Longitudinal Long-term Magnetic Resonance Imaging and Clinical Follow-up After Single-Row Arthroscopic Rotator Cuff Repair: Clinical Superiority of Structural Tendon Integrity

2017 ◽  
Vol 45 (6) ◽  
pp. 1283-1288 ◽  
Author(s):  
Philipp R. Heuberer ◽  
Daniel Smolen ◽  
Leo Pauzenberger ◽  
Fabian Plachel ◽  
Sylvia Salem ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Full Thickness ◽  
Constant Strength ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: The number of arthroscopic rotator cuff surgeries is consistently increasing. Although generally considered successful, the reported number of retears after rotator cuff repair is substantial. Short-term clinical outcomes are reported to be rarely impaired by tendon retears, whereas to our knowledge, there is no study documenting long-term clinical outcomes and tendon integrity after arthroscopic rotator cuff repair. Purpose: To investigate longitudinal long-term repair integrity and clinical outcomes after arthroscopic rotator cuff reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Thirty patients who underwent arthroscopic rotator cuff repair with suture anchors for a full-tendon full-thickness tear of the supraspinatus or a partial-tendon full-thickness tear of the infraspinatus were included. Two and 10 years after initial arthroscopic surgery, tendon integrity was analyzed using magnetic resonance imaging (MRI). The University of California, Los Angeles (UCLA) score and Constant score as well as subjective questions regarding satisfaction with the procedure and return to normal activity were used to evaluate short- and long-term outcomes. Results: At the early MRI follow-up, 42% of patients showed a full-thickness rerupture, while 25% had a partial rerupture, and 33% of tendons remained intact. The 10-year MRI follow-up (129 ± 11 months) showed 50% with a total rerupture, while the other half of the tendons were partially reruptured (25%) or intact (25%). The UCLA and Constant scores significantly improved from preoperatively (UCLA total: 50.6% ± 20.2%; Constant total: 44.7 ± 10.5 points) to 2 years (UCLA total: 91.4% ± 16.0% [ P < .001]; Constant total: 87.8 ± 15.3 points [ P < .001]) and remained significantly higher after 10 years (UCLA total: 89.7% ± 15.9% [ P < .001]; Constant total: 77.5 ± 15.6 points [ P < .001]). The Constant total score and Constant strength subscore, but not the UCLA score, were also significantly better at 10 years postoperatively in patients with intact tendons compared with patients with retorn tendons (Constant total: 89.0 ± 7.8 points vs 75.7 ± 14.1 points, respectively [ P = .034]; Constant strength: 18.0 ± 4.9 points vs 9.2 ± 5.2 points, respectively [ P = .006]). The majority of patients rated their satisfaction with the procedure as “excellent” (83.3%), and 87.5% returned to their normal daily activities. Conclusion: Arthroscopic rotator cuff repair showed good clinical long-term results despite a high rate of retears. Nonetheless, intact tendons provided significantly superior clinical long-term outcomes, making the improvement of tendon healing and repair integrity important goals of future research efforts.

scholarly journals Randomized Prospective Trial of Arthroscopic Rotator Cuff With or Without Acromioplasty: No Difference in Patient-reported Outcomes at Long-term Follow-up

