Rotater cuff repair

Tearing of the rotator cuff commonly occurs as among one of the most frequently experienced tendon disorders. While treatment typically involves surgical repair, failure rates to achieve or sustain healing range from 20 to 90%. The insufficient capacity to recover damaged tendon to heal to the bone, especially at the enthesis, is primarily responsible for the failure rates reported. Various types of biomaterials with special structures have been developed to improve tendon-bone healing and tendon regeneration, and have received considerable attention for replacement, reconstruction, or reinforcement of tendon defects...

Massive irreparable rotator cuff tears are difficult to treat. Although several treatment options exist, none provides superior long-term results. There is no consensus on optimal surgical technique. Superior capsular reconstruction is an operative treatment option aimed at restoring native biomechanics of the glenohumeral joint by providing a restraint to superior subluxation. Partial rotator cuff repair for massive tears has also been shown to improve shoulder kinematics and can be performed in conjunction with superior capsule reconstruction...

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)...

PURPOSE: To prospectively review functional outcomes and healing rates of large and massive rotator cuff tears repaired with a load-sharing rip-stop (LSRS) technique. METHODS: Twenty-one consecutive patients underwent arthroscopic rotator cuff repair with an LSRS construct between January and December 2014. Seventeen patients with a minimum of 2 years' follow-up were included. Four patients did not complete clinical evaluations and functional outcome scores at a minimum of 2 years' follow-up and were lost to follow-up...

BACKGROUND: The anterior rotator cable is critical in force transmission of the rotator cuff. However, few clinical studies have examined the correlation between the integrity of the anterior supraspinatus tendon and surgical outcomes in patients with rotator cuff tears. PURPOSE: To compare the clinical and structural outcomes of the arthroscopic repair of full-thickness rotator cuff tears with and without anterior disruption of the supraspinatus tendon. STUDY DESIGN: Cohort study; Level of evidence, 3...

PURPOSE: Fatty infiltration (FI) is known to be an irreversible change which continues degeneration after rotator cuff repair. Previous studies evaluated postoperative changes in FI using a preoperative baseline. This study aimed to investigate the changes in FI using an immediate postoperative baseline. We hypothesized that FI was progressed more when measured relative to an immediate postoperative baseline than to a preoperative baseline. METHODS: From 2008 to 2010, 77 patients who met the following criteria were included in this study: arthroscopic rotator cuff repair of a full-thickness rotator cuff tear and presence of preoperative (approximately 1 month before surgery), immediate postoperative (approximately 3 days after surgery), and 1-year postoperative (at least 9 months to 1 year after surgery) magnetic resonance imaging (MRI) undertaken...

BACKGROUND: The aims of the study were as follows: to perform a systematic review of meta-analyses comparing "early motion" and "delayed motion" after arthroscopic rotator cuff repair; to provide a framework to analyze the best available evidence to develop recommendations; and to identify gaps where suggestions could be made for future investigations. METHODS: Literature searches were performed to identify meta-analyses examining arthroscopic rotator cuff repair with early-motion vs...

BACKGROUND: Fatty infiltration (FI) compromises outcomes of rotator cuff repairs. Most clinicians consider FI of the infraspinatus, whether it is torn or intact, because it is most rapidly affected. The purpose of this study was to report long-term outcomes of isolated supraspinatus repairs and to determine their associations with FI of the infraspinatus and supraspinatus. METHODS: The records of 182 patients who underwent repair of isolated supraspinatus tears and had preoperative magnetic resonance imaging were retrieved...

PURPOSE: To compare the histologic and biomechanical effects of 3 different footprint preparations for repair of tendon-to-bone insertions and to assess the behavior of bone marrow-derived cells in each method of insertion repair. METHODS: We randomized 81 male Sprague-Dawley rats and green fluorescent protein-bone marrow chimeric rats into 3 groups. In group A, we performed rotator cuff repair after separating the supraspinatus tendon from the greater tuberosity and removing the residual tendon tissue...

BACKGROUND: Anterosuperior rotator cuff tears are more frequent than expected. We report the results of a 10-year follow-up study after repair. Our hypothesis was that the extent of the subscapularis tear influenced the prognosis. MATERIALS AND METHODS: The study population consisted of all 138 patients who underwent surgery in 14 participating centers in 2003 for full-thickness tears of the rotator cuff with lesions in the subscapularis and supraspinatus tendons...

BACKGROUND: Work-related rotator cuff injuries are a common cause of disability and employee time loss. PURPOSE: To examine the effectiveness of expedited rotator cuff surgery in injured workers who underwent rotator cuff decompression or repair and to explore the impact of demographic, clinical, and psychosocial factors in predicting the outcome of surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Injured workers who were seen at a shoulder specialty program and who underwent expedited arthroscopic rotator cuff decompression or repair were observed for a period of 6 to 12 months based on their type of surgery and recovery trajectory...

