Comparison of Structural Integrity and Functional Outcome Between Delaminated and Nondelaminated Rotator Cuff Tears After En Masse Arthroscopic Repair: A Retrospective Cohort Study With Propensity Score Matching

2019 ◽  
Vol 47 (6) ◽  
pp. 1411-1419 ◽  
Author(s):  
Young-Kyu Kim ◽  
Kyu-Hak Jung ◽  
Hyuk-Min Kwon
Keyword(s):  
Cohort Study ◽  
Rotator Cuff ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Structural Integrity ◽  
Rotator Cuff Tears ◽  
Group 2 ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Infraspinatus Tendon

Background: Arthroscopic repair of delaminated rotator cuff tears (RCTs) has shown poor prognoses. Despite the importance of delaminated tears, only a few studies have compared delaminated and nondelaminated tears. Purpose: This study aimed to compare the clinical outcomes and structural integrity after en masse arthroscopic rotator cuff repair between delaminated and nondelaminated RCTs and to evaluate whether infraspinatus tendon involvement affects the prognosis for delaminated tears after arthroscopic cuff repair, through use of propensity score matching for precise comparison. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 180 consecutive patients with medium- or large-sized RCTs who had an arthroscopic rotator cuff repair with a minimum 2-year follow-up, of whom 57 and 123 had delaminated tears (group 1) and nondelaminated tears (group 2), respectively. The en masse repair technique using a single-row or transosseous-equivalent double-row suture-bridge technique was used for of all the delaminated cases. Preoperative and postoperative visual analog scale pain scores, shoulder active range of motion, American Shoulder and Elbow Surgeons (ASES) scores, and Constant scores were assessed. Magnetic resonance imaging was performed at least 24 months postoperatively to identify retear of the repaired rotator cuffs. After propensity score matching, 32 cases in both groups were successfully matched, and the clinical and radiological results were analyzed. Results: Before propensity score matching, postoperative clinical outcomes were improved, showing no significant differences between the groups, excluding forward elevation ( P = .011). Groups 1 and 2 had 17 (29.8%) and 11 retear cases (8.9%), respectively ( P < .001). After propensity score matching, only the ASES score (72.5 vs 77.1) showed a significant superiority in group 2 ( P = .038). Propensity-matched groups 1 and 2 had 8 (25.0%) and 2 (6.3%) retear cases, respectively ( P = .034). No significant difference was found in structural integrity depending on whether the RCT included the infraspinatus tendon (IST). The odds ratio for retear of the delaminated tears, including IST, was 5.5 (95% confidence interval, 1.0-30.0, P = .038). Conclusion: Delaminated RCT was a negative prognostic factor of structural integrity after repair and could affect the functional outcome. However, whether IST tear was involved had no effect on the prognosis after repair.

scholarly journals Evaluation of Deltoid Origin Status Following Open and Arthroscopic Repair of Large Rotator Cuff Tears: A Propensity-Matched Case-Control Study

2020 ◽  
Vol 23 (1) ◽  
pp. 11-19
Author(s):  
Erica Kholinne ◽  
Jae-Man Kwak ◽  
Yucheng Sun ◽  
Hyojune Kim ◽  
Kyoung Hwan Koh ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Rotator Cuff Repair ◽  
Arthroscopic Repair ◽  
Rotator Cuff Tears ◽  
Open Approach ◽  
Full Thickness ◽  
Lateral Border ◽  
Cuff Repair

Background: The purpose of this study was to evaluate and compare deltoid origin status following large rotator cuff repair carried out using either an open or an arthroscopic method with a propensity score matching technique. Methods: A retrospective review of 112 patients treated for full-thickness, large rotator cuff tear via either a classic open repair (open group) or an arthroscopic repair (arthroscopic group) was conducted. All patients included in the study had undergone postoperative magnetic resonance imaging (MRI) and clinical follow-up for at least 12 and 18 months after surgery, respectively. Propensity score matching was used to select controls matched for age, sex, body mass index, and affected site. There were 56 patients in each group, with a mean age of 63.3 years (range, 50–77 years). The postoperative functional and radiologic outcomes for both groups were compared. Radiologic evaluation for postoperative rotator cuff integrity and deltoid origin status was performed with 3-Tesla MRI.Results: The deltoid origin thickness was significantly greater in the arthroscopic group when measured at the anterior acromion (P=0.006), anterior third (P=0.005), and middle third of the lateral border of the acromion level (P=0.005). The deltoid origin thickness at the posterior third of the lateral acromion was not significantly different between the arthroscopic and open groups. The arthroscopic group had significantly higher intact deltoid integrity with less scarring (P=0.04). There were no full-thickness deltoid tears in either the open or arthroscopic group. Conclusion: Open rotator cuff repair resulted in a thinner deltoid origin, especially from the anterior acromion to the middle third of the lateral border of the acromion, at the 1-year postoperative MRI evaluation. Meticulous reattachment of the deltoid origin is as essential as rotator cuff repair when an open approach is selected.

scholarly journals Evaluation of 3 different rehabilitation protocols after rotator cuff repair, and the effectiveness of pool therapy: a randomized control study

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0000
Author(s):  
Alex Laedermann ◽  
Fayssal Kadri ◽  
Alec Cikes
Keyword(s):  
Physical Therapy ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
The Self ◽  
Arthroscopic Rotator Cuff Repair ◽  
Independent Observer ◽  
Early Results ◽  
Group 2 ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Objectives: Exercises performed in water have shown to improve strength and range of motion in various joint pathologies. This study aims to identify the best rehabilitation protocol for patients who undergo arthroscopic rotator cuff repair, and the effectiveness of a pool therapy protocol. Methods: Patients who underwent arthroscopic rotator cuff repair for small to medium sized rotator cuff tears, with small to moderate retraction of the affected tendon and who underwent surgery between 2013 and 2016, were randomized in 3 different groups at the time of surgical indication. Groups: 1. Patients who had rehabilitation with physical therapy and no aquatic protocol; The "Dry group", 2. Patients who had rehabilitation with physical therapy, including an aquatic protocol; The "Pool Group", 3. Patients who had self-rehabilitation alone, with no physical therapist. The "Self Group" follow-up: all patients were assessed by an independent observer. The mean outcome measures consisted of pre and postoperative SSV, Constant score, and patient satisfaction. Patients were followed-up at 4, 8 and 12 weeks postoperatively, as well as in 1 and 2 years. Results: Group 1 (Dry group) and Group 2 (Pool group) showed better Constant scores 2 months postoperatively, although this was not statistically significant. However, patients in group 2 (Pool group) showed statistically better Constant scores and overall satisfaction 3 months postoperatively. All the groups had similar results 6 months, 1 year and 2 years postoperatively, with slightly better outcomes for the Dry and Pool groups compared to the Self group. Conclusion: Water therapy after rotator cuff repair provides better early results compared to traditional "dry" rehabilitation or self-exercise therapy. The results remain better for patients who had pool or dry rehabilitation 1 and 2 years postoperatively, although the difference is not statistically significant in the long term.

scholarly journals Outcome and Structural Integrity of Rotator Cuff after Arthroscopic Treatment of Large and Massive Tears with Double Row Technique: A 2-Year Followup

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Ignacio Carbonel ◽  
Angel A. Martínez ◽  
Elisa Aldea ◽  
Jorge Ripalda ◽  
Antonio Herrera
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Functional Outcome ◽  
Rotator Cuff Repair ◽  
Structural Integrity ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Double Row ◽  
Massive Rotator Cuff Tears ◽  
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.

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.

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