scholarly journals Pathology and clinical outcomes after arthroscopic stabilization in shoulders with traumatic anterior instability older than 40 years: Comparison between shoulders with the first dislocation before or after 40 years (241)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0034
Author(s):  
Yusuke Ueda PhD ◽  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Instability ◽  
External Rotation ◽  
Bankart Lesion ◽  
Rotator Cuff Tears ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Stabilization ◽  
Group 2 ◽  
Group 1

Objectives: Traumatic anterior shoulder instability is common in young population but sometimes seen in middle-aged and elderly patients. The higher incidence of rotator cuff tears has been reported in middle-aged and elderly patients with anterior shoulder instability than young population. We, however, had an impression through clinical experiences that the pathology, including the incidence of rotator cuff tears, might be different by age at the first dislocation. There have been few articles that reported the pathology of shoulders with anterior shoulder instability in older population. The purpose of this study was to investigate pathology and clinical outcomes in patients who underwent arthroscopic stabilization at 40 years or older and to compare them between shoulders with the first dislocation before or after 40 years. Methods: The inclusion criteria of this study were as follows: 1) shoulders that underwent arthroscopic stabilization between October 2005 and September 2017, 2) traumatic anterior shoulder instability, and 3) 40 year old or older. The exclusion criterion was < 2-year follow-up. Glenoid morphology was evaluated with preoperative 3-dimensional computed tomography, and the size of glenoid bone defect was measured. Intraoperative findings, including rotator cuff tear, Bankart lesion, and humeral avulsion of the glenohumeral ligament (HAGL) lesion, and surgical procedures were investigated with surgical records. Range of motion was assessed preoperatively and at the final follow-up. Postoperative re-dislocation was also investigated. The subjects were divided into two groups according to the age at the first dislocation: Group 1, < 40 years; Group 2, 40 years or older. The findings and outcomes were compared between the two groups. The unpaired t-test was used to compare continuous data between the groups, and the paired t-test was used for pre- and postoperative comparison of continuous data. The chi-square test was used for categorical variables. The level of significance was set at p < 0.05. Results: Between October 2005 and September 2017, 198 shoulders (198 patients) underwent arthroscopic shoulder stabilization for traumatic anterior shoulder instability at 40 years or older. Fifty-six shoulders were excluded due to < 2-year follow-up, and 142 shoulders (142 patients) were included in this study. They consisted of 69 males and 73 females with a mean age of 51 (range, 40-78) years. The mean follow-up was 4 (range, 2-12) years. Group 1 included 105 shoulders (52 males and 53 females] with a mean age of 48 (range, 40-77) years. Group 2 included 37 shoulders (17 male and 20 females) with a mean age of 59 (range, 40-78) years. Group 1 had a longer time from the first dislocation to surgery (P<.001) and larger number of dislocation (P<.001) than Group 2 (Table 1). Bony Bankart lesion was more frequently seen in Group 2 than Group 1 (P=.02), and bone defect was greater in Group 1 than Group 2 (P=.02). The incidence of Bankart lesion or HAGL lesion was not significantly different between the groups. There were 2 full-thickness (1 small and 1 medium) and 16 joint-side partial-thickness rotator cuff tears in Group 1, while 16 full-thickness (4 small, 4 medium, 5 large, and 3 massive) and 8 joint-side partial-thickness tears were found in Group 2. The difference in the incidence of rotator cuff tears was significant between the groups (P<.001). Arthroscopic Bankart repair (ABR) with or without augmentation was performed in 103 shoulders (98 %) in Group 1 and in 35 shoulders (95%) in Group 2 (Table 2). There were 2 isolated HAGL repairs (2 %) in Group 1 and 2 isolated rotator cuff repairs (6 %) in Group 2. Two shoulders (6%) in Group 2 experienced re-dislocation. Forward flexion showed significant improvement from 159 (range, 100-180) to 170 (range, 140-180) degrees in Group 1 and from 148 (range, 40-180) to 163 (range, 70-180) degrees in Group 2 (P<.001 for each). Postoperative forward flexion showed no significant difference between the groups. External rotation showed no postoperative changes in both groups, while Group 1 had significantly better pre- and postoperative external rotation than Group 2. Conclusions: This study demonstrated that the incidence of rotator cuff tears was much higher in shoulders with the first dislocation after 40 years compared to shoulders with the first dislocation before 40 years. Shoulders with the first dislocation before 40 years had larger glenoid bone loss, while 51% of shoulders with the first dislocation after 40 years retained bony fragments. The longer time from the initial injury to surgery might be associated with the larger glenoid bone loss and absorption of bone fragments. Both groups showed satisfactory outcomes with the low rate of complications.

