scholarly journals Clinical And MRI Outcomes After Arthroscopic Superior Capsule Reconstruction With Human Dermal Allograft For Irreparable Posterosuperior Rotator Cuff Tears A Minimum Two Year Follow-up

2020 ◽  
Vol 8 (3_suppl2) ◽  
pp. 2325967120S0012 ◽  
Author(s):  
Lucca Lacheta ◽  
Marilee P. Horan ◽  
William W. Schairer ◽  
Grant J. Dornan ◽  
Brandon T. Goldenberg ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Rotator Cuff ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Rotator Cuff Tears ◽  
Dash Score ◽  
Complication Rates ◽  
Superior Capsule Reconstruction ◽  
Outcome Scores

Objectives: Arthroscopic superior capsule reconstruction (SCR) using acellular human dermal allograft (DA) is a recently developed procedure for the treatment of irreparable rotator cuff tears to reduce pain and restore shoulder function. The purpose of this study was to report clinical and structural outcomes of patients who underwent SCR with DA for irreparable tears of the posterosuperior rotator cuff. We hypothesized that SCR using DA would result in significant improvements in clinical outcomes and that outcomes would be positively correlated with graft integrity. Methods: Patients who underwent SCR using DA for irreparable tears of the supraspinatus and infraspinatus tendons and who were at least two years out from surgery were included. Patients reported clinical outcomes were assessed prospectively by the use of the American Shoulder and Elbow Surgeons (ASES) Score, Single Assessment Numerical Evaluation (SANE) Score, Quick Disabilities of the Arm, Shoulder and Hand (DASH) Score, and patient satisfaction. Structurally, acromiohumeral distances (AHD) were assessed both pre- and postoperatively with standard radiographs. Integrity of the DA was assessed by magnetic resonance imaging (MRI). Clinical failures were defined as persistent loss of function and/or pain. Complications were also recorded. Results: Twenty-one patients who underwent SCR with a mean age of 56 (range 41-65) had and a mean follow up of 2.1 years (range 2 - 3) were included. All postoperative outcome scores improved significantly: ASES score improved from 54.2 to 83.9 (p<0.001), SANE score improved from 43.6 to 71.2 points (p<0.001) and QuickDASH improved from 37.5 to 16.2 points (p=0.002). Median satisfaction of all patients was 9 (range 1-10). Complete radiographs were obtained in 18/21 (85.7%) of patients and showed a significant increase of the mean AHD from 7.0 mm to 8.3 mm, pre- to postoperatively (p=0.029). Postoperative MRI’s were obtained in 95% (20/21) of the patients and showed a graft integrity rate of 50% (10/20). There were no significant differences in clinical outcome scores (p=0.214) comparing patients with intact grafts to patients with torn grafts. The AHD increased significantly from pre- to postoperatively in patients with intact grafts (p=0.003), while it didn’t increase significantly for those with a torn graft (p=0.432). There was one clinical failure in one patient who achieved no functional improvement who later underwent revision SCR and ended up with a successful clinical outcome. No postoperative complications occurred. Conclusion: SCR using DA for irreparable tears of the rotator cuff improves clinical outcomes with high patient satisfaction and low complication rates at short-term follow-up. Interestingly, intact grafts, although correlated with improved AHD, had no positive effects on clinical outcomes at final follow-up.

Clinical Outcomes, Tendon Integrity, and Shoulder Strength After Revision Rotator Cuff Reconstruction: A Minimum 2 Years’ Follow-up

2018 ◽  
Vol 46 (11) ◽  
pp. 2700-2706 ◽  
Author(s):  
Lukas Willinger ◽  
Lucca Lacheta ◽  
Knut Beitzel ◽  
Stefan Buchmann ◽  
Klaus Woertler ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Constant Score ◽  
Case Series ◽  
Shoulder Function ◽  
Dash Score ◽  
Outcome Scores ◽  
Retear Rate

