Biceps Augmentation Outperforms Tear Completion Repair or In Situ Repair for Bursal-Sided Partial-Thickness Rotator Cuff Tears in a Rabbit Model

2021 ◽  
pp. 036354652110533
Author(s):  
Junjie Xu ◽  
Yufeng Li ◽  
Zipeng Ye ◽  
Chenliang Wu ◽  
Kang Han ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Failure Load ◽  
Biceps Tendon ◽  
Rotator Cuff Tears ◽  
Histological Evaluation ◽  
Bicipital Groove ◽  
Partial Thickness ◽  
Over Time ◽  
In Situ Repair

Background: There is an ongoing debate on the treatment of bursal-sided partial-thickness rotator cuff tears (PTRCTs), including ideal repair techniques. Augmentation using a collagen patch has been introduced as a new surgical approach to treat PTRCTs, while the effect of autogenous biceps augmentation (BA) has not been investigated. Purpose: To analyze the effects of BA on bursal-sided PTRCTs and compare its histological and biomechanical results with those of tear completion followed by repair and in situ repair (ISR). Study Design: Controlled laboratory study. Methods: Unilateral chronic PTRCTs were created in 96 mature New Zealand White rabbits, which were randomly divided into 4 groups: no repair, tear completion repair (TCR), ISR, and BA. A new bicipital groove was fabricated in BA for the biceps tendon that was transferred to augment the bursal-sided PTRCT repair. In each group, we sacrificed 6 rabbits for biomechanical testing of the whole tendon-to-bone complex (WTBC) and 6 for histological evaluation of bursal- and articular-sided layers at 6 and 12 weeks postoperatively. Healing responses between the biceps and new bicipital groove in the BA group were determined using histological analysis, and final groove morphologies were evaluated using micro–computed tomography. Results: The remaining tendon and enthesis in bursal-sided PTRCTs progressively degenerated over time. WTBCs of ISR exhibited a larger failure load than those of TCR, although better healing properties in the bursal-sided repaired site were achieved using TCR based on histological scores and superior articular-sided histological scores were observed using ISR. However, WTBCs of BA displayed the best biomechanical results and superior histological scores for bursal- and articular-sided regions. The new bicipital groove in BA remodeled over time and formed similar morphologies to a native groove, which provided a mature bone bed for transferred biceps tendon healing to augment bursal-sided PTRCTs. Conclusion: BA achieved better biomechanical and histological results for repairing bursal-sided PTRCTs as compared with TCR and ISR. When compared with that of TCR, the WTBC of ISR exhibited a higher failure load, showing histological superiority in the articular-sided repair and inferiority in the bursal-sided repair. Clinical Relevance: BA may be an approach to improve bursal-sided PTRCT repair in humans, which warrants further clinical investigation.

The Biomechanical and Histological Processes of Rerouting Biceps to Treat Chronic Irreparable Rotator Cuff Tears in a Rabbit Model

2022 ◽  
pp. 036354652110629
Author(s):  
Junjie Xu ◽  
Yufeng Li ◽  
Xueying Zhang ◽  
Kang Han ◽  
Zipeng Ye ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Failure Load ◽  
Biceps Tendon ◽  
Rabbit Model ◽  
Rotator Cuff Tears ◽  
Bicipital Groove ◽  
Superior Capsular Reconstruction ◽  
Over Time

Background: Recently, the biceps was rerouted into a newly fabricated bicipital groove for in situ superior capsular reconstruction (SCR), resulting in promising time-zero cadaveric and clinical outcomes. However, no studies have determined the in vivo biomechanical and histological processes after the biceps is transposed to a nonanatomic position. Purpose: To explore the in vivo biomechanical and histological processes of the rerouting biceps tendon to treat chronic irreparable rotator cuff tears (IRCTs) in a rabbit model. Study Design: Controlled laboratory study. Methods: A total of 94 skeletally mature male rabbits were used to create a chronic IRCT model in the supraspinatus tendon. Then, the biceps rerouting procedures were performed in rabbits with chronic IRCT. Eighteen rabbits were sacrificed at 1, 3, 6, 9, and 12 weeks postoperatively for biomechanical testing, micro—computed tomography scanning, and histological analysis. The biomechanical and histological changes of intra- and extra-articular portions of the rerouting biceps were evaluated at each time point, with the contralateral native superior capsule (NSC) and the native biceps (NB) as controls, respectively. The morphology and bone formation of the fabricated bicipital grooves were evaluated, with native grooves as controls. Results: The intra-articular rerouting biceps tendon was progressively remodeled over time, displaying denser fibers and more mature collagen than those of the NSC, with gradual improvements in the tendon-to-bone healing interface from 6 to 12 weeks. Consequently, the failure load and stiffness of the intra-articular rerouting biceps portion increased with time and were significantly higher than those of the NSC from 9 weeks. Similarly, the extra-articular portion of the rerouting biceps progressively healed into a new bicipital groove, as demonstrated by a smaller tendon-to-bone interface from 6 to 12 weeks, resulting in greater failure load and stiffness at 9 and 12 weeks than those of the NB attachment. The newly fabricated bicipital groove showed similar morphology to that of the native groove with sufficient trabecular bone formed underneath. Conclusion: The rerouting biceps could progressively remodel and heal into the newly fabricated bicipital groove over time, resulting in greater biomechanical performances in intra- and extra-articular portions than the NSC and the NB attachment. Clinical Relevance: The biceps rerouting technique may be a feasible procedure to perform in situ SCR to treat IRCT in the future clinical practice; however, more clinical evidence is required.

