|
1
|
Rinaldi VG, Iacopo S, Coliva F, Favero A, Bazzocchi A, Miceli M, Di Paolo S, Zaffagnini S, Marcheggiani Muccioli GM. Double-row suture-bridge technique does not yield better clinical and radiological results than single-row technique in patients older than 55 years at 2 years minimum follow-up: A comparative study. J Exp Orthop 2025; 12:e70056. [PMID: 40330814 PMCID: PMC12053094 DOI: 10.1002/jeo2.70056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/02/2024] [Accepted: 08/07/2024] [Indexed: 05/08/2025] Open
Abstract
Purpose Arthroscopic rotator cuff repair has evolved, with suture anchor-based techniques like single-row (SR) and Double-row Suture-bridge (DRSB) gaining popularity. Despite improvements, early repair failures remain concerning, necessitating continued assessment of repair methods and devices' lasting impact. This study compares DRSB versus SR repairs at 24 months minimum follow-up, hypothesizing superior clinical outcomes and improved tendon healing with DRSB techniques. Methods Fifty patients with rotator cuff tears underwent either SR or DRSB repairs. Clinical evaluation included standardized scoring systems and strength testing. Magnetic Resonance Imaging (MRI) assessed tendon integrity. Partial cuff tears were evaluated according to Snyder's Southern California Orthopaedic Institute rotator cuff classification system, which classifies <2 cm lesions as C2 in its scoring system. Results Both groups showed comparable clinical outcomes, strength and MRI findings at 24 months minimum follow-up. No significant correlation was found between repair technique and clinical outcomes or retear rates. Preoperative Patte and Goutallier grades >1 were associated with lower postoperative Constant-Murley scores. Conclusion This study suggests that both SR and DRSB techniques offer comparable clinical outcomes and tendon healing rates for rotator cuff tears in patients over 55 at 24 months minimum follow-up. While limitations exist, our findings contribute to understanding optimal surgical approaches, emphasizing individualized treatment based on patient characteristics and surgeon expertise. Further research, including randomized controlled trials with long-term follow-up, is needed to refine treatment algorithms and improve patient outcomes in rotator cuff surgery. Level of Evidence Level III.
Collapse
Affiliation(s)
- Vito Gaetano Rinaldi
- II Clinica Ortopedica e Traumatologica—IRCCS Istituto Ortopedico RizzoliBolognaItaly
- DIBINEMUniversity of BolognaBolognaItaly
| | | | | | | | - Alberto Bazzocchi
- Radiologia Diagnostica ed Interventistica—IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Marco Miceli
- Radiologia Diagnostica ed Interventistica—IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Stefano Di Paolo
- II Clinica Ortopedica e Traumatologica—IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica—IRCCS Istituto Ortopedico RizzoliBolognaItaly
- DIBINEMUniversity of BolognaBolognaItaly
| | | |
Collapse
|
|
2
|
Schönweger F, Marbach F, Feltri P, Milev SR, Filardo G, Candrian C. Sling Is Not Inferior to Brace Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Arthroscopy 2024:S0749-8063(24)01087-9. [PMID: 39732211 DOI: 10.1016/j.arthro.2024.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 12/09/2024] [Accepted: 12/10/2024] [Indexed: 12/30/2024]
Abstract
PURPOSE To compare the safety and efficacy of immobilizing the upper limb with a brace versus a less-constrained sling in the rehabilitation after arthroscopic rotator cuff repair (ARCR), by documenting clinical and radiologic results. METHODS ARCR was performed in 110 patients (54.9 ± 8.3 years) randomized in group A, using a brace for 6 weeks after surgery (3 weeks day and night then 3 weeks only at night), and group B, using a simple sling for 2 weeks only. Patients were evaluated at baseline, 6 weeks, and 3 and 6 months. Functional outcomes were range of motion, strength, Disabilities of the Arm, Shoulder and Hand score, and Constant-Murley Score (CMS). Pain was assessed with a visual analog scale and quality of life with the SF-36 questionnaire. The primary outcome was the CMS at 6 months. At 6 months, 3-Tesla magnetic resonance imaging was performed to document the status of the rotator cuff repair. The minimal clinically important difference was also analyzed. RESULTS Both groups A and B showed a worsening at 6 weeks and an improvement at 3 and 6 months of Disabilities of the Arm, Shoulder and Hand and CMS, as well as a significant visual analog scale decrease at every follow-up (P < .005). SF-36 showed a different trend: General health improved at 6 weeks, then decreased at 3 months, and increased again at 6 months. No difference was retrieved between the 2 groups at any follow-up in terms of pain, functional, and general health scores. The minimal clinically important difference for the primary outcome was 14.5 points and was reached in 56.5% and 61.2% of patients in the sling and brace group, respectively. The evaluation of magnetic resonance imaging scans identified 5 patients in each group with a supraspinatus tendon re-rupture, with no statistical difference in the re-rupture rate between the 2 groups. CONCLUSIONS This randomized controlled trial demonstrated that ARCR postoperative sling immobilization was not inferior to immobilization with a brace, having no differences in terms of functional scores, pain levels, general health, and risk of tendon re-rupture. LEVEL OF EVIDENCE Level I, high-quality randomized controlled trial (designed as a therapeutic study investigating the results of treatment) with statistically significant difference.
Collapse
Affiliation(s)
- Florian Schönweger
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Francesco Marbach
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Pietro Feltri
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Stamen Roumenov Milev
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland.
| | - Giuseppe Filardo
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Christian Candrian
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| |
Collapse
|
|
3
|
Yang G, Li S, Jiang C, Zhang H, Lu Y. The role of bone marrow stimulation in rotator cuff repair: a systematic review and meta-analysis. J Exp Orthop 2023; 10:27. [PMID: 36918448 PMCID: PMC10014641 DOI: 10.1186/s40634-023-00589-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/23/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE The objective of this study was to investigate whether RCR (rotator cuff repair) with BMS (bone marrow stimulation) can provide a lower retear rate and better shoulder function than arthroscopic RCR alone in rotator cuff tear (RCT) patients. METHOD The PubMed, Cochrane Library, EMBASE and Web of Science databases were searched until Feb 2022. Risk of bias for randomized controlled trials was evaluated by two independent reviewers with Cochrane collaboration risk bias of tool, and that for cohort studies was evaluated with the Newcastle-Ottawa Scale (NOS). The primary outcome was the retear rate. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles Shoulder Scale (UCLA) score, Constant-Murley score (CMS) and visual analogue scale (VAS) score. Subgroup analysis was performed to explore the effect of suture method and tear size on BMS procedure. RESULT Five randomized controlled trials and four cohort studies with a total of 827 patients were included. The pooled retear rate between the RCR with BMS group and the RCR alone group was significantly different (17.5% vs. 28.9%; P < 0.0001). There were no differences in the ASES score, UCLA score and VAS score. The CMS was significantly higher in RCR with BMS group than the RCR alone groups (P = 0.02), while the difference was well below the MCID. RCR with BMS resulted in a significantly lower retear rate than RCR alone for large and massive RCTs (19.7% vs. 32.5%; P = 0.01). CONCLUSION Compared with RCR alone, RCR with BMS can significantly reduce the retear rate in arthroscopic RCT patients while not clinically relevant differences were found. BMS may further reduce the retear rate of large and massive RCTs. LEVEL OF EVIDENCE Level III; Systematic Review and Meta-analysis.
Collapse
Affiliation(s)
- Guang Yang
- Sports Medicine Department, Beijing Jishuitan Hospital, No.31, Xin Jie Kou Dong Street, Xi Cheng District, Beijing, 100035, P. R. China
| | - Shangzhe Li
- Sports Medicine Department, Beijing Jishuitan Hospital, No.31, Xin Jie Kou Dong Street, Xi Cheng District, Beijing, 100035, P. R. China
| | - Chunyan Jiang
- Sports Medicine Department, Beijing Jishuitan Hospital, No.31, Xin Jie Kou Dong Street, Xi Cheng District, Beijing, 100035, P. R. China
| | - Hailong Zhang
- Sports Medicine Department, Beijing Jishuitan Hospital, No.31, Xin Jie Kou Dong Street, Xi Cheng District, Beijing, 100035, P. R. China
| | - Yi Lu
- Sports Medicine Department, Beijing Jishuitan Hospital, No.31, Xin Jie Kou Dong Street, Xi Cheng District, Beijing, 100035, P. R. China.
| |
Collapse
|
|
4
|
Man versus Machine: Surgeon versus elastography assessment of the quality of the rotator cuff. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
|
|
5
|
Maia Dias C, Gonçalves SB, Completo A, da Silva MR, de Campos Azevedo C, Mineiro J, Ferreira F, Folgado J. Mechanical consequences at the tendon-bone interface of different medial row knotless configurations and lateral row tension in a simulated rotator cuff repair. J Exp Orthop 2022; 9:94. [PMID: 36117186 PMCID: PMC9482894 DOI: 10.1186/s40634-022-00536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/06/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose Little is known about the direct influence of different technical options at the rotator cuff tendon-bone interface (TBI) and, more specifically, at the medial bearing row (MBR), regarding local contact force, area and pressure. We evaluated the mechanical repercussions of different medial row anchor configurations for that setting using different values of tension in the lateral row anchors. Methods Knotless transosseous equivalent (TOE) rotator cuff repairs with locked versus nonlocked medial anchors and single versus double-hole suture passage were tested in a synthetic rotator cuff mechanical model, using 2 different values of lateral row tension. Contact force, area, pressure, peak force and MBR force were compared at the simulated TBI using a pressure mapping sensor. Results When compared to locked anchors, medial row sliding configurations generate lower values for all the above-mentioned parameters. The use of double-hole suture passage in the medial cuff generated slightly higher values contact area regardless of lateral row tension. At higher lateral row tension values, lower values of the remaining parameters, including MBR force, were found when compared to single-hole suture passage. Lateral row anchor tension increase induced an increase of all parameters regardless of the medial row configuration and TBI contact force and MBR force were the most susceptible parameters, regardless of the medial row pattern. Conclusion Medial row mechanism, suture configuration and lateral row tension interfere with the mechanical force, area and pressure at by TBI. Lateral row tension increase is a major influencer in those parameters. These results can help surgeons choose the right technique considering its mechanical effect at the TBI. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00536-1.
Collapse
Affiliation(s)
- Carlos Maia Dias
- Department of Bioengineering, and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal. .,Hospital CUF Tejo, Shoulder and Elbow Unit, Lisbon, Portugal.
| | - Sérgio B Gonçalves
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - António Completo
- TEMA, Department of Mechanical Engineering, University of Aveiro (UA), Aveiro, Portugal
| | | | - Clara de Campos Azevedo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Hospital CUF Tejo, Elbow and Shoulder Unit, Lisbon, PT, Portugal.,Hospital Dos SAMS de Lisboa, Lisbon, Portugal
| | | | - Frederico Ferreira
- Department of Bioengineering, and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - João Folgado
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
|
6
|
Fackler NP, Ehlers CB, Callan KT, Amirhekmat A, Smith EJ, Parisien RL, Wang D. Statistical Fragility of Single-Row Versus Double-Row Anchoring for Rotator Cuff Repair: A Systematic Review of Comparative Studies. Orthop J Sports Med 2022; 10:23259671221093391. [PMID: 35571970 PMCID: PMC9096204 DOI: 10.1177/23259671221093391] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/17/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Comparative studies and randomized controlled trials (RCTs) often use the P (probability) value to convey the statistical significance of their findings. P values are an imperfect measure, however, and are vulnerable to a small number of outcome reversals to alter statistical significance. The inclusion of a fragility index (FI) and fragility quotient (FQ) may aid in the interpretation of a study’s statistical strength. Purpose/Hypothesis: The purpose of this study was to examine the statistical stability of studies comparing single-row to double-row rotator cuff repair. It was hypothesized that the findings of these studies would be vulnerable to a small number of outcome event reversals, often fewer than the number of patients lost to follow-up. Study Design: Systematic review; Level of evidence, 3. Methods: We analyzed comparative studies and RCTs on primary single-row versus double-row rotator cuff repair that were published between 2000 and 2021 in 10 leading orthopaedic journals. Statistical significance was defined as a P < .05. The FI for each outcome was determined by the number of event reversals necessary to alter significance. The FQ was calculated by dividing the FI by the respective sample size. Results: Of 4896 studies screened, 22 comparative studies, 10 of which were RCTs, were ultimately included for analysis. A total of 74 outcomes were examined. Overall, the median FI was 2 (interquartile range [IQR], 1-3), and the median FQ was 0.035 (IQR, 0.020-0.057). The mean FI was 2.55 ± 1.29, and the mean FQ was 0.043 ± 0.027. In 64% of outcomes, the FI was less than the number of patients lost to follow-up.) Additionally, 81% of significant outcomes needed just a single outcome reversal to lose their significance. Conclusion: Over half of the studies currently used to guide clinical practice have a number of patients lost to follow-up greater than their FI. The results of these studies should be interpreted within the context of these limitations. Future analyses may benefit from the inclusion of the FI and the FQ in their statistical analyses.
