scholarly journals Clinical Outcomes and Repair Integrity after Arthroscopic Full-thickness Rotator Cuff Repair: Traditional Suture-bridge Versus Novel Modified Suture-bridge Technique

2021 ◽  
Author(s):  
Zengshuai Han ◽  
Wenru Ma ◽  
Dongfang Zhang ◽  
Yi Zhang ◽  
Chao Qi ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Scale Score ◽  
Full Thickness ◽  
Suture Bridge ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Suture Bridge Technique

Abstract Background: This prospective study compared the clinical and radiologic outcomes of patients who underwent arthroscopic rotator cuff repairs by the traditional suture bridge technique and the modified suture bridge technique.Methods: From December 2018 to December 2019, 50 consecutive cases of full-thickness medium rotator cuff tear, 1 to 3 cm in the coronal plane, for which arthroscopic rotator cuff repair was performed, were included. The TSB technique was used in 24 consecutive shoulders; and the MSB technique, in 26 consecutive shoulders. Clinical outcomes at 3 months, 6 months and a minimum of 1 years (mean, 11.92±1.92months) were evaluated postoperatively using range of shoulder, the visual analog scale score; University of California Los Angeles Shoulder Scale score; Constant-Murley shoulder score and American Shoulder and Elbow Surgeons Subjective Shoulder Scale score. All patients underwent preoperative MRI and B-US to identify the rotator cuff tear, and postoperatively at final follow-up to evaluate tendon integrity. Results: At the final follow-up, the clinical outcomes improved in both groups. There were no significant differences in the results of the ROM between the two groups at 3 months, 6 months and the final follow-up. The average VAS score decreased from 6.12±0.95 to 1.04±0.45 in MSB Group and decreased from 6.29±0.91 to 1.33±0.48 at the final follow-up in TSB Group. The VAS score significantly differed between the two groups only at the final follow-up (P=0.03). The mean UCLA score increased from 12.23±3.47 to 30.96±2.54 in MSB Group and increased from 11.50±4.00 to 28.79±4.47 in TSB Group at the final follow-up; the mean Constant shoulder score increased from 40.54±5.61 to 92.08±7.21 in MSB Group and increased from 41.79±5.51 to 86.96±8.42 in TSB Group at the final follow-up. The average ASES score increased from 36.04±2.47 to 96.04±7.28 in MSB Group and increased from 35.04±3.10 to 91.50±7.33 in TSB Group at the final follow-up. The UCLA (P=0.044), Constant (P=0.025), ASES (P=0.033) score significantly differed between the two groups only at the final follow-up. At the final follow-up postoperatively, the MRI assessments showed no retear in MSB Group and two retears in TSB Group (8%)(Z=-1.538, P=0.124), B-US assessments showed no retear in MSB Group and one retear in TSB Group (4%)(Z=-1.169, P=0.242). No significant difference was found between the 2 groups regarding cuff integrity in accordance with MRI assessments and B-US assessmentsConclusion: For medium-sized RCTs, the patients who underwent MSB repair had shown better shoulder functional outcomes and a lower but not significant re-tear rate with those who underwent TSB repair. Therefore, the MSB repair technique can be considered an effective treatment for patients with medium-sized full-thickness RCTs.ClinicalTrials.gov Identifier: NCT04825249 Level of evidence: A prospective study, Level II.

Longitudinal Long-term Magnetic Resonance Imaging and Clinical Follow-up After Single-Row Arthroscopic Rotator Cuff Repair: Clinical Superiority of Structural Tendon Integrity

