques of rotator cuff, a gold standard method has not been defined yet and transosseous fixation through deltoid-splitting (mini-open) approach is still regarded as a good option. The primary purpose of this study is to present satisfactory clinical and functional outcomes with a novel transosseous device in full-thickness rotator cuff tear through deltoid-splitting. Materials and Methods: This retrospective study was performed on 70 consecutive patients who underwent surgery by a single surgeon from June 2014 to June 2016 for a full-thickness rotator cuff tear and was managed with a novel transosseous device. Total number of patients, mean age, percentage of male and female patients, mean duration of follow-up, percentage of involvement of the dominant extremity, affected shoulder, and tear size were recorded. Functional and clinical outcomes were assessed baseline and postoperatively at 3 and 6 months and final follow-up using Disabilities of the Arm, Shoulder and Hand (Q-DASH) and Constant-Murley scores. Results: A total of 70 (49 (70%) female, 21 (30%) male) patients whose mean age was 58.66 ± 9.19 (38–77) years were included. The mean surgery time was 35.33 ± 5.34 (28–55) min. The mean follow-up time was 28.31 ± 3.03 (24–36) months. According to the DeOrio and Cofield classification, 15 (21.43%) tears were small, 33 (47.14%) medium, 16 (22.86%) large, and 6 (8.57%) massive. By the final follow-up, the mean Constant-Murley score had significantly improved from 27.67 ± 7.46 (13–41) to 81.25 ± 3.77 (74–87; p = 0.0001) and the Q-DASH score had decreased from 82.34 ± 10.37 (65.91–100) to 10.28 ± 6.88 (0–23.45; p = 0.0001). There were no significant differences in the Constant-Murley or Q-DASH score at baseline–final follow-up between the small, medium, large, and massive tear groups ( p > 0.05). Conclusions: Treatment of full-thickness rotator cuff tear using this novel transosseous device significantly improved functional and clinical scores. However, further long-term prospective randomized multicenter trials involving comparative studies are necessary to confirm these findings.

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Clinical Outcomes, Tendon Integrity, and Shoulder Strength After Revision Rotator Cuff Reconstruction: A Minimum 2 Years’ Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546518786006 ◽

2018 ◽

Vol 46 (11) ◽

pp. 2700-2706 ◽

Cited By ~ 9

Author(s):

Lukas Willinger ◽

Lucca Lacheta ◽

Knut Beitzel ◽

Stefan Buchmann ◽

Klaus Woertler ◽

...

Keyword(s):

Rotator Cuff ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Constant Score ◽

Case Series ◽

Shoulder Function ◽

Dash Score ◽

Outcome Scores ◽

Retear Rate

Background: The retear rate after primary rotator cuff (RC) reconstruction is high and commonly leads to poorer clinical outcomes and shoulder function. In the case of primary failure, revision RC reconstruction (RCR) has become increasingly important to re-create RC integrity and improve outcomes. To date, clinical and structural outcomes after RCR have not been sufficiently investigated and described at midterm follow-up. Hypothesis/Purpose: The purpose was to evaluate the clinical and radiological outcomes after revision RCR. It was hypothesized that revision RCR significantly improves clinical outcomes and that the outcomes positively correlate with tendon integrity on magnetic resonance imaging (MRI). Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent revision RCR between 2008 and 2014 were retrospectively evaluated with a minimum follow-up of 2 years. Outcomes were assessed by a clinical examination, a visual analog scale for pain (VAS), the Constant Score (CS), the American Shoulder and Elbow Surgeons (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Tendon integrity was determined using 3-T MRI and graded according to the Sugaya classification. Results: Thirty-one of 40 patients (77.5%) were available for the final assessment at a mean follow-up of 50.3 ± 20.4 months. Clinical outcome scores significantly improved from preoperatively to postoperatively for the CS (39.7 ± 16.7 to 65.1 ± 19.7; P < .001), ASES (44.2 ± 17.7 to 75.2 ± 24.8; P < .001), and DASH (68.6 ± 15.1 to 21.5 ± 19.1; P < .001). The VAS score decreased from 6.1 ± 1.8 preoperatively to 1.3 ± 1.8 at final follow-up ( P < .001). MRI demonstrated a retear rate of 55.5%. No differences in CS, ASES, and DASH scores were detected between patients with an intact repair and failure. Abduction strength was not significantly different in patients with an intact repair and retears (55.5 N vs 44.0 N, respectively, P = .52). Conclusion: Revision RCR improves clinical outcomes and shoulder function at midterm follow-up. The clinical outcome scores were comparable in patients with an intact repair and those with failed RC healing. Therefore, tendon integrity was not correlated with better clinical outcomes after revision RCR at final follow-up.