Collapse
Affiliation(s)
- Nathan P. Fackler
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Cooper B. Ehlers
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, California, USA
| | - Kylie T. Callan
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, USA
| | - Arya Amirhekmat
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, USA
| | - Eric J. Smith
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, USA
| | | | - Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, USA
| |
Collapse
|
|
7
|
Wang W, Kang H, Li H, Li J, Meng Y, Li P. Comparative efficacy of 5 suture configurations for arthroscopic rotator cuff tear repair: a network meta-analysis. J Orthop Surg Res 2021; 16:714. [PMID: 34895286 PMCID: PMC8665484 DOI: 10.1186/s13018-021-02847-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rotator cuff tear is one of the most common complaint with shoulder pain, disability, or dysfunction. So far, different arthroscopic techniques including single row (SR), double row (DR), modified Mason-Allen (MMA), suture bridge (SB) and transosseous (TO) have been identified to repair rotator cuff. However, no study has reported the comparative efficacy of these 5 suture configurations. The overall aim of this network meta-analysis was to analyze the clinical outcomes and healing rate with arthroscopy among SR, DR, MMA, SB and TO. METHODS A systematic literature was searched from PubMed, EBSCO-MEDLINE, Web of Science, google scholar and www.dayi100.com , and checked for the inclusion and exclusion standards. The network meta-analysis was conducted using Review Manager 5.3 and SATA 15.0 software. RESULTS Thirty-four studies were eligible for inclusion, including 15 randomized controlled trials, 17 retrospective and 2 prospective cohort studies, with total 3250 shoulders. Two individual reviewers evaluated the quality of the 34 studies, the score form 5 and 9 of 10 were attained according to the Newcastle-Ottawa Scale for the 17 retrospective and 2 prospective studies. There was no significant distinction for the Constant score among 5 groups in the 16 studies with 1381 shoulders. The treatment strategies were ranked as MMA, DR, SB, SR and TO. In ASES score, 14 studies included 1464 shoulders showed that no significant differences was showed among all 5 groups after surgery. Whereas the efficacy probability was TO, MMA, DR, SB and SR according to the cumulative ranking curve. The healing rate in 25 studies include 2023 shoulders was significant in both SR versus DR [risk ratio 0.45 with 95% credible interval (0.31, 0.65)], and SR versus SB [risk ratio 0.45 (95% credible interval 0.29, 0.69)], and no significant in the other comparison, the ranking probability was MMA, SB, DR, TO and SR. CONCLUSION Based on the clinical results, this network meta-analysis revealed that these 5 suture configurations shows no significant difference. Meanwhile, suture bridge may be the optimum treatment strategy which may improve the healing rate postoperatively, whereas the DR is a suboptimal option for arthroscopic rotator cuff repairs.
Collapse
Affiliation(s)
- Wei Wang
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Hui Kang
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Hongchuan Li
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Jian Li
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Yibin Meng
- Departments of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Peng Li
- Department of Hand Surgery, Honghui Hospital, Xi'an Jiaotong University, 76 Guo Road, Beilin South District, Xian City, 710054, Shanxi Province, China.
| |
Collapse
|
|
8
|
GÜNAY M, EKEN G. The effect of row number on clinical and life quality outcomes of patients who underwent arthroscopic rotator cuff repair. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.957621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
|
9
|
Chiang CH, Shaw L, Chih WH, Yeh ML, Ting HH, Lin CH, Chen CP, Su WR. Modified Superior Capsule Reconstruction Using the Long Head of the Biceps Tendon as Reinforcement to Rotator Cuff Repair Lowers Retear Rate in Large to Massive Reparable Rotator Cuff Tears. Arthroscopy 2021; 37:2420-2431. [PMID: 33864834 DOI: 10.1016/j.arthro.2021.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/04/2020] [Accepted: 04/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To retrospectively assess the clinical outcomes of the patients with large to massive reparable RCTs treated by arthroscopic rotator cuff repair (ARCR) combined with modified superior capsule reconstruction (mSCR) using the long head of biceps tendon (LHBT) as reinforcement with a minimum of 2 years of follow-up. METHODS We retrospectively evaluated 40 patients with large to massive reparable RCTs who underwent ARCR and mSCR (group I) between February 2017 and June 2018 (18 patients) or underwent ARCR and tenotomy of LHBT performed at the insertion site (group II) between January 2015 and January 2017 (22 patients). The pain visual analog score (VAS) was assessed preoperatively and 1, 3, 6, 12, 24 months postoperatively. American Shoulder and Elbow Surgeons (ASES) scores, the University of California, Los Angeles (UCLA) shoulder rating scale, and active range of motion (AROM) were assessed before surgery and 6, 12, and 24 months after surgery. The integrity of the rotator cuff and mSCR was evaluated using magnetic resonance images at 12 months postoperatively. RESULTS After surgery, both groups had significantly improved in VAS, ASES, UCLA and AROM scores in the final follow-up. There were no significant between-group differences in the characteristics of the patients before surgery. Group I had improved pain relief at 1 month (P < .001) and at 3 months (P < .01) after surgery. For the AROM, group I (flexion, external rotation, internal rotation) demonstrated better improvement than group II 6 months after surgery (all P < .05) and better internal rotation 12 and 24 months after surgery (all P < .05). The mSCR survival rate was 94.4% (17/18). The retear rate of repaired rotator cuffs for groups I and II was 16.7% (3/18) and 40.9% (9/22), respectively, and the differences were significant (P < .046). CONCLUSIONS ARCR combined with mSCR using LHBT as reinforcement may lead to a lower retear rate and earlier functional recovery than conventional ARCR with tenotomy of LHBT for large to massive reparable RCTs. LEVEL OF EVIDENCE Level III, retrospective therapeutic comparative trial.
Collapse
Affiliation(s)
- Chen-Hao Chiang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Leo Shaw
- Department of Orthopaedics, Taichung Veterans' General Hospital, Taichung, Taiwan.
| | - Wei-Hsing Chih
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Hsien Ting
- Department of Anesthesiology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chang-Hao Lin
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chao-Ping Chen
- Department of Orthopaedics, Taichung Veterans' General Hospital, Taichung, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Acupressure Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedics, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C
| |
Collapse
|
|
10
|
Gaume M, Pages L, Bahman M, Rousseau MA, Boyer P. Arthroscopic knotless repair: an effective technique for small-sized supraspinatus tendon tears. Knee Surg Sports Traumatol Arthrosc 2021; 29:2305-2311. [PMID: 32902686 DOI: 10.1007/s00167-020-06249-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose was to evaluate the clinical and radiological results of knotless repair with flat-braided suture in full small-sized supraspinatus tendon tears (< 1 cm). METHODS A consecutive series of 54 patients with isolated small supraspinatus tendon tear (< 1 cm and Goutallier index < 2) was evaluated in the study. Patients underwent a knotless arthroscopic repair using flat-braided suture (2 mm wide). Minimal follow-up required was 5 years. Changes in Murley-Constant score, ASES score, strength, and pain relief were assessed. The Sugaya score was used to confirm the tendon repair on MRI. Data were analyzed in two subgroups: technique with additional U point for dog ear deformity (group 1) and technique without additional U point (group 2). The immobilization period was 3 weeks long. Passive mobilization was immediate. RESULTS Fifty-four patients were included. Mean age was 57 ± 4 years. The average follow-up was 68 ± 10 months. Average preoperative score of Constant was 51.2 ± 8.5 and 83.1 ± 14.6 at the end of the follow-up (p < 0.001). Mean VAS went from 5.8 ± 1.8 to 1.9 ± 2.1 (p < 0.001). Average forward elevation of the shoulder went from 86.3° ± 9 preoperatively to 169.6° ± 15.9 at the end of the follow-up (p < 0.001). The strength score was significantly higher post-operatively (18.4 vs. 8.3, p < 0.001.). The ASES score was significantly improved 49.1 ± 13.1 vs. 88.6 ± 15.8, p < 0.001). The MRI assessment revealed 94% of Sugaya 1-2. No significant difference was observed between group 1 and 2 regarding all clinical outcomes. Two complex regional pain syndromes were described with a favorable evolution. Three patients presented a retear requiring an iterative arthroscopic repair. CONCLUSION The use of a knotless arthroscopic construct with flat-braided suture for small supraspinatus repair achieved excellent structural and clinical results. This technique is fully adequate for the arthroscopic treatment of such tears, enabling early mobilization. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Mathilde Gaume
- Orthopedics Department, Bichat Hospital, Paris Diderot University, Assistance Publique Hôpitaux de Paris, Paris, France.
| | - Laure Pages
- Orthopedics Department, Bichat Hospital, Paris Diderot University, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Mohammad Bahman
- Orthopedics Department, Bichat Hospital, Paris Diderot University, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marc-Antoine Rousseau
- Orthopedics Department, Bichat Hospital, Paris Diderot University, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Patrick Boyer
- Orthopedics Department, Bichat Hospital, Paris Diderot University, Assistance Publique Hôpitaux de Paris, Paris, France
| |
Collapse
|
|
11
|
de Almeida Filho IA, Coelho DA. Rotator Cuff Healing. Rev Bras Ortop 2021; 56:291-298. [PMID: 34239192 PMCID: PMC8249069 DOI: 10.1055/s-0040-1713764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/15/2020] [Indexed: 11/05/2022] Open
Abstract
The present article broadly addresses the aspects that interfere with the healing process of the rotator cuff. Life habits, such as smoking and alcoholism, are considered, systemic factors such as diabetes mellitus, hypertension, and obesity, as well as local factors, among which are those related to the pre, peri, and postoperative periods. From an extensive literature review, with the citation of 60 scientific articles from both Western and Eastern literature, the authors intend to deepen the theme by bringing to medical practice conducts based on new established concepts.