2017 ◽  
Vol 45 (6) ◽  
pp. 1283-1288 ◽  
Author(s):  
Philipp R. Heuberer ◽  
Daniel Smolen ◽  
Leo Pauzenberger ◽  
Fabian Plachel ◽  
Sylvia Salem ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Full Thickness ◽  
Constant Strength ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: The number of arthroscopic rotator cuff surgeries is consistently increasing. Although generally considered successful, the reported number of retears after rotator cuff repair is substantial. Short-term clinical outcomes are reported to be rarely impaired by tendon retears, whereas to our knowledge, there is no study documenting long-term clinical outcomes and tendon integrity after arthroscopic rotator cuff repair. Purpose: To investigate longitudinal long-term repair integrity and clinical outcomes after arthroscopic rotator cuff reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Thirty patients who underwent arthroscopic rotator cuff repair with suture anchors for a full-tendon full-thickness tear of the supraspinatus or a partial-tendon full-thickness tear of the infraspinatus were included. Two and 10 years after initial arthroscopic surgery, tendon integrity was analyzed using magnetic resonance imaging (MRI). The University of California, Los Angeles (UCLA) score and Constant score as well as subjective questions regarding satisfaction with the procedure and return to normal activity were used to evaluate short- and long-term outcomes. Results: At the early MRI follow-up, 42% of patients showed a full-thickness rerupture, while 25% had a partial rerupture, and 33% of tendons remained intact. The 10-year MRI follow-up (129 ± 11 months) showed 50% with a total rerupture, while the other half of the tendons were partially reruptured (25%) or intact (25%). The UCLA and Constant scores significantly improved from preoperatively (UCLA total: 50.6% ± 20.2%; Constant total: 44.7 ± 10.5 points) to 2 years (UCLA total: 91.4% ± 16.0% [ P < .001]; Constant total: 87.8 ± 15.3 points [ P < .001]) and remained significantly higher after 10 years (UCLA total: 89.7% ± 15.9% [ P < .001]; Constant total: 77.5 ± 15.6 points [ P < .001]). The Constant total score and Constant strength subscore, but not the UCLA score, were also significantly better at 10 years postoperatively in patients with intact tendons compared with patients with retorn tendons (Constant total: 89.0 ± 7.8 points vs 75.7 ± 14.1 points, respectively [ P = .034]; Constant strength: 18.0 ± 4.9 points vs 9.2 ± 5.2 points, respectively [ P = .006]). The majority of patients rated their satisfaction with the procedure as “excellent” (83.3%), and 87.5% returned to their normal daily activities. Conclusion: Arthroscopic rotator cuff repair showed good clinical long-term results despite a high rate of retears. Nonetheless, intact tendons provided significantly superior clinical long-term outcomes, making the improvement of tendon healing and repair integrity important goals of future research efforts.

Does an Injection of Adipose-Derived Mesenchymal Stem Cells Loaded in Fibrin Glue Influence Rotator Cuff Repair Outcomes? A Clinical and Magnetic Resonance Imaging Study

2017 ◽  
Vol 45 (9) ◽  
pp. 2010-2018 ◽  
Author(s):  
Yong Sang Kim ◽  
Chang Hun Sung ◽  
Sung Hoon Chung ◽  
Sang Joon Kwak ◽  
Yong Gon Koh
Keyword(s):  
Rotator Cuff ◽  
Fibrin Glue ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Conventional Group ◽  
Injection Group ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: The mesenchymal stem cell (MSC)–based tissue engineering approach has been developed to improve the treatment of rotator cuff tears. Hypothesis/Purpose: The purpose was to determine the effect of an injection of adipose-derived MSCs loaded in fibrin glue during arthroscopic rotator cuff repair on clinical outcomes and to evaluate its effect on structural integrity using magnetic resonance imaging (MRI). The hypothesis was that the application of adipose-derived MSCs would improve outcomes after the surgical repair of a rotator cuff tear. Study Design: Cohort study; Level of evidence, 3. Methods: Among 182 patients treated with arthroscopic surgery for a rotator cuff tear, 35 patients treated with arthroscopic rotator cuff repair alone (conventional group) were matched with 35 patients who underwent arthroscopic rotator cuff repair with an injection of adipose-derived MSCs loaded in fibrin glue (injection group) based on sex, age, and lesion size. Outcomes were assessed with respect to the visual analog scale (VAS) for pain, range of motion (ROM) (including forward flexion, external rotation at the side, and internal rotation at the back), and functional measures of the Constant score and University of California, Los Angeles (UCLA) shoulder rating scale. Repaired tendon structural integrity was assessed by using MRI at a minimum of 12 months after surgery, and the mean clinical follow-up was 28.8 ± 4.2 months in the conventional group and 28.3 ± 3.8 months in the injection group. Results: The mean VAS score at rest and during motion improved significantly in both groups after surgery. However, there were no significant differences between the groups at the final follow-up ( P = .256 and .776, respectively). Compared with preoperative measurements, forward flexion and external rotation at the side significantly improved at the final follow-up in both groups (all P < .05). However, no significant improvements in internal rotation at the back were observed in either group ( P = .625 and .834 for the conventional and injection groups, respectively). There were also no significant differences between the groups at the final follow-up for any of the 3 ROM positions (all P > .05). The mean Constant score and UCLA score improved significantly in both groups after surgery, but there were no significant differences between the groups at the final follow-up ( P = .634 and .302, respectively). MRI indicated a retear rate of 28.5% in the conventional group and 14.3% in the injection group ( P < .001). Conclusion: This study revealed that an injection of adipose-derived MSCs loaded in fibrin glue during rotator cuff repair could significantly improve structural outcomes in terms of the retear rate. There were, however, no clinical differences in the 28-month period of follow-up. Although still in the early stages of application, MSC augmentation of surgical rotator cuff repair appears useful for providing an adequate biological environment around the repair site.

