scholarly journals Functional and Structural Outcomes After Retears of Arthroscopically Repaired Large and Massive Rotator Cuff Tears

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110357
Author(s):  
Suguru Tanaka ◽  
Masafumi Gotoh ◽  
Koji Tanaka ◽  
Yasuhiro Mitsui ◽  
Hidehiro Nakamura ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Outcome Measures ◽  
Functional Outcomes ◽  
Japanese Orthopaedic Association ◽  
Case Series ◽  
Fatty Degeneration ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears ◽  
The Mean ◽  
Tear Size

Background: Most studies have shown acceptable clinical results in patients with large or massive tears treated by arthroscopic rotator cuff repair (ARCR); however, the effects of retears after surgery in these patients remain unknown. Purpose: To evaluate functional and structural outcomes after retears of large and massive rotator cuff tears treated by ARCR. Study Design: Case series; Level of evidence, 4. Methods: A total of 196 consecutive patients with large to massive rotator cuff tears underwent physical examination and magnetic resonance imaging before and after ARCR at 6, 12, and 24 months. Of these, 9 patients were lost at 6 months after surgery. Therefore, 187 patients were followed up for 24 months after surgery; 148 patients showed no postsurgical ruptures. Consequently, the remaining 39 patients with postsurgical ruptures were included in this study (mean age at surgery, 64.2 ± 8.7 years). Functional outcome measures comprised the University of California, Los Angeles (UCLA) and Japanese Orthopaedic Association (JOA) scores. Structural outcome measures consisted of the global fatty degeneration index (GFDI), mediolateral tear size, and residual tendon attachment area as evaluated by our own scoring system. Results: The mean UCLA and JOA scores significantly improved from 16.3 ± 3.9 and 63.2 ± 10.7 preoperatively to 27.9 ± 5.5 ( P < .0001) and 84.5 ± 9.4 ( P < .0001) at final follow-up, respectively. The mean mediolateral tear size ( P = .03, .02, and .02, respectively) and residual tendon attachment area ( P = .04, .03, and .04, respectively) significantly improved from preoperatively to 6, 12, and 24 months postoperatively. The correlation analysis between the functional and structural variables confirmed significant associations between the residual tendon attachment area, the JOA and UCLA scores at 24 months postoperatively, and the preoperative GFDI ( r = –0.81 to 0.78). Conclusion: The residual tendon attachment area after a retear was significantly larger at 24 months after surgery than before surgery. In addition, significant associations were confirmed between preoperative fatty degeneration, the residual tendon attachment area, and functional outcomes after a retear. These results may explain why functional outcomes significantly improved even after retears in this series.

scholarly journals Midterm Functional and Structural Outcomes of Large/Massive Cuff Tears Treated by Arthroscopic Partial Repair

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098879
Author(s):  
Hiroaki Moriyama ◽  
Masafumi Gotoh ◽  
Koji Tanaka ◽  
Yashuhiro Mitsui ◽  
Hidehiro Nakamura ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Functional Outcome ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Japanese Orthopaedic Association ◽  
Rotator Cuff Tears ◽  
Partial Repair ◽  
Massive Rotator Cuff Tears ◽  
Tear Size