scholarly journals Atelocollagen Injection Improves Tendon Integrity in Partial-Thickness Rotator Cuff Tears: A Prospective Comparative Study

2020 ◽  
Vol 8 (2) ◽  
pp. 232596712090401
Author(s):  
Jong-Ho Kim ◽  
Dong-Jin Kim ◽  
Hyo-Jin Lee ◽  
Baek-Kyu Kim ◽  
Yang-Soo Kim
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Type I ◽  
Pain Scores ◽  
Partial Thickness ◽  
Functional Scores ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Ongoing controversy surrounds the best treatment modality for partial-thickness rotator cuff tears. Purpose: To investigate the effects of atelocollagen injection in patients with small, symptomatic, intratendinous rotator cuff tears. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: From January 2014 to December 2017, 94 patients who had small, symptomatic, intratendinous rotator cuff tears were enrolled and randomly allocated to 1 of 3 groups: intratendinous injection with 0.5 mL of type I atelocollagen (group 1, n = 32), intratendinous injection with 1 mL of type I atelocollagen (group 2, n = 30), and no injection of type I atelocollagen (group 3, n = 32). American Shoulder and Elbow Surgeons score, Constant Shoulder Score, visual analog scale pain score, and range of motion were evaluated before injection; at 3, 6, and 12 months after injection; and at final follow-up. Magnetic resonance imaging (MRI) was performed at least 6 months after injection to evaluate rotator cuff integrity. Results: Demographic data did not differ significantly among the 3 groups before injection ( P > .05). The mean follow-up period was 24.7 months. The functional and pain scores in groups 1 and 2 were significantly improved at final follow-up ( P < .05). No significant improvement was seen in functional or pain scores at final follow-up in group 3 ( P > .05). Groups 1 and 2 had significantly better functional scores compared with group 3 at final follow-up ( P < .05). The proportion of patients with a decrease in size of the torn tendon on follow-up MRI at least 6 months after atelocollagen injection was significantly higher in group 1 (28.1%; P = .02) and group 2 (36.7%; P = .003) compared with group 3 (6.3%). Conclusion: Atelocollagen injection can improve the functional outcome and integrity of the tendon in intratendinous rotator cuff tears.

Equivalent Clinical Results of Arthroscopic Single-Row and Double-Row Suture Anchor Repair for Rotator Cuff Tears

2007 ◽  
Vol 35 (8) ◽  
pp. 1254-1260 ◽  
Author(s):  
Francesco Franceschi ◽  
Laura Ruzzini ◽  
Umile Giuseppe Longo ◽  
Francesca Maria Martina ◽  
Bruno Beomonte Zobel ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Suture Anchor ◽  
Rotator Cuff Tears ◽  
Double Row ◽  
Single Row ◽  
Group 2 ◽  
Cuff Repair ◽  
Repair Group ◽  
Group 1