Collapse
Affiliation(s)
- Ildeu Afonso de Almeida Filho
- Departamento de Ortopedia, Hospital Felício Rocho, Belo Horizonte, MG, Brasil
- Hospital Vera Cruz, Belo Horizonte, MG, Brasil
| | - Daniel Andrade Coelho
- Hospital Vera Cruz, Belo Horizonte, MG, Brasil
- Hospital Semper, Belo Horizonte, MG, Brasil
| |
Collapse
|
|
12
|
Hackl M, Nacov J, Kammerlohr S, Staat M, Buess E, Leschinger T, Müller LP, Wegmann K. Intratendinous Strain Variations of the Supraspinatus Tendon Depending on Repair Technique: A Biomechanical Analysis Regarding the Cause of Medial Cuff Failure. Am J Sports Med 2021; 49:1847-1853. [PMID: 33872064 DOI: 10.1177/03635465211006138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Double-row (DR) and transosseous-equivalent (TOE) techniques for rotator cuff repair offer more stability and promote better tendon healing compared with single-row (SR) repairs and are preferred by many surgeons. However, they can lead to more disastrous retear patterns with failure at the medial anchor row or the musculotendinous junction. The biomechanics of medial cuff failure have not been thoroughly investigated thus far. PURPOSE To investigate the intratendinous strain distribution within the supraspinatus tendon depending on repair technique. STUDY DESIGN Controlled laboratory study. METHODS Twelve fresh-frozen cadaveric shoulders were used. The intratendinous strain within the supraspinatus tendon was analyzed in 2 regions-(1) at the footprint at the greater tuberosity and (2) medial to the footprint up to the musculotendinous junction-using a high-resolution 3-dimensional camera system. Testing was performed at submaximal loads of 40 N, 60 N, and 80 N for intact tendons, after SR repair, after DR repair, and after TOE repair. RESULTS The tendon strain of the SR group differed significantly in both regions from that of the intact tendons and the TOE group at 40 N (P≤ .043) and from the intact tendons, the DR group, and the TOE group at 60 N and 80 N (P≤ .048). SR repairs showed more tendon elongation at the footprint and less elongation medial to the footprint. DR and TOE repairs did not provide significant differences in tendon strain when compared with the intact tendons. However, the increase in tendon strain medial to the footprint from 40 N to 80 N was significantly more pronounced in the DR and TOE group (P≤ .029). CONCLUSION While DR and TOE repair techniques more closely reproduced the strains of the supraspinatus tendon than did SR repair in a cadaveric model, they showed a significantly increased tendon strain at the musculotendinous junction with higher loads in comparison with the intact tendon. CLINICAL RELEVANCE DR and TOE rotator cuff reconstructions lead to a more anatomic tendon repair. However, their use has to be carefully evaluated whenever tendon quality is diminished, as they lead to a more drastic increase in tendon strain medial to the footprint, putting these repairs at risk of medial cuff failure.
Collapse
Affiliation(s)
- Michael Hackl
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Julia Nacov
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Sandra Kammerlohr
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Manfred Staat
- Institute of Bioengineering, FH Aachen University of Applied Sciences, Jülich, Germany
| | | | - Tim Leschinger
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Lars P Müller
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Kilian Wegmann
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| |
Collapse
|
|
13
|
Tokish JM, Hawkins RJ. Current concepts in the evolution of arthroscopic rotator cuff repair. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:75-83. [PMID: 37588146 PMCID: PMC10426701 DOI: 10.1016/j.xrrt.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Arthroscopic rotator cuff repair has become one of the most common and successful surgeries performed in orthopedics. It represents the culmination of advances in many diverse fields such as optics, fluid dynamics, mechanical engineering, and most recently, orthobiologics. This article reviews the current state of the art of arthroscopic rotator cuff repair, through the lens of its historical context and evolution to our present understanding. We review the limitations in the current approach, and glance toward the future of rotator cuff regeneration with emerging technologies.
Collapse
|
|
14
|
Maia Dias C, Gonçalves SB, Completo A, Tognini M, da Silva MR, Mineiro J, Curate F, Ferreira F, Folgado J. Why are tapes better than wires in knotless rotator cuff repairs? An evaluation of force, pressure and contact area in a tendon bone unit mechanical model. J Exp Orthop 2021; 8:9. [PMID: 33537914 PMCID: PMC7859138 DOI: 10.1186/s40634-020-00321-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Knotless repairs have demonstrated encouraging performance regarding retear rate reduction, but literature aiming at identifying the specific variables responsible for these results is scarce and conflictive. The purpose of this paper was to evaluate the effect of the material (tape or wire suture) and medial tendon passage (single or double passage) on the contact force, pressure and area at the tendon bone interface in order to identify the key factors responsible for this repairs´ success. METHODS A specific knotless transosseous equivalent cuff repair was simulated using 2 tape or suture wire loaded medial anchors and 2 lateral anchors, with controlled lateral suture limb tension. The repair was performed in a previously validated sawbones® mechanical model. Testing analyzed force, pressure and area in a predetermined and constant size "repair box" using a Tekscan® sensor, as well as peak force and pressure, force applied by specific sutures and force variation along the repair box. RESULTS Tapes generate lower contact force and pressure and double medial passage at the medial tendon is associated with higher contact area. Suture wires generate higher peak force and pressure on the repair and higher mean force in their tendon path and at the medial bearing row. Force values decrease from medial to lateral and from posterior to anterior independently of the material or medial passage. CONCLUSION Contrary to most biomechanical literature, suture tape use lowers the pressure and force applied at the tendon bone junction, while higher number of suture passage points medially increases the area of contact. These findings may explain the superior clinical results obtained with the use uf suture tapes because its smaller compressive effect over the tendon may create a better perfusion environment healing while maintaining adequate biomechanical stability.
Collapse
Affiliation(s)
- Carlos Maia Dias
- Department of Bioengineering, and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
| | - Sérgio B Gonçalves
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - António Completo
- TEMA, Department of Mechanical Engineering, University of Aveiro (UA), Aveiro, Portugal
| | | | | | | | - Francisco Curate
- Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - Frederico Ferreira
- Department of Bioengineering, and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - João Folgado
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
|
15
|
Imam M, Sallam A, Ernstbrunner L, Boyce G, Bardakos N, Abdelkafy A, Moussa M, Ghazal MA. Three-year functional outcome of transosseous-equivalent double-row vs. single-row repair of small and large rotator cuff tears: a double-blinded randomized controlled trial. J Shoulder Elbow Surg 2020; 29:2015-2026. [PMID: 32951642 DOI: 10.1016/j.jse.2020.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The trial aimed to prospectively compare the functional outcomes of patients undergoing arthroscopic rotator cuff repair using transosseous-equivalent double-row (TEDR) or single-row (SR) suture anchor techniques at 3 years postoperatively for both large (>3 cm) and small (<3 cm) tears. METHODS Eighty patients with a symptomatic and magnetic resonance imaging (MRI)-proven full-thickness rotator cuff tear, who had failed conservative management of at least 6 months' duration and who had a complete passive range of motion of the affected shoulder, were enrolled in the trial. Patients were randomized to TEDR repair (n = 40) or SR repair (n = 40). Subgroup analysis was conducted for tears <3 cm (TEDR n = 17, SR n = 19) and tears >3 cm (TEDR n = 23, SR n = 21). Primary outcomes included the Oxford Shoulder Score (OSS), the University of California, Los Angeles (UCLA) score, and the Constant-Murley score (CMS). The secondary outcomes included a 0-100-mm visual analog scale (VAS) score for pain, range of motion (ROM), and EQ-5D scores. All patients completed a follow-up of 3 years. RESULTS There was a significant difference in the mean OSS postoperative score for tears >3 cm (P = .01) and mean improvement from baseline in the TEDR group (P = .001). For tears >3 cm, mean postoperative scores were also significantly higher in the TEDR group for UCLA (P = .015) and CMS (P = .001). Post hoc testing showed that the differences between these groups was statistically significant (P < .05). For tears <3 cm, a significant postoperative difference in favor of SR repair was seen in the mean CMSs (P = .011), and post hoc testing showed that the difference was statistically significant (P = .015). No significant difference was seen with mean postoperative OSS or UCLA, and post hoc testing did not show a statistically significant difference between groups. CONCLUSIONS TEDR repair showed improved functional outcomes for tears >3 cm compared with SR repair. For tears <3 cm, no clear benefit was seen with either technique.
Collapse
Affiliation(s)
- Mohamed Imam
- Norfolk and Norwich University Hospitals, Norfolk, England; Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| | - Asser Sallam
- Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt.
| | - Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Glenn Boyce
- Bendigo Orthopaedic and Sports Medicine, and University Hospital Geelong, Ryrie and Bellarine Street Geelong, Geelong, VIC, Australia
| | | | - Ashraf Abdelkafy
- Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| | - Moussa Moussa
- Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| | - Mohamed-Adel Ghazal
- Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| |
Collapse
|
|
16
|
Endo A, Hoogervorst P, Safranek C, Sochacki KR, Safran MR, Sherman SL, Donahue J. Linked Double-Row Equivalent Arthroscopic Rotator Cuff Repair Leads to Significantly Improved Patient Outcomes. Orthop J Sports Med 2020; 8:2325967120938311. [PMID: 32728593 PMCID: PMC7366410 DOI: 10.1177/2325967120938311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/26/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Biomechanical studies have demonstrated that arthroscopic rotator cuff repair using a linked double-row equivalent construct results in significantly higher load to failure compared with conventional transosseous-equivalent constructs. Purpose: To determine the patient-reported outcomes (PROs), reoperation rates, and complication rates after linked double-row equivalent rotator cuff repair for full-thickness rotator cuff tears. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent linked double-row equivalent arthroscopic rotator cuff repair with minimum 2-year follow-up were included. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score at final follow-up. Secondary outcomes included the Simple Shoulder Test (SST), shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, visual analog scale (VAS), reoperations, and complications. Clinical relevance was defined by the minimally clinically important difference (MCID). Comparisons on an individual level that exceeded MCID (individual-level scores) were deemed clinically relevant. Comparisons between preoperative and postoperative scores were completed using the Student t test. All P values were reported with significance set at P < .05. Results: A total of 42 shoulders in 41 consecutive patients were included in this study (21 male patients [51.2%]; mean age, 64.5 ± 11.9 years; mean follow-up, 29.7 ± 4.5 months). All patients (100%) completed the minimum 2-year follow-up. The rotator cuff tear measured on average 15.2 ± 8.9 mm in the coronal plane and 14.6 ± 9.8 mm in the sagittal plane. The ASES score improved significantly from 35.5 ± 18.2 preoperatively to 93.4 ± 10.6 postoperatively (P < .001). The QuickDASH (P < .001), SST (P < .001), and VAS (P < .001) scores also significantly improved after surgery. All patients (42/42 shoulders; 100%) achieved clinically relevant improvement (met or exceeded MCID) on ASES and SST scores postoperatively. There were no postoperative complications (0.0%) or reoperations (0.0%) at final follow-up. Conclusion: Arthroscopic repair of full-thickness rotator cuff tears with the linked double-row equivalent construct results in statistically significant and clinically relevant improvements in PRO scores with low complication rates (0.0%) and reoperation rates (0.0%) at short-term follow-up.
Collapse
Affiliation(s)
- Atsushi Endo
- Sports Orthopedic and Rehabilitation, Redwood City, California, USA
| | - Paul Hoogervorst
- Sports Orthopedic and Rehabilitation, Redwood City, California, USA
| | - Conrad Safranek
- Stanford University, Bioengineering, Stanford, California, USA
| | - Kyle R Sochacki
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Joseph Donahue
- Sports Orthopedic and Rehabilitation, Redwood City, California, USA
| |
Collapse
|
|
17
|
Lin Y, Zhao J, Qiu H, Huang Y. Comparison of arthroscopic single-row and double-row repair in the treatment of rotator cuff tears: A protocol of cohort analysis. Medicine (Baltimore) 2020; 99:e21030. [PMID: 32702843 PMCID: PMC7373522 DOI: 10.1097/md.0000000000021030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Single-row (SR) and double-row (DR) techniques are 2 kinds of widely used approaches for the arthroscopic repair of rotator cuff. This retrospective clinical trial was performed to address the question of whether a DR rotator cuff anchor repair gives results superior to a SR anchor repair in clinical outcome scores and complication rates. METHODS This study was performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. We retrospectively reviewed our database, which was collected prospectively. From 2014 to 2017, 264 patients underwent arthroscopic rotator cuff repair by an experienced single shoulder surgeon with the SR and DR techniques. This study was approved by the institutional review board in our hospital and was registered in the Research Registry. Outcome measures included Constant-Murley score, muscle strength, patient satisfaction, passive range of motion, and retear rates. RESULTS The hypothesis was that the DR technique would achieve better functional scores and fewer complications as compared to the SR technique in treatment of rotator cuff tears.