Background: The retear rate after primary rotator cuff (RC) reconstruction is high and commonly leads to poorer clinical outcomes and shoulder function. In the case of primary failure, revision RC reconstruction (RCR) has become increasingly important to re-create RC integrity and improve outcomes. To date, clinical and structural outcomes after RCR have not been sufficiently investigated and described at midterm follow-up. Hypothesis/Purpose: The purpose was to evaluate the clinical and radiological outcomes after revision RCR. It was hypothesized that revision RCR significantly improves clinical outcomes and that the outcomes positively correlate with tendon integrity on magnetic resonance imaging (MRI). Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent revision RCR between 2008 and 2014 were retrospectively evaluated with a minimum follow-up of 2 years. Outcomes were assessed by a clinical examination, a visual analog scale for pain (VAS), the Constant Score (CS), the American Shoulder and Elbow Surgeons (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Tendon integrity was determined using 3-T MRI and graded according to the Sugaya classification. Results: Thirty-one of 40 patients (77.5%) were available for the final assessment at a mean follow-up of 50.3 ± 20.4 months. Clinical outcome scores significantly improved from preoperatively to postoperatively for the CS (39.7 ± 16.7 to 65.1 ± 19.7; P < .001), ASES (44.2 ± 17.7 to 75.2 ± 24.8; P < .001), and DASH (68.6 ± 15.1 to 21.5 ± 19.1; P < .001). The VAS score decreased from 6.1 ± 1.8 preoperatively to 1.3 ± 1.8 at final follow-up ( P < .001). MRI demonstrated a retear rate of 55.5%. No differences in CS, ASES, and DASH scores were detected between patients with an intact repair and failure. Abduction strength was not significantly different in patients with an intact repair and retears (55.5 N vs 44.0 N, respectively, P = .52). Conclusion: Revision RCR improves clinical outcomes and shoulder function at midterm follow-up. The clinical outcome scores were comparable in patients with an intact repair and those with failed RC healing. Therefore, tendon integrity was not correlated with better clinical outcomes after revision RCR at final follow-up.

scholarly journals Mid-Term Outcomes after Arthroscopic “Tear Completion Repair” of Partial Thickness Rotator Cuff Tears

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 74
Author(s):  
Giuseppe Fama ◽  
Jacopo Tagliapietra ◽  
Elisa Belluzzi ◽  
Assunta Pozzuoli ◽  
Carlo Biz ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Rotator Cuff ◽  
Constant Score ◽  
Tendon Healing ◽  
Critical Zone ◽  
Rotator Cuff Tears ◽  
Complication Rates ◽  
Range Of Movement ◽  
Partial Thickness

Background and Objectives: Different arthroscopic procedures are used for partial-thickness rotator cuff tears (PT-RCTs), but there is still no evidence on the superiority of one procedure over the other. The aim of this study was to evaluate the clinical outcomes and the rate of complications of a tear completion repair (TCR) technique. Materials and Methods: Patients who had undergone arthroscopic TCR technique for PT-RCTs with a follow-up of at least 2-years after surgery were included. The TCR technique involved the removal of the “critical zone” and creating microfractures to biologically support tendon healing. Functional outcomes were assessed prospectively by the Constant score (CS) and active and passive range of movement (ROM). Pain and patient satisfaction were measured using a visual analog scale (VAS). Complication rates were recorded, and tendon integrity was assessed with magnetic resonance imaging (MRI) or ultrasound performed at least 2-years after surgery. Results: Eighty-seven patients with a median age of 57 years were followed-up for a median of 5 years. The CS score improved from 53.5 preoperatively to 94.0 postoperatively (p < 0.001). Median VAS score decreased from 8.6 to 1.0 (p < 0.0001). Median patient satisfaction was 9.3. The overall complication rate was 14.9%. Conclusions: Patients with PT-RCTs of the supraspinatus tendon treated by the TCR technique with “critical zone” removal and biological stimulation by microfractures showed good functional results with excellent strength recovery, a high degree of patient satisfaction, and resolution of painful symptoms at mid-term follow-up.