scholarly journals In situ repair of partial-thickness rotator cuff tears: a critical analysis review

2020 ◽  
Vol 5 (3) ◽  
pp. 138-144
Author(s):  
Luciano A. Rossi ◽  
Maximiliano Ranalletta
Keyword(s):  
Rotator Cuff ◽  
Functional Outcomes ◽  
Rotator Cuff Tears ◽  
Return To Sports ◽  
Overhead Athletes ◽  
Partial Thickness ◽  
Long Term Follow Up ◽  
Tendon Thickness ◽  
In Situ Repair

After failed conservative management, operative intervention is typically indicated for patients with partial-thickness rotator cuff tears (PTRCTs) with persistent pain and disability symptoms. For PTRCTs involving < 50% of the tendon thickness, debridement with or without acromioplasty resulted in favourable outcomes in most studies. For PTRCTs involving > 50% of the tendon thickness, in situ repair has proven to significantly improve pain and functional outcomes for articular and bursal PTRCTs. The few available comparative studies in the literature showed similar functional and structural outcomes between in situ repair and repair after conversion to full-thickness tear for PTRCTs. Most non-overhead athletes return to sports at the same level as previous to the injury after in situ repair of PTRCTs. However, rates of return to preinjury level of competition for overhead athletes have been generally poor regardless of the utilized technique. During long-term follow-up, arthroscopic in situ repair of articular and bursal PTRCTs produced excellent functional outcomes in most patients, with a low rate of revision. Cite this article: EFORT Open Rev 2020;5:138-144. DOI: 10.1302/2058-5241.5.190010

Completion repair exhibits increased healing characteristics compared with in situ repair of partial thickness bursal rotator cuff tears

2018 ◽  
Vol 26 (8) ◽  
pp. 2498-2504 ◽  
Author(s):  
Arel Gereli ◽  
Baris Kocaoglu ◽  
Tekin Kerem Ulku ◽  
Sena Silay ◽  
Evren Kilinc ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Partial Thickness ◽  
In Situ Repair

Tear Completion Versus In Situ Repair for 50% Partial-Thickness Bursal-Side Rotator Cuff Tears: A Biomechanical and Histological Study in an Animal Model

2020 ◽  
Vol 48 (8) ◽  
pp. 1818-1825
Author(s):  
Anil Pulatkan ◽  
Wasim Anwar ◽  
Omer Ayık ◽  
Ergun Bozdag ◽  
Ayse Nur Yildirim ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Bone Healing ◽  
Histological Study ◽  
Rabbit Model ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Mean Values ◽  
Partial Thickness ◽  
In Situ Repair