Background: Previous studies have shown good clinical outcomes in patients with irreparable large or massive rotator cuff tears treated using arthroscopic partial repair (APR); however, few studies have evaluated both functional and structural outcomes in these patients. Purpose: To evaluate both functional and structural outcomes in patients with large or massive rotator cuff tears treated using APR. Study Design: Case series; Level of evidence, 4. Methods: Between March 2009 and November 2016, a total of 30 patients underwent APR because of the irreparability of their large or massive rotator cuff tears during surgery. Of these patients, 24 completed the minimum 24-month follow-up (mean, 61.8 ± 27.1 months; range, 24-112 months) and were included in this study. Functional outcome measures included the Japanese Orthopaedic Association (JOA) and University of California Los Angeles (UCLA) scores and the visual analog scale for pain. Structural outcome measures comprised preoperative fatty degeneration, mediolateral tear size, residual tendon attachment area, and glenohumeral (GH) arthritic changes evaluated on magnetic resonance imaging scans or plain radiographs before and after surgery. Functional and structural outcomes were evaluated preoperatively, at 3 months postoperatively, and at the final follow-up. Results: The JOA scores for all patients significantly improved from 67.9 ± 11.3 preoperatively to 85.4 ± 15.6 postoperatively ( P < .0001). Similarly, the UCLA scores significantly improved from 15.8 ± 4.20 preoperatively to 29 ± 6.69 at final follow-up postoperatively ( P < .0001). The mediolateral tear size were significantly decreased at 3 months postoperatively ( P < .001) and at the final follow-up ( P < .001). Compared with preoperative scores, the novel score evaluating the residual tendon attachment area improved from 3.08 ± 0.46 to 3.54 ± 0.41 ( P < .001) after surgery overall, although it significantly deteriorated from 3 months postoperatively to the final follow-up. GH osteoarthritis progressed in 6 patients (25%). Patients who developed osteoarthritis had lower JOA and UCLA scores than did those who did not (JOA, P = .010; UCLA, P = .037). Conclusion: In irreparable large or massive rotator cuff tears treated using APR, functional outcome improved after surgery. Although the residual tendon attachment area improved, functional outcome after APR corresponded to the GH alterations at the midterm follow-up. Longer-term follow-up is needed to further elucidate the effect of APR on clinical outcomes in these patients.

scholarly journals Clinical Outcomes of Arthroscopic Repair for Large or Massive Rotator Cuff Tear with Delamination: Comparison of Three Suture-Bridge Technique

2021 ◽  
Author(s):  
Atsushi Okubo ◽  
Tadahiko Yotsumoto ◽  
Nobuyoshi Watanabe ◽  
Teruyoshi Kajikawa ◽  
Shun Nakajima ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Double Layer ◽  
Rotator Cuff Tear ◽  
Fatty Degeneration ◽  
Rotator Cuff Tears ◽  
Suture Bridge ◽  
Cuff Tear ◽  
Massive Rotator Cuff Tears ◽  
The Mean

Abstract Background: Rotator cuff tear with delamination is considered as a risk factor for postoperative retear after rotator cuff repair. The purpose of this study was to compare clinical outcomes between 3 repair procedures for large or massive rotator cuff tears with delamination: conventional en masse suture bridge (EMSB), double-layer suture bridge (DLSB), and combination of double-layer suture bridge and modified Debyere-Patte (DLSB+DP) methods.Methods: A total of 53 shoulders of 52 patients who had large or massive rotator cuff tears with delamination were included. The patients were categorized into 3 groups: EMSB group comprised 18 patients, DLSB group comprised 24 shoulders of 23 patients, and DLSB+DP group comprised 11 patients. DP was applied for cases in which the rotator cuff was unable to be covered up to the footprint even though it was sufficiently mobilized. The mean postoperative follow-up period was 34.6 months (range, 24-72 months). Pre- and postoperative evaluations included the Constant scores and range of motion (ROM). Tendon integrity according to Sugaya classification, and fatty degeneration were also evaluated by magnetic resonance images (MRI).Results: The ROM significantly improved after the operation in all groups. Mean constant scores significantly improved (from 45.5±14.3 to 77.4±13.6, in the EMSB, from 45.5±11.6 to 87.6±11.4 in the DLSB, and from 46.3±11.2 to , and 88.0±10.5 in the DLSB+DP). Significant differences were noted in the postoperative Constant score (p<0.05: DLSB vs. EMSB , and p<0.05: DLSB+DP vs. EMSB)． The Constant pain score was better in the DLSB+DP than in the EMSB group. The mean pre-operative global fatty degeneration index was 1.52 in the EMSB group, 1.80 in the DLSB group, and 2.28 in the DLSB+DP group. Retear occurred in 27.8% in the EMSB group, 12.5% in the DLSB group, and 9.1% in the DLSB+DP group. Conclusions: Comparison of 3 groups demonstrated that DLSB and DLSB+DP achieved better clinical outcome than EMSB. DLSB+DP is useful for large or massive rotator cuff tears with severe fatty degeneration or for cases where presence of excessive tension is anticipated when repairing the torn cuff.