Collapse
|
|
18
|
Khazzam M, Sager B, Box HN, Wallace SB. The effect of age on risk of retear after rotator cuff repair: a systematic review and meta-analysis. JSES Int 2020; 4:625-631. [PMID: 32939497 PMCID: PMC7479041 DOI: 10.1016/j.jseint.2020.03.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hypothesis The purpose of this study was to perform a systematic review and meta-analysis to determine the effect of age on rotator cuff repair failure. The hypothesis of this study was that increased patient age would lead to a higher rate of retears and/or repair failures after rotator cuff repair. Methods We conducted a systematic review and meta-analysis of level I and II studies evaluating patients undergoing rotator cuff repair that also included an imaging assessment of the structural integrity of the repair. Univariate and multivariate meta-regression was performed to assess the dependence of the retear rate on the mean age of the cohort, imaging modality, time to imaging, and publication year. Results The meta-regression included 38 studies with a total of 3072 patients. Significant heterogeneity in retear rates was found among the studies (Q = 209.53, I2 = 82.34, P < .001). By use of a random-effects model, the retear rate point estimate was 22.1% (95% confidence interval [CI], 18.6%-26.0%). On univariate analysis, type of imaging modality did not significantly influence the retear rate (P = .188). On univariate analysis, mean age (odds ratio [OR], 1.05 [95% CI, 1.01-1.09]; P = .027) and mean time to imaging (OR, 1.04 [95% CI, 1.01-1.08]; P = .006) were associated with the retear rate. Publication year (OR, 0.94 [95% CI, 0.88-1.01]; P = .083) demonstrated a trend toward significance. On multivariate analysis, increased age was associated with a 5%/yr increased odds of retear (OR, 1.05 [95% CI, 1.01-1.08]; P = .025). The risk of retear doubled from 15% at age 50 years to >30% at age 70 years. Time to imaging demonstrated a trend toward increased odds of retear (OR, 1.03 [95% CI, 1.00-1.07]; P = .056). Publication year was not associated with the retear rate on multivariate analysis (OR, 0.96 [95% CI, 0.90-1.02]; P = .195). Conclusion The risk of retear after rotator cuff repair is associated with increased age and doubles between the ages of 50 and 70 years.
Collapse
Affiliation(s)
- Michael Khazzam
- Shoulder Service, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brian Sager
- Shoulder Service, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hayden N Box
- Shoulder Service, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steven B Wallace
- Shoulder Service, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
|
19
|
Maassen NH, Somerson JS. A Majority of Single Versus Double-Row Rotator Cuff Repair Comparisons Fail to Consider Modern Single-Row Techniques. JBJS Rev 2020; 8:e0203. [DOI: 10.2106/jbjs.rvw.19.00203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
|
20
|
Fırat A, Aydın M, Tecimel O, Öçgüder A, Sanisoğlu Y, Uğurlu M. Comparison of the clinical and radiological outcomes of arthroscopic transosseous and transosseous-equivalent double-row rotator cuff repair techniques. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:178-185. [PMID: 32254034 DOI: 10.5152/j.aott.2020.02.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study compared the clinical and radiological results of the arthroscopic transosseous (ATO) and transosseous-equivalent (TOE) double-row rotator cuff repair techniques. METHODS Prospective data collected from patients treated with ATO (32 women and 7 men, mean age: 57.03±6.39 years) and TOE (36 women and 8 men; mean age: 57.86±7.81 years) techniques were retrospectively evaluated. The visual analog scale score, Constant score, and Oxford shoulder score were used to assess the clinical results. Anchor pullout on standard anteroposterior shoulder radiographs and rotator cuff re-tear on magnetic resonance images were examined at the final follow-up to evaluate the radiological results. Rotator cuff re-tears were graded as per the classification system described by Sugaya et al. Results: The mean follow-up duration was 33.3±11.8 months. No difference was observed in the demographic data of the two groups. Significant improvement was observed in the postoperative shoulder scores of the groups; however, no difference was observed between the groups. Re-tear was detected in 10 patients of the TOE group and 9 patients of the ATO group. Age, tear size, and retraction level could cause re-tear. CONCLUSION In the treatment of rotator cuff tears, the ATO and TOE techniques may achieve considerable improvements in shoulder functions in the short term. LEVEL OF EVIDENCE Level III, Therapeutic study.
Collapse
Affiliation(s)
- Ahmet Fırat
- Department of Orthopedics, Ankara City Hospital, Ankara, Turkey
| | - Mustafa Aydın
- Department of Orthopedics, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Osman Tecimel
- Department of Orthopedics, Ankara City Hospital, Ankara, Turkey
| | - Ali Öçgüder
- Department of Orthopedics, Ankara City Hospital, Ankara, Turkey
| | - Yavuz Sanisoğlu
- Department of Biostatistics, Yıldırım Beyazıt University, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Mahmut Uğurlu
- Department of Orthopedics, Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
|
21
|
Application of a new polyester patch in arthroscopic massive rotator cuff repair-a prospective cohort study. J Shoulder Elbow Surg 2020; 29:e11-e21. [PMID: 31405714 DOI: 10.1016/j.jse.2019.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Massive rotator cuff (RC) tears still present a clinically challenging problem, with reported rerupture rates in up to 94%. The study objective was to determine the impact of synthetic patch augmentation for massive RC tears. METHODS Between June 2012 and 2014, we performed 50 arthroscopic RC reconstructions augmented with a synthetic polyester patch. Pre- and postoperative imaging methods included arthrographic magnetic resonance imaging, arthrographic computed tomography, and ultrasound examination to determine tendon integrity or rerupture. Clinical outcome was evaluated using the Constant-Murley score and the subjective shoulder value. Mean clinical midterm and final follow-up was 22 months (9-35 months) and 52 months (25-74 months), respectively. RESULTS The mean Constant-Murley score increased significantly from 36.5 (±16.4 standard deviation [SD]) preoperatively to a midterm value of 81.2 (±9.6 SD; P < .0001) and further improved to a mean of 83.4 (±10.8 SD) at final follow-up. The mean subjective shoulder value increased from 40.3 (±24.3 SD) to 89.2 (±12.9 SD; P < .0001) at midterm and to 89.6 (±15.2 SD) at final follow-up. We observed 7 complete reruptures (14%). However, reruptures did not correlate with revision surgery, which was performed in 8 patients. The main reason for revision was frozen shoulder or arthrofibrosis with an intact reconstruction and patch, which was performed in 6 cases. CONCLUSIONS The retear rate of 14% compared favorably with nonaugmented RC repairs in the literature. Therefore, we conclude that patch augmentation in massive RC tears is feasible to reduce retears and to improve clinical outcome.
Collapse
|
|
22
|
Kim KC, Lee WY, Shin HD, Han SC. Incomplete articular-side repair increase re-tear rate in full-thickness rotator cuff tears. J Orthop Surg (Hong Kong) 2019; 26:2309499018760113. [PMID: 29486671 DOI: 10.1177/2309499018760113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE This study compared the functional outcome and repair integrity of arthroscopic rotator cuff repair according to articular-side repair state in full-thickness tears. METHODS We prospectively enrolled 80 consecutive patients with full-thickness rotator cuff tears of 1.5-3.5 cm at the anterior to posterior dimension. These patients were divided into two groups according to intraoperative articular-side repair state during operation: complete and incomplete repair groups. Repair integrity was evaluated at 6 months after the operation by magnetic resonance image or ultrasonography. Clinical outcomes were evaluated at 1 year and 2 years postoperatively. Four outcome measures were used in this study: visual analog scale pain score, American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA) score, and range of motion. RESULTS At 2-year follow-up, the average UCLA, ASES, and constant score improved significantly to 32.46, 87.94, and 79.69, respectively, in the complete group and to 32.50, 87.65, and 78.92, respectively, in the incomplete group. The UCLA, ASES, and constant score improved in both groups postoperatively (all ps < 0.000); however, there was no significant difference between the two groups ( p = 0.960, 0.921, and 0.796, respectively). The re-tear rate was 13.7% in the shoulders that underwent complete repair and 33.3% in the shoulders that underwent incomplete repair; this difference was statistically significant ( p = 0.041). CONCLUSION Regardless of the repair state of articular-side rotator cuff, the arthroscopic rotator cuff repair resulted in comparable functional outcomes between two groups at short-term follow-up. However, patients who repaired articular-side rotator cuff incompletely revealed higher re-tear rate after operation than those who repaired completely.
Collapse
Affiliation(s)
- Kyung Cheon Kim
- 1 Shoulder Center, Department of Orthopedic Surgery, TanTan Hospital, Daejeon, South Korea
| | - Woo-Yong Lee
- 2 Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyun Dae Shin
- 2 Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sun-Cheol Han
- 1 Shoulder Center, Department of Orthopedic Surgery, TanTan Hospital, Daejeon, South Korea
| |
Collapse
|
|
23
|
Ajrawat P, Dwyer T, Almasri M, Veillette C, Romeo A, Leroux T, Theodoropoulos J, Nauth A, Henry P, Chahal J. Bone marrow stimulation decreases retear rates after primary arthroscopic rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elbow Surg 2019; 28:782-791. [PMID: 30885313 DOI: 10.1016/j.jse.2018.11.049] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/31/2018] [Accepted: 11/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the optimization of biomechanical and patient factors in the setting of rotator cuff repair (RCR), postoperative retear rates remain high in many series reported in the literature. Preclinical studies have suggested bone marrow stimulation (BMS) at the rotator cuff footprint may reduce the rate of retear after RCR. The objective of this meta-analysis was to analyze the clinical evidence investigating the effect of arthroscopic RCR, with and without BMS, on rotator cuff healing and functional outcomes. METHODS PubMed, MEDLINE, Embase, and the Cochrane Library were searched through December 2017. Two reviewers selected studies based on the inclusion criteria and assessed methodologic quality. Pooled analyses were performed for continuous and binomial variables where appropriate. RESULTS Four studies (365 patients), including 2 Level I randomized controlled trials and 2 Level III retrospective comparative cohort studies were included. There was no statistical difference in the Disabilities of the Arm, Shoulder and Hand score, University of California Los Angeles Shoulder Rating Scale score, or the Constant score between the BMS and conventional repair groups. The pooled retear rates were 18.4% (28 of 152) and 31.8% (56 of 176) for patients treated with and without BMS, respectively. The pooled analysis of rotator cuff retear rates from the 4 studies (328 patients) showed a statistically significant difference favoring BMS over conventional repair (odds ratio, 0.42; 95% confidence interval, 0.25-0.73; P = .002; I2 = 0%). CONCLUSION BMS reduces the retear rate after RCR but shows no difference in functional outcomes compared with conventional repair. This study provides evidence for the use of BMS as a potential cost-effective biological approach toward improving rotator cuff healing.
