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Rotator cuff repair

Y Lopiz, C Arvinius, C García-Fernández, M C Rodriguez-Bobada, P González-López, A Civantos, F Marco
AIM: Rotator cuff repairs have shown a high level of re-ruptures. It is hypothesised that the use of rhBMP-2 in a carrier could improve the biomechanical and histological properties of the repair. MATERIAL AND METHODS: Controlled experimental study conducted on 40 rats with section and repair of the supraspinatus tendon and randomisation to one of five groups: Group 1 (control) only suture; Group 2 (double control), suture and alginate-chitin carrier; Group 3 (alginate-control), the rhBMP-2 was added to the alginate; Group 4 (chitin-control) application of the rhBMP-2 to the chitin, and Group 5 (double sample): The two components of the carrier (alginate and chitin) have rhBMP-2...
October 20, 2016: Revista Española de Cirugía Ortopédica y Traumatología
Robert J Gillespie, Derrick M Knapik, Ozan Akkus
Rotator cuff injuries are common in both young and elderly patients. Despite improvements in instrumentation and surgical techniques, the failure rates following tendon reconstruction remain unacceptably high. To improve outcomes, graft patches have been developed to provide mechanical strength and to furnish a scaffold for biologic growth across the delicate tendon-bone junction. Although no patch effectively re-creates the structured, highly organized system of prenatal tendon development, augmenting rotator cuff repair may help restore native tendon-to-bone attachment while reproducing the mechanical and biologic properties of native tendon...
October 20, 2016: Journal of the American Academy of Orthopaedic Surgeons
Sven Reuter, Andreas B Imhoff, Frank Martetschläger
BACKGROUND: The aim of this study was to systematically review the literature for the impact of rotator cuff tear (RCT) surgery on postoperative sporting activity in professional and recreational athletes. METHODS: To identify any published clinical study on return to sports data for athletes following rotator cuff surgery a systematic search in literature was conducted. Inclusion criteria were partial- and full-thickness rotator cuff tears and any open or arthroscopic RCT surgery in sports participating people...
October 20, 2016: Journal of Sports Medicine and Physical Fitness
Stephen J Nicholas, Steven J Lee, Michael J Mullaney, Timothy F Tyler, Takumi Fukunaga, Christopher D Johnson, Malachy P McHugh
BACKGROUND: The functional benefits of double-row (DR) versus single-row (SR) rotator cuff repair are not clearly established. PURPOSE: To examine the effect of DR versus SR rotator cuff repair on functional outcomes and strength recovery in patients with full-thickness tears. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS: Forty-nine patients were randomized to DR or SR repairs; 36 patients (13 women, 23 men; mean age, 62 ± 7 years; 20 SR, 16 DR) were assessed at a mean 2...
October 2016: Orthopaedic Journal of Sports Medicine
Kelechi R Okoroha, Nima Mehran, Jonathan Duncan, Travis Washington, Tyler Spiering, Michael J Bey, Marnix Van Holsbeeck, Vasilios Moutzouros
Ultrasound and magnetic resonance imaging (MRI) are both capable of diagnosing full-thickness rotator cuff tears. However, it is unknown which imaging modality is more accurate and precise in evaluating the characteristics of full-thickness rotator cuff tears in a surgical population. This study reviewed 114 patients who underwent arthroscopic repair of a full-thickness rotator cuff tear over a 1-year period. Of these patients, 61 had both preoperative MRI and ultrasound for review. Three musculoskeletal radiologists evaluated each ultrasound and MRI in a randomized and blinded fashion on 2 separate occasions...
October 18, 2016: Orthopedics
Jennica J Tucker, Joshua A Gordon, Robert C Zanes, Andrey Zuskov, John D Vinciguerra, Roy D Bloebaum, Louis J Soslowsky
BACKGROUND: Current techniques in rotator cuff repair often lack structural integrity. P(2) porous titanium-coated constructs (DJO Surgical, Austin, TX, USA) promote osseointegration and soft tissue ingrowth. This study examined the ability of this material to improve the structural integrity of supraspinatus tendon repair in a rat model. We hypothesized that P(2) implants placed at the tendon-to-bone interface would improve mechanical and histologic measures of supraspinatus healing...