scholarly journals Sex-Based Differences in Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988195
Author(s):  
Stephen D. Daniels ◽  
Cory M. Stewart ◽  
Kirsten D. Garvey ◽  
Emily M. Brook ◽  
Laurence D. Higgins ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcomes ◽  
Surgical Techniques ◽  
Arthroscopic Rotator Cuff Repair ◽  
Patient Reported ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Rotator cuff repair is one of the most common surgical procedures performed on the shoulder. Previous studies have indicated that pain and disability can vary significantly between patients with similarly appearing rotator cuff tears on diagnostic imaging. Prior literature has compared functional outcomes between operative and nonoperative treatments as well as variability in surgical techniques. However, few studies have examined postoperative outcomes based on patient factors such as sex. Purpose: To compare patient-reported outcomes after rotator cuff repair between men and women. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 283 patients (153 male, 130 female) who underwent primary arthroscopic rotator cuff repair were included in this study; of those, 275 patients (97.2%) completed 1-year follow-up. Patient-reported pain visual analog scale (VAS), Veterans RAND 12-item Health Survey (VR-12 mental and physical components), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE) scores were collected preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year postoperatively using an electronic outcomes system. Results: Women reported higher VAS pain scores when compared with men preoperatively ( P < .01) and at 2 weeks ( P < .01), 6 weeks ( P < .01), and 3 months ( P = .02) postoperatively. Additionally, women experienced a greater overall change in the mean VAS score preoperatively when compared with 1 year postoperatively ( P < .01). The use of narcotic pain medication 2 weeks after surgery was greater in women ( P = .032). Women had significantly lower preoperative VR-12 mental scores ( P = .03) and experienced a greater increase in the mean VR-12 mental score preoperatively when compared with 1 year postoperatively ( P < .01). Men had higher ASES scores preoperatively ( P < .01) and at 3 months postoperatively ( P < .01). Women experienced a greater overall change in the ASES score preoperatively when compared with 1 year postoperatively ( P < .01). Conclusion: Women reported greater pain and decreased shoulder function compared with men during the initial 3 months after arthroscopic rotator cuff repair. There were no sex-based differences in patient-reported outcomes at 1-year follow-up. The results of this study indicate that there are sex-related differences in the early postoperative recovery of patients undergoing rotator cuff repair, contributing to postoperative expectations for both clinicians and patients alike.

Arthroscopic Rotator Cuff Repair Using Modified Mason-Allen Medial Row Stitch

2012 ◽  
Vol 40 (11) ◽  
pp. 2440-2447 ◽  
Author(s):  
Yong Girl Rhee ◽  
Nam Su Cho ◽  
Chong Suck Parke
Keyword(s):  
Rotator Cuff ◽  
Clinical Results ◽  
Rotator Cuff Tears ◽  
Knot Tying ◽  
Suture Bridge ◽  
Group A ◽  
Group B ◽  
Arthroscopic Rotator Cuff ◽  
Suture Bridge Technique

