Delamination Does Not Affect Outcomes After Arthroscopic Rotator Cuff Repair as Compared With Nondelaminated Rotator Cuff Tears: A Study of 1043 Consecutive Cases

2019 ◽  
Vol 47 (3) ◽  
pp. 674-681 ◽  
Author(s):  
Jieun Kwon ◽  
Ye Hyun Lee ◽  
Sae Hoon Kim ◽  
Jung Hoon Ko ◽  
Byung Kyu Park ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Fatty Infiltration ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Symptom Duration ◽  
Negative Prognostic Factor ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Limited information is available regarding the characteristics of delaminated rotator cuff tears as compared with nondelaminated tears. Furthermore, there is conflicting information regarding the effects of delamination on the anatomic healing of repaired cuffs. Purpose: To evaluate the characteristics and anatomic outcomes of delaminated rotator cuff tears in comparison with nondelaminated tears to determine whether delamination is a negative prognostic factor affecting rotator cuff repair outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2010 and 2014, 1043 patients were enrolled in the study to assess the prevalence of delamination. Among them, the findings from 531 patients who underwent magnetic resonance imaging or computed tomographic arthrography at least 1 year after surgery were included to determine whether delamination was a negative prognostic factor affecting the anatomic outcomes of arthroscopic rotator cuff repair. Delamination was assessed intraoperatively and defined by distinguishable edge cleavage tearing or interstitial horizontal gap between the articular and bursal surfaces of the torn tendon. One of 3 repair techniques (modified Mason Allen, single row, or double row) was used according to tear configuration and tendon mobilization. The authors evaluated visual analog scale scores for pain and satisfaction and American Shoulder and Elbow Surgeons scores to quantify clinical outcomes. Results: The incidence of delamination was 42.9% (447 of 1043). As compared with those with nondelaminated tears, patients with delaminated tears were older ( P < .001) and had longer symptom duration ( P = .019), larger tear sizes and retractions ( P < .001 for both), higher grades of fatty infiltration of the rotator cuff muscles (all P < .001), and poorer tendon quality ( P < .001). The overall healing failure rate was 19.0% (101 of 531). In univariate analysis, the rate of healing failure for the repaired cuffs was significantly higher in the delaminated group (delaminated tears, 60 of 238, 25.2%; nondelaminated tears, 41 of 293, 14.0%; P = .001). However, results of subgroup and multivariate analyses showed that the presence of delamination was ultimately not an independent risk factor for the failure of cuff healing. Between the delaminated and nondelaminated groups, there was no significant difference in postoperative functional outcomes. Conclusion: The results suggest that delaminated rotator cuff tears might represent chronic degenerative tears of longer symptom duration, with larger tear sizes and higher grades of fatty infiltration in older patients. It appears that delamination could be a confounding factor, not an independent prognostic factor, affecting rotator cuff healing.

Effect of Smoking on Healing Failure After Rotator Cuff Repair

2018 ◽  
Vol 46 (12) ◽  
pp. 2960-2968 ◽  
Author(s):  
Jung Ho Park ◽  
Kyung-Soo Oh ◽  
Tae Min Kim ◽  
Jayoun Kim ◽  
Jong Pil Yoon ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Fatty Infiltration ◽  
Outcome Evaluation ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Smoking History ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Heavy Smokers

Background: No study to date has directly evaluated rotator cuff repair results among smokers. Purpose: To evaluate whether smoking affects healing after arthroscopic rotator cuff repair through propensity score matching (PSM). Study Design: Cohort study; Level of evidence, 3. Methods: Among 249 patients who underwent arthroscopic repair of full-thickness rotator cuff tears, 34 current heavy smokers were selected with a smoking history >20 pack-years (mean ± SD pack-years, 33.91 ± 12.13). Characteristics between current heavy smokers and nonsmokers were compared. According to the PSM technique, 34 nonsmokers were selected after 1:1 matching for age, fatty infiltration, and tear size—the main prognostic factors of outcomes after rotator cuff repair. Each patient’s outcome evaluation was completed anatomically at a minimum of 6 months (magnetic resonance imaging or ultrasonography) and functionally at a minimum of 1 year (pain visual analog scale, range of motion, American Shoulder and Elbow Surgeons, Constant, University of California, Los Angeles, and Simple Shoulder Test scores), and every outcome was analyzed in the matched smoker and nonsmoker groups. Results: Current heavy smokers had a higher incidence of male sex ( P < .001), heavy manual work ( P = .025), high bone density ( P = .036), and poor tendinosis grade ( P = .028). After adjustment for the confounding variables by PSM, the matched smoker group showed a significantly higher healing failure rate than the matched nonsmoker group (29.4% vs 5.9%, P = .023). However, we failed to detect significant differences in the functional outcomes between the matched groups ( P > .05). Conclusion: Smoking affected healing failure after arthroscopic rotator cuff repair. Attention should be paid to smokers, especially current heavy smokers, in cases of rotator cuff repair surgery.

