Experience of a second attempt at surgical repair of a failed initial rotator-cuff repair.

Objectives: While rotator cuff pathology may be amenable to conservative therapy, patients with full thickness tears not improving with non-operative treatment are indicated for repair. The decision to undergo surgery is often multifactorial with pain, loss of function, and concern for progression all factoring in the decision-making process. The purpose of this investigation was to evaluate patients main determining factors in deciding to have surgery for their rotator cuff tear, correlate these factors with strength of surgeon recommendation and clinical outcomes. Methods: One hundred and fifty patients undergoing arthroscopic rotator cuff repair (ARCR) were enrolled prospectively. Patients received a questionnaire preoperatively to determine why they decided to proceed with surgical repair. This 13-question survey was developed based on evidence-based review of rotator cuff repair literature and the Delphi technique. Patients were asked to rate each factor with regard to importance in their decision to proceed with repair. Surgeons were given a similar Likert Scale and were queried on how strongly they would recommend surgery for their patients based upon various factors such as MRI findings, age, etc. Pre- and post-operative shoulder function was assessed with the American Shoulder and Elbow Society (ASES) Score. Descriptive statistics were used to evaluate the reasons to proceed with surgery and correlated with outcomes based on ASES scores. Results: The most influential patient reported factors for proceeding with surgical repair were: limited functionality of the shoulder (81%), surgeon recommendation (80%), and daily chronic pain (77%). Patients improved from 42.6 to 77.0 on the ASES from baseline to 6-months (p<0.001). Patients who listed that they were unable to play a favorite sport or hobby as their top reason for surgery demonstrated a significant increase in their ASES score relative to other factors at the 3 month time point (p=0.0014); otherwise, there was no significant difference in outcomes for any other time point based on category importance. Subgroup analysis of males and females and older v. younger patients demonstrated significant findings. Females were more likely to proceed with repair due to inability to sleep and daily, chronic pain (p<.005) relative to males. Younger patients were more likely to proceed with repair for the inability to play a sport/hobby and increased demands of work relative to older patients (p<.005). There was no correlation between any decision factor and final outcome of ASES scores. Younger patients and male patients both demonstrated higher baseline ASES scores (p<.05); however, there was no difference in outcome measures at final follow-up. Conclusion: Prior studies have shown that rotator cuff repair is best at alleviating pain for full thickness rotator cuff tears and may not be as impactful for improving function. Despite this evidence, the majority of patients undergoing rotator cuff repair in our study did so to improve function of their shoulder. While pain, inability to sleep, and inability to participate in ones favorite hobby/sport were important to our patient population, a strong surgeon recommendation had no correlation with our patients decision to proceed with repair. Surgeons should be mindful of these differences between gender and age when counseling patients pre-operatively. Outcomes of ARCR do not appear to be determined by pre-operative decision making on the part of the patient.

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Stem cell application in rotator cuff repair: Interposition stem cell sheet versus overlaid stem cell sheet

10.21203/rs.3.rs-25042/v1 ◽

2020 ◽

Author(s):

Jae hee Choi ◽

Michael Seungcheol Kang ◽

Myung Jin Shin ◽

Dong Min Kim ◽

Yu Na Lee ◽

...

Keyword(s):

Stem Cells ◽

Stem Cell ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Surgical Repair ◽

Cell Sheet ◽

Biomechanical Analysis ◽

Control Group ◽

Cell Sheets ◽

Cuff Repair

Abstract Background Stem cells are an effective method of biologic healing and can be used to enhance the natural enthesis of the tendon-to-bone junction in rotator cuff repair. The purpose of this study was to investigate if the application of engineered stem cell sheets using adipose-derived cells (ADSCs) was effective in regeneration of natural enthesis and if there was a difference in the result of repair depending on the applied location Methods A chronic rotator cuff tear model was induced for 2 weeks, and cell sheets made using ADSCs isolated from rats were transplanted into the tendon-to-bone junction during surgical repair. Depending on the transplant location of the cell sheet, the difference in rotator cuff healing level between the overlaid group and the interposition group was compared to the surgical repair only group. The samples were obtained based on the tendon-to-bone junction and analysis of gross morphology, histology staining, and biomechanical analysis were performed. Results The differentiation potentials of ADSCs as stem cells were confirmed, as was the potential for tenogenic differentiation by growth factors. ADSCs were prepared as a sheet form to maintain the shape at the target site and to be easily attached. GFP-expressing ADSCs were proliferated in vivo and observed at the transplantation site. The overall healing level was better in the cell sheet transplanted group than in the control group that surgical repair only. Additionally, differences in healing level were shown depending on the cell sheet location by morphological, histological, and biomechanical perspectives. Histological results showed that the interposition transplantation group (1.75 ± 0.43, P = 0.004) showed better fibrocartilage formation and collagen orientation at the junction than the overlaid transplantation group (0.86 ± 0.83). Conclusion In the chronic rotator cuff repair model, the engineered stem cell sheets enhanced the regeneration of the tendon-to-bone junction. This regeneration was more effective when the stem cell sheet was interpositioned at the tendon-to-bone interface. Trial registration: Not applicable

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Delaminated Rotator Cuff Tear: Concurrent Concept and Treatment