Background: When using a method of suture bridge technique, there may be a possibility of strangulation of the rotator cuff tendon at the medial row. The style of knots chosen to secure the medial row might conceivably be a factor to reduce this possibility. Purpose: To compare the clinical results and repair integrity of arthroscopic rotator cuff repair between a knotless and a conventional knot-tying suture bridge technique for patients with full-thickness rotator cuff tears and to evaluate retear patterns in the cases with structural failure after arthroscopic repair by magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 2. Methods: After arthroscopic repair for medium-sized rotator cuff tears, 110 patients available for postoperative MRI evaluation at least 6 months were enrolled in this study. According to the repair technique, 51 shoulders were enrolled in a knotless suture bridge technique group (group A) and 59 shoulders in a conventional knot-tying suture bridge technique group (group B). The mean age at the time of the operation was 61.0 years (range, 44-68 years) in group A and 57.6 years (range, 45-70 years) in group B. The mean follow-up period was 21.2 months (range, 12-34 months) and 22.1 months (range, 13-32 months), respectively. Results: The Constant score of group A increased from the preoperative mean of 65.2 points to 79.1 points at the last follow-up ( P < .001). The corresponding figures for group B improved from 66.6 points to 76.3 points ( P < .001). The preoperative Shoulder Rating Scale of the University of California at Los Angeles (UCLA) score was 21.1 points in group A and 18.3 points in group B. The UCLA score at the last follow-up was 31.0 points in group A and 27.9 points in group B ( P < .001, P < .001). Retear rate was significantly lower in group A (5.9%) than group B (18.6%) ( P < .001). In group B, retear occurred at the musculotendinous junction in 72.7%, but group A had no medial cuff failure. Conclusion: In arthroscopic suture bridge repair of full-thickness rotator cuff tears, clinical results of both a knotless and a conventional knot-tying group showed improvement without significant difference between the 2 groups. However, the knotless group had a significantly lower retear rate compared with the conventional knot-tying group. A knotless suture bridge technique could be a new supplementary repair technique to conventional technique.

scholarly journals Five Years Follow-up After Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique: Evaluation of the Retear Rate and the Impairment of the Shoulder Function

2020 ◽  
Author(s):  
Zhang Sheng ◽  
Shi Huisheng ◽  
Liu Xiaohua ◽  
Wang Zheng ◽  
Li Yan ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Muscle Strength ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Suture Bridge ◽  
The Difference ◽  
Arthroscopic Rotator Cuff ◽  
Retear Rate

Abstract Purpose: To evaluate the retear rate after arthroscopic rotator cuff repair using a suture bridge (SB) technique for patients with full thickness rotator cuff tears and whether the non- healing cuff impaired the shoulder function.Methods: From January 2013 to January 2014, 92 patients in our institution underwent arthroscopic double-row suture bridge repair for the treatment of full-thickness rotator cuff tear 55 patients who have completed the 5 years follow-up were enrolled in this study. There were 36 female and 19 male patients, and the average age was 58.6 years (range, 41- 70 years). The tears were classified into small (<1 cm), medium (1-3 cm), large (3-5 cm), and massive (> 5 cm) according to the classification of DeOrio and Cofield. According to the intraoperative measurement, small tears were found in 5 shoulders (9%), medium tears in 19 shoulders (34.5%), large tears in 23 shoulders (41.8%), and massive tears in 8 shoulders (14.5%). The mean follow-up was 71.2 months (range, 66-78 months). Post-operative cuff integrity was evaluated with ultrasound (US) according to the published literature which was comparable to Sugaya MRI classification. Types I-III indicated cuff healing and types IV or V indicated retear. The retear patterns were divided into type 1 (failure at the original repair site) or 2 (failure around the medial row). At baseline and final follow-up, shoulder functional outcomes were measured using validated, shoulder-specific outcome scores, including the Constant-Murley score (CS) and the American Shoulder and Elbow Score (ASES). The difference in abduction muscle strength was also evaluated between the integrity and the retear group.Results: At final follow-up, the rotator cuff was completely healed in 45 of the 55 shoulders. There were recurrent tears in 10 shoulders, and the retear rate was 18.2%. The type 1 re- tear pattern was found in 4 shoulders (40%), and type 2 in 6 shoulders (60%). The Constant and ASES scores improved from 41.00 to 92.00, and from 41.33 to 88.00, respectively. The mean differences in shoulder scaption strength between the healing and the retear group were 1.1±0.82Kg and 3.0±0.88Kg respectively. The difference in muscle strength between the retear and the healing group was statistically significant (p<0.001).Conclusion: Arthroscopic suture bridge repair of full-thickness rotator cuff tears led to excellent improvement in shoulder function, but maintained a high retear rate. Although the retear group had inferior muscle strength, the patients were still satisfied, and shoulder function was improved due to pain relief. Whether such changes in muscle strength impair patients' long-term quality of life and shoulder function remains to be discussed.Level of evidence IV

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