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Outcome of partial repair of massive rotator cuff tears with and without human tissue allograft bridging repair

Shoulder & Elbow ◽

10.1177/1758573216665114 ◽

2016 ◽

Vol 9 (1) ◽

pp. 23-30 ◽

Cited By ~ 25

Author(s):

Radhakant Pandey ◽

Suhayl Tafazal ◽

Srinivasan Shyamsundar ◽

Amit Modi ◽

Harvinder Pal Singh

Keyword(s):

Rotator Cuff ◽

Human Tissue ◽

Constant Score ◽

Rotator Cuff Tears ◽

Partial Repair ◽

Massive Rotator Cuff Tears ◽

Tissue Allograft ◽

Tissue Matrix ◽

Repair Group

Background The surgical management of massive rotator cuff tears remains a challenge. It is suggested that, even in a massive tear that appears irreparable, attempting to repair it as much as possible can be helpful in improving functional outcomes. However the results can be short term and variable. The purpose of our study was to determine if human tissue allograft bridged repair of massive irreparable rotator cuff tears to achieve a complete repair produces similar outcomes compared to partial repair alone. Methods We prospectively reviewed outcome scores in 13 patients who underwent partial repair alone for massive irreparable rotator cuff tears and compared them to 13 patients who had partial repairs bridged with allograft. Oxford and Constant scores were compared pre-operatively and at a minimum follow-up of 2 years (range 2 years to 5 years). Results The mean improvement in the Constant score at final follow-up compared to pre-operative scores was 27.7 points in the partial repair group and 42.8 points in the allograft group ( p < 0.01). The Oxford Shoulder Score improved mean of 19.3 points in the partial repair group and 29 points in the allograft group ( p < 0.02) at 2 years. Conclusions Human tissue matrix allograft provides a better outcome for open bridging of irreparable rotator cuff tears than partial repair alone.

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Is Subacromial Balloon Spacer Appropriate for Treatment of Irreparable Rotator Cuff Tears in Elderly Patients?

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0013.7399 ◽

2019 ◽

Vol 21 (6) ◽

pp. 417-426

Author(s):

Kamil Yamak ◽

Hüseyin Gökhan Karahan ◽

Taşkın Altay ◽

Cemil Kayalı ◽

Fırat Ozan

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tears ◽

Dash Score ◽

X Rays ◽

Preoperative Period ◽

Subacromial Space ◽

Significant Difference ◽

The Difference ◽

Quick Dash

Background. The aim of this study was to evaluate the clinical and radiographic results of surgical treatment of irreparable rotator cuff tears by subacromial balloon spacer insertion in patients over 65 years old. Material and methods. Results of patients with failed conservative treatment for irreparable rotator cuff tears and who underwent subacromial balloon spacer insertion were evaluated retrospectively. The VAS and Quick-DASH scores were used for clinical and functional assessment. Results. Eleven patients were included. Mean age of patients was 69.1 (range: 65-77) years old. Evaluation of anteroposterior shoulder x-rays revealed Hamada grade 2 and grade 1 arthropathy in 10 patients (91%) and 1 patient (9%),respectively. Mean duration of follow-up was 45.09 (±5.43,37-52) months. The difference in the subacromial space measured from standard AP shoulder x-rays in the preoperative period, in the 6th postoperative month, and at the end of follow-up was 5.44 mm (2.29), 6.51 mm (±2.23), and 5.08 mm (±2.13), respectively. Mean Quick-DASH score was 74.49(±14.36) in the preoperative period, compared to 72.19 (±14.38) at the end of follow-up. There was no statistically significant difference between preoperative period and end of follow-up scores in terms of mean Quick-DASH scores (p= 0.232). Mean VAS score was 7.09 (±0.831) in the preoperative period and 6.64 (±0.809) at the end of follow-up. No statistically significant difference was revealed in terms of mean VAS scores when preoperative and end of follow-up scores were compared (p=0.333). Conclusion. Clinical and radiographic results of subacromial balloon spacer insertion in the treatment of irreparable rotator cuff tears could not be evaluated as satisfactory.

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Comparison of Clinical and Structural Outcomes by Subscapularis Tendon Status in Massive Rotator Cuff Tear

The American Journal of Sports Medicine ◽

10.1177/0363546517721187 ◽

2017 ◽

Vol 45 (11) ◽

pp. 2555-2562 ◽

Cited By ~ 8

Author(s):

Sung Hyun Lee ◽

Dae Jin Nam ◽

Se Jin Kim ◽

Jeong Woo Kim

Keyword(s):