Background Restoring the anatomical footprint may improve the healing and mechanical strength of repaired tendons. A double row of suture anchors increases the tendon-bone contact area, reconstituting a more anatomical configuration of the rotator cuff footprint. Hypothesis There is no difference in clinical and imaging outcome between single-row and double-row suture anchor technique repairs of rotator cuff tears. Study Design Randomized controlled trial; Level of evidence, 1. Methods The authors recruited 60 patients. In 30 patients, rotator cuff repair was performed with a single-row suture anchor technique (group 1). In the other 30 patients, rotator cuff repair was performed with a double-row suture anchor technique (group 2). Results Eight patients (4 in the single-row anchor repair group and 4 in the double-row anchor repair group) did not return at the final follow-up. At the 2-year follow-up, no statistically significant differences were seen with respect to the University of California, Los Angeles score and range of motion values. At 2-year follow-up, postoperative magnetic resonance arthrography in group 1 showed intact tendons in 14 patients, partial-thickness defects in 10 patients, and full-thickness defects in 2 patients. In group 2, magnetic resonance arthrography showed an intact rotator cuff in 18 patients, partial-thickness defects in 7 patients, and full-thickness defects in 1 patient. Conclusion Single- and double-row techniques provide comparable clinical outcome at 2 years. A double-row technique produces a mechanically superior construct compared with the single-row method in restoring the anatomical footprint of the rotator cuff, but these mechanical advantages do not translate into superior clinical performance.

scholarly journals Outcomes of the Latarjet Procedure for the Treatment of Chronic Anterior Shoulder Instability: Patients With Prior Arthroscopic Bankart Repair Versus Primary Cases

2019 ◽  
Vol 48 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Jean-David Werthel ◽  
Vincent Sabatier ◽  
Bradley Schoch ◽  
Lior Amsallem ◽  
Geoffroy Nourissat ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Recurrent Instability ◽  
Simple Shoulder Test ◽  
Arthroscopic Bankart Repair ◽  
Group 2 ◽  
Group 1

Background: It remains unclear whether results differ between a Latarjet procedure performed after a failed arthroscopic Bankart repair and one performed as the primary operation. Purpose: To compare the postoperative outcomes of the Latarjet procedure when performed as primary surgery and as revision for a failed arthroscopic Bankart repair. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective comparative case-cohort analysis was performed for all patients undergoing a Latarjet procedure for recurrent anterior shoulder instability. Patients were separated into 2 groups depending on if the Latarjet procedure was performed after a failed arthroscopic Bankart repair (group 1) or as the first operation (group 2). Outcome measures included recurrent instability, reoperation rates, complications, pain, Walch-Duplay scores, and Simple Shoulder Test. Results: A total of 308 patients were eligible for participation in the study; 72 (23.4%) did not answer and were considered lost to follow-up, leaving 236 patients available for analysis. Mean follow-up was 3.4 ± 0.8 years. There were 20 patients in group 1 and 216 in group 2. Despite similar rates of recurrent instability (5.0% in group 1 vs 2.3% in group 2; P = .5) and revision surgery (0% in group 1 vs 6.5% in group 2; P = .3), group 1 demonstrated significantly worse pain scores (2.56 ± 2.7 vs 1.2 ± 1.7; P = .01) and patient-reported outcomes (Walch-Duplay: 52 ± 25.1 vs 72.2 ± 25.0; P = .0007; Simple Shoulder Test: 9.3 ± 2.4 vs 10.7 ± 1.9; P = .001) when compared with those patients undergoing primary Latarjet procedures. Conclusion: Functional outcome scores and postoperative pain are significantly worse in patients undergoing a Latarjet procedure after a failed arthroscopic Bankart repair when compared with patients undergoing primary Latarjet. The assumption that a failed a Bankart repair can be revised by a Latarjet with a similar result to a primary Latarjet appears to be incorrect. Surgeons should consider these findings when deciding on the optimal surgical procedure for recurrent shoulder instability.

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.

Is It Safe to Inject Corticosteroids Into the Glenohumeral Joint After Arthroscopic Rotator Cuff Repair?