scholarly journals Comparing Clinical Outcomes After Subacromial Spacer Insertion Versus Other Reconstruction Methods in the Treatment of Irreparable Massive Rotator Cuff Tears

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711986960
Author(s):  
Joo Han Oh ◽  
Joo Hyun Park ◽  
Hyeon Jang Jeong ◽  
Sung-Min Rhee
Keyword(s):  
Rotator Cuff ◽  
Fatty Degeneration ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears ◽  
Reconstruction Methods ◽  
Functional Scores ◽  
Group 2 ◽  
Tear Size ◽  
Group 1

Background: Previous studies on subacromial spacer (SAS) insertion have been limited to case series that did not compare the effectiveness of this technique with other techniques. Hypothesis: Outcomes after SAS insertion for the treatment of irreparable massive rotator cuff tears (IMRCTs) will be similar to those of other techniques. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study was based on data collected from patients who underwent correction of IMRCTs between January 2010 and October 2017. Group 1 patients (n = 17) received SAS insertion with or without partial repair; group 2 patients (n = 36) were treated with other techniques (isolated partial repairs or bridging grafts). Preoperative tear size and global fatty degeneration index values were evaluated. Range of motion, visual analog scale for pain, American Shoulder and Elbow Surgeons (ASES) score, Constant score, Simple Shoulder Test (SST), Disabilities of the Arm, Shoulder and Hand score, and acromiohumeral distance (AHD) were assessed preoperatively and at final follow-up at least 2 years after the surgery (range, 24-60 months). In both groups, ultrasonographic examination was performed at 3 and 6 months postoperatively, and magnetic resonance imaging (MRI) was performed at 1 year. Results: Tear size and preoperative global fatty degeneration index were not significantly different between the groups (all P > .05). There were no differences in functional scores between the groups at final follow-up (all P > .05). AHD was maintained at final follow-up in group 1 (mean ± SD: 6.2 ± 2.1 mm [postoperatively] vs 6.7 ± 2.3 mm [final follow-up]; P = .678), and there was no difference compared with group 2 (7.2 ± 3.2 mm; P = .244). Patients with retears in group 2 (23 of 36, 63.9%) had lower ASES ( P = .041) and SST ( P = .027) scores at final follow-up when compared with patients in group 1. Six patients (35.3%) in group 1 had partial repairs; these patients had better external rotation at 90° ( P = .047), better SST scores ( P = .036), and higher AHDs at final follow-up ( P = .046) than those in group 1 who had no repair. Three patients (50%) showed retears of partially repaired tendons on MRI. Of 13 patients (76.5%) in group 1 with postoperative MRI, 12 (92.3%) showed fibrotic tissue in the subacromial space not seen preoperatively. Conclusion: There was no difference in outcomes between SAS and the other reconstruction methods for treating IMRCTs. However, given the high retear rate associated with other techniques and poor functional outcomes after retear, SAS insertion could be a viable option for treating IMRCTs.

scholarly journals Outcomes of the Star Repair for Large and Massive Rotator Cuff Tears: A Modified Triple-Row Technique

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712095299
Author(s):  
Mohamed G. Morsy ◽  
Hesham M. Gawish ◽  
Mostafa A. Galal ◽  
Ahmed H. Waly
Keyword(s):  
Quality Of Life ◽  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Functional Evaluation ◽  
Massive Rotator Cuff Tears ◽  
Health Related ◽  
The Mean ◽  
Cuff Repair ◽  
Disease Specific

