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Rotator cuff augmentation

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https://www.readbyqxmd.com/read/28271082/preliminary-results-of-a-consecutive-series-of-large-massive-rotator-cuff-tears-treated-with-arthroscopic-rotator-cuff-repairs-augmented-with-extracellular-matrix
#1
Paolo Consigliere, Ioannis Polyzois, Tanaya Sarkhel, Rohit Gupta, Ofer Levy, A Ali Narvani
BACKGROUND: Recurrence rate of rotator cuff tears is still high despite the improvements of surgical techniques, materials used and a better knowledge of the healing process of the rotator cuff tendons. Large to massive rotator cuff tears are particularly associated with a high failure rate, especially in elderly. Augmentation of rotator cuff repairs with extracellular matrix or synthetic patches has gained popularity in recent years with the aim of reducing failure. The aim of this study was to investigate the outcome of rotator cuff repairs augmented with denatured extracellular matrix in a series of patients who underwent arthroscopic rotator cuff repair for large to massive tears...
January 2017: Archives of Bone and Joint Surgery
https://www.readbyqxmd.com/read/28266691/resorbable-electrospun-polydioxanone-fibres-modify-the-behaviour-of-cells-from-both-healthy-and-diseased-human-tendons
#2
A Kendal, S Snelling, S Dakin, E Stace, P-A Mouthuy, A Carr
Chronic tendinopathy in an active and ageing population represents an increasing burden to healthcare systems. Rotator cuff tendinopathy alone accounts for approximately 70 % of all shoulder pain. Tendinopathic tissue has a disorganised extracellular matrix, altered vasculature, and infiltration of fibroblasts and inflammatory cells. This altered biology may contribute to the limited success of surgical repair strategies. Electrospun resorbable scaffolds can potentially enhance endogenous repair mechanisms by influencing the tissue microenvironment...
February 20, 2017: European Cells & Materials
https://www.readbyqxmd.com/read/28261304/the-influence-of-different-footprint-preparation-techniques-on-tissue-regeneration-in-rotator-cuff-repair-in-an-animal-model
#3
Andreas Ficklscherer, Michaela Serr, Thomas Loitsch, Thomas R Niethammer, Matthias Lahner, Matthias F Pietschmann, Peter E Müller
INTRODUCTION: Rotator cuff tears are common diseases of the upper extremity. There are no recommendations to the surgeon on how to prepare the footprint to ensure optimal tendon-to-bone healing. However, biologic augmentation using stem cells and growth factors is considered to encourage the healing process of the tendon. The aim of the study was to investigate the biomechanical and histological outcome of different footprint preparations in rotator cuff repair. MATERIAL AND METHODS: One hundred and eighty-nine Sprague-Dawley rats were randomly assigned to either spongialization, radiofrequency ablation or an untreated control group...
March 1, 2017: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/28259350/editorial-commentary-a-bridge-to-nowhere-%C3%A2-do-patches-help-improve-our-outcomes-after-rotator-cuff-surgery
#4
EDITORIAL
Joshua S Dines
Patches have been used in a variety of ways to improve outcomes after repair of large to massive rotator cuff tears. Some authors have advocated using these patch grafts as augmentation, whereas other authors have used them as bridging tissue from the rotator cuff to the tuberosity. A recent study reports a well-written systematic review on healing rates and outcomes of the 2 different graft indications, showing no significant differences in healing. I do think that, equally as important, this study highlights the lack of well-designed studies on the use of patches in rotator cuff surgery...
March 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28194290/latissimus-dorsi-tendon-transfer-with-graftjacket%C3%A2-augmentation-to-increase-tendon-length-for-an-irreparable-rotator-cuff-tear
#5
John G Skedros, Tanner R Henrie
Massive irreparable rotator cuff tears can be reconstructed with latissimus dorsi tendon transfers (LDTT). Although uncommon, the natural length of the latissimus dorsi tendon (LDT) could be insufficient for transfer even after adequate soft tissue releases. Descriptions of cases where grafts were needed to lengthen the LDT are therefore rare. We located only two reports of the use of an acellular dermal matrix to increase effective tendon length in tendon transfers about the shoulder: (1) GraftJacket patch for a pectoralis major tendon reconstruction and (2) ArthroFlex® patch for LDTT...