2019 ◽  
Vol 47 (7) ◽  
pp. 1694-1700 ◽  
Author(s):  
Yang-Soo Kim ◽  
Hong-Ki Jin ◽  
Hyo-Jin Lee ◽  
Hyung-Lae Cho ◽  
Wan-Seok Lee ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Significant Difference ◽  
Group 2 ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Group 1

Background: Injection of intra-articular corticosteroids is effective for improving the recovery of range of motion (ROM) and pain in various conditions of the shoulder but its use is limited after rotator cuff repair owing to concern over the possible harmful effects of steroids on the repaired tendon. Purpose: To evaluate the effect of intra-articular corticosteroid injections on the clinical outcomes and cuff integrity of patients after rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Between March 2011 and April 2014, 80 patients with a small- to medium-sized rotator cuff tear were enrolled in this study and underwent arthroscopic rotator cuff repair. Forty patients received an injection of triamcinolone (40 mg) and lidocaine (1.5 mL) into the glenohumeral joint 8 weeks after surgery (group 1), while the remaining 40 patients received normal saline injection (group 2). Outcome measures—including ROM, American Shoulder and Elbow Surgeons (ASES) score, Constant score, pain visual analog scale, and Simple Shoulder Test score—were evaluated at 3, 6, and 12 months after surgery and at the last follow-up. The integrity of the repaired tendon was evaluated by magnetic resonance imaging (MRI) and classified per Sugaya classification at 8 weeks (before injection) and 12 months after surgery. Results: The mean follow-up period was 25.7 months. At 3 months postoperatively, patients in group 1 had a significantly higher ROM with respect to forward flexion ( P = .05), external rotation at the side ( P = .05), and external rotation at abduction ( P = .04) as compared with group 2, whereas no significant difference was noted between the groups for internal rotation behind the back ( P = .65). Patients in group 1 had significantly lower visual analog scale pain scores ( P = .02) and higher ASES scores (group 1, 68.90; group 2, 60.28; P = .02) at 3-month follow-up. However, there was no significant difference after 6 months with respect to ROM and ASES scores (group 1, 77.80; group 2, 75.88; P = .33). Retears (Sugaya classification IV and V) were determined by MRI at 12 months and observed in a total of 7 patients (8.8%): 3 from group 1 (7.5%) and 4 from group 2 (10%). No retears were observed on MRI in the remaining 73 patients (91.2%): 37 patients from group 1 and 36 patients from group 2. There was no statistically significant difference in rate of retears between groups ( P = .69). Conclusion: Intra-articular injection of corticosteroids after rotator cuff repair does not increase the risk of retears and is thus an effective and safe treatment method for increasing ROM (forward flexion, external rotation) and improving clinical score (ASES) during the early postoperative period of patients undergoing rotator cuff repair.

scholarly journals How do massive immobile rotator cuff tears behave after arthroscopic interval slides? Comparison with mobile tears

Joints ◽  
2014 ◽  
Vol 02 (02) ◽  
pp. 66-70 ◽  
Author(s):  
Chiara Fossati ◽  
Paolo Arrigoni ◽  
Vincenza Ragone ◽  
Pietro Spennacchio ◽  
Giuseppe Banfi ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Constant Score ◽  
Arthroscopic Repair ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Massive Rotator Cuff Tears ◽  
Group 2 ◽  
Group 1

