Arthroscopic Repair of Massive Rotator Cuff Tears

Chung, Seok Won; Kim, Joon Yub; Kim, Min Hyung; Kim, Sae Hoon; Oh, Joo Han

doi:10.1177/0363546513485719

Cited by 273 publications

(135 citation statements)

References 53 publications

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“…Chung et al [14] , in a study of 272 patients after arthroscopic rotator cuff repair, found that bone mineral density, fatty infiltration, and retraction of the rotator cuff tendon were the only independent predictors of rotator cuff healing. Chung et al [15] , in another study of 108 patients who underwent arthroscopic repair of massive rotator cuff tears, found that while several factors were associated with failure of cuff healing in the univariate analysis including age, only fatty infiltration was significantly related to healing failure in the multivariate analysis. Similarly, Oh et al [13] noted that age was not an independent predictor of tendon healing or functional outcome.…”

Section: Agementioning

confidence: 99%

“…Galatz et al [6] reported that despite failure of healing in 94% of patients at 1 year followup, excellent pain relief and improvement in the ability to perform activities of daily living was noted although these results did deteriorate somewhat at 24 mo follow-up. Chung et al [15] reported significantly improved functional improvement in a series of arthroscopically repaired massive cuff tears despite an anatomic failure rate of 39.8%. Despite this, not all patients with an unhealed repair do well clinically [18][19][20][21] .…”

Section: Tear Sizementioning

confidence: 99%

“…Older age was related to poor postoperative repair integrity Ⅳ Tear size Galatz et al [6] Case series 18 pts/36 mo US High rate of tendon healing failure Ⅳ Chung et al [15] Case series 108 pts/31.7 mo CT arthrogram, US High rate of tendon healing failure Ⅳ Fatty infiltration/atrophy Thomazeau et al [22] Case series 30 pts/21.1 mo MRI Supraspinatus atrophy was a strong risk factor for retear Ⅳ Liem et al [10] Case series 53 pts/26.4 mo MRI Higher degrees of muscular atrophy and fatty infiltration preoperatively are associated with tear recurrence Ⅳ Goutallier et al [23] Case series 220 shoulders/37 mo CT arthrogram, MRI The likelihood of a recurrent tear was greater for tendons whose muscle showed fatty degeneration greater than grade 1…”

Section: Ct Arthrogrammentioning

confidence: 99%

“…Chung et al [15] Case series 108 pts/31.7 mo CT arthrogram, US Higher FI of the infraspinatus was the single most important factor negatively affecting cuff healing…”

mentioning

confidence: 99%

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Factors affecting healing after arthroscopic rotator cuff repair

Abtahi

Granger

Tashjian

2015

WJO

158

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Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymal stem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair. Core tip: Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscletendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing after rotator cuff repair. Smoking cessation and blood glucose and cholesterol control are methods to potentially improve healing rates. Slower, less aggressive rehabilitation programs may improve healing rates with no negative effect on final range of motion and are therefore recommended after arthroscopic repair of most full thickness tears. Finally, no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates after rotator cuff repair. Routine use of these adjuvants is therefore not currently recommended.

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Section: Agementioning

confidence: 99%

Section: Tear Sizementioning

confidence: 99%

Section: Ct Arthrogrammentioning

confidence: 99%

“…Chung et al [15] Case series 108 pts/31.7 mo CT arthrogram, US Higher FI of the infraspinatus was the single most important factor negatively affecting cuff healing…”

mentioning

confidence: 99%

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Factors affecting healing after arthroscopic rotator cuff repair

Abtahi

Granger

Tashjian

2015

WJO

158

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“…Muscle atrophy and fatty infiltration are major deleterious phenomena in RCT and are closely correlated with poor functional outcome following even adequate repair because they have been considered irreversible phenomena 1, 6, 7. Therefore, RCT could be considered a good model to understand age‐associated muscle fatty infiltration.…”

Section: Introductionmentioning

confidence: 99%

Fatty acid‐binding protein 4 regulates fatty infiltration after rotator cuff tear by hypoxia‐inducible factor 1 in mice

Lee

Kim

et al. 2017

J cachexia sarcopenia muscle

Self Cite

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BackgroundFatty infiltration in skeletal muscle is directly linked to loss of muscle strength and is associated with various adverse physical outcomes such as muscle atrophy, inflammation, insulin resistance, mobility impairments, and even mortality in the elderly. Aging, mechanical unloading, muscle injury, and hormonal imbalance are main causes of muscle fat accumulation, and the fat cells are derived from muscle stem cells via adipogenic differentiation. However, the pathogenesis and molecular mechanisms of fatty infiltration in muscles are still not fully defined. Fatty acid‐binding protein 4 (FABP4) is a carrier protein for fatty acids and is involved in fatty acid uptake, transport, and lipid metabolism. Rotator cuff tear (RCT) usually occurs in the elderly and is closely related with fatty infiltration in injured muscle. To investigate potential mechanisms for fatty infiltration other than adipogenic differentiation of muscle stem cells, we examined the role of FABP4 in muscle fatty infiltration in an RCT mouse model.MethodsIn the RCT model, we evaluated the expression of FABP4 by qRT‐PCR, western blotting, and immunohistochemical analyses. Histological changes such as inflammation and fat accumulation in the injured muscles were examined immunohistochemically. To evaluate whether hypoxia induces FABP4 expression, the levels of FABP4 mRNA and protein in C3H10T1/2 cells after hypoxia were examined. Using a transient transfection assay in 293T cells, we assessed the promoter activity of FABP4 by hypoxia‐inducible factors (HIFs). Additionally, we evaluated the reduction in FABP4 expression and fat accumulation using specific inhibitors for HIF1 and FABP4, respectively.ResultsFABP4 expression was significantly increased after RCT in mice, and its expression was localized in the intramuscular fatty region. Rotator cuff tear‐induced FABP4 expression was up‐regulated by hypoxia. HIF1α, which is activated by hypoxia, augmented the promoter activity of FABP4, together with HIF1β. Hypoxia‐induced FABP4 expression was significantly decreased by HIF1 inhibitor treatment. Furthermore, in RCT model mice, fat accumulation was remarkably reduced by FABP4 inhibitor treatment.ConclusionsThis study shows that RCT induces FABP4 expression, leading to fat accumulation in injured muscle. FABP4 transcription is regulated by the direct binding of HIF1 to the FABP4 promoter in the hypoxic condition induced by RCT. Fat accumulation in injured muscle was reduced by the inhibition of FABP4. Ultimately, in the RCT model, we identified a novel mechanism for fatty infiltration by FABP4, which differs from adipogenic differentiation of muscle stem cells, and we found that fatty infiltration might be regulated by inhibition of HIF1 or FABP4.

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Rotator Cuff Repair

Wang¹,

He²

2022

Biofabrication for Orthopedics

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Arthroscopic Repair of Massive Rotator Cuff Tears

Cited by 273 publications

References 53 publications

Factors affecting healing after arthroscopic rotator cuff repair

Factors affecting healing after arthroscopic rotator cuff repair

Fatty acid‐binding protein 4 regulates fatty infiltration after rotator cuff tear by hypoxia‐inducible factor 1 in mice

Rotator Cuff Repair

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