Superior Capsule Reconstruction for Irreparable Massive Rotator Cuff Tears: Does It Make Sense? A Systematic Review of Early Clinical Evidence

2020 ◽  
Vol 48 (13) ◽  
pp. 3365-3375 ◽  
Author(s):  
Burak Altintas ◽  
Michael Scheidt ◽  
Victor Kremser ◽  
Robert Boykin ◽  
Sanjeev Bhatia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Clinical Evidence ◽  
External Rotation ◽  
Rotator Cuff Tears ◽  
Current Evidence ◽  
Massive Rotator Cuff Tears ◽  
Superior Capsule Reconstruction

Background: Treatment of irreparable massive rotator cuff tears (MRCTs) in patients without advanced glenohumeral osteoarthritis remains a challenge. Arthroscopic superior capsule reconstruction (SCR) represents a newer method for treatment with increasing popularity and acceptance. Purpose: To analyze the clinical evidence surrounding SCR and determine the current clinical outcomes postoperatively. Study Design: Systematic review. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Electronic databases of PubMed, MEDLINE, Cochrane, and Google Scholar were used for the literature search. The study quality was evaluated according to the Modified Coleman Methodology Score. Studies in English evaluating SCR outcomes were included. Results: Seven studies were reviewed, including 352 patients (358 shoulders) treated with arthroscopic SCR with the mean duration of follow-up ranging from 15 to 48 months (range, 12-88 months). Fourteen patients were lost to follow-up, leaving 338 patients (344 shoulders) with clinical outcome data. Graft types included dermal allografts (n = 3 studies), fascia lata autografts (n = 3), or both (n = 1). Most commonly, a double-row technique was utilized for humeral graft fixation. The most common complication included graft tears in 13% of patients, resulting in 15 SCR revisions and 7 reverse shoulder arthroplasties. Postoperatively, improvements in visual analog scale (2.5 to 5.9), American Shoulder and Elbow Surgeons (20 to 56), Japanese Orthopaedic Association (38.0), Subjective Shoulder Value (37.0 to 41.3), and Constant (11.6 to 47.4) scores were observed. Three studies reported respective satisfaction rates of 72.9%, 85.7% and 90%. Increases in external rotation, internal rotation, and abduction with improved strength in external rotation were observed postoperatively. Improvement of pseudoparalysis was also observed in 3 studies. One study reported return to sports in 100% of patients (2 competitively, 24 recreationally) with no adverse outcomes. Conclusion: SCR showed good to excellent short-term clinical outcomes with adequate pain relief and functional improvement. The current evidence suggests that the procedure is an alternative for symptomatic patients with irreparable MRCT; however, the included studies were fair to poor in quality, and there were some notable complications. Long-term follow-up will determine the longevity and ultimate role of this new method in the treatment of irreparable MRCT.

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

scholarly journals Five-year Follow-up of Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0019 ◽  
Author(s):  
Teruhisa Mihata ◽  
Thay Q. Lee ◽  
Akihiko Hasegawa ◽  
Kunimoto Fukunishi ◽  
Takeshi Kawakami ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Rates Of Return ◽  
Shoulder Range Of Motion ◽  
Superior Capsule Reconstruction ◽  
Significant Difference ◽  
Graft Thickness ◽  
Glenohumeral Osteoarthritis

