scholarly journals Surgical Management of Comminuted, Displaced Greater Tuberosity Fractures: A New Technique of Subacromial Spacer on Top of Double-Row Suture Anchor Fixation

Joints ◽  
2018 ◽  
Vol 06 (03) ◽  
pp. 211-214
Author(s):  
Leslie Naggar
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Rigid Fixation ◽  
Double Row ◽  
Greater Tuberosity ◽  
Technical Report ◽  
A New Technique ◽  
Arthroscopic Rotator Cuff ◽  
Suture Anchor Fixation

AbstractArthroscopic treatment of greater tuberosity (GT) fractures has been previously described. Arthroscopy allows identifying and addressing coexisting injuries, such as rotator cuff tears, labrum, or superior labrum anterior and posterior lesions, which are often present. Fracture comminution precludes the use of rigid fracture fixation with screws and arthroscopic rotator cuff repair is performed instead. Recent articles have depicted the role of the balloon-shaped subacromial spacer in massive and irreparable rotator cuff tears. The purpose of this technical report is to outline another use of the spacer in patients with a GT fracture. The concept is to leverage the advantage of the compression effect of the subacromial spacer to prevent displacement of the GT fracture and allow early active shoulder rehabilitation, especially in comminuted or eggshell fractures when rigid fixation is not feasible.

Arthroscopic Single-Row Versus Double-Row Suture Bridge Technique for Rotator Cuff Tears in Patients Younger Than 55 Years: A Prospective Comparative Study

2017 ◽  
Vol 46 (1) ◽  
pp. 116-121 ◽  
Author(s):  
Michael E. Hantes ◽  
Yohei Ono ◽  
Vasilios A. Raoulis ◽  
Nikolaos Doxariotis ◽  
Aaron Venouziou ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Constant Score ◽  
Tendon Healing ◽  
Rotator Cuff Tears ◽  
Double Row ◽  
Single Row ◽  
Suture Bridge ◽  
Ucla Score ◽  
Arthroscopic Rotator Cuff

Background: When arthroscopic rotator cuff repair is performed on a young patient, long-lasting structural and functional tendon integrity is desired. A fixation technique that potentially provides superior tendon healing should be considered for the younger population to achieve long-term clinical success. Hypothesis/Purpose: The purpose was to compare the radiological and clinical midterm results between single-row and double-row (ie, suture bridge) fixation techniques for arthroscopic rotator cuff repair in patients younger than 55 years. We hypothesized that a double-row technique would lead to improved tendon healing, resulting in superior mid- to long-term clinical outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: A consecutive series of 66 patients younger than 55 years with a medium to large full-thickness tear of supraspinatus and infraspinatus tendons who underwent arthroscopic single-row or double-row (ie, suture bridge) repair were enrolled and prospectively observed. Thirty-four and 32 patients were assigned to single-row and double-row groups, respectively. Postoperatively, tendon integrity was assessed by MRI following Sugaya’s classification at a minimum of 12 months, and clinical outcomes were assessed with the Constant score and the University of California, Los Angeles (UCLA) score at a minimum of 2 years. Results: Mean follow-up time was 46 months (range, 28-50 months). A higher tendon healing rate was obtained in the double-row group compared with the single-row group (84% and 61%, respectively [ P < .05]). Although no difference in outcome scores was observed between the 2 techniques, patients with healed tendon demonstrated superior clinical outcomes compared with patients who had retorn tendon (UCLA score, 34.2 and 27.6, respectively [ P < .05]; Constant score, 94 and 76, respectively [ P < .05]). Conclusion: The double-row repair technique potentially provides superior tendon healing compared with the single-row technique. Double-row repair should be considered for patients younger than 55 years with medium to large rotator cuff tears.

scholarly journals Early postoperative pain as a risk factor of shoulder stiffness after arthroscopic rotator cuff repair

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mohammad Reza Guity ◽  
Amir Sobhani Eraghi ◽  
Fatemeh Sadat Hosseini-Baharanchi
Keyword(s):  
Postoperative Pain ◽  
Rotator Cuff ◽  
Pain Score ◽  
Shoulder Arthroscopy ◽  
Level Of Evidence ◽  
Double Row ◽  
Shoulder Stiffness ◽  
Shoulder Range Of Motion ◽  
Arthroscopic Rotator Cuff