Clinics in Shoulder and Elbow ◽

10.5397/cise.2019.22.3.159 ◽

2019 ◽

Vol 22 (3) ◽

pp. 159-170

Author(s):

Jung-Han Kim ◽

Soo-Hwan Jung

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Rotator Cuff Repair ◽

Surgical Repair ◽

Recent Literature ◽

Poor Prognostic Factor ◽

Rotator Cuff Tendon ◽

Cuff Tear ◽

Cuff Repair ◽

Repair Techniques

Delaminated rotator cuff tear pertains to the horizontal split of the tendon substance. As reported previously, the presence of a delaminated tear and incidence of delaminated rotator cuff tear ranges from 38% to 92%. The different strain intensities applied across the rotator cuff tendon, and the shear stress between the bursal and articular layers seem to play a role in its pathogenesis. In a delaminated rotator cuff tear, the degree and direction of retraction between two layers differ, with accompanying intrasubstance cleavage. A surgeon therefore needs to consider and carefully evaluate the tear characteristics when repairing delaminated rotator cuff tear. Delaminated rotator cuff tear is considered to be a poor prognostic factor after rotator cuff repair, but numerous surgical repair techniques have been introduced and applied to resolve this problem. Recent literature has reported good clinical outcomes after delaminated rotator cuff repair.

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Surgical repairs of the Rotator Cuff Tears

Annals of King Edward Medical University ◽

10.21649/akemu.v8i1.1629 ◽

2017 ◽

Vol 8 (1) ◽

Author(s):

S M H Jafri ◽

W A Khan ◽

M Pervaiz ◽

A Ghaffar ◽

S Raziq

Keyword(s):

Pain Relief ◽

Rotator Cuff ◽

Old Age ◽

Rotator Cuff Repair ◽

Surgical Repair ◽

Senior Author ◽

Rotator Cuff Tears ◽

Cuff Repair ◽

Cause Of Pain

Evaluation of 15 cases who underwent surgical rotator cuff repair is presented. This study extends from 1995 to 2001. Cases operated by senior author have been included in this study. The follow up ranges from 9 months to 4 years. Evaluation includes study as regard to pain relief, range of motion and strength achieved after surgery. In all cases acromion- plasty was done. Rotator cuff problem is a well-know cause of pain and disability in shoulder especially in old age. Good results after surgical repair of rupture rotator cuff have been well documented. To our best knowledge this is the first study in this country about results of surgical rotator cuff repair.

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When Should We Repair Partial-Thickness Rotator Cuff Tears? Outcome Comparison Between Immediate Surgical Repair Versus Delayed Repair After 6-Month Period of Nonsurgical Treatment

The American Journal of Sports Medicine ◽

10.1177/0363546518757425 ◽

2018 ◽

Vol 46 (5) ◽

pp. 1091-1096 ◽

Cited By ~ 10

Author(s):

Yang-Soo Kim ◽

Hyo-Jin Lee ◽

Jong-Ho Kim ◽

Dong-Young Noh

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Surgical Repair ◽

Nonoperative Treatment ◽

Rotator Cuff Tears ◽

Delayed Repair ◽

Group 2 ◽

Cuff Repair ◽

Repair Group ◽

Group 1

Background: Patients with partial-thickness rotator cuff tears (PTRCTs) can be treated nonoperatively and/or undergo operative treatment, but the ideal time for surgical intervention is unclear. Purpose: To compare the results of immediate arthroscopic rotator cuff repair with repair after 6 months of nonoperative care of PTRCTs involving more than 50% of the tendon thickness. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: The authors prospectively randomized and analyzed 78 consecutive patients diagnosed with either isolated bursal-side or articular-side PTRCTs (supraspinatus only). Group 1 (n = 44) received immediate rotator cuff repair. Group 2 (n = 34) received delayed rotator cuff repair after 6 months of nonoperative treatment. The American Shoulder and Elbow Surgeons (ASES) Score, Constant score, visual analog scale (VAS) for pain, and range of motion at initial visit; months 3, 6, and 12 postoperatively; and the last visit after 24 months were used for the evaluation. Cuff integrity was assessed with magnetic resonance imaging at 12 months postoperatively. Results: There were no significant differences in age, sex (18/26 vs 13/21, male/female), symptom duration, composition of PTRCTs, or clinical outcomes between groups 1 and 2 ( P > .05). In group 2, 10 patients voluntarily dropped out from the study due to improvement of symptoms during the 6 months of preoperative nonoperative treatment. The mean follow-up period in groups 1 and 2 was 31.9 ± 1.5 months and 37.0 ± 2.2 months, respectively. At the end of the study, both groups showed significant improvements in terms of functional scores and pain VAS scores compared with the initial period. There were no significant differences between the 2 groups, except for lower pain VAS score and higher ASES Score in group 2 at 6 months postoperatively. At 12 months postoperatively, 1 patient from group 1 and 2 patients from group 2 experienced a retear. Conclusion: Both immediate surgical repair and delayed repair after nonsurgical care for PTRCTs were effective in improving clinical outcomes, and there was a very low incidence of retears in both groups. However, at 6 months postoperatively, superior functional outcomes were observed in the delayed repair group compared with the immediate repair group. A trial period of preoperative nonsurgical care is reasonable, and immediate surgical repair is not crucial for the treatment of PTRCT.

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