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Rotator cuff augmentation

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
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
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
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, J A Greenspoon, S G Moulton, P J Millett
BACKGROUND: Massive rotator cuff tears in active patients with minimal glenohumeral arthritis remain a particular challenge for the treating surgeon. METHODS: A selective literature search was performed and personal surgical experiences are reported. RESULTS: For patients with irreparable rotator cuff tears, a reverse shoulder arthroplasty or a tendon transfer are often performed. However, both procedures have rather high complication rates and debatable long-term results, particularly in younger patients...
2016: Open Orthopaedics Journal
Joshua A Greenspoon, Samuel G Moulton, Peter J Millett, Maximilian Petri
BACKGROUND: Surgical treatment of rotator cuff tears has consistently demonstrated good clinical and functional outcomes. However, in some cases, the rotator cuff fails to heal. While improvements in rotator cuff constructs and biomechanics have been made, the role of biologics to aid healing is currently being investigated. METHODS: A selective literature search was performed and personal surgical experiences are reported. RESULTS: Biologic augmentation of rotator cuff repairs can for example be performed wtableith platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs)...
2016: Open Orthopaedics Journal
Giuseppe Filardo, Berardo Di Matteo, Elizaveta Kon, Giulia Merli, Maurilio Marcacci
PURPOSE: Platelet-rich plasma (PRP) is currently the most exploited strategy in the clinical practice to provide a regenerative stimulus for tendon healing. The aim of the present study was to systematically review the available evidence on the treatment of the main tendon disorders where PRP is currently applied. METHODS: A systematic review of the literature was performed on the use of PRP as a treatment for tendinopathies focusing on the following sites: Achilles tendon, patellar tendon, rotator cuff tendons, and lateral elbow tendons...
September 24, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Richard Holtby, Monique Christakis, Eran Maman, Joy C MacDermid, Tim Dwyer, George S Athwal, Kenneth Faber, John Theodoropoulos, Linda J Woodhouse, Helen Razmjou
BACKGROUND: Increased interest in using platelet-rich plasma (PRP) as an augment to rotator cuff repair warrants further investigation, particularly in smaller rotator cuff tears. PURPOSE: To examine the effectiveness of PRP application in improving perioperative pain and function and promoting healing at 6 months after arthroscopic repair of small- or medium-sized rotator cuff tears. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1...
September 2016: Orthopaedic Journal of Sports Medicine
Steven P Arnoczky, Shariff K Bishai, Brian Schofield, Scott Sigman, Brad D Bushnell, Jan Pieter Hommen, Craig Van Kampen
PURPOSE: To histologically evaluate biopsy specimens from patients who previously underwent rotator cuff repair augmented with a highly porous collagen implant. METHODS: Biopsies of collagen implant/host-tissue constructs were obtained from 7 patients undergoing a second arthroscopic procedure at various time periods (5 weeks to 6 months) after arthroscopic rotator cuff repair augmented with a collagen implant overlay. The biopsy specimens were examined histologically for host-tissue ingrowth, host-tissue maturation, and host-implant biocompatibility...
September 17, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Stephen J Snyder
Acellular human dermal matrix allografts are now being used to augment and sometimes replace severely damaged rotator cuff tissue. I have been interested in this important aspect of orthopaedics for 15 years and am pleased to have the opportunity to share my personal reflections of some of the highlights in science and the literature that helped get to the point now where we can expect greater than 80% healing even in these difficult cases of revision after massive failed cuff repair. The field of tissue engineering will certainly be a critical part of our rotator cuff surgical future...
September 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
James H Lubowitz, Jefferson C Brand, Michael J Rossi, Matthew T Provencher
Shoulder arthroscopic and related surgeons may require expertise in use of the 70° arthroscope, biologic patch augmentation, repair of massive rotator cuff tears, the Latarjet procedure and related glenoid bone augmentation, and reverse total shoulder arthroplasty.
September 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Joseph Cooper, Raffy Mirzayan
The success of rotator cuff repair (RCR) surgery can be measured clinically (validated outcome scores, range of motion) as well as structurally (re-tear rates using imaging studies). Regardless of repair type or technique, most studies have shown that patients do well clinically. However, multiple studies have also shown that structurally, the failure rate can be very high. A variety of factors, including poor tendon quality, age over 63 years, smoking, advanced fatty infiltration into the muscle, and the inability of the tendon to heal to bone, have been implicated as the cause of the high re-tear rate in RCRs...