Factors Predictive of Healing in Large Rotator Cuff Tears: Is It Possible to Predict Retear Preoperatively?

2018 ◽  
Vol 46 (7) ◽  
pp. 1693-1700 ◽  
Author(s):  
Ho Yeon Jeong ◽  
Hwan Jin Kim ◽  
Yoon Sang Jeon ◽  
Yong Girl Rhee
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Fatty Infiltration ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Significant Difference ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Many studies have identified risk factors that cause retear after rotator cuff repair. However, it is still questionable whether retears can be predicted preoperatively. Purpose: To determine the risk factors related to retear after arthroscopic rotator cuff repair and to evaluate whether it is possible to predict the occurrence of retear preoperatively. Study Design: Case-control study; Level of evidence, 3. Methods: This study enrolled 112 patients who underwent arthroscopic rotator cuff repair with single-row technique for a large-sized tear, defined as a tear with a mediolateral length of 3 to 5 cm. All patients underwent routine magnetic resonance imaging (MRI) at 9 months postoperatively to assess tendon integrity. The sample included 61 patients (54.5%) in the healed group and 51 (45.5%) in the retear group. Results: In multivariate analysis, the independent predictors of retears were supraspinatus muscle atrophy ( P < .001) and fatty infiltration of the infraspinatus ( P = .027), which could be preoperatively measured by MRI. A significant difference was found between the two groups in sex, the acromiohumeral interval, tendon tension, and preoperative or intraoperative mediolateral tear length and musculotendinous junction position in univariate analysis. However, these variables were not independent predictors in multivariate analysis. The cutoff values of occupation ratio of supraspinatus and fatty infiltration of the infraspinatus were 43% and grade 2, respectively. The occupation ratio of supraspinatus <43% and grade ≥2 fatty infiltration of the infraspinatus were the strongest predictors of retear, with an area under the curve of 0.908, sensitivity of 98.0%, and specificity of 83.6% (accuracy = 90.2%). Conclusion: In patients with large rotator cuff tears, it was possible to predict the retear before rotator cuff repair regardless of intraoperative factors. The retear could be predicted most effectively when the occupation ratio of supraspinatus was <43% or the fatty infiltration of infraspinatus was grade ≥2. Predicting retear preoperatively may help surgeons determine proper treatment and predict the postoperative prognosis.

scholarly journals Rotator Cuff Repair Improves Clinical Function and Stability in Patients Older Than 50 Years With Anterior Shoulder Dislocations and Massive Rotator Cuff Tears

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096921
Author(s):  
Xiaoxi Ji ◽  
Lingchao Ye ◽  
Yinghui Hua ◽  
Xiaobo Zhou
Keyword(s):  
Rotator Cuff ◽  
Shoulder Instability ◽  
Rotator Cuff Repair ◽  
Older Patients ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Shoulder Stability

Background: Older patients with shoulder instability have a higher prevalence of rotator cuff tears and anterior capsular lesions. Simultaneous rotator cuff repair and labral repair are commonly performed to improve shoulder stability and function. Purpose: To investigate the clinical outcomes of arthroscopic rotator cuff repair for older patients with shoulder dislocations combined with massive rotator cuff tears and intact labral tissue. Study Design: Case series; Level of evidence, 3. Methods: A cohort consisting of 11 patients older than 50 years with shoulder dislocations and massive rotator cuff tears undergoing arthroscopic rotator cuff repair was identified between December 2015 and January 2018. Rotator cuff repair was performed after Bankart, superior labral anterior-posterior, and humeral avulsion of the glenohumeral ligament lesions were excluded during arthroscopic surgery. Preoperative and 12-month postoperative outcomes including modified University of California Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES), Western Ontario Shoulder Instability Index (WOSI), and visual analog scale for pain scores as well as range of motion (ROM) were recorded. Results: The supraspinatus tendon was torn in all patients. Also, 36.4% of the patients had 3 rotator cuff tendons torn. For shoulder function, the preoperative UCLA score (12.1 ± 2.5 [range, 9-16]) and ASES score (35.4 ± 12.7 [range, 24-44]) significantly improved to 29.4 ± 4.3 (range, 24-35; P < .001) and 79.4 ± 16.0 (range, 45-95; P < .001), respectively, at 12 months postoperatively. None of the patients experienced shoulder redislocations at 12 months after surgery. For shoulder stability, the postoperative WOSI score (156.8 ± 121.0 [range, 45-365]) was significantly better than was the preoperative score (713.0 ± 238.6 [range, 395-1090]) ( P < .001). For comparisons between preoperative and postoperative ROM, forward flexion, abduction, and external and internal rotation at the side significantly improved. Conclusion: For patients older than 50 years with shoulder dislocations combined with massive rotator cuff tears and an intact labrum, arthroscopic rotator cuff repair alone achieved satisfactory functional outcomes and ROM without the recurrence of dislocations.