Purpose: the aim of this study was to compare clinical outcomes of contracted immobile massive rotator cuff tears mobilised through an arthroscopic interval slide technique versus massive mobile cuff tears directly repaired without any mobilisation. Methods: twenty-five patients who underwent arthroscopic repair for massive rotator cuff tears with a minimum of 18 months follow-up were included. The patients were retrospectively divided into two groups. In group 1, a single or double interval slide was performed to achieve adequate tendon mobilisation. In group 2 (control group), massive rotator cuff tears were arthroscopically repaired without any additional release. Patients were evaluated with validated outcomes scores: subjective and objective Constant score, a Visual Analogue Scale (VAS) for pain, and single Assessment Numeric Evaluation (SANE). Results: the two groups were comparable in terms of age, gender and involvement of the dominant arm. The mean follow-up duration was 31 months in group 1 and 28 months in group 2 (p = 0.4). The two groups showed no significant differences in SANE and VAS results (group 1: SANE 77%, VAS 1.3; group 2: SANE 88%, VAS 1.6), or in total Constant score (group1: 66.5 ± 11; group 2: 75 ± 14; p = 0.1) and subjective Constant score (Group 1: 31 ± 5; group 2: 30.8 ± 7; p = 0.9). A significant difference was found for the objective Constant score, which was higher in the control group (group 1: 35.5 ± 7; group 2: 44 ± 8; p = 0.009). Conclusions: Subjective clinical outcomes of arthroscopic repair with or without interval slides did not differ and were satisfactory. Objectively, immobile cuff tears showed inferior results.The use of interval slides might be considered a first step or an alternative to more invasive procedures for low demanding patients. Level of evidence: Level III, retrospective comparative study.

scholarly journals Metallic versus biodegradable suture anchors for rotator cuff repair: a case control study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Umile Giuseppe Longo ◽  
Stefano Petrillo ◽  
Mattia Loppini ◽  
Vincenzo Candela ◽  
Giacomo Rizzello ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
External Rotation ◽  
Suture Anchors ◽  
The Mean ◽  
Group 2 ◽  
Cuff Repair ◽  
Control Study ◽  
Shoulder Score ◽  
Group 1

Abstract Backgrounds Repair of full-thickness rotator cuff (RC) tears is routinely performed using suture anchors, which produce secure and effective soft tissue fixation to bone. The aim of this prospective study is to compare the long-term outcomes of single row arthroscopic rotator cuff repair (RCR) performed using metal or biodegradable suture anchors. The null hypothesis is that there is no difference in shoulder function using metal or biodegradable suture anchors as evaluated by UCLA shoulder score, Wolfgang criteria, and Oxford shoulder score. Methods Arthroscopic RCR was performed in 110 patients included in this case control study. They were divided into 2 groups of 51 and 59 patients respectively. Metal suture anchors were used in group 1, and biodegradable suture anchors in group 2. Results were obtained at a mean follow up of 4.05 + 2 years. Clinical outcomes and functional outcomes were evaluated. Results The mean modified UCLA shoulder score was 26.9 + 7.1 in group 1, and 27.7 + 6.5 in group 2 (P = 0.5); the mean Wolfgang score was 13.3 + 3.3 in group 1, and 14 + 2.6 in group 2 (P = 0.3); the mean OSS was 23.7 + 11.4 in group 1, and 20.7 + 9.2 points in group 2 (P = 0.1). The mean active anterior elevation was 163.5° + 28.2° in group 1 and 163.6° + 26.9 in group 2 (P = 0.9); the mean active external rotation was 46° + 19.7° in group 1 and 44.6° + 16.3° in group 2 (P = 0.7). The mean strength in anterior elevation was 4.8.02 + 23.52 N in group 1, and 43.12 + 17.64 N in group 2 (P = 0.2); the mean strength in external rotation was 48.02 + 22.54 N in group 1 and 46.06 + 17.64 N in group 2 (P = 0.6); the mean strength in internal rotation was 67.62 + 29.4 N in group 1, and 68.6 + 25.48 N in group 2 (P = 0.9). Conclusions There are no statistically significant differences at a mean follow-up of 4.05 + 2 years in clinical and functional outcomes of single row arthroscopic RCR using metallic or biodegradable suture anchors for RC < 5 cm.