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0008 ◽  
Author(s):  
Brian Robert Waterman ◽  
Jonathan Newgren ◽  
Anirudh K. Gowd ◽  
Brandon C. Cabarcas ◽  
Bernard R. Bach ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcomes ◽  
Arthroscopic Rotator Cuff Repair ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Objectives: To evaluate long-term clinical outcomes after arthroscopic rotator cuff repair with and without acromioplasty. Methods: Between 2007-2011, prospectively-enrolled patients undergoing arthroscopic repair for full-thickness rotator cuff tears were previously randomized into either acromioplasty or non-acromioplasty groups. Patients with death, advanced neurologic conditions, or subsequent shoulder arthroplasty were excluded. Baseline and long-term follow-up questionnaires, including the American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), University of California-Los Angeles (UCLA), Visual Analog Scale (VAS) for pain, and Constant scores were obtained. Rates of revision rotator cuff surgery, or secondary reoperation were recorded. Averages with standard deviation (SD) were calculated, and t-tests were utilized to compare outcomes of interest between cohorts. Results: After exclusion of 5 additional patients from the short-term follow-up study, 66 of 90 patients (73.3%) were available at 92.4 months (±10.5). Comparison of baseline demographics and intraoperative information revealed no significant differences, including age, gender, workers compensation, acute mechanism of injury, tear size, degree of retraction, and surgical technique (e.g. single- vs. double-row). At final follow-up, there were no statistically significant differences according to ASES (p=0.33), VAS pain (p=0.79), Constant (p=0.17), SST (p=0.05), UCLA (p=0.19), and SF-12 (p=0.79) in patients with and without acromioplasty (Figure 1). One patient with acromioplasty (2.9%) and two patients without acromioplasty (6.3%) sustained atraumatic recurrent rotator cuff tear with secondary repair (p=0.99). Conclusion: Combined acromioplasty and rotator cuff repair offer no significant long-term benefits in patient-reported outcomes or secondary surgery when compared to arthroscopic rotator cuff repair alone. [Figure: see text]

scholarly journals Long-term Follow-up of Extensive Peri-anchor (Poly-L/D-lactic Acid) Cyst Formation after Arthroscopic Rotator Cuff Repair: A Case Report

2019 ◽  
Vol 22 (2) ◽  
pp. 100-105
Author(s):  
Jong-Ho Kim ◽  
Jong-Ick Kim ◽  
Hyo-Jin Lee ◽  
Dong-Jin Kim ◽  
Gwang Young Sung ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Cyst Formation ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Long Term Follow Up ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Suture anchors are commonly used in shoulder surgeries, especially for rotator cuff tears. Peri-anchor cyst formation, however, is sometimes detected on follow-up radiologic image after surgery. The purpose of this report is to discuss the case of a patient who presented with regression of extensive peri-anchor cyst on postoperative 4-year follow-up magnetic resonance imaging and had good clinical outcome despite peri-anchor cyst formation after arthroscopic rotator cuff repair.

scholarly journals Clinical outcome in patients with hand lesions associated with complex regional pain syndrome after arthroscopic rotator cuff repair

2021 ◽  
Author(s):  
Takaki Imai ◽  
Masafumi Gotoh ◽  
Keiji Fukuda ◽  
Misa Ogino ◽  
Hidehiro Nakamura ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Complex Regional Pain Syndrome ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Pain Syndrome ◽  
Arthroscopic Rotator Cuff Repair ◽  
Sf 36 ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Complex regional pain syndrome (CRPS)-related hand lesions are one of the complications following arthroscopic rotator cuff repair (ARCR). This study aimed to investigate the clinical outcomes of patients with CRPS-related hand lesions following ARCR.Methods: Altogether, 103 patients with ARCR were included in this study (mean age, 63.6±8.2 years; 66 males and 37 females; follow-up period, preoperative to 12 months postoperative). Clinical assessment included the Japanese Orthopaedic Association (JOA) score, University of California, Los Angeles (UCLA) score, Constant score, 36-item short form health survey (SF-36) score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score from preoperative to 12 months postoperatively. The patients were either assigned to the CRPS group or non-CRPS group depending on CRPS diagnosis until the final follow-up, and clinical outcomes were then compared between the groups.Results: Of 103 patients, 20 (19.4%) had CRPS-related hand lesions that developed entirely within 2 months postoperatively. Both groups showed significant improvement in JOA, UCLA, and Constant scores preoperatively to 12 months postoperatively (P<0.0001). Comparisons between the two groups were not significantly different, except for SF-36 “general health perception” (P<0.05) at 12 months postoperatively. At final follow-up, three patients had residual CRPS-related hand lesions with limited range of motion and finger edema.Conclusions: CRPS-related hand lesions developed in 19.4% of patients following ARCR. Shoulder or upper-limb function improved in most cases at 12 months, with satisfactory SF-36 patient-based evaluation results. Patients with residual CRPS-related hand lesions at the last follow-up require long-term follow-up.