Collapse
Affiliation(s)
- Prabjit Ajrawat
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Tim Dwyer
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Mahmoud Almasri
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Christian Veillette
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Anthony Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Timothy Leroux
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - John Theodoropoulos
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Aaron Nauth
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Patrick Henry
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Jaskarndip Chahal
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada.
| |
Collapse
|
|
24
|
Xu B, Chen L, Zou J, Gu Y, Hao L, Peng K. The Clinical Effect of Arthroscopic Rotator Cuff Repair techniques: A Network Meta-Analysis and Systematic Review. Sci Rep 2019; 9:4143. [PMID: 30858460 PMCID: PMC6411857 DOI: 10.1038/s41598-019-40641-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/20/2019] [Indexed: 12/18/2022] Open
Abstract
Rotator cuff tears are common and are associated with shoulder pain, disability, and dysfunction. Previous studies that have reported different arthroscopic techniques are controversial. A network meta-analysis with indirect and direct evidence was performed to compare the effectiveness of arthroscopic techniques for the treatment of rotator cuff tears. PUBMED, the Cochrane Register of Controlled Trials, EMBASE and Scopus were searched based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and related studies that evaluated arthroscopic techniques for the treatment of rotator cuff tears were identified in May 2018. The primary outcome measure was the retear rate. The secondary outcome measures included the constant score and the range of motion (forward flexion and external rotation). Twenty-one trials comprising 1815 shoulders were included in the study. This study indicated that single-row (SR) repair resulted in a higher retear rate than suture bridge (SB) and double-row (DR) repairs. Moreover, the SR and DR repairs resulted in higher incidences of retear than SB repair. The ranking of the treatments based on the constant score and external rotation was SB repair, SR repair and DR repair, whereas the treatment ranking according to forward flexion was SB repair, DR repair and SR repair. In summary, this network meta-analysis provides evidence that SB repairs might be the best choice to improve the postoperative recovery of function and decrease the retear rate.
Collapse
Affiliation(s)
- Binwu Xu
- Department of Orthopedics, the second affiliated hospital of Nanchang university, Nanchang, Jiangxi, China
| | - Long Chen
- Department of Orthopedics, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Jun Zou
- Department of Orthopedics, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Yurong Gu
- Department of Orthopedics, the second affiliated hospital of Nanchang university, Nanchang, Jiangxi, China
| | - Liang Hao
- Department of Orthopedics, the second affiliated hospital of Nanchang university, Nanchang, Jiangxi, China
| | - Kun Peng
- Department of Orthopedics, the second affiliated hospital of Nanchang university, Nanchang, Jiangxi, China.
| |
Collapse
|
|
25
|
Lee KW, Yang DS, Lee GS, Ma CH, Choy WS. Clinical outcomes and repair integrity after arthroscopic full-thickness rotator cuff repair: suture-bridge versus double-row modified Mason-Allen technique. J Shoulder Elbow Surg 2018; 27:1953-1959. [PMID: 29803504 DOI: 10.1016/j.jse.2018.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/29/2018] [Accepted: 04/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND This retrospective study compared the clinical and radiologic outcomes of patients who underwent arthroscopic rotator cuff repairs by the suture-bridge and double-row modified Mason-Allen techniques. METHODS From January 2012 to May 2013, 76 consecutive cases of full-thickness rotator cuff tear, 1 to 4 cm in the sagittal plane, for which arthroscopic rotator cuff repair was performed, were included. The suture-bridge technique was used in 37 consecutive shoulders; and the double-row modified Mason-Allen technique, in 39 consecutive shoulders. Clinical outcomes at a minimum of 2 years (mean, 35.7 months) were evaluated postoperatively using the visual analog scale; University of California, Los Angeles Shoulder Scale; American Shoulder and Elbow Surgeons Subjective Shoulder Scale; and Constant score. Postoperative cuff integrity was evaluated at a mean of 17.7 months by magnetic resonance imaging. RESULTS At the final follow-up, the clinical outcomes improved in both groups (all P < .001) but with no significant differences between the 2 groups (all P > .05). The retear rate was 18.9% in the shoulders subjected to suture-bridge repair and 12.8% in the double-row modified Mason-Allen group; the difference was not significant (P = .361). CONCLUSIONS Despite the presence of fewer suture anchors, the patients who underwent double-row modified Mason-Allen repair had comparable shoulder functional outcomes and a comparable retear rate with those who underwent suture-bridge repair. Therefore, the double-row modified Mason-Allen repair technique can be considered an effective treatment for patients with medium- to large-sized full-thickness rotator cuff tears.
Collapse
Affiliation(s)
- Kwang Won Lee
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Dae Suk Yang
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea.
| | - Gyu Sang Lee
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Chang Hyun Ma
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Won Sik Choy
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| |
Collapse
|
|
26
|
Dyrna F, Voss A, Pauzenberger L, Obopilwe E, Mazzocca AD, Castagna A, Edgar C. Biomechanical evaluation of an arthroscopic transosseous repair as a revision option for failed rotator cuff surgery. BMC Musculoskelet Disord 2018; 19:240. [PMID: 30025529 PMCID: PMC6053743 DOI: 10.1186/s12891-018-2089-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/15/2018] [Indexed: 02/06/2023] Open
Abstract
Background The number of revision rotator cuff cases is increasing. The literature is lacking guidance or biomechanical evaluation for fixation strength in a revision case scenario. Therefore, the aim of the study was to provide biomechanical data investigating primary fixation strength of a transosseous technique after anchor pullout failure of a single row reconstruction. It was hypothesized that an arthroscopic transosseous repair system as a procedure for rotator cuff revisions is providing equivalent stability compared to a primary single row suture anchor fixation due to change of fixation site. Methods Eight matched pairs (n = 16) of fresh frozen human shoulders were tested. The paired specimen shoulders were randomly divided into two repair groups (A single row and B primary transosseous repair). The potted specimens were mounted onto the Servohydraulic test system. Both groups were tested under cyclic loading followed by load to failure testing. Suture anchor repair shoulders (group A) that were tested to failure underwent a revision transosseous repair and were subsequently tested again using the same setup and protocol (group C). Results The mean native footprint areas did not show a significant difference between groups. The reconstructed footprint area showed a significantly greater coverage in favor of the transosseous repair. Ultimate load to failure of reconstructions with the primary anchor fixation (344.73 N ± 63.19) and the primary transosseous device (375.36 N ± 70.27) was not significantly higher compared to the revision repair (332.19 N ± 119.01 p = 0.45, p = 0.53). Conclusion The tested transosseous anchor device is a suitable option to widely used suture anchors, providing equivalent fixation properties even in a revision case scenario. Level of evidence Basic Science Study, Biomechanics.
Collapse
Affiliation(s)
- Felix Dyrna
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Andreas Voss
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Leo Pauzenberger
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | | | - Cory Edgar
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
| |
Collapse
|
|
27
|
Milks RA, Kolmodin JD, Ricchetti ET, Iannotti JP, Derwin KA. Augmentation with a reinforced acellular fascia lata strip graft limits cyclic gapping of supraspinatus repairs in a human cadaveric model. J Shoulder Elbow Surg 2018; 27:1105-1111. [PMID: 29398399 DOI: 10.1016/j.jse.2017.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/15/2017] [Accepted: 12/03/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND A reinforced biologic strip graft was designed to mechanically augment the repair of rotator cuff tears that are fully reparable by arthroscopic techniques yet have a likelihood of failure. This study assessed the extent to which augmentation of human supraspinatus repairs with a reinforced fascia strip can reduce gap formation during in vitro cyclic loading. METHODS The supraspinatus tendon was sharply released from the proximal humerus and repaired back to its insertion with anchors in 9 matched pairs of human cadaveric shoulders. One repair from each pair was also augmented with a reinforced fascia strip. All repairs were subjected to cyclic mechanical loading of 5 to 180 N for 1000 cycles. RESULTS All augmented and nonaugmented repair constructs completed 1000 cycles of loading. Augmentation with a reinforced fascia strip graft significantly decreased the amount of gap formation compared with nonaugmented repairs. The average gap formation of augmented repairs was 1.5 ± 0.7 mm after the first cycle vs. 3.0 ± 1.2 mm for nonaugmented repairs (P = .003) and 5.0 ± 1.5 mm after 1000 cycles of loading, which averaged 24% ± 21% less than the gap formation of nonaugmented repairs (7.0 ± 2.8 mm, P = .014). CONCLUSION Cadaveric human supraspinatus repairs augmented with a reinforced fascia strip have significantly less initial stroke elongation and gap formation than repairs without augmentation. Augmentation limited gap formation to the greatest extent early in the testing protocol. Human studies are necessary to confirm the appropriate indications and effectiveness of augmentation scaffolds for rotator cuff repair healing in the clinical setting.
Collapse
Affiliation(s)
- Ryan A Milks
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joel D Kolmodin
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph P Iannotti
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kathleen A Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
|
28
|
Robinson S, Krigbaum H, Kramer J, Purviance C, Parrish R, Donahue J. Double row equivalent for rotator cuff repair: A biomechanical analysis of a new technique. J Orthop 2018; 15:426-431. [PMID: 29881170 DOI: 10.1016/j.jor.2018.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/16/2018] [Indexed: 01/09/2023] Open
Abstract
Introduction There are numerous configurations of double row fixation for rotator cuff tears however, there remains to be a consensus on the best method. In this study, we evaluated three different double-row configurations, including a new method. Our primary question is whether the new anchor and technique compares in biomechanical strength to standard double row techniques. Methods Eighteen prepared fresh frozen bovine infraspinatus tendons were randomized to one of three groups including the New Double Row Equivalent, Arthrex Speedbridge and a transosseous equivalent using standard Stabilynx anchors. Biomechanical testing was performed on humeri sawbones and ultimate load, strain, yield strength, contact area, contact pressure, and a survival plots were evaluated. Results The new double row equivalent method demonstrated increased survival as well as ultimate strength at 415N compared to the remainder testing groups as well as equivalent contact area and pressure to standard double row techniques. Conclusions This new anchor system and technique demonstrated higher survival rates and loads to failure than standard double row techniques. This data provides us with a new method of rotator cuff fixation which should be further evaluated in the clinical setting. Level of Evidence Basic science biomechanical study.
Collapse
Affiliation(s)
- Sean Robinson
- San Francisco Orthopaedic Residency Program, 450 Stanyan St, San Francisco CA 94117, United States
| | | | - Jon Kramer
- San Francisco Orthopaedic Residency Program, 450 Stanyan St, San Francisco CA 94117, United States
| | | | | | | |
Collapse
|
|
29
|
Do functional outcomes and cuff integrity correlate after single- versus double-row rotator cuff repair? A systematic review and meta-analysis study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:593-605. [PMID: 29442181 DOI: 10.1007/s00590-018-2145-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study is to perform a systematic review and meta-analysis of all available level I prospective randomized controlled trials comparing arthroscopic single-row (SR) with double-row (DR) rotator cuff repairs by both clinical outcomes and radiological re-tear rates. METHODS PubMed, EMBASE, Google Scholar, and Cochrane databases search was done for level I RCTs comparing clinical and radiological outcomes after SR versus DR rotator cuff repair. Clinical outcomes included UCLA, ASES, Constant, WORC, and SANE scores; structural outcomes included MRI, MRA, or US. RESULTS Seven level I studies were included (5 mid-term and 2 short-term). Postoperative ASES, Constant, WORC, and SANE scores showed nonsignificant slightly better function of DR groups. Only, UCLA score showed significantly better scores with DR repair (p = 0.007). Full-thickness re-tear incidence was reported in 15/174 (8.6%) in DR group and 20/175 (11.4%) in SR group (p = 0.44). Partial-thickness re-tear rate was reported in 18/174 patients (10.3%) in DR group and 41/175 patients (23.4%) in SR group (p = 0.009). CONCLUSION Within the domain of level I mid-term and short-term studies, DR repair showed significant better UCLA score only. (ASES, Constant, WORC, and SANE scores showed no significance.) This may correlate weakly with the significant lower partial-thickness re-tear rates of DR repairs. In contrary, long-term level III studies showed a direct correlation of both functional outcomes and cuff structural integrity, with significant superiority of DR over SR repair techniques. LEVEL OF EVIDENCE Level 1, systematic review and meta-analysis.