Abstract Background The role of postoperative pain in incidence of shoulder stiffness (SS) after shoulder arthroscopy has not been thoroughly investigated. The present study was conducted to assess the effects of early postoperative pain (EPOP) on onset of SS after arthroscopic rotator cuff (RC) repair. Materials and methods In a retrospective analysis of a prospectively collected database, 335 patients who underwent arthroscopic RC repair were evaluated. RC tendons were sutured to the bone using the double-row technique. EPOP was evaluated 1 week after surgery using the visual analog scale (VAS). SS was assessed 3 months after surgery and was categorized into moderate or severe based on shoulder range of motion (ROM). Each type of complication including SS was identified and recorded. Results Postoperative shoulder stiffness (POSS) was identified in 121 patients (36.2%) that was moderate in 86 patients (70.1%) and severe in 35 patients (28.9%). After 1 week, VAS pain score was equal to 7.7 ± 3.1 and 4.5 ± 2.1 in the patients with and without stiffness, respectively (p < 0.001). Diabetes and traumatic tear were found to be associated with postoperative stiffness (p = 0.046 and p < 0.001, respectively). Similar associations were found on multivariate analysis of data. VAS pain score was higher in the patients with severe stiffness compared with those with moderate stiffness (p < 0.001). Conclusions Our findings revealed that EPOP is associated with shoulder stiffness after arthroscopic RC repair. Therefore, strategies to ameliorate EPOP could be opted to decrease rate of POSS. Level of evidence Level IV

scholarly journals Linked Double-Row Equivalent Arthroscopic Rotator Cuff Repair Leads to Significantly Improved Patient Outcomes

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093831
Author(s):  
Atsushi Endo ◽  
Paul Hoogervorst ◽  
Conrad Safranek ◽  
Kyle R. Sochacki ◽  
Marc R. Safran ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Complication Rates ◽  
Double Row ◽  
Individual Level ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Biomechanical studies have demonstrated that arthroscopic rotator cuff repair using a linked double-row equivalent construct results in significantly higher load to failure compared with conventional transosseous-equivalent constructs. Purpose: To determine the patient-reported outcomes (PROs), reoperation rates, and complication rates after linked double-row equivalent rotator cuff repair for full-thickness rotator cuff tears. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent linked double-row equivalent arthroscopic rotator cuff repair with minimum 2-year follow-up were included. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score at final follow-up. Secondary outcomes included the Simple Shoulder Test (SST), shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, visual analog scale (VAS), reoperations, and complications. Clinical relevance was defined by the minimally clinically important difference (MCID). Comparisons on an individual level that exceeded MCID (individual-level scores) were deemed clinically relevant. Comparisons between preoperative and postoperative scores were completed using the Student t test. All P values were reported with significance set at P < .05. Results: A total of 42 shoulders in 41 consecutive patients were included in this study (21 male patients [51.2%]; mean age, 64.5 ± 11.9 years; mean follow-up, 29.7 ± 4.5 months). All patients (100%) completed the minimum 2-year follow-up. The rotator cuff tear measured on average 15.2 ± 8.9 mm in the coronal plane and 14.6 ± 9.8 mm in the sagittal plane. The ASES score improved significantly from 35.5 ± 18.2 preoperatively to 93.4 ± 10.6 postoperatively ( P < .001). The QuickDASH ( P < .001), SST ( P < .001), and VAS ( P < .001) scores also significantly improved after surgery. All patients (42/42 shoulders; 100%) achieved clinically relevant improvement (met or exceeded MCID) on ASES and SST scores postoperatively. There were no postoperative complications (0.0%) or reoperations (0.0%) at final follow-up. Conclusion: Arthroscopic repair of full-thickness rotator cuff tears with the linked double-row equivalent construct results in statistically significant and clinically relevant improvements in PRO scores with low complication rates (0.0%) and reoperation rates (0.0%) at short-term follow-up.

scholarly journals Increased acromiohumeral distance in a double-row arthroscopic rotator cuff surgery compared to a single-row surgery after 12 months

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kaya Turan ◽  
Haluk Çabuk ◽  
Cenk Köroğlu ◽  
Çağatay Öztürk
Keyword(s):  
Rotator Cuff ◽  
Functional Results ◽  
Rotator Cuff Tears ◽  
Double Row ◽  
Single Row ◽  
The Mean ◽  
Acromiohumeral Distance ◽  
Arthroscopic Rotator Cuff ◽  
Repair Group