scholarly journals Application of Platelet-Rich Plasma in Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (7) ◽  
pp. 232596712110168
Author(s):  
Wennan Xu ◽  
Qingyun Xue
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Short Term ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Retear Rate

Background: It is unclear how and which factors affect the clinical efficacy of platelet-rich plasma (PRP) applied during arthroscopic rotator cuff repair. Purpose: To evaluate the clinical efficacy of PRP for arthroscopic repair of full-thickness rotator cuff tear and investigate the factors that affect its clinical efficacy. Study Design: Systematic review; Level of evidence, 1. Methods: We searched Cochrane Library, EMBASE, MEDLINE, and OVID to identify randomized controlled trials (RCTs) of patients who received PRP treatment and arthroscopic rotator cuff repair (PRP group) versus controls (no-PRP group). The primary outcomes included retear rate, Constant-Murley score, University of California Los Angeles (UCLA) score, short-term American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) score for pain, and adverse events. Results: A total of 14 RCTs were included in this systematic review. Significant improvement in Constant-Murley, UCLA, and VAS pain scores were found in the PRP group during short-term, midterm, and long-term follow-up. The PRP group had a significantly decreased retear rate (risk ratio [RR], 0.57 [95% CI, 0.42 to 0.78]; P = .0003), especially for long-term follow-up (RR, 0.38 [95% CI, 0.17 to 0.83]; P = .02), large to massive tears (RR, 0.58 [95% CI, 0.42 to 0.80]; P = .0008), use of leukocyte-poor PRP (RR, 0.50 [95% CI, 0.33 to 0.76]; P = .001), and intraoperative application of PRP (RR, 0.57 [95% CI, 0.42 to 0.79]; P = .0007). No significant difference between the 2 groups was found in the incidence of adverse events (RR, 1.34 [95% CI, 0.83 to 2.15]; P = .23) or in ASES scores at short-term follow-up (weighted mean difference, 1.04 [95% CI, –3.10 to 5.19]; P = .62). Conclusion: The results of this review indicated that arthroscopic rotator cuff repair with PRP significantly reduced the long-term retear rate and shoulder pain and provided improved long-term shoulder function in patients. Intraoperative application of PRP, use of leukocyte-poor plasma, and large to massive tear size contributed to a significantly decreased retear rate for rotator cuff repair combined with PRP.

scholarly journals Bilateral single-staged arthroscopic rotator cuff repair is comparable to staged procedures: a retrospective follow up study of 2 years

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chen Wang ◽  
Pu Yang ◽  
Dongfang Zhang ◽  
In-Ho Jeon ◽  
Tengbo Yu ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Single Stage ◽  
Arthroscopic Rotator Cuff Repair ◽  
Significant Difference ◽  
Outcome Scores ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Abstract Background Bilateral rotator cuff tears are not uncommon and the timing of the surgical treatment of both shoulders is debated. In the present study, we aimed to compare the clinical outcomes of patients who underwent single-stage or staged bilateral arthroscopic rotator cuff repair. Methods From March 2013 to May 2018, a retrospective review on all patients who underwent bilateral arthroscopic rotator cuff repair at our department was performed. Patients were separated into 2 groups: single-stage and staged. The minimum follow-up period was 2 years. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, Constant-Murley (Constant) score, the range of motion (ROM) of the shoulder and the hospitalization costs were evaluated for comparison between the two groups before and after the operation. Differences between groups were assessed using t-tests and ANOVA. Results All 51 patients completed follow-up of 2 years, single stage (n = 24) and staged group (n = 27). There was no significant difference in the VAS, ASES, UCLA and Constant scores between the single-stage group and the staged group before the operation. Postoperative clinical scores were significantly improved in both groups (P < 0.05). All outcome scores were significantly different between the two groups at 6 months postoperatively, and the staged scored better than the single-stage (P < 0.05). At 12, 18, and 24 months after the operation, the outcome scores were not significantly different between the two groups. At follow-up, the ROM of the shoulder was not significantly different between the two groups. In the single-stage group, the outcome scores and ROM were similar for both shoulders and comparable to the staged group. We also found significant cost savings in the single-stage group (4440.89 ± 130.55 USD) compared to the staged group (5065.73 ± 254.76 USD) (p < 0.05). Conclusions Patients receiving single-stage or staged bilateral arthroscopic rotator cuff repair showed similarly good clinical outcomes at follow-ups longer than 6 months. Moreover, good outcomes were observed on both sides of the single-stage group.