2017: Case Reports in Orthopedics
https://www.readbyqxmd.com/read/28162917/influence-of-preoperative-musculotendinous-junction-position-on-rotator-cuff-healing-after-double-row-repair
#6
Robert Z Tashjian, Gregory A Erickson, Richard J Robins, Yue Zhang, Robert T Burks, Patrick E Greis
PURPOSE: The primary purpose of this study was to determine the effect of the preoperative position of the musculotendinous junction (MTJ) on rotator cuff healing after double-row arthroscopic rotator cuff repair. A secondary purpose was to evaluate how tendon length and MTJ position change when the rotator cuff heals. METHODS: Preoperative and postoperative magnetic resonance imaging (MRI) scans of 42 patients undergoing arthroscopic double-row rotator cuff repair were reviewed...
February 2, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28162888/the-effectiveness-of-demineralized-cortical-bone-matrix-in-a-chronic-rotator-cuff-tear-model
#7
Tanujan Thangarajah, Frederick Henshaw, Anita Sanghani-Kerai, Simon M Lambert, Gordon W Blunn, Catherine J Pendegrass
BACKGROUND: The purpose of this study was to assess the effect of demineralized bone matrix (DBM) on rotator cuff tendon-bone healing. The hypothesis was that compared with a commercially available dermal matrix scaffold, DBM would result in a higher bone mineral density and regenerate a morphologically superior enthesis in a rat model of chronic rotator cuff degeneration. METHODS: Eighteen female Wistar rats underwent unilateral detachment of the supraspinatus tendon...
February 2, 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/28149719/arthroscopic-rotator-cuff-repair-with-graft-augmentation-of-fascia-lata-for-large-and-massive-tears
#8
Takeshi Kokubu, Yutaka Mifune, Atsuyuki Inui, Ryosuke Kuroda
Excellent clinical results of arthroscopic repair of rotator cuff tears have been reported. However, retears after surgical repair of large and massive rotator cuff tears are one of the most common complications. We present single-row repair with graft augmentation of the fascia lata for large and massive rotator cuff tears to reduce tension at the tendon-bone repair site, and this technique may prevent retears of the repaired rotator cuff. A candidate for this technique is a patient who has a large or massive rotator cuff tear in which the torn edge cannot reach the footprint after mobilization of the torn rotator cuff...
December 2016: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28063677/the-results-of-tension-band-rotator-cuff-suture-fixation-of-locked-plating-of-displaced-proximal-humerus-fractures
#9
Dave R Shukla, Steven McAnany, Christian Pean, Samuel Overley, Andrew Lovy, Bradford O Parsons
INTRODUCTION: The purpose of this study was to assess 1-year outcomes of patients with displaced proximal humerus fractures who underwent treatment with locked plate fixation with rotator cuff suture augmentation. METHODS: A total of 86 patients who had sustained 2, 3 and 4-part displaced proximal humerus fractures underwent locked plate fixation with multiple sutures placed in the cuff tendons. Clinical outcome variables included active forward elevation (AFE), active external rotation (AER), and Constant and American Shoulder and Elbow Surgeons (ASES) scores...
February 2017: Injury
https://www.readbyqxmd.com/read/28043853/the-biology-of-rotator-cuff-healing
#10
REVIEW
M-A Zumstein, A Lädermann, S Raniga, M-O Schär
Despite advances in surgical reconstruction of chronic rotator cuff (RC) tears leading to improved clinical outcomes, failure rates of 13-94% have been reported. Reasons for this rather high failure rate include compromised healing at the bone-tendon interface, as well as the musculo-tendinous changes that occur after RC tears, namely retraction and muscle atrophy, as well as fatty infiltration. Significant research efforts have focused on gaining a better understanding of these pathological changes in order to design effective therapeutic solutions...
February 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/28005110/biomechanics-of-polyhydroxyalkanoate-mesh-augmented-single-row-rotator-cuff-repairs
#11
Robert Z Tashjian, Christopher W Kolz, Thomas Suter, Heath B Henninger
Polyhydroxyalkanoate (PHA) mesh is a bioresorbable scaffold used to reinforce the suture-tendon interface in rotator cuff repairs (RCRs). We conducted a study of cyclic and ultimate failure properties of PHA mesh-augmented single-row RCRs and nonaugmented RCRs. Eight pairs of fresh-frozen cadaver humeri (6 male, 2 female) were tested. Mean (SD) age was 61 (9) years. The supraspinatus tendon was resected and reattached in a single-row configuration using 2 triple-loaded suture anchors and 6 simple stitches. The opposite humerus underwent RCR augmented with 2 strips of 13-mm × 23-mm PHA mesh...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/27956233/graft-augmentation-versus-bridging-for-large-to-massive-rotator-cuff-tears-a-systematic-review
#12
REVIEW
Yohei Ono, Diego Alejandro Dávalos Herrera, Jarret M Woodmass, Richard S Boorman, Gail M Thornton, Ian K Y Lo
PURPOSE: To systematically review the literature on the healing rates and clinical outcomes of the 2 different graft indications (i.e., augmentation vs bridging) during rotator cuff repair. METHODS: A systematic literature review was performed for clinical studies of rotator cuff repair using grafts for large to massive tears. The primary outcome was tendon healing on either magnetic resonance imaging or ultrasound. The secondary outcomes included visual analog scale for pain, American Shoulder and Elbow Surgeons score, and University of California at Los Angeles score, and forward elevation...