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 Arthroscopic repair of rotator cuff tears: analysis and functional outcome

2020 ◽  
Vol 6 (2) ◽  
pp. 256
Author(s):  
Rejo V. Jacob ◽  
Prateek Girotra ◽  
K. Prashanth Kumar
Keyword(s):  
Rotator Cuff ◽  
Functional Outcome ◽  
Rotator Cuff Repair ◽  
Arthroscopic Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Daily Routine ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Shoulder Score

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong>Rotator cuff injuries are common injuries occurring around the shoulder with an incidence ranging from 5 to 39%. Rotator cuff tears can be either partial thickness or full thickness. If remains untreated, may lead to persistent shoulder pain, functional limitation and decreased quality of life. In the present study, we assess the functional outcome following arthroscopic repair of rotator cuff tears. We also assess the various parameters affecting the functional outcome following repair.</p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>15 patients with rotator cuff tears were subjected to this study. Preoperative evaluation of the American Shoulder and Elbow Surgeons (ASES) shoulder score and University of California and Los Angeles (UCLA) shoulder score was done. Arthroscopic rotator cuff repair using single row repair with suture anchors was done. The patients were followed up at 6 weeks, 3 months and 6 months where ASES score and UCLA score were assessed<span lang="EN-US">.<strong></strong></span></p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>Of the 15 patients, 14 had supraspinatus tear, 2 patients had infraspinatus tear and 2 patients had subscapularis tear. According to UCLA scoring system 22% patients had excellent, 43% patients had good results, 23% patients had fair results and 12% patients had poor results. ASES score also showed progressive improvement at subsequent follow ups at 3 and 6 months.</p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>From our present study we conclude that arthroscopic rotator cuff repair is a good modality showing excellent functional outcome with less morbidity, minimal postoperative pain, better cosmesis and early resumption of daily routine activities.</p><p> </p>

scholarly journals Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case–control study

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880250 ◽  
Author(s):  
Kyung Cheon Kim ◽  
Woo-Yong Lee ◽  
Hyun Dae Shin ◽  
Sun-Cheol Han ◽  
Kyu-Woong Yeon
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Rating Scale ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Workers Compensation ◽  
Vas Scores ◽  
Arthroscopic Rotator Cuff ◽  
The Impact ◽  
Cuff Repair

Purpose: We compared preoperative and postoperative measures among workers’ compensation board (WCB) recipients and non-recipients and determined the impact of WCB receipt on the 1- and 2-year outcomes of rotator cuff repair. Methods: We retrospectively reviewed patients with full-thickness rotator cuff tears who underwent arthroscopic repair between September 2011 and September 2014. Patients were divided into two groups based on WCB status: WCB recipients and non-recipients. All patients returned for follow-up functional evaluations at 1 and 2 years after the operation. Four outcome measures were evaluated: visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA), and range of motion (ROM). Results: Seventy patients (38 males, 32 females) were evaluated, 20 of whom were WCB recipients. At 1 year after the operation, ASES, UCLA, and VAS scores as well as abduction ROM (Abd-ROM) had improved significantly in both groups. However, non-recipients showed significantly greater improvement than did WCB recipients in ASES, UCLA, and VAS scores and in forward flexion ROM and Abd-ROM ( p = 0.000, 0.009, 0.002, 0.046, and 0.020, respectively). However, at 2 years after the operation (after the end of WCB), there were no significant differences in any clinical outcome between WCB recipients and non-recipients ( p = 0.057, 0.106, 0.075, 0.724, and 0.787, respectively). Conclusion: Although workers’ compensation recipients who underwent arthroscopic rotator cuff repair had worse outcomes while receiving WCB benefits, the outcomes were similar after WCB benefits ended.

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