scholarly journals Treatment of Large and Massive Rotator Cuff Tears: Does Infraspinatus Muscle Tear Affect Repair Integrity?

2019 ◽  
Vol 22 (4) ◽  
pp. 203-209
Author(s):  
Sungwook Choi ◽  
Hyunchul Yang ◽  
Hyunseong Kang ◽  
Gyeong Min Kim
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears ◽  
Infraspinatus Muscle ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Clinical outcomes and prognosis of large and massive rotator cuff tears are known to be unpredictable not only in degeneration of the rotator cuff, but also due to a high rate of retear.Methods: Totally, 81 patients who had undergone arthroscopic rotator cuff repair from May 2008 to February 2016 were evaluated in our study. Clinical and functional evaluations were performed with the Constant score and the University of California, Los Angeles (UCLA) score, as well as full physical examination of the shoulder. All patients were confirmed to have magnetic resonance imaging (MRI) of tendon healing at least 1 year postoperatively.Results: The average age at the time of surgery was 65 years (range, 47?78 years). The average duration of postoperative time in which a follow-up MRI was performed was 36.1 months (range, 12?110 months). Large tears were present in 48 cases (59.3%) and massive tears in 33 cases (40.7%). Overall, there were 33 retear cases (40.7%). All the average clinical outcome scores were significantly improved at the last follow-up (<i>p</i><0.001), although repair integrity was not maintained. Compared to type A, types C, and D of the Collin’s classification showed significantly higher retear rates (<i>p</i>=0.036).Conclusions: Arthroscopic rotator cuff repair yields improved clinical outcomes and a relatively high degree of patient satisfaction, despite the repair integrity not being maintained. Involvement of the subscapularis muscle or infraspinatus muscle had no effect on the retear rate.

scholarly journals A Multicenter Randomized Controlled Trial Comparing Single-Row With Double-Row Fixation in Arthroscopic Rotator Cuff Repair: Long-Term Follow-up

2021 ◽  
pp. 036354652110290
Author(s):  
Peter Lapner ◽  
Ang Li ◽  
J. W. Pollock ◽  
Tinghua Zhang ◽  
Katie McIlquham ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Controlled Trial ◽  
Arthroscopic Rotator Cuff Repair ◽  
Double Row ◽  
Single Row ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: The long-term outcomes of single- versus double-row fixation in arthroscopic rotator cuff repair are not currently known. Purpose: To compare the treatment effects of the single- versus double-row suture technique in arthroscopic rotator cuff repair of full-thickness tears at 10-year follow-up. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients were evaluated at 10 years postoperatively. The primary outcome measure was the Western Ontario Rotator Cuff Index (WORC). Secondary outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Constant score, strength, and incidence of revision surgery. Ultrasound was used to evaluate the rotator cuff to determine repair integrity. Statistical analyses consistent with those of the main trial were conducted. Results: Of the original 90 participants, 77 (85%) returned at a mean follow-up of 10 years. At ten year follow-up, the WORC score was higher in the double row group (79.9 [95% CI, 16.2 to 99.1]) compared with the single row group (72.9, [95% CI, 4.3 to 100]), P = .020. From baseline to 2 years, the mean change in WORC scores for the single-row group was –48.5 compared with −40.6 for the double-row group, with a between-group difference of −7.8 (95% CI, −20.4 to 4.7). From 2 to 10 years, the change in WORC scores for the single-row group was 11.5 compared with −0.2 for the double-row group, with a between-group difference of 11.7 (95% CI, −0.7 to 24.3). From baseline to 10 years, the mean between-group difference was 3.9 (95% CI, −7.8 to 15.6). Similarly, a decrease in ASES scores was observed between 2 and 10 years for the single-row group (9.2 [95% CI, 0.9 to 17.5]; P = .029), with a nonsignificant decrease in ASES scores for the double-row group (6.2 [95% CI, −3.2 to 15.6]; P = .195) as well as a decrease in Constant scores for both the single- (9.5 [95% CI, 1.4 to 17.5]; P = .020) and double-row (14.4 [95% CI, 5.6 to 23.3]; P = .001) groups. Overall, 3 participants developed a full-thickness tear after 2 years: 2 from the double-row group and 1 from the single-row group. One participant from each study group underwent revision surgery after the 2-year time point. Conclusion: A statistically significant (but likely not clinically important) difference in WORC scores was seen at 10-year follow-up in favor of double-row fixation. Between baseline and 10-year follow-up, a decrease in most outcome scores was observed in both the single- and the double-row groups. Registration: NCT00508183 ( ClinicalTrials.gov identifier).