October 14, 2016: Journal of Shoulder and Elbow Surgery
Sahishnu Patel, Anthony P Gualtieri, Helen H Lu, William N Levine
Rotator cuff tear is a very common shoulder injury that often necessitates surgical intervention for repair. Despite advances in surgical techniques for rotator cuff repair, there is a high incidence of failure after surgery because of poor healing capacity attributed to many factors. The complexity of tendon-to-bone integration inherently presents a challenge for repair because of a large biomechanical mismatch between the tendon and bone and insufficient regeneration of native tissue, leading to the formation of fibrovascular scar tissue...
October 17, 2016: Annals of the New York Academy of Sciences
Jourdan M Cancienne, Stephen F Brockmeier, Scott A Rodeo, Chris Young, Brian C Werner
PURPOSE: To evaluate the association of postoperative fluoroquinolone use following arthroscopic primary rotator cuff repair with failure requiring revision rotator cuff repair. METHODS: An insurance database was queried for patients undergoing rotator cuff repair from 2007 to 2015. These patients were divided into three groups: (1) patients prescribed fluoroquinolones within 6 months postoperatively (divided into 0-2, 2-4, and 4-6 months), (2) a matched negative control cohort of patients not prescribed fluoroquinolones, and (3) a matched positive control cohort of patients prescribed fluoroquinolones between 6 and 18 months following rotator cuff repair...
October 13, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
William R Mook, Joshua A Greenspoon, Peter J Millett
BACKGROUND: Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row. METHODS: The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construct...
2016: Open Orthopaedics Journal
Jennifer L Pierce, Nicholas C Nacey, Stephen Jones, Davis Rierson, Brian Etier, Stephen Brockmeier, Mark W Anderson
Imaging interpretation of the postoperative shoulder is a challenging and difficult task for both the radiologist and the orthopedic surgeon. The increasing number of shoulder rotator cuff, labrum, and biceps tendon repairs performed in the United States also makes this task a frequent occurrence. Whether treatment is surgical or conservative, imaging plays a crucial role in patient care. Many imaging findings can be used to predict prognosis and functional outcomes, ultimately affecting treatment. In addition, evolving surgical techniques alter the normal anatomy and imaging appearance of the shoulder such that accepted findings proved to be pathologic in the preoperative setting cannot be as readily described as pathologic after surgery...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Amir Lebaschi, Xiang-Hua Deng, Jianchun Zong, Guang-Ting Cong, Camila B Carballo, Zoe M Album, Christopher Camp, Scott A Rodeo
Rotator cuff (RC) injuries represent a significant source of pain, functional impairment, and morbidity. The large disease burden of RC pathologies necessitates rapid development of research methodologies to treat these conditions. Given their ability to model anatomic, biomechanical, cellular, and molecular aspects of the human RC, animal models have played an indispensable role in reducing injury burden and advancing this field of research for many years. The development of animal models in the musculoskeletal (MSK) research arena is uniquely different from that in other fields in that the similarity of macrostructures and functions is as critical to replicate as cellular and molecular functions...
October 10, 2016: Annals of the New York Academy of Sciences
Hong Jun Jung, Gyeong-Bo Sim, Kun Hyung Bae, Aashay L Kekatpure, Jae-Myeung Chun, In-Ho Jeon
BACKGROUND: The purpose of this study was to evaluate whether rotator cuff repair improves subjective and functional outcomes in patients aged ≥75 years. METHODS: From May 2005 to March 2013, 121 elderly patients who underwent rotator cuff repair for large and massive rotator cuff tears were evaluated retrospectively. Patients with an American Society of Anesthesiologists physical status classification system grade ≥4 were excluded. The patients were evaluated using visual analog scales, subjective satisfaction surveys, American Shoulder and Elbow Surgeons scores, and Constant scores...
October 5, 2016: Journal of Shoulder and Elbow Surgery
Nicholas A Early, John J Elias, Steven B Lippitt, Danielle E Filipkowski, Robert A Pedowitz, William J Ciccone
BACKGROUND: This in vitro study evaluated the biomechanical benefit of adding spanning sutures to single-row rotator cuff repair. METHODS: Mechanical testing was performed to evaluate 9 pairs of cadaveric shoulders with complete rotator cuff repairs, with a single-row technique used on one side and the suture spanning technique on the other. The spanning technique included sutures from 2 lateral anchors securing tendon near the musculotendinous junction, spanning the same anchor placement from single-row repair...