Objectives: For irreparable rotator cuff tears, we developed a new surgical treatment—arthroscopic superior capsule reconstruction (SCR)—to restore superior shoulder stability, muscle balance, and shoulder function. The objective of this study was to assess (1) changes in functional outcome; (2) changes in graft thickness; (3) rates of graft tear; and (4) rates of glenohumeral osteoarthritis during a 5-year follow-up period. Methods: From 2007 to 2013, arthroscopic SCR using autograft of fascia lata was performed on 37 shoulders with irreparable rotator cuff tears. Seven patients were lost to follow-up. Consequently, 30 shoulders (mean age, 68.0 years) were enrolled in the study. Shoulder range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores, acromiohumeral distance (AHD), Hamada grade, and Goutallier grade were compared among before surgery, 1 year after SCR, and 5 years after SCR. Graft thickness, which was measured in MRI, was compared among 3 months, 1 year, and 5 years after SCR. One-way analysis of variance followed by Fisher’s LSD post-hoc test was performed for statistical analysis. In addition, rates of return to sport or work were investigated in those patients who had been employed (12 patients: 5 carpenters, 5 farmers, and 2 construction workers) or played sports (8 patients: 2 table tennis, 1 golf, 1 martial arts, 1 yoga, 1 badminton, 1 mountain-climbing, and 1 ground golf) before injury. Results: Both ASES and JOA scores after arthroscopic SCR improved significantly at both 1 year ( P < 0.001) and 5 years after SCR ( P < 0.001). ASES score at 5 years after SCR was significantly better than that at 1 year after SCR ( P = 0.02). Postoperative ASES scores at both 1 year and 5 years after SCR were better in healed patients (27 patients) than in unhealed patients suffering from graft tear (3 patients). Active elevation was significantly improved at both 1 year and 5 years after SCR ( P < 0.001). At five years after SCR, 11 patients were still working and one patient, who had returned to part-time work at 1 year, had retired. All 8 patients were still playing sport before their injuries at 5 years after SCR. AHD was increased significantly at both 1 and 5 years after SCR ( P < 0.001). There was no significant difference in AHD between 1 and 5 years after SCR ( P = 0.16). In the 27 patients in whom the graft remained intact, graft thickness did not differ significantly among 3 months, 1 year, and 5 years after SCR ( P = 0.67). Hamada grade was significantly improved at both 1 and 5 years after SCR (preoperative: 2.3 ± 0.8; 1 year: 1.3 ± 0.7; 5 years: 1.3 ± 0.7, P < 0.001). All patients who had graft healing had no progression of glenohumeral osteoarthritis during the 5-year follow-up period. Two of the 3 patients with graft tear were suffering severe glenohumeral osteoarthritis (with narrowing of the glenohumeral joint space) at 5 years after SCR. The Goutallier grade did not change significantly after SCR in any patients. Conclusion: In a 5-year follow-up study, arthroscopic SCR restored shoulder function and resulted in high rates of return to recreational sport and work. Shoulder function and ROM were likely to get better with time. Graft tear exacerbated the clinical outcome after SCR and caused glenohumeral osteoarthritis in 2 of 3 patients by 5 years after SCR. Graft thickness and postoperative AHD did not change significantly between 1 and 5 years of follow-up, suggesting that we can expect excellent functional outcomes with long-term follow-up. [Table: see text]

scholarly journals Predictors of Clinical Outcomes After Proximal Hamstring Repair

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711882371 ◽  
Author(s):  
Eric N. Bowman ◽  
Nathan E. Marshall ◽  
Michael B. Gerhardt ◽  
Michael B. Banffy
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Activity Level ◽  
Medical Comorbidities ◽  
Outcome Scores ◽  
The Mean ◽  
Tegner Score ◽  
Proximal Hamstring