Effects of Anxiety and Depression Measured via the Hospital Anxiety and Depression Scale on Early Pain and Range of Motion After Rotator Cuff Repair

2021 ◽  
Vol 49 (2) ◽  
pp. 314-320
Author(s):  
Joo Hyun Park ◽  
Sung-Min Rhee ◽  
Hyong Suk Kim ◽  
Joo Han Oh
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Preoperative Anxiety ◽  
Arthroscopic Rotator Cuff Repair ◽  
Psychological Status ◽  
Anxiety And Depression ◽  
Group B ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Preoperative anxiety and depression are independent predictors of clinical outcomes after arthroscopic rotator cuff repair. However, few studies have evaluated correlations between outcomes such as pain and range of motion (ROM) after arthroscopic rotator cuff repair and preoperative anxiety and depression. Purpose: To evaluate the effects of preoperative anxiety and depression, measured using the Hospital Anxiety and Depression Scale (HADS), on early pain and ROM after rotator cuff repair. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 144 consecutive patients who underwent arthroscopic rotator cuff repair were enrolled and divided into 2 groups according to HADS scores: group A, those with a healthy psychological status (n = 103; anxiety ≤7 and depression ≤7), and group B, those with psychological distress (n = 41; anxiety ≥8 or depression ≥8). Clinical outcomes were assessed using the visual analog scale for pain (pVAS) and ROM at 3 and 6 months postoperatively and annually. Results: There were no significant preoperative differences in age, sex, tear size, pVAS scores, and ROM. However, at 3 months postoperatively, group A showed significantly lower mean pVAS scores (2.2 ± 1.3 vs 3.4 ± 1.8, respectively; P = .001) and significantly higher mean forward flexion (146.4°± 23.0° vs 124.1°± 28.2°, respectively; P < .001) than group B, as well as significantly higher mean levels of internal rotation at the back (T11.5 ± 2.8 vs L1.9 ± 2.5, respectively; P < .001) and significantly higher mean external rotation (42.4°± 15.9° vs 35.2°± 16.8°, respectively; P = .019). At 6 months postoperatively, the mean pVAS score was still significantly lower in group A than in group B (0.8 ± 1.6 vs 1.8 ± 2.1, respectively; P = .016), but other ROM measurements had no significant differences. There was also no significant difference in clinical and functional outcomes at the final follow-up. Conclusion: Anxiety and depression negatively affected clinical outcomes after rotator cuff repair. Recovery from pain and of ROM after arthroscopic rotator cuff repair occurred more quickly in patients with a healthy psychological status. Therefore, assessments of preoperative psychological status should be emphasized to improve early clinical outcomes after arthroscopic rotator cuff repair.

Sign in / Sign up

Export Citation Format

Share Document