Evaluating the Outcomes of Rotator Cuff Repairs With Polytetrafluoroethylene Patches for Massive and Irreparable Rotator Cuff Tears With a Minimum 2-Year Follow-up

2018 ◽  
Vol 46 (13) ◽  
pp. 3155-3164 ◽  
Author(s):  
Vasanth Seker ◽  
Lisa Hackett ◽  
Patrick H. Lam ◽  
George A.C. Murrell
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
External Rotation ◽  
Case Series ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Irreparable Tear ◽  
Pain At Rest

Background: Massive and irreparable rotator cuff tears are difficult to manage surgically. One technique is to use a synthetic polytetrafluoroethylene (PTFE) patch to bridge the tear. However, there is little information regarding the outcomes of this procedure. Purpose: To determine the ≥2-year outcomes of patients for whom synthetic patches were used as tendon substitutes to bridge irreparable rotator cuff defects. Study Design: Case series; Level of evidence, 4. Methods: This retrospective cohort study used prospectively collected data. Patients included those with a synthetic patch inserted as an interposition graft for large and/or irreparable rotator cuff tears with a minimum 2-year follow-up. Standardized assessment of shoulder pain, function, range of motion, and strength was performed preoperatively, at 6 and 12 weeks, and at 6 months and ≥2 years. Radiograph and ultrasound were performed preoperatively, at 6 months, and ≥2 years. Results: At a mean of 36 months, 58 of 68 eligible patients were followed up, and 53 of 58 (90%) patches remained in situ. Three patches failed at the patch-tendon interface, while 1 patient (2 shoulders/patches) went on to have reverse total shoulder replacements. Patient-ranked shoulder stiffness ( P < .001), frequency of pain with activity and sleep ( P < .0001), level of pain at rest and overhead ( P < .0001), and overall shoulder function improved from bad to very good ( P < .0001) by 6 months. Supraspinatus (mean ± SEM: 29 ± 16 N to 42 ± 13 N) and external rotation (39 ± 13 N to 59 ± 15 N) strength were the most notable increases at the ≥2-year follow-up ( P < .0001). Passive range of motion also improved by 49% to 67%; forward flexion, from 131° to 171°; abduction, from 117° to 161°; external rotation, from 38° to 55°; and internal rotation, from L3 to T10 ( P < .0001) preoperatively to ≥2 years. The most improvement in passive range of motion occurred between 12 months and ≥2 years. The mean (SD) Constant-Murley score was 90 (12), while the American Shoulder and Elbow Surgeons score was 95 (8). Conclusion: At 36 months postoperatively, patients who had synthetic patches used as tendon substitutes to bridge irreparable rotator cuff defects reported less pain and greater overall shoulder function as compared with preoperative assessments. They demonstrated improved range of passive motion and improved strength. The data support the hypothesis that the technique of using a synthetic PTFE patch to bridge a large and/or irreparable tear has good construct integrity and improves patient and clinical outcomes.

scholarly journals Arthroscopic knotless single-row repair preserving full footprint versus tear completion repair for partial articular-sided rotator cuff tear

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901877089 ◽  
Author(s):  
Cen Tao Liu ◽  
Heng an Ge ◽  
Rui Hu ◽  
Jing Biao Huang ◽  
Yi Chao Cheng ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Pain Score ◽  
Operation Time ◽  
Clinical Results ◽  
Rotator Cuff Tears ◽  
Single Row ◽  
Repair Technique ◽  
Randomized Controlled Studies ◽  
Group 2 ◽  
Group 1