October 5, 2016: Journal of Shoulder and Elbow Surgery
Kunitaro Watanabe, Joho Tokumine, Tomoko Yorozu, Kumi Moriyama, Hideaki Sakamoto, Tetsuo Inoue
BACKGROUND: Dexamethasone added to local anesthetic for brachial plexus block improves postoperative pain after arthroscopic rotator cuff repair, as compared with the use of local anesthetic alone. Dexamethasone is present in non-particulate form in local anesthetic solution, while betamethasone is partially present in particulate form. The particulate betamethasone gradually decays and is expected to cause its longer-lasting effect. This study investigated the postoperative analgesic effect of betamethasone added to ropivacaine for brachial plexus block in patients who underwent arthroscopic rotator cuff repair...
October 4, 2016: BMC Anesthesiology
Matthew Yalizis, Kevin Kruse, Arnaud Godenèche
Proper visualization is of paramount importance during arthroscopic rotator cuff repair. We propose a technique that significantly improves the visualization of the rotator cuff when viewing from the anterolateral or lateral portals. This "panorama" view is obtained by a release of the deep layer of the deltoid fascia, which in turn increases the space between the humerus and the deltoid muscle. This release increases the volume of the subdeltoid bursa, secondarily increasing the field of view of the subacromial space with the camera viewing from the anterolateral or lateral portals...
August 2016: Arthroscopy Techniques
Steven Giuseffi, Larry D Field, Thomas V Giel, Brian T Brislin, Felix H Savoie
Patients with rotator cuff tears may present with or subsequently develop concomitant shoulder stiffness. The treatment of rotator cuff tears in the face of passive glenohumeral motion loss is controversial. Preoperative shoulder stiffness has been considered by some a contraindication to rotator cuff repair. Some surgeons recommend staging surgical procedures and delaying rotator cuff repair until shoulder stiffness has resolved. However, this can lead to prolonged recovery times and patient dissatisfaction...
August 2016: Arthroscopy Techniques
Daniel J Kaplan, Andrew P Dold, David J Fralinger, Robert J Meislin
Patients with gluteus minimus and medius tears that fail nonoperative management may be indicated for surgical repair; however, structural failure after gluteal tendon repair remains unacceptably high. This is likely related to the limited healing potential of tendinous tissue, which is poorly vascular and heals by formation of fibrocartilaginous scar tissue rather than histologically normal tendon. An emerging option to augment tendon healing is the use of a bioinductive implant that is designed to amplify the host healing response and induce the formation of healthy tendon tissue...
August 2016: Arthroscopy Techniques
A Ali Narvani, Paolo Consigliere, Ioannis Polyzois, Tanaya Sarkhel, Rohit Gupta, Ofer Levy
Despite the vast improvement in techniques and technology for arthroscopic rotator cuff surgery, repairs of massive and large tears remain challenging because they are associated with significantly high failure rates. In recent years, patch augmentation has gained popularity as a technique to decrease these high failure rates. Arthroscopic patch augmentation of rotator cuff repair, however, is technically difficult. The purpose of this report is to describe a simple and reproducible technique for all-arthroscopic extracellular matrix graft augmentation...
August 2016: Arthroscopy Techniques
M Petri, M Ettinger, S Brand, T Stuebig, C Krettek, M Omar
BACKGROUND: The role of nonoperative management for rotator cuff tears remains a matter of debate. Clinical results reported in the literature mainly consist of level IV studies, oftentimes combining a mixed bag of tear sizes and configurations, and are contradictory to some extent. METHODS: A selective literature search was performed and personal surgical experiences are reported. RESULTS: Most studies show an overall success rate of around 75% for nonoperative treatment...
2016: Open Orthopaedics Journal
Dirk Kokmeyer, Eric Dube, Peter J Millett
BACKGROUND: Rehabilitation after rotator cuff repair surgery has been the focus of several clinical trials in the past decade. Many illuminate new evidence with regard to the prognosis of structural and functional success after surgery. METHODS: A selective literature search was performed and personal physiotherapeutic and surgical experiences are reported. RESULTS: Post-operative rehabilitation parameters, namely the decision to delay or allow early range of motion after surgery, play a large role in the overall success after surgery...
2016: Open Orthopaedics Journal
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