Collapse
|
|
30
|
Hantes ME, Ono Y, Raoulis VA, Doxariotis N, Venouziou A, Zibis A, Vlychou M. Arthroscopic Single-Row Versus Double-Row Suture Bridge Technique for Rotator Cuff Tears in Patients Younger Than 55 Years: A Prospective Comparative Study. Am J Sports Med 2018; 46:116-121. [PMID: 28942685 DOI: 10.1177/0363546517728718] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND When arthroscopic rotator cuff repair is performed on a young patient, long-lasting structural and functional tendon integrity is desired. A fixation technique that potentially provides superior tendon healing should be considered for the younger population to achieve long-term clinical success. Hypothesis/Purpose: The purpose was to compare the radiological and clinical midterm results between single-row and double-row (ie, suture bridge) fixation techniques for arthroscopic rotator cuff repair in patients younger than 55 years. We hypothesized that a double-row technique would lead to improved tendon healing, resulting in superior mid- to long-term clinical outcomes. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A consecutive series of 66 patients younger than 55 years with a medium to large full-thickness tear of supraspinatus and infraspinatus tendons who underwent arthroscopic single-row or double-row (ie, suture bridge) repair were enrolled and prospectively observed. Thirty-four and 32 patients were assigned to single-row and double-row groups, respectively. Postoperatively, tendon integrity was assessed by MRI following Sugaya's classification at a minimum of 12 months, and clinical outcomes were assessed with the Constant score and the University of California, Los Angeles (UCLA) score at a minimum of 2 years. RESULTS Mean follow-up time was 46 months (range, 28-50 months). A higher tendon healing rate was obtained in the double-row group compared with the single-row group (84% and 61%, respectively [ P < .05]). Although no difference in outcome scores was observed between the 2 techniques, patients with healed tendon demonstrated superior clinical outcomes compared with patients who had retorn tendon (UCLA score, 34.2 and 27.6, respectively [ P < .05]; Constant score, 94 and 76, respectively [ P < .05]). CONCLUSION The double-row repair technique potentially provides superior tendon healing compared with the single-row technique. Double-row repair should be considered for patients younger than 55 years with medium to large rotator cuff tears.
Collapse
Affiliation(s)
- Michael E Hantes
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
| | - Yohei Ono
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Vasilios A Raoulis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
| | - Nikolaos Doxariotis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
| | - Aaron Venouziou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
| | - Aristidis Zibis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
| | - Marianna Vlychou
- Department of Radiology, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
| |
Collapse
|
|
31
|
Bishop ME, MacLeod R, Tjoumakaris FP, Hammoud S, Cohen SB, Dodson CC, Ciccotti MG, Freedman KB. Biomechanical and Clinical Comparison of Suture Techniques in Arthroscopic Rotator Cuff Repair. JBJS Rev 2017; 5:e3. [DOI: 10.2106/jbjs.rvw.17.00019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
|
32
|
Fukuhara T, Mihata T, Jun BJ, Neo M. Bridging suture makes consistent and secure fixation in double-row rotator cuff repair. J Orthop Sci 2017. [PMID: 28625583 DOI: 10.1016/j.jos.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Inconsistent tension distribution may decrease the biomechanical properties of the rotator cuff tendon after double-row repair, resulting in repair failure. The purpose of this study was to compare the tension distribution along the repaired rotator cuff tendon among three double-row repair techniques. METHODS In each of 42 fresh-frozen porcine shoulders, a simulated infraspinatus tendon tear was repaired by using 1 of 3 double-row techniques: (1) conventional double-row repair (no bridging suture); (2) transosseous-equivalent repair (bridging suture alone); and (3) compression double-row repair (which combined conventional double-row and bridging sutures). Each specimen underwent cyclic testing at a simulated shoulder abduction angle of 0° or 40° on a material-testing machine. Gap formation and tendon strain were measured during the 1st and 30th cycles. To evaluate tension distribution after cuff repair, difference in gap and tendon strain between the superior and inferior fixations was compared among three double-row techniques. RESULTS At an abduction angle of 0°, gap formation after either transosseous-equivalent or compression double-row repair was significantly less than that after conventional double-row repair (p < 0.01). During the 30th cycle, both transosseous-equivalent repair (p = 0.02) and compression double-row repair (p = 0.01) at 0° abduction had significantly less difference in gap formation between the superior and inferior fixations than did conventional double-row repair. After the 30th cycle, the difference in longitudinal strain between the superior and inferior fixations at 0° abduction was significantly less with compression double-row repair (2.7% ± 2.4%) than with conventional double-row repair (8.6% ± 5.5%, p = 0.03). CONCLUSIONS Bridging sutures facilitate consistent and secure fixation in double-row rotator cuff repairs, suggesting that bridging sutures may be beneficial for distributing tension equally among all sutures during double-row repair of rotator cuff tears.
Collapse
Affiliation(s)
- Tetsutaro Fukuhara
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan; Yaenosato Hospital, Higashi-Osaka, Japan
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan; First Towakai Hospital, Takatsuki, Japan; Katsuragi Hospital, Kishiwada, Japan.
| | - Bong Jae Jun
- Lerner Research Institute, Cleveland Clinic, USA
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| |
Collapse
|
|
33
|
Rush LN, Savoie FH, Itoi E. Double-row rotator cuff repair yields improved tendon structural integrity, but no difference in clinical outcomes compared with single-row and triple-row repair: a systematic review. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
|
34
|
|
|
35
|
Heuberer PR, Smolen D, Pauzenberger L, Plachel F, Salem S, Laky B, Kriegleder B, Anderl W. Longitudinal Long-term Magnetic Resonance Imaging and Clinical Follow-up After Single-Row Arthroscopic Rotator Cuff Repair: Clinical Superiority of Structural Tendon Integrity. Am J Sports Med 2017; 45:1283-1288. [PMID: 28272899 DOI: 10.1177/0363546517689873] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
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.
Collapse
Affiliation(s)
- Philipp R Heuberer
- Department of Orthopedic Surgery, St Vincent Hospital, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine, Vienna, Austria
| | - Daniel Smolen
- Department of Orthopedic Surgery, St Vincent Hospital, Vienna, Austria
| | - Leo Pauzenberger
- Department of Orthopedic Surgery, St Vincent Hospital, Vienna, Austria
| | - Fabian Plachel
- Department of Orthopedic Surgery, St Vincent Hospital, Vienna, Austria
| | - Sylvia Salem
- Department of Orthopedic Surgery, St Vincent Hospital, Vienna, Austria
| | - Brenda Laky
- Department of Orthopedic Surgery, St Vincent Hospital, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine, Vienna, Austria
| | | | - Werner Anderl
- Department of Orthopedic Surgery, St Vincent Hospital, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine, Vienna, Austria
| |
Collapse
|
|
36
|
Scheiderer B, Lacheta L, Imhoff AB, Siebenlist S. V-shaped double-row distal triceps tendon repair: a novel technique using unicortical button fixation. Eur J Med Res 2017; 22:9. [PMID: 28292324 PMCID: PMC5351271 DOI: 10.1186/s40001-017-0250-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/06/2017] [Indexed: 08/21/2023] Open
Abstract
Background This report was designed to present a novel technique combining suture anchor and unicortical button fixation for distal triceps tendon repair. Technical description For anatomical reinsertion of an acute distal triceps tendon rupture, two suture anchors and one unicortical button forming a V-shaped configuration were used. The operative approach is described in detail. Results Excellent clinical and functional results were achieved in the early postoperative phase. The patient reached full elbow range of motion and extension muscle strength (5/5) compared to the uninjured arm 12 weeks after surgery. Complications did not occur. Conclusion This is the first report using unicortical button fixation in distal triceps tendon repair with promising preliminary results. Level of evidence Technical description, case report, Level V
Collapse
Affiliation(s)
- Bastian Scheiderer
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Lucca Lacheta
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| |
Collapse
|
|
37
|
Baums MH, Kostuj T, Klinger HM, Papalia R. [Rotator cuff repair: single- vs double-row. Clinical and biomechanical results]. DER ORTHOPADE 2016; 45:118-24. [PMID: 26694067 DOI: 10.1007/s00132-015-3210-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The goal of rotator cuff repair is a high initial mechanical stability as a requirement for adequate biological recovery of the tendon-to-bone complex. Notwithstanding the significant increase in publications concerning the topic of rotator cuff repair, there are still controversies regarding surgical technique. OBJECTIVES The aim of this work is to present an overview of the recently published results of biomechanical and clinical studies on rotator cuff repair using single- and double-row techniques. MATERIALS AND METHODS The review is based on a selective literature research of PubMed, Embase, and the Cochrane Database on the subject of the clinical and biomechanical results of single- and double-row repair. RESULTS In general, neither the biomechanical nor the clinical evidence can recommend the use of a double-row concept for the treatment for every rotator cuff tear. Only tears of more than 3 cm seem to benefit from better results on both imaging and in clinical outcome studies compared with the use of single-row techniques. CONCLUSIONS Despite a significant increase in publications on the surgical treatment of rotator cuff tears in recent years, the clinical results were not significantly improved in the literature so far. Unique information and algorithms, from which the optimal treatment of this entity can be derived, are still inadequate. Because of the cost-effectiveness and the currently vague evidence, the double-row techniques cannot be generally recommended for the repair of all rotator cuff tears.
Collapse
Affiliation(s)
- M H Baums
- Orthopädie Aukamm-Klinik Wiesbaden, Leibnizstr. 21, 65191, Wiesbaden, Deutschland.
- Abteilung Orthopädie, Universitätsmedizin Göttingen (UMG), Georg-August-Universität, Göttingen, Deutschland.
| | - T Kostuj
- Klinik für Orthopädie und Unfallchirurgie, St. Josef-Hospital im Katholischen Klinikum Bochum, Ruhr-Universität-Bochum (RUB), Bochum, Deutschland
| | - H-M Klinger
- Abteilung Orthopädie, Universitätsmedizin Göttingen (UMG), Georg-August-Universität, Göttingen, Deutschland
| | - R Papalia
- UOC Ortopedia e Traumatologia, Policlinico Universitario Campus Bio-Medico, Rom, Italien
| |
Collapse
|
|
38
|
Lorbach O, Trennheuser C, Kieb M, Efe T, Kohn D, Anagnostakos K. Reconstruction of 25 and 50 % subscapularis tears: a single anchor with a double-mattress suture is sufficient for the reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24:3855-3862. [PMID: 26318490 DOI: 10.1007/s00167-015-3767-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/19/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE Evaluation of the biomechanical performance of repairs of 25 % (Fox/Romeo II) and 50 % (Fox/Romeo III) full-thickness subscapularis tears using a single-suture anchor. METHODS Six pairs of human cadaver specimens were used for the testing. Artificial subscapularis tears were created in order to simulate a 25 % (6) and a 50 % (6) full-thickness tear. The reconstructions were made with a double-loaded suture anchor (5.5-mm Bio-Corkscrew with two No. 2 Fiberwire) creating a double-mattress suture repair. Reconstructions were cyclically loaded from 10 to 60 N. The load was increased stepwise up to 100 and 180 N. Cyclic displacement (means + standard dev.) as well as load-to-failure was determined, and mode of failure was recorded. RESULTS In the reconstructed shoulders at 60 N, a mean cyclic displacement of 3.2 ± 0.7 mm was found in the 25 % tear, 2.6 ± 0.6 mm in the 50 % tear. At 100 N, 5.1 ± 1.2 mm was seen in the 25 % tear and 4.3 ± 0.3 mm in the 50 % tear. At highest load of 180 N, 7.6 ± 2.2 mm was recorded in the 25 % tear, 6.5 ± 0.8 mm was found in the 50 % tear. Ultimate failure load was 486 ± 167 N in the 25 % tear and 455 ± 213 N in the 50 % tear. Statistically significant differences between the tested repairs were seen neither in cyclic displacement nor in ultimate failure loads (p > 0.05). Mode of failure revealed bone fractures and anchor pull-out as major cause in the 25 % group, whereas failure of the suture-tendon interface was the major cause of failure in the 50 % group. CONCLUSIONS Subscapularis repair using a single double-loaded suture anchor revealed similar biomechanical performance in 25 % compared to 50 % full-thickness subscapularis tears. With increased tear size, however, an optimized suture-tendon interface seems to become more relevant in order to decrease failure rate of the repair. CLINICAL RELEVANCE A single double-loaded suture anchor provides sufficient biomechanical strength even in Fox/Romeo grade III tears of the subscapularis tendon. However, a modified suture configuration is recommended, especially in grade III tears as the suture-tendon interface is the weakest point of the construct.