Background: Large and massive rotator cuff repairs constitute a true challenge for arthroscopic shoulder surgeons. Retear rates as high as 20% have been reported after arthroscopic double-row and suture-bridge techniques used for these tears. Hypothesis: A modified triple-row repair will provide satisfactory clinical results with lower risk for retear. Study Design: Case series; Level of evidence, 4. Methods: Between March 2016 and August 2017, a total of 52 patients with large and massive rotator cuff tears received a modified triple-row cuff repair. A middle repositioning anchor was inserted between the medial and the lateral rows. The middle anchor sutures were loaded to lateral knotless anchors in a star-shaped configuration. Functional evaluation was performed using the American Shoulder and Elbow Surgeons score, University of California, Los Angeles score, Constant-Murley score, and Simple Shoulder Test. Subjective evaluation was carried out using a visual analog scale for pain and a subjective shoulder value score. Health-related as well as disease-specific quality-of-life scores were also used. Retear rates were assessed by means of musculoskeletal ultrasonography. Patients were evaluated for a minimum of 24 months. Results: This study included 34 female and 18 male patients with a mean age of 57.17 ± 6.7 years. There were 35 patients (67.3%) with large tears and 17 patients (32.7%) with massive tears. Significant improvement from preoperative values was seen in all functional and subjective scores ( P < .001). The mean forward flexion was 163° ± 9.7°, and the mean lateral abduction was 159.4° ± 9.4°. All patients had excellent scores on the general health-related and disease-specific quality-of-life scales. No retears were reported at the end of the follow-up period. Conclusion: The star-shaped, modified triple-row cuff repair is a valid and effective solution for surgical management of large and massive rotator cuff tears, providing excellent results and low risk for retears.

Irreparable Large to Massive Rotator Cuff Tears With Low-Grade Fatty Degeneration of the Infraspinatus Tendon: Minimum 7-Year Follow-up of Fascia Autograft Patch Procedure and Partial Repair

2021 ◽  
pp. 036354652110435
Author(s):  
Daisuke Mori ◽  
Kazuha Kizaki ◽  
Noboru Funakoshi ◽  
Fumiharu Yamashita ◽  
Yasuyuki Mizuno ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Fatty Degeneration ◽  
Rotator Cuff Tears ◽  
Low Grade ◽  
Partial Repair ◽  
Massive Rotator Cuff Tears ◽  
Infraspinatus Tendon

Background: In shoulders with irreparable massive rotator cuff tears (RCTs) with high-grade fatty degeneration (Goutallier stage 3 or 4) of the supraspinatus tendon and low-grade fatty degeneration (Goutallier stage 1 or 2) of the infraspinatus tendon (ISP), arthroscopic patch grafting (PG) has been reported as superior to partial repair (PR) regarding the ISP retear rate at short-term to midterm follow-up. However, the longer term outcomes are unclear. Purpose: To compare clinical and structural outcomes in the PG and PR groups at a minimum of 7 years postoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 24 patients in the PG group and 24 patients in the PR group. We primarily used the Constant score for clinical outcomes and performed magnetic resonance imaging for structural outcomes in the PG and PR groups. The risk factors for a retear of the ISP were identified by univariate and multivariate (forward stepwise selection method) logistic regression analyses. We primarily compared values at midterm follow-up (<4 years) with values at the final follow-up (minimum 7 years) for each patient. Results: The mean midterm and final follow-up times for the PG group were 41.0 and 95.1 months, respectively, compared with 35.7 and 99.3 months, respectively, for the PR group. We found significant differences for the midterm and final follow-up Constant total scores in the PG and PR groups (midterm follow-up: 79.1 vs 69.9, respectively [ P = .001]; final follow-up: 76.0 vs 65.3, respectively [ P = .006]) and in the Constant strength scores (midterm follow-up: 14.6 vs 8.5, respectively [ P < .001]; final follow-up: 13.1 vs 8.3, respectively [ P = .001]). Treatment group (PR) was a significant predictor of an ISP retear in the logistic regression analysis (odds ratio, 3.545; P = .043). Conclusion: Patients with low-grade massive RCTs treated with PG or PR improved significantly in terms of clinical outcomes at the midterm and final follow-up time points. However, Constant scores were significantly better in the PG group at the final follow-up.

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