Magnetic Resonance Imaging ◽

Rotator Cuff ◽

Rotator Cuff Tear ◽

Rotator Cuff Tears ◽

Subscapularis Tendon ◽

Resonance Imaging ◽

Massive Rotator Cuff Tear ◽

Cuff Tear ◽

Massive Rotator Cuff Tears

Background: The subscapularis tendon is essential in maintaining normal glenohumeral biomechanics. However, few studies have addressed the outcomes of tears extending to the subscapularis tendon in massive rotator cuff tears. Purpose: To assess the clinical and structural outcomes of arthroscopic repair of massive rotator cuff tears involving the subscapularis. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2010 and January 2014, 122 consecutive patients with massive rotator cuff tear underwent arthroscopic rotator cuff repair. Overall, 122 patients were enrolled (mean age, 66 years; mean follow-up period, 39.5 months). Patients were categorized into 3 groups based on subscapularis tendon status: intact subscapularis tendon (I group; n = 45), tear involving less than the superior one-third (P group; n = 35), and tear involving more than one-third of the subscapularis tendon (C group; n = 42). All rotator cuff tears were repaired; however, subscapularis tendon tears involving less than the superior one-third in P group were only debrided. Pain visual analog scale, Constant, and American Shoulder and Elbow Surgeons scores and passive range of motion were measured preoperatively and at the final follow-up. Rotator cuff integrity, global fatty degeneration index, and occupation ratio were determined via magnetic resonance imaging preoperatively and 6 months postoperatively. Results: We identified 37 retears (31.1%) based on postoperative magnetic resonance imaging evaluation. Retear rate in patients in the C group (47.6%) was higher than that in the I group (22.9%) or P group (20.0%) ( P = .011). Retear subclassification based on the involved tendons showed that subsequent subscapularis tendon retears were noted in only the C group. The improvement in clinical scores after repair was statistically significant in all groups but not different among the groups. Between-group comparison showed significant differences in preoperative external rotation ( P = .021). However, no statistically significant difference was found in any shoulder range of motion measurements after surgery. Conclusion: Arthroscopic repair of massive tears results in substantial improvements in shoulder function, despite the presence of combined subscapularis tears. However, this study showed a high failure rate of massive posterosuperior rotator cuff tear repair extending more than one-third of the subscapularis tendon. When combined subscapularis tendon tear was less than the superior one-third of the subscapularis tendon, arthroscopic debridement was a reasonable treatment method where comparable clinical and anatomic outcomes could be expected.

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Arthroscopic Partial Repair of Massive Contracted Rotator Cuff Tears

Clinics in Shoulder and Elbow ◽

10.5397/cise.2014.17.1.44 ◽

2014 ◽

Vol 17 (1) ◽

pp. 44-47 ◽

Cited By ~ 1

Author(s):

Sung Jae Kim ◽

Young Hwan Kim ◽

Yong Min Chun

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Functional Outcomes ◽

Muscle Quality ◽

Rotator Cuff Tears ◽

Massive Rotator Cuff Tear ◽

Cuff Tear ◽

Partial Repair ◽

Tendon Coverage

Typically, massive rotator cuff tears have stiff and retracted tendon with poor muscle quality, in such cases orthopaedic surgeons are confronted with big challenging to restore the cuff to its native footprint. Furthermore, even with some restoration of the footprint, it is related with a high re-tear rate due to less tension free repair and less tendon coverage. In this tough circumstance, the partial repair has yielded satisfactory outcomes at relatively short follow-up by re-creating the transverse force couple of the rotator cuff. Through this partial repair, the massive rotator cuff tear can be converted to the "functional rotator cuff tear" and provide improvement in pain and functional outcomes in patient's shoulder.

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Assessment of functional outcome of mini-open rotator cuff repair: a hospital based prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20180681 ◽

2018 ◽

Vol 4 (2) ◽

pp. 285 ◽

Cited By ~ 1

Author(s):

Vikas Sharma ◽

Shailesh V. Udapudi ◽

Somnath T. Sanikop ◽

Sameer Haveri ◽

Mahantesh Y. Patil

Keyword(s):

Rotator Cuff ◽

Functional Outcome ◽

Shoulder Joint ◽

Rotator Cuff Repair ◽

Constant Score ◽

Cuff Tear ◽

Ucla Score ◽

Cuff Repair ◽

Mini Open

Background: The mini-open repair is considered to be the gold standard for rotator cuff repair. This study was aimed to assess functional outcome of mini-open rotator cuff repair of shoulder joint in adult patients.Methods: This was a one year hospital based prospective study conducted from January 2016 to December 2016. A total of 20 patients diagnosed to have rotator cuff tear of shoulder joint undergoing rotator cuff repair in the department of Orthopaedics, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, and KLES Dr. Prabhakar Kore Charitable Hospital, Belagavi were studied.Results: Majority of the patients (85%) of the patients was male and male to female ratio was 5.6:1. Most of the patients were aged between 31 to 40 years (30%). The mean age was 41.90±13.98 years. Most of patients had degenerative rotator cuff tear (45%) and (70%) presented with features of swelling. At enrollment all the patients (100%) had poor constant score (>30) and fair/poor UCLA score (<27) suggestive of severe pain functional restriction. There were gradual but steady increase in scores from enrollment to each follow up till six month follow up with respect to mean flexion (6.25±5.35 to 163.50±7.63),abduction (5.50±5.10 to 112.0±5.94),external rotation (3.00±4.7 to 82.50±2.56 ),internal rotation (2.50±4.44 to 67.25±3.43 ) and UCLA score (5.35±1.63 to 29.60±0.82 ) (p<0.001) also there was gradual but steady decrease in mean VAS score from enrolment (7.70±0.47 ) to six months follow up (0.00±0.00) and constant score ( from 85.70±1.98 to 7.85±1.46 respectively) (p<0.001). The constant score and UCLA score at six month follow up revealed excellent functional outcome. Conclusions: The mini-open rotator cuff repair of shoulder joint results in excellent functional outcome among adult patients with rotator cuff tear of shoulder joint especially after six month with no complications and complete pain relief.

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