Background: Proximal hamstring avulsions cause considerable morbidity. Operative repair results in improved pain, function, and patient satisfaction; however, outcomes remain variable. Purpose: To evaluate the predictors of clinical outcomes after proximal hamstring repair. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed proximal hamstring avulsions repaired between January 2014 and June 2017 with at least 1-year follow-up. Independent variables included patient demographics, medical comorbidities, tear characteristics, and repair technique. Primary outcome measures were the Single Assessment Numerical Evaluation (SANE), International Hip Outcome Tool–12 (iHOT-12), and Kerlan-Jobe Orthopaedic Clinic (KJOC) Athletic Hip score. Secondary outcome measures included satisfaction, visual analog scale for pain, Tegner score, and timing of return to sports. Results: Of 102 proximal hamstring repairs, 86 were eligible, 58 were enrolled and analyzed (67%), and patient-reported outcomes were available for 45 (52%), with a mean 29-month follow-up. The mean patient age was 51 years, and 57% were female. Acute tears accounted for 66%; 78% were complete avulsions. Open repair was performed on 90%. Overall satisfaction was 94%, although runners were less satisfied compared with other athletes ( P = .029). A majority of patients (88%) returned to sports by 7.6 months, on average, with 72% returning at the same level. Runners returned at 6.3 months, on average, but to the same level 50% of the time and at a decreased number of miles per week compared to nonrunners (15.7 vs 7.8, respectively; P < .001). Postoperatively, 78% had good/excellent SANE Activity scores, but the mean Tegner score decreased (from 5.5 to 5.1). Acute tears had higher SANE Activity scores. The mean iHOT-12 and KJOC scores were 99 and 77, respectively. Endoscopic repairs had equivalent outcome scores to open repairs, although conclusions were limited given the small number of patients in the endoscopic group. Greater satisfaction was noted in patients older than 50 years ( P = .024), although they were less likely to return to running ( P = .010). Conclusion: Overall, patient satisfaction and functionality were high. With the numbers available, we were unable to detect any significant differences in functional outcome scores based on patient age, sex, body mass index, smoking status, medical comorbidities, tear grade, activity level, or open versus endoscopic technique. Acute tears had better SANE Activity scores. Runners should be cautioned that they may be unable to return to the same preinjury activity level after proximal hamstring repair. Clinical Relevance: When counseling patients with proximal hamstring tears, runners and those with chronic tears should set appropriate expectations.

Is Subacromial Balloon Spacer Appropriate for Treatment of Irreparable Rotator Cuff Tears in Elderly Patients?

2019 ◽  
Vol 21 (6) ◽  
pp. 417-426
Author(s):  
Kamil Yamak ◽  
Hüseyin Gökhan Karahan ◽  
Taşkın Altay ◽  
Cemil Kayalı ◽  
Fırat Ozan
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Dash Score ◽  
X Rays ◽  
Preoperative Period ◽  
Subacromial Space ◽  
Significant Difference ◽  
The Difference ◽  
Quick Dash

Background. The aim of this study was to evaluate the clinical and radiographic results of surgical treatment of irreparable rotator cuff tears by subacromial balloon spacer insertion in patients over 65 years old. Material and methods. Results of patients with failed conservative treatment for irreparable rotator cuff tears and who underwent subacromial balloon spacer insertion were evaluated retrospectively. The VAS and Quick-DASH scores were used for clinical and functional assessment. Results. Eleven patients were included. Mean age of patients was 69.1 (range: 65-77) years old. Evaluation of anteroposterior shoulder x-rays revealed Hamada grade 2 and grade 1 arthropathy in 10 patients (91%) and 1 patient (9%),respectively. Mean duration of follow-up was 45.09 (±5.43,37-52) months. The difference in the subacromial space measured from standard AP shoulder x-rays in the preoperative period, in the 6th postoperative month, and at the end of follow-up was 5.44 mm (2.29), 6.51 mm (±2.23), and 5.08 mm (±2.13), respectively. Mean Quick-DASH score was 74.49(±14.36) in the preoperative period, compared to 72.19 (±14.38) at the end of follow-up. There was no statistically significant difference between preoperative period and end of follow-up scores in terms of mean Quick-DASH scores (p= 0.232). Mean VAS score was 7.09 (±0.831) in the preoperative period and 6.64 (±0.809) at the end of follow-up. No statistically significant difference was revealed in terms of mean VAS scores when preoperative and end of follow-up scores were compared (p=0.333). Conclusion. Clinical and radiographic results of subacromial balloon spacer insertion in the treatment of irreparable rotator cuff tears could not be evaluated as satisfactory.

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