BACKGROUND: Transforming growth factor β1 (TGF-β1) positively regulates the tenogenic marker genes scleraxis ( Scx) and tenomodulin ( Tnmd) in mesenchymal progenitors in vitro. However, little is known about the effect of TGF-β1 on the expression of tenogenic markers during rotator cuff (RC) healing in rats. HYPOTHESIS: TGF-β1 improves the biomechanical properties and histological maturity of reparative tissue in a rat RC repair model by stimulating the growth of tenogenic cells...

BACKGROUND: Failure of rotator cuff healing is a common complication despite the rapid development of surgical repair techniques for the torn rotator cuff. PURPOSE: To verify the effect of atelocollagen on tendon-to-bone healing in the rabbit supraspinatus tendon compared with conventional cuff repair. STUDY DESIGN: Controlled laboratory study. METHODS: A tear of the supraspinatus tendon was created and repaired in 46 New Zealand White rabbits...

BACKGROUND: There is considerable debate on the recovery of rotator cuff muscle atrophy after rotator cuff repair. PURPOSE: To evaluate the serial changes in supraspinatus muscle volume after rotator cuff repair by using semiautomatic segmentation software and to determine the relationship with functional outcomes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Seventy-four patients (mean age, 62.8 ± 8.8 years) who underwent arthroscopic rotator cuff repair and obtained 3 consecutive (preoperatively, immediately postoperatively, and later postoperatively [≥1 year postoperatively]) magnetic resonance imaging (MRI) scans having complete Y-views were included...

Tears of the rotator cuff are a frequent pathology, but the best surgical procedure remains unclear. The arthroscopic approach has become the gold standard, but there are many different suture configurations that can be used. We describe an all-suture repair system with which the anatomical reduction of the rotator cuff is achieved performing traction from the anchor of the lateral row to subsequently performing a suture bridge suture from the medial row. The major advantage of this technique is that it creates compression forces and minimizing tensioning of the tissue...

Symptomatic partial-thickness rotator cuff tears and full-thickness tears with poor tissue quality often pose a dilemma for orthopaedic surgeons. Despite advances in repair techniques and fixation devices, retear rates remain high. Progression of partial-thickness tears has been noted to be over 50%, with remaining fibers seeing increased strain. Patch augmentation that induces a healing response while decreasing peak strain of adjacent tissue is becoming more popular among orthopaedic surgeons. Therefore, we present an all-arthroscopic technique guide for application of a Food and Drug Administration-approved bovine bioinductive patch (Rotation Medical, Plymouth, MN)...

Whether to use an immediate range of motion exercise protocol or, rather, to delay the initiation of rehabilitation exercises for patients after arthroscopic rotator cuff repair presents a significant dilemma for the treating surgeon. The study "The Effect of Early Range of Motion on Quality of Life, Clinical Outcome, and Repair Integrity After Arthroscopic Rotator Cuff Repair" by Mazzocca, Arciero, Shea, Apostolakos, Solovyova, Gomlinski, Wojcik, Tafuto, Stock, and Cote reveals that no differences in quality of life scores or rotator cuff healing were identified after comparing 2 groups of patients undergoing either immediate (within 3 days) or delayed (after 28 days) postoperative rehabilitation protocols...

BACKGROUND: Controversy exists regarding how much external rotation should be allowed following rotator cuff repair. Clinicians may use ultrasound imaging (USI) to visualize the supraspinatus (SSp) tendon during passive external rotation. However, the validity and reliability of USI used to assess supraspinatus tendon gap formation during external rotation needs to be established prior to using this technique in patient cohorts. METHODS: Ten subjects with magnetic resonance imaging (MRI) confirmation of full-thickness SSp tears were matched to 10 control subjects...

BACKGROUND: The surgical management of massive rotator cuff tears remains a challenge. It is suggested that, even in a massive tear that appears irreparable, attempting to repair it as much as possible can be helpful in improving functional outcomes. However the results can be short term and variable. The purpose of our study was to determine if human tissue allograft bridged repair of massive irreparable rotator cuff tears to achieve a complete repair produces similar outcomes compared to partial repair alone...

PURPOSE: Rising perioperative opioid use in the United States is of increasing concern. The purposes of this study were (1) to define opioid consumption after rotator cuff repair (RCR) in the United States and (2) to evaluate patient factors that may be associated with prolonged opioid use after arthroscopic RCR. METHODS: All arthroscopic RCRs performed between 2007 and 2014 were identified by use of Current Procedural Terminology code (29,827). Patients who filled opioid prescriptions preoperatively were divided into those who filled prescriptions at 1 to 3 months preceding RCR and those who filled opioid prescriptions only in the 1 month preceding RCR...