Background: The comparison of clinical outcomes of arthroscopic footprint-preserving knotless single-row repair with the tear completion repair technique for articular-sided partial-thickness rotator cuff tears (PTRCTs) remains unclear. Methods: A total of 68 patients diagnosed with articular-sided PTRCTs who underwent rotator cuff repair between December 2014 and June 2015 were included. Of the 68 patients, 30 received footprint-preserving knotless single-row repair (group 1) and 38 received the tear completion repair technique (group 2). Preoperative and postoperative assessments were compared. Results: Both groups had significantly improved American Shoulder and Elbow Surgeons (ASES) scores (group 1: 48.2 preoperatively to 81.9 postoperatively, p < 0.001; group 2: 47.1 preoperatively to 84.9 postoperatively, p < 0.001) and visual analog scale (VAS) pain score (group 1: 6.0 preoperatively to 0.93 postoperatively, p < 0.001; group 2: 6.1 preoperatively to 1.1 postoperatively, p < 0.001), showing that the two procedures significantly improved postoperative shoulder function. No significant differences were shown in ASES score or VAS pain score between the two groups ( p > 0.05). The mean operation time was significantly shorter in group 1 with an average of 48.1 min than in group 2 with an average of 60.4 min ( p < 0.001). Conclusions: Footprint-preserving knotless single-row repair obtains similar clinical results compared to tear completion repair in the treatment of articular-sided PTRCTs. Footprint-preserving knotless single-row repair may be a convenient choice for the treatment of articular-sided PTRCTs. Randomized controlled studies are needed to investigate whether the footprint-preserving knotless single-row repair yields better long-term outcomes through the protection of the bursal cuff and restoration of the healthy footprint.

Management of Massive Rotator Cuff Tears in Active Patients with Minimal Glenohumeral Arthritis: A Prospective Observational Study with Clinical and Radiographic Analyses of Reconstruction using Dermal Tissue Matrix Xenograft

2013 ◽  
Vol 3 (1) ◽  
pp. 80-87
Author(s):  
Alison P Toth ◽  
Anil K Gupta
Keyword(s):  
Rotator Cuff ◽  
Observational Study ◽  
Prospective Observational Study ◽  
External Rotation ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears ◽  
Dermal Tissue ◽  
Tissue Matrix ◽  
Rotation Strength

ABSTRACT Objectives To evaluate the clinical and radiographic outcomes of patients undergoing interposition reconstruction of massive, otherwise irreparable rotator cuff tears through a mini-open approach with the use of a porcine dermal tissue matrix. Materials and methods We performed a prospective observational study of 26 patients (27 shoulders) who underwent reconstruction of massive rotator cuff tears using dermal tissue matrix xenograft. Pain level (scale 0-10, 10 = severe pain), active range of motion, and supraspinatus and external rotation strength were assessed. Additional outcome measures included modified American shoulder and elbow score (MASES) and short form-12 (SF-12) score. Clinical and radiographic analyses were performed at an average 32 months follow-up period (minimum 2-year follow-up). Ultrasound imaging (static and dynamic) of the operative shoulder was performed at final followup to assess the integrity of the reconstruction. Results Mean patient age was 60. Mean pain level decreased from 5.1 to 0.4 (p = 0.002). Mean active forward flexion, abduction, and external rotation motion improved from 138.8 to 167.3 (p = 0.024), 117.9 to 149.3 (p = 0.001) and 57.7 to 64.7° (p = 0.31), respectively. Supraspinatus and external rotation strength improved from 7.2 to 9.4 (p = 0.001) and 7.4 to 9.5 (p = 0.001), respectively. Mean MASES improved from 62.7 to 91.8 (p = 0.0007) and mean SF-12 scores improved from 48.4 to 56.6 (p = 0.044). Twenty-one patients (twenty-two shoulders) returned for a dynamic and static ultrasound of the operative shoulder at a minimum 2-year follow-up. Sixteen (73%) demonstrated a fully intact tendon/graft reconstruction. Five (22%) patients had partially intact reconstructions, and one (5%) had a complete tear at the graft-bone interface due to suture anchor pullout as a result of a fall. There were no cases of infection or tissue rejection. Conclusion We present a reproducible surgical technique for the management of massive irreparable rotator cuff tears. In our series, patients demonstrated a significant improvement in both subjective and objective clinical outcomes. Radiographic analysis demonstrated that the majority of patients had a fully intact reconstruction at a minimum 2-year follow-up. Gupta AK, Toth AP. Management of Massive Rotator Cuff Tears in Active Patients with Minimal Glenohumeral Arthritis: A Prospective Observational Study with Clinical and Radiographic Analyses of Reconstruction using Dermal Tissue Matrix Xenograft. The Duke Orthop J 2013;3(1):80-87.

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