Collapse
Affiliation(s)
- Olaf Lorbach
- Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany.
| | - Christian Trennheuser
- Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany
| | - Matthias Kieb
- Department of Orthopaedic and Trauma Surgery, Klinikum Ernst von Bergmann, Potsdam/Bad Belzig, Germany
| | - Turgay Efe
- Department of Orthopaedic Surgery, Marburg University, Marburg, Germany
| | - Dieter Kohn
- Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany
| | - Konstantinos Anagnostakos
- Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany
| |
Collapse
|
|
39
|
Panella A, Amati C, Moretti L, Damato P, Notarnicola A, Moretti B. Single-row and transosseous sutures for supraspinatus tendon tears: a retrospective comparative clinical and strength outcome at 2-year follow-up. Arch Orthop Trauma Surg 2016; 136:1507-1511. [PMID: 27568220 DOI: 10.1007/s00402-016-2558-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Rotator cuff tears commonly necessitate surgical repair; however, the optimal technique for repair continues to be investigated. Recently, double-row repairs have been considered an alternative to single-row repair, allowing a greater coverage area for healing and a possibly stronger repair. AIM We performed a study to compare single-row repair and suture-bridge (SB) technique (a TOE technique) in terms of the recovery of the strength and functional outcome. MATERIAL AND METHOD The purpose of the retrospective study was to compare 44 patients treated for a rotator cuff repair with the single-row (24) or suture-bridge techniques (20). At 24-month FU, there were not statistically significant differences for the UCLA score, Individual Constant Score, pain, ROM, and strength on the treated and contra-lateral arm. Comparing the mean values of the differences in strength obtained between the treated arm and the contra lateral in each group, the final results appeared significantly different in favor of SB (p = 0.03). CONCLUSION Patients treated with DR could expect to regain the same strength of the contra-lateral side, while patients treated with SR could expect globally good results, overall in terms of pain relief and functionality, but lower strength.
Collapse
Affiliation(s)
- A Panella
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - C Amati
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - L Moretti
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - P Damato
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - A Notarnicola
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - B Moretti
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| |
Collapse
|
|
40
|
Roth KM, Warth RJ, Lee JT, Millett PJ, ElAttrache NS. Arthroscopic Single-Row Versus Double-Row Repair for Full-Thickness Posterosuperior Rotator Cuff Tears: A Critical Analysis Review. JBJS Rev 2016; 2:01874474-201407000-00006. [PMID: 27490063 DOI: 10.2106/jbjs.rvw.m.00081] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Kevin M Roth
- Webster Orthopedic Medical Group, 3010 Colby Street, Suite 118, Berkeley, CA 94705
| | - Ryan J Warth
- The Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657
| | - Jared T Lee
- The Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657
| | - Peter J Millett
- The Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657
| | - Neal S ElAttrache
- The Kerlan-Jobe Orthopaedic Clinic, 6801 Park Terrace, Los Angeles, CA 90045
| |
Collapse
|
|
41
|
Spiegl UJ, Euler SA, Millett PJ, Hepp P. Summary of Meta-Analyses Dealing with Single-Row versus Double-Row Repair Techniques for Rotator Cuff Tears. Open Orthop J 2016; 10:330-338. [PMID: 27708735 PMCID: PMC5041206 DOI: 10.2174/1874325001610010330] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 05/16/2015] [Accepted: 02/01/2016] [Indexed: 02/07/2023] Open
Abstract
Background: Several meta-analyses of randomized clinical trials have been performed to analyze whether double-row (DR) rotator cuff repair (RCR) provides superior clinical outcomes and structural healing compared to single-row (SR) repair. The purpose of this study was to sum up the results of meta-analysis comparing SR and DR repair with respect on clinical outcomes and re-tear rates. Methods: A literature search was undertaken to identify all meta-analyses dealing with randomized controlled trials comparing clinical und structural outcomes after SR versus DR RCR. Results: Eight meta-analyses met the eligibility criteria: two including Level I studies only, five including both Level I and Level II studies, and one including additional Level III studies. Four meta-analyses found no differences between SR and DR RCR for patient outcomes, whereas four favored DR RCR for tears greater than 3 cm. Two meta-analyses found no structural healing differences between SR and DR RCR, whereas six found DR repair to be superior for tears greater than 3 cm tears. Conclusion: No clinical differences are seen between single-row and double-row repair for small and medium rotator cuff tears after a short-term follow-up period with a higher re-tear rate following single-row repairs. There seems to be a trend to superior results with double-row repair in large to massive tear sizes.
Collapse
Affiliation(s)
- U J Spiegl
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Germany
| | - S A Euler
- Department of Trauma Surgery and Sports Traumatology, Medical University Innsbruck, Austria
| | | | - P Hepp
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Germany
| |
Collapse
|
|
42
|
Wani Z, Abdulla M, Habeebullah A, Kalogriantis S. Rotator cuff tears: Review of epidemiology, clinical assessment and operative treatment. TRAUMA-ENGLAND 2016. [DOI: 10.1177/1460408615596770] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Rotator cuff tears (RTCs) are the most common cause of shoulder disability. There has been a proportional increase in the prevalence of RCT in accordance with the rising trend of an ageing population. In this article we review the current literature encompassing RCT epidemiology, risk factors and aetiopathogenesis. We also summarize the current diagnostic modalities, treatment options, rehabilitation and outcomes.
Collapse
Affiliation(s)
- Zubair Wani
- University Hospital Birmingham, Birmingham, UK
| | - Mohamed Abdulla
- Department of Anatomy, University of Birmingham Medical School, UK
| | | | - Socrates Kalogriantis
- University Hospital Birmingham, Birmingham, UK
- Department of Anatomy, University of Birmingham Medical School, UK
| |
Collapse
|
|
43
|
Franceschi F, Papalia R, Franceschetti E, Palumbo A, Del Buono A, Paciotti M, Maffulli N, Denaro V. Double-Row Repair Lowers the Retear Risk After Accelerated Rehabilitation. Am J Sports Med 2016; 44:948-56. [PMID: 26797698 DOI: 10.1177/0363546515623031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recently, an accelerated rehabilitation protocol after rotator cuff (RC) repair has been proposed for patients at risk of postoperative stiffness. PURPOSE To investigate, in patients undergoing early accelerated mobilization, whether double-row (DR) repair provides better clinical outcomes and a lower retear rate compared with single-row (SR) configurations. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 58 patients were randomized to undergo either SR or DR repair. After 2 years of follow-up, 12 men and 13 women (mean age, 61.8 years; range, 52-67 years) in the SR group and 15 men and 10 women (mean age, 58.9 years; range, 51-69 years) in the DR group were evaluated. To assess the retear rate, magnetic resonance imaging of the shoulder was performed at 2-year follow-up. The clinical evaluation was based on the modified University of California, Los Angeles (UCLA) shoulder score and range of motion (ROM) measurements. RESULTS Magnetic resonance arthrography showed a significantly lower full-thickness retear rate for the DR group than for the SR group (8% vs 24%, respectively; P < .05). Conversely, at both 6-month and 2-year follow-up, there was no statistically significant difference in terms of the rate of stiffness in the SR and DR groups (8% vs 12% and 0% vs 0%, respectively; P > .05). No clinical differences were recorded regarding the UCLA score (SR group: mean, 32.6 [range, 30-35]; DR group: mean, 33.3 [range, 29-35]; P = .61) and ROM. CONCLUSION In selected patients at a high risk of shoulder stiffness and therefore necessitating accelerated postoperative rehabilitation, DR repair of the RC could lower retear rates.
Collapse
Affiliation(s)
- Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Alessio Palumbo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Angelo Del Buono
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Michele Paciotti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| |
Collapse
|
|
44
|
A 3D finite element model for geometrical and mechanical comparison of different supraspinatus repair techniques. J Shoulder Elbow Surg 2016; 25:557-63. [PMID: 26652702 DOI: 10.1016/j.jse.2015.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Contact pressure and contact area are among the most important mechanical factors studied to predict the effectiveness of a rotator cuff repair. The suture configurations can strongly affect these factors but are rarely correlated with each other. For example, there is a significant difference between the single-row technique and the transosseous or transosseous-like approaches in terms of footprint contact area coverage. A finite element model-based approach is presented and applied to account for various parameters (eg, suture pretension, geometry of the repair, effect of the sutures, geometry of the lesion) and to compare the efficacy of different repair techniques in covering the original footprint. METHODS The model allows us to evaluate the effect of parameters such as suture configuration and position and suture pretension. The validity of such an approach was assessed in comparing 3 different repair techniques: single row, transosseous equivalent, and double row. RESULTS Results from the application of the models show that the double-row and transosseous-equivalent techniques lead to progressive increase of the contact area compared with the single-row approach, supporting the conclusion that transosseous-equivalent fixation leads to an increase of the contact area and a better distribution of the pressure coverage. CONCLUSION The 3-dimensional finite element model approach allows multiple variables to be assessed singularly, weighing the specific influence. Moreover, the approach presented in this study could be a valid tool to predict and to reproduce different configurations, identifying how to reduce the stress over the tendon and when a repair could be effective or not.
Collapse
|
|
45
|
Kim SH, Kim J, Choi YE, Lee HR. Healing disturbance with suture bridge configuration repair in rabbit rotator cuff tear. J Shoulder Elbow Surg 2016; 25:478-86. [PMID: 26541205 DOI: 10.1016/j.jse.2015.08.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/13/2015] [Accepted: 08/25/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Medial row failure has been reported in the suture bridge technique of rotator cuff repair. This study compared the healing response of suture bridge configuration repair (SBCR) and parallel type transosseous repair (PTR). METHODS Acute rotator cuff repair was performed in 32 rabbits. Both shoulders were repaired using PTR or SBCR. In PTR, simple PTR was performed through 2 parallel transosseous tunnels created using a microdrill. In SBCR, 2 additional crisscross transosseous tunnels were added to mimic arthroscopic SBCR. At 1, 2, and 5 weeks postoperatively, comparative biomechanical testing was performed in 8 rabbits, and histologic analysis, including immunohistochemical staining for CD31, was performed in 4 rabbits. RESULTS Failure loads at 1 week (38.12 ± 20.43 N vs 52.00 ± 27.23 N; P = .284) and 5 weeks (97.93 ± 48.35 N vs 119.60 ± 60.81 N; P = .218) were not statistically different between the SBCR and PTR groups, respectively, but were significantly lower in the SBCR group than in the PTR group (23.56 ± 13.56 N vs. 44.25 ± 12.53 N; P = .009), respectively, at 2 weeks. Markedly greater fibrinoid deposition was observed in the SBCR group than in the PTR group at 2 weeks. For vascularization, there was a tendency that more vessels could be observed in PTR than in SBCR at 2 weeks (15.9 vs 5.6, P = .068). CONCLUSIONS In a rabbit acute rotator cuff repair model, SBCR exhibited inferior mechanical strength, and fewer blood vessels were observed at the healing site at 2 weeks postoperatively. Medial row tendon failure was more common in SBCR. Surgeons should consider the clinical effect of SBCR when performing rotator cuff repair.