July 2016: American Journal of Orthopedics
Ryan A Mlynarek, Andrew W Kuhn, Asheesh Bedi
The use of platelet-rich plasma (PRP) injections in the treatment of musculoskeletal conditions has become more prevalent in recent years. Current literature has exhibited that PRP injections are relatively safe and can potentially accelerate or augment the soft tissue healing process. This review presents the most current literature update on the use of PRP in the treatment of rotator cuff tears, osteoarthritis of the knee, ulnar collateral ligament tears, lateral epicondylitis, hamstring injuries, and Achilles tendinopathy...
July 2016: American Journal of Orthopedics
Dianne Bryant, Richard Holtby, Kevin Willits, Robert Litchfield, Darren Drosdowech, Alison Spouge, David White, Gordon Guyatt
BACKGROUND: The rate of rotator cuff repair failure is between 13% and 67%. Porcine small intestine submucosa (SIS) may be suitable to augment the repair. METHODS: There were 62 patients with moderate and large cuff tears randomized to repair alone (control) or augmentation with SIS (Restore Orthobiologic Implant; DePuy, Warsaw, IN, USA). Primary outcome was repair failure using magnetic resonance arthrography. Randomization occurred on completion of the repair...
October 2016: Journal of Shoulder and Elbow Surgery
Julianne Huegel, Dong Hwa Kim, James M Cirone, Adam M Pardes, Tyler R Morris, Courtney A Nuss, Robert L Mauck, Louis J Soslowsky, Andrew F Kuntz
Rotator cuff tendon tears are one of the most common shoulder pathologies, especially in the aging population. Due to a poor healing response and degenerative changes associated with aging, rotator cuff repair failure remains common. Although cell-based therapies to augment rotator cuff repair appear promising, it is unknown whether the success of such a therapy is age-dependent. We hypothesized that autologous cell therapy would improve tendon-to-bone healing across age groups, with autologous juvenile cells realizing the greatest benefit...
August 8, 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Marie E Walcott, Stephen D Daniels, Nathan J Sinz, Larry D Field, Laurence D Higgins
HYPOTHESIS: Our purpose was to describe an arthroscopic repair technique for and outcomes of traumatic transtendinous rotator cuff tears affecting the supraspinatus tendon. MATERIALS AND METHODS: A retrospective review was performed on a series of patients between January 2009 and January 2012. Demographic data, as well as preoperative and postoperative clinical data including strength, visual analog scale pain score, Subjective Shoulder Value, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test score, were obtained...
July 13, 2016: Journal of Shoulder and Elbow Surgery
Clemens Gwinner, Christian Gerhardt, Hendrik Haneveld, Markus Scheibel
INTRODUCTION: Failure rates after arthroscopic rotator cuff repair remain high. Platelet-rich plasma has gained interest as a potential biological augmentation to enhance bone-tendon healing. The purpose of this study is to evaluate the clinical and structural outcomes of repeated PRP application on rotator cuff repair. MATERIALS AND METHODS: Thirty-six patients underwent arthroscopic reconstruction, using knotless anchor double-row repair. Eighteen patients [10 female, 8 male; 61...
August 2016: Archives of Orthopaedic and Trauma Surgery
Abby Chainani, Dianne Little
Rotator cuff tears continue to be at significant risk for re-tear or for failure to heal after surgical repair despite the use of a variety of surgical techniques and augmentation devices. Therefore, there is a need for functionalized scaffold strategies to provide sustained mechanical augmentation during the critical first 12-weeks following repair, and to enhance the healing potential of the repaired tendon and tendon-bone interface. Tissue engineered approaches that combine the use of scaffolds, cells, and bioactive molecules towards promising new solutions for rotator cuff repair are reviewed...
June 2016: Techniques in Orthopaedics: TIO
Ariel A Williams, Thomas S Stang, Jan Fritz, Derek F Papp
Calcific tendinitis is a relatively rare condition in which calcium is inappropriately deposited in tendons, resulting in a local inflammatory reaction that can cause severe symptoms in certain cases. The cause of this disease process is not completely understood, although repetitive microtrauma likely plays a role in its development. Although the disorder most often involves the rotator cuff, it can affect other structures throughout the body, such as the tendons about the ankle and hip-including the rectus femoris and gluteus maximus...
September 1, 2016: Orthopedics
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