March 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/27909664/arthroscopic-assisted-lower-trapezius-tendon-transfer-for-massive-irreparable-posterior-superior-rotator-cuff-tears-surgical-technique
#13
Bassem T Elhassan, Eduard Alentorn-Geli, Andrew T Assenmacher, Eric R Wagner
Tendon transfer options to reconstruct a massive irreparable posterior-superior rotator cuff tear include latissimus dorsi, teres major, or lower trapezius transfer. We previously described the lower trapezius transfer using a 2-incision approach, which includes a medial incision to harvest the lower trapezius and lateral transacromial incision to expose the rotator cuff and then perform the transfer through a deep tunnel connecting these 2 sites. In this report, we describe an arthroscopic-assisted technique of lower trapezius transfer augmented with an Achilles tendon allograft to reconstruct an irreparable posterior-superior rotator cuff tear...
October 2016: Arthroscopy Techniques
https://www.readbyqxmd.com/read/27887870/involvement-of-indian-hedgehog-signaling-in-mesenchymal-stem-cell-augmented-rotator-cuff-tendon-repair-in-an-athymic-rat-model
#14
Jian-Chun Zong, Michael J Mosca, Ryan M Degen, Amir Lebaschi, Camila Carballo, Andrew Carbone, Guang-Ting Cong, Liang Ying, Xiang-Hua Deng, Scott A Rodeo
BACKGROUND: Bone marrow aspirate has been used in recent years to augment tendon-to-bone healing, including in rotator cuff repair. However, the healing mechanism in cell-based therapy has not been elucidated in detail. METHODS: Sixteen athymic nude rats were randomly allocated to 2 groups: experimental (human mesenchymal stem cells in fibrin glue carrier) and control (fibrin glue only). Animals were sacrificed at 2 and 4 weeks. Immunohistochemical staining was performed to evaluate Indian hedgehog (Ihh) signaling and SOX9 signaling in the healing enthesis...
November 22, 2016: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/27855678/augmentation-and-repair-of-tendons-using-demineralised-cortical-bone
#15
Sherif Elnikety, Catherine J Pendegrass, Roberta Ferro de Godoy, Charles Holden, Gordon W Blunn
BACKGROUND: In severe injuries with loss of tendon substance a tendon graft or a synthetic substitute is usually used to restore functional length. This is usually associated with donor site morbidity, host tissue reactions and lack of remodelling of the synthetic substitutes, which may result in suboptimal outcome. A biocompatible graft with mechanical and structural properties that replicate those of normal tendon and ligament has so far not been identified. The use of demineralised bone for tendon reattachment onto bone has been shown to be effective in promoting the regeneration of a normal enthesis...
November 17, 2016: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/27814629/advances-in-the-treatment-of-rotator-cuff-lesions-by-cytokines
#16
Genbin Wu, Peng Cheng Xu, Peng Wu, Kaihua Hu, Yeqing Sun, Biao Cheng, Yong Lu
Rotator cuff tears are one of the most common shoulder problems that usually require operative treatments. Therapeutic options used to repair ruptured tendons have consisted of suture, autografts, allografts, and synthetic prostheses. Although surgical treatments have improved dramatically up to now, shoulder pathology is still challenging to orthopedic surgery primarily because these injuries often respond poorly to treatment and require prolonged rehabilitation. Recent attention has focused on several biologic pathways which can augment function to tendon healing, consequently leading to the identification of growth factors involved in this process...
January 1, 2017: Frontiers in Bioscience (Landmark Edition)
https://www.readbyqxmd.com/read/27768610/biologic-and-synthetic-grafts-in-the-reconstruction-of-large-to-massive-rotator-cuff-tears
#17
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...
December 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27750374/advances-in-biologic-augmentation-for-rotator-cuff-repair
#18
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...
November 2016: Annals of the New York Academy of Sciences
https://www.readbyqxmd.com/read/27720412/suture-spanning-augmentation-of-single-row-rotator-cuff-repair-a-biomechanical-analysis
#19
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...
February 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/27709043/endoscopic-gluteus-medius-repair-augmented-with-bioinductive-implant
#20
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
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