Collapse
Affiliation(s)
- Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jangwoo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Eun Choi
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hwa-Ryeong Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
|
46
|
Imam MA, Abdelkafy A. Outcomes following arthroscopic transosseous equivalent suture bridge double row rotator cuff repair: a prospective study and short-term results. SICOT J 2016; 2:7. [PMID: 27163096 PMCID: PMC4849220 DOI: 10.1051/sicotj/2015041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 12/19/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The transosseous-equivalent cross bridge double row (TESBDR) rotator cuff (RC) repair technique has been developed to optimize healing biology at a repaired RC tendon insertion. It has been shown in the laboratory to improve pressurized contact area and mean foot print pressure when compared with a double row anchor technique. Pressure has been shown to influence healing between tendon and bone, and the tendon compression vector provided by the transosseous-equivalent suture bridges may enhance healing. The purpose was to prospectively evaluate the outcomes of arthroscopic TESBDR RC repair. METHODS Single center prospective case series study. Sixty-nine patients were selected to undergo arthroscopic TESBDR RC repair and were included in the current study. Primary outcome measures included the Oxford Shoulder Score (OSS), the University of California, Los Angeles (UCLA) score, the Constant-Murley (CM) Score and Range of motion (ROM). Secondary outcome measures included a Visual Analogue Scale (VAS) for pain, another VAS for patient satisfaction from the operative procedure, EuroQoL 5-Dimensions Questionnaire (EQ-5D) for quality of life assessment. RESULTS At 24 months post-operative, average OSS score was 44, average UCLA score was 31, average CM score was 88, average forward flexion was 145°, average internal rotation was 35°, average external rotation was 79°, average abduction was 150°, average EQ-5D score was 0.73, average VAS for pain was 2.3, and average VAS for patient satisfaction was 9.2. CONCLUSION Arthroscopic TESBDR RC repair is a procedure with good post-operative functional outcome and low re-tear rate based on a short term follow-up.
Collapse
Affiliation(s)
- Mohamed Abdelnabi Imam
-
The South West London Elective Orthopaedic Centre Dorking Road Epsom
KT18 7EG London UK
-
Orthopaedic Surgery and Trauma Department, Faculty of Medicine, Suez Canal University Circular Road 41522
Ismailia Egypt
| | - Ashraf Abdelkafy
-
Orthopaedic Surgery and Trauma Department, Faculty of Medicine, Suez Canal University Circular Road 41522
Ismailia Egypt
| |
Collapse
|
|
47
|
Oliva F, Piccirilli E, Bossa M, Via AG, Colombo A, Chillemi C, Gasparre G, Pellicciari L, Franceschetti E, Rugiero C, Scialdoni A, Vittadini F, Brancaccio P, Creta D, Buono AD, Garofalo R, Franceschi F, Frizziero A, Mahmoud A, Merolla G, Nicoletti S, Spoliti M, Osti L, Padulo J, Portinaro N, Tajana G, Castagna A, Foti C, Masiero S, Porcellini G, Tarantino U, Maffulli N. I.S.Mu.L.T - Rotator Cuff Tears Guidelines. Muscles Ligaments Tendons J 2016; 5:227-63. [PMID: 26958532 DOI: 10.11138/mltj/2015.5.4.227] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources.
Collapse
Affiliation(s)
- Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Eleonora Piccirilli
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Michela Bossa
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome "Tor Vergata", Italy
| | - Alessio Giai Via
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | | | - Claudio Chillemi
- Department of Orthopaedic and Traumatology, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Giuseppe Gasparre
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | - Leonardo Pellicciari
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome "Tor Vergata", Italy
| | - Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Italy
| | - Clelia Rugiero
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Alessandro Scialdoni
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Filippo Vittadini
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | | | - Domenico Creta
- Physical Therapy and Rehabilitation Service, Private Hospital "Madre Fortunata Toniolo", Bologna, Italy
| | - Angelo Del Buono
- Orthopaedics and Traumatology, Ospedale Sant'Anna, Sanfermo della Battaglia, Como, Italy
| | - Raffaele Garofalo
- Shoulder Service, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Italy
| | - Antonio Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | - Asmaa Mahmoud
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome "Tor Vergata", Italy
| | - Giovanni Merolla
- Shoulder and Elbow Unit Biomechanics Laboratory "M. Simoncelli" D. Cervesi Hospital, Cattolica, Italy
| | - Simone Nicoletti
- Department of Orthopaedics and Traumatology, San Jacopo Hospital, Italy
| | - Marco Spoliti
- Department of Orthopaedics and Traumatology, San Camillo Hospital, Rome, Italy
| | - Leonardo Osti
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - Johnny Padulo
- Sport Science, University e-Campus, Novedrate, Italy; Tunisian Research Laboratory "Sports Performance Optimization", National Center of Medicine and Science in Sport, Tunis, Tunisia
| | - Nicola Portinaro
- UO Pediatric Orthopaedics, Humanitas Research Hospital, Milano, Italy
| | | | - Alex Castagna
- Shoulder and Elbow Unit, IRCCS Humanitas Institute, Rozzano, Milano, Italy
| | - Calogero Foti
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome "Tor Vergata", Italy
| | - Stefano Masiero
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | - Giuseppe Porcellini
- Shoulder and Elbow Unit Biomechanics Laboratory "M. Simoncelli" D. Cervesi Hospital, Cattolica, Italy
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Nicola Maffulli
- Head of Department of Orthopaedics and Traumatology, Azienda Ospedaliera San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
| |
Collapse
|
|
48
|
Gülecyüz M, Bortolotti H, Pietschmann M, Ficklscherer A, Niethammer T, Roßbach B, Müller P. Primary stability of rotator cuff repair: can more suture materials yield more strength? INTERNATIONAL ORTHOPAEDICS 2015; 40:989-97. [PMID: 26442512 DOI: 10.1007/s00264-015-3012-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/22/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION It remains unclear if the increased biomechanical stability of the double-row repair is solely a result of the technique itself or due to the greater number of utilized materials. This study analyses the various rotator cuff (RC) repair interfaces and the influence of doubling the number of suture knots, stitch techniques and suture anchors on the primary stability of the RC reconstruction. MATERIALS AND METHODS Established cyclic testing protocols were used to test the primary stability of the knot interface with a Duncan loop and Roeder knot, the tendon-to-suture interface with a single-stitch and Mason-Allen-stitch and the anchor-to-bone interface with OPUS Magnum 2® and BioCorkscrew® anchors. After doubling the materials, the interfaces were tested again and compared to the yielded solitary values. The maximum failure loads (Fmax), clinical failure (CF), system displacement (SD) and modes of failure were recorded. RESULTS Doubling the amount of knots, stitches and suture anchors improved almost all interface parameters. For example, Fmax, CF and SD of the Roeder knot could be significantly improved from 142.5 N to 256.7 N, from 82.5 N to 155.0 N and from 0.45 mm to 0.20 mm, respectively. The Mason-Allen stitch's Fmax improved from 196.4 N to 324.9 N, and CF from 94.25 N to 139.8 N, with almost identical SD of 0.81 mm and 0.84 mm. Bio-Corkscrew® Fmax improved from 232.5 N to 317.5 N, CF from 182.5 N to 210 N, and SD from 0.85 mm to 0.64 mm. CONCLUSION Doubling the number of knots, stitches and suture anchors increases the primary stability of the various RC repair interfaces and may result in RC rerupture rate reduction. Furthermore, this study suggests that a suture anchor loaded with two or three sutures may yield the same primary stability as two or three suture anchors loaded with a single suture. This in vitro biomechanical study focuses solely on the rotator cuff interfaces at time zero; the biological healing process was therefore not analysed and requires further investigation. CLINICAL RELEVANCE Improved primary stability by increased number of suture materials may reduce rate of RC rerupture.
Collapse
Affiliation(s)
- Mehmet Gülecyüz
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Medical Center of the University of Munich, Munich, Germany.
| | - Hannes Bortolotti
- Department of Trauma Surgery and Sports Traumatology, A.Ö. BKH Kufstein, Kufstein, Austria
| | - Matthias Pietschmann
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Medical Center of the University of Munich, Munich, Germany
| | - Andreas Ficklscherer
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Medical Center of the University of Munich, Munich, Germany
| | - Thomas Niethammer
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Medical Center of the University of Munich, Munich, Germany
| | - Björn Roßbach
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Medical Center of the University of Munich, Munich, Germany
| | - Peter Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Medical Center of the University of Munich, Munich, Germany
| |
Collapse
|
|
49
|
Ying ZM, Lin T, Yan SG. Arthroscopic single-row versus double-row technique for repairing rotator cuff tears: a systematic review and meta-analysis. Orthop Surg 2015; 6:300-12. [PMID: 25430714 DOI: 10.1111/os.12139] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 08/31/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The purpose of this study was to systematically review published reports that compare the outcomes of single-row and double-row suture anchor fixation in arthroscopic rotator cuff repair. METHODS Combined data regarding relevant patient characteristics, rotator cuff pathology, surgical techniques, postoperative rehabilitation regimens, University of California at Los Angeles (UCLA) Scores, Constant scores, American Shoulder and Elbow Society (ASES) scores, tendon healing, incidence of recurrent rotator cuff defects, shoulder muscle strength, range of motion, surgical time and patient satisfaction were assessed. RESULTS Seven eligible randomized controlled studies and four prospective cohort studies were identified. There were no significant differences between the single-row and double-row groups in terms of Constant or ASES scores. However, UCLA scores, tendon healing, abduction shoulder strength index (SSI), external rotation SSI and internal rotation SSI were significantly better for double-row technique than for single-row technique. A statistically significant advantage for double-row repair according to UCLA score and external rotation SSI was found in the subgroup with tears greater than 3 cm. CONCLUSION No definite conclusion could be drawn about differences in overall outcomes of double- and single-row techniques for repairing for small to medium (<3 cm) or large to massive (>3 cm) rotator cuff tears, even though some measures of clinical outcome showed significant differences between these two techniques.
Collapse
Affiliation(s)
- Zhi-min Ying
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | |
Collapse
|
|
50
|
Wang E, Wang L, Gao P, Li Z, Zhou X, Wang S. Single-versus double-row arthroscopic rotator cuff repair in massive tears. Med Sci Monit 2015; 21:1556-61. [PMID: 26017641 PMCID: PMC4459574 DOI: 10.12659/msm.893058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background It is a challenge for orthopaedic surgeons to treat massive rotator cuff tears. The optimal management of massive rotator cuff tears remains controversial. Therefore, the goal of this study was to compare arthroscopic single- versus double-row rotator cuff repair with a larger sample size. Material/Methods Of the subjects with massive rotator cuff tears, 146 were treated using single-row repair, and 102 were treated using double-row repair. Pre- and postoperative functional outcomes and radiographic images were collected. The clinical outcomes were evaluated for a minimum of 2 years. Results No significant differences were shown between the groups in terms of functional outcomes. Regarding the integrity of the tendon, a lower rate of post-treatment retear was observed in patients who underwent double-row repair compared with single-row repair. Conclusions The results suggest that double-row repair is relatively superior in shoulder ROM and the strength of tendon compared with single-row repair. Future studies involving more patients in better-designed randomized controlled trials will be required.
Collapse
Affiliation(s)
- EnZhi Wang
- Department of Orthopaedic Surgery, People's Hospital of Zhangqiu, Zhangqiu, Shandong, China (mainland)
| | - Liang Wang
- Department of Orthopaedic Surgery, People's Hospital of Zhangqiu, Zhangqiu, Shandong, China (mainland)
| | - Peng Gao
- Department of Orthopaedic Surgery, People's Hospital of Zhangqiu, Zhangqiu, Shandong, China (mainland)
| | - ZhongJi Li
- Department of Orthopaedic Surgery, People's Hospital of Zhangqiu, Zhangqiu, Shandong, China (mainland)
| | - Xiao Zhou
- Department of Orthopaedic Surgery, People's Hospital of Zhangqiu, Zhangqiu, Shandong, China (mainland)
| | - SongGang Wang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| |
Collapse
|