Abstract Background Arthroscopic rotator cuff surgery is an effective treatment for rotator cuff tears with the considered use of double-row repair techniques becoming popular in the last decade. We aim to compare the effects of double- and single-row arthroscopic rotator cuff repairs (ARCR) on repair integrity (RI) and acromiohumeral distance (AHD). Methods In this observational study, we retrospectively identified 98 patients with degenerative rotator cuff tear treated with arthroscopic rotator cuff repair between 2016 and 2019. We excluded 22 patients with partial-thickness tears, 15 with associated subscapularis or SLAP tears, 13 with massive tears, and 5 patients lost to follow-up; we included 43 patients who had ARCR for full-thickness cuff tear and clinical, radiologic follow-up. Of these 43 patients, 23 are grouped as double-row repair group (DRG) and 20 as single-row repair group (SRG). A minimum of 12 months after the surgery, bilateral shoulder MRIs were obtained. Contralateral shoulders without asymptomatic rotator cuff tears served as a control group (CG). The operating surgeon and two other surgeons experienced in arthroscopy blindly measured the AHD and determined the RI at the control MRIs in all groups. Functional assessments relied on UCLA and qDASH Scores. Results The mean age was 57.89 (45–78) years, and the mean follow-up time was 28,65 (21–43) months. The mean AHD of the CG was 9.7 ± 0.96 mm, the preoperative AHD of DRG was 8.62 ± 1.45 mm, and SRG was 9.71 ± 0.95 mm. The postoperative mean AHD of DRG 9.61 ± 1.83 mm and SRG was 10.21 ± 1.97 mm. AHD differences between the preoperative and postoperative groups were significant (P=0.009). The increase of the AHD in the double-row group was significantly higher than the single-row group (P=0.004). There was a high correlation between the RI and DASH scores (P=0.005). RI did not correlate with the repair method (P=0.580). Conclusion Although double-row repairs can maintain greater AHD than single-row repairs in the clinical setting, this difference did not affect functional results. Regardless of the surgical intervention, functional results are favourable if RI is achieved. Level of evidence Level III, Retrospective Cohort Study

scholarly journals Should We be Routinely Performing Arthroscopic Subacromial Decompression During Rotator Cuff Repair (RCR)?

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Sachin Kumar ◽  
Rajiv Gogna ◽  
Daniel Morris, ◽  
Amol Tambe
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Nonoperative Management ◽  
Relevant Literature ◽  
Rotator Cuff Tears ◽  
Subacromial Decompression ◽  
Arthroscopic Rotator Cuff ◽  
Arthroscopic Subacromial Decompression ◽  
Cuff Repair

Symptomatic rotator cuff tears cause pain and impaired function. Arthroscopic rotator cuff repair is an established treatment when nonoperative management fails. However, debate exists regarding the requirement of concurrent subacromial decompression. This review aims to answer pertinent questions and outline relevant literature in the role of arthroscopic subacromial decompression in rotator cuff repair. Keywords: Decompression, Cuff, Arthroscopic, Repair.

scholarly journals Use of Gracile and semi-tendinosus tendons (GRAST) for the reconstruction of irreparable rotator cuff tears

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marie Protais ◽  
Maxime Laurent-Perrot ◽  
Mickaël Artuso ◽  
M. Christian Moody ◽  
Alain Sautet ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Donor Site ◽  
Anatomical Study ◽  
Donor Site Morbidity ◽  
Rotator Cuff Tears ◽  
Subacromial Space ◽  
Greater Tuberosity ◽  
Working Zone ◽  
Superior Capsular Reconstruction

Abstract Background Irreparable rotator cuff tears are common and difficult to treat. Techniques for “filling the loss of substance” require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula. Methods This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SS) and upper infraspinatus (IS) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed. We proceeded to the same technique under arthroscopy for a 73 years old patient whom we treated for a painful shoulder with irreparable cuff tear. We inserted a GRAST graft using arthroscopy. Results The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases. Conclusion This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial “spacer” effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.

scholarly journals Comparison of Clinical Outcomes Between Knotted and Knotless Double Row Arthroscopic Rotator Cuff Repairs: A Meta-Analysis

2020 ◽  
Author(s):  
Pirateb Paramasivam Meenakshi Sundaram ◽  
Wei Wen Bryan Lee ◽  
Andrew Arjun Sayampanathan ◽  
Hwee Chye Andrew Tan
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Double Row ◽  
Arthroscopic Rotator Cuff
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