Background: Tear completion followed by repair (TCR) and in situ repair (ISR) have been widely used for bursal-side partial-thickness rotator cuff tears (PTRCTs). Both techniques have shown favorable results; however, controversy continues in terms of the best management. Purpose: To compare the histological and biomechanical outcomes of these 2 techniques for 50% partial-thickness bursal-side rotator cuff tear repair in a rabbit model. Study Design: Controlled laboratory study. Methods: A total of 27 rabbits were used in this experimental study. Seven rabbits were sacrificed at the beginning of the study to form an intact tendon control group. A chronic 50% partial-thickness bursal-side tear model was created in 20 rabbits, and 5 rabbits were sacrificed for biomechanical testing of chronic partial-thickness tears (control group) without repair. In 15 rabbits, partial-thickness tears were repaired after 8 weeks. Partial-thickness tears in the right shoulders were completed to full thickness and repaired; in contrast, left shoulders were repaired in situ. All rabbits were euthanized 8 weeks after the repair. The tendons were tested biomechanically for ultimate failure, linear stiffness, and displacement. Histological evaluations of tendon-to-bone healing were performed via the modified Watkins score. Results: Macroscopically, all repaired tendons were attached to the greater tuberosity. The TCR group had a higher failure load than the ISR group, with mean values of 140.4 ± 13.8 N and 108.1 ± 16.6 N, respectively ( P = .001). The modified Watkins score was significantly higher in the TCR group (23.5; range, 22-27) than in the ISR group (19.5; range, 16-22) ( P = .009). Conclusion: Both repair techniques are effective for 50% partial-thickness bursal-side rotator cuff tears; however, TCR yields significantly superior biomechanical and histological characteristics compared with ISR. Clinical Relevance: Tear completion and repair technique may increase tendon-to-bone healing and thereby reduce re-rupture rate in the partial thickness bursal side rotator cuff tears.

scholarly journals Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aniket Agarwal ◽  
Kavita Vani ◽  
Anurag Batta ◽  
Kavita Verma ◽  
Shishir Chumber
Keyword(s):  
Rotator Cuff ◽  
Biceps Tendon ◽  
Surgical Correction ◽  
Statistical Testing ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness ◽  
Linear Probe ◽  
Significant Difference ◽  
Sensitivity Specificity

Abstract Background Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference. Results Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings. Conclusion Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.

Arthroscopic in Situ Repair of Partial Bursal Rotator Cuff Tears Without Acromioplasty

2017 ◽  
Vol 33 (7) ◽  
pp. 1294-1298 ◽  
Author(s):  
Maximiliano Ranalletta ◽  
Luciano A. Rossi ◽  
Nicolas A. Atala ◽  
Agustin Bertona ◽  
Gastón D. Maignon ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
In Situ Repair

scholarly journals Arthroscopic management of bursal sided rotator cuff tears, In situ repair vs conversion. A Systematic Review of Literature

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A Samy ◽  
T Khalil ◽  
A H Khater
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Tendon Repair ◽  
Rotator Cuff Tears ◽  
Cochrane Library ◽  
Common Source ◽  
Arthroscopic Management ◽  
Insignificant Difference ◽  
In Situ Repair

Abstract Background and Rational Rotator cuff tears are a common source of pain and dysfunction in various groups of age and occupation. The tear can either be complete or partial thickness rotator cuff tears (PTRCTs). PTRCTs involving &lt;50% of the thickness have been managed arthroscopically by debridement alone without acromioplasty. While massive PTRCTs involving more than 50% were repaired either arthroscopically by convergence to full thickness tears then tendon repair or in situ repair. There is no widely accepted technique in repairing Bursal sided PTRCTs. This study is to conduct a systematic review to compare the results of two of the most commonly used surgeries for management of bursal side rotator cuff tears, repair in situ vs tear completion then repair, as the search for the optimal surgery is crucial to improve long term outcomes, decrease side effects and costs and enhance patient quality of life. Methodology The search was conducted using the databases Medline, PubMed, Medscape, Cochrane library, using the following keywords: “partial rotator cuff tears”, “ bursal sided tears”, “in situ” “convergence” and “arthroscopic management” for published studies from 1990 to 2018. Results Our search included 11 studies, 5 tear completion, 4 repair in situ and 2 were comparative of both techniques. Studies showed insignificant difference in clinical outcomes between both surgical procedures, both repair in situ and tear completion techniques produce good results in rotator cuff tears techniques thus both remain in their places in management of bursal side rotator cuff tears. Conclusion Both in situ and tear completion techniques remain in their places in management of bursal side rotator cuff tears. We suggest that the final consensus should be postponed until further studies are the future, systematic reviews & comparative studies with longer term follow up period are needed to evaluate and guide for the best arthroscopic management of bursal side rotator cuff tears.

scholarly journals Biceps tendon properties worsen initially but improve over time following rotator cuff tears in a rat model

2011 ◽  
Vol 29 (6) ◽  
pp. 874-879 ◽  
Author(s):  
Cathryn D. Peltz ◽  
Jason E. Hsu ◽  
Miltiadis H. Zgonis ◽  
Nicholas A. Trasolini ◽  
David L. Glaser ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rat Model ◽  
Biceps Tendon ◽  
Rotator Cuff Tears ◽  
Tendon Properties ◽  
Over Time
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