Clinical and anatomic results of rotator cuff repair at 10 years depend on tear type

Agout, Charles; Berhouet, Julien; Bouju, Yves; Godenèche, Arnaud; Collin, Philippe; Kempf, Jean-François; Favard, Luc

doi:10.1007/s00167-018-4854-1

Cited by 42 publications

(28 citation statements)

References 34 publications

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“…36,50 These results approximate well those of the SOFCOT cohort for the isolated SSp group (19% retear). 2 On the contrary, regarding massive tears assessed by MRI at 9.9 years postoperatively, Zumstein et al 53 reported a much higher retear rate (57%), which comes closer to the figures reported in our studies for C3-C4 tears (SSp nonintegrity, 71%).…”

Section: Discussionsupporting

confidence: 87%

“…In the SOFCOT cohort, RC repair was open in one-half of the patients and arthroscopic in the other. Here the percentage of tendon healing was reported as ranging between 68% and 81%, depending on the initial type of tear, 2 and a separate study by the same study group on massive tears indicated a retear rate of 34%. 8 Interestingly, the differences in the retear rate between isolated SSp tears and larger tears with different extension were not found to be significant, although the failure rate was higher in the group with posterior extension.…”

Section: Discussionmentioning

confidence: 96%

“…The cohort presented in this study is the first one where ultrasound evaluation was performed to assess RC integrity after arthroscopic repair at a minimum follow-up of 10 years and the third one for which such long-term results are described. 2,8,15,21 Heuberer et al 21 presented in 2017 the results of a case series of 30 patients whose clinical outcomes were collected prospectively 10 years after arthroscopic RC repair with MRI assessment of RC integrity. More recently, several studies originating from the same cohort of patients, enrolled under the direction of the Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT) in 2003, were published.…”

Section: Discussionmentioning

confidence: 99%

“…These studies evaluated different aspects of RC repair and their results, including a relevant fraction of patients who underwent open RC repair. 2,8,15…”

Section: Discussionmentioning

confidence: 99%

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Long-term Results of Arthroscopic Rotator Cuff Repair: Initial Tear Size Matters: A Prospective Study on Clinical and Radiological Results at a Minimum Follow-up of 10 Years

et al. 2019

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Background: Arthroscopic techniques are now considered the gold standard for treatment of most rotator cuff (RC) tears; however, no consensus exists on the maintenance of results over time, and long-term follow-up data have been reported for few cohorts of patients. Purpose: To present the long-term results associated with the arthroscopic treatment of RC tears and to evaluate associations between preoperative factors and RC integrity at final follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 169 patients were contacted at least 10 years after arthroscopic RC surgery and were invited to a clinical evaluation. Information on preoperative conditions, tear size, subjective satisfaction, and functional scores was collected; isometric strength and range of motion were also measured; and each patient underwent an ultrasound examination to evaluate supraspinatus integrity and a shoulder radiograph to evaluate osteoarthritis. Results: A total of 149 patients (88.2% of the eligible patients) were available for a complete telephonic interview, and 102 patients were available for the final evaluation. Ultrasound revealed an intact supraspinatus in 54 patients (53.47%). By adding the 10 patients who underwent revision surgery to the nonintact group, this percentage would drop to 48.65%. Tear size was associated with supraspinatus integrity in univariate analysis (hazard ratio, 3.04; 95% CI, 1.63-5.69; P = .001) and multivariable analysis (hazard ratio, 2.18; 95% CI, 1.03-4.62; P = .04). However, no significant differences were encountered in the subjective and functional scores collected, with the exception of the Constant-Murley Score, which was significantly higher in patients with smaller tears at the index procedure. Strength testing also revealed significantly superior abduction and flexion strength in this group, and radiographs showed a significantly higher acromion-humeral distance and lower grades of osteoarthritis. Patients with an intact supraspinatus at final follow-up showed superior results in all functional scores, greater satisfaction, superior abduction and flexion strength, higher acromion-humeral distance, and lower grades of osteoarthritis. Conclusion: RC tear size at the time of surgery significantly affects supraspinatus integrity at a minimum follow-up of 10 years. However, a larger tear is not associated with an inferior subjective result, although it negatively influences abduction and flexion strength, range of motion, and osteoarthritis progression. Intraoperative efforts to obtain a durable RC repair are encouraged, since supraspinatus integrity at final follow-up influences clinical and functional outcomes, patient satisfaction, and osteoarthritis progression.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

“…These studies evaluated different aspects of RC repair and their results, including a relevant fraction of patients who underwent open RC repair. 2,8,15…”

Section: Discussionmentioning

confidence: 99%

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Long-term Results of Arthroscopic Rotator Cuff Repair: Initial Tear Size Matters: A Prospective Study on Clinical and Radiological Results at a Minimum Follow-up of 10 Years

et al. 2019

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“…Surgical repair of RCTs with these characteristics is often technically challenging and is associated with higher rates of treatment failure or only modest clinical improvement. 1,12 Rockwood et al 43 described irreparable RCTs as those in which a direct repair of the native tendon to its insertion site is not possible. Signs of irreparability include fatty infiltration affecting 50% or more of the rotator cuff musculature, static superior migration of the humeral head, and a narrowed or absent acromiohumeral interval on an upright anteroposterior shoulder radiograph.…”

mentioning

confidence: 99%

Outcomes of Subacromial Balloon Spacer Implantation for Massive and Irreparable Rotator Cuff Tears: A Systematic Review

Stewart

Kaplin

Parada

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:Selection of optimal treatment for massive to irreparable rotator cuff tears (RCTs) entails a challenging decision-making process in which surgeons must consider several factors, including duration of symptoms, tear pattern, tear size, and muscle quality, as well as patient characteristics such as age, comorbidities, shoulder dominance, and activity level. Unfortunately, no clear consensus has been reached regarding optimal management.Purpose:To systematically review the published literature assessing outcomes after subacromial balloon spacer implantation for treatment of massive and irreparable RCTs.Study Design:Systematic review; Level of evidence, 4.Methods:A comprehensive literature search was performed in September 2018 through use of MEDLINE and the Cochrane Library electronic databases. Studies were assessed for multiple outcomes of interest including Constant score, Oxford Shoulder Score (OSS), University of California Los Angeles (UCLA) Shoulder Score, complications, and patient satisfaction.Results:After applying the selection criteria, 12 clinical studies were included for data extraction and analysis. In total, 291 shoulders (in 284 patients) treated with subacromial balloon spacer implantation were pooled for evaluation, with a mean follow-up of 22.9 ± 14.9 months (range, 6-60 months). Constant scores were used as an outcome metric for 267 shoulders (91.7%; 11 studies), with improvements in mean Constant score ranging from 18.5 to 49.6 points. Patient satisfaction was assessed in 105 patients (37.0%; 5 studies), with rates of patients indicating they were satisfied or very satisfied with their treatment outcome ranging from 45.8% to 100%. A total of 6 patients (2.1%) experienced complications related to balloon spacer implantation, including transient neurapraxia of the lateral antebrachial cutaneous nerve, superficial wound infection, deep wound infection, and balloon migration. Of these, 3 patients (2 balloon migration, 1 deep wound infection) required subsequent surgeries for balloon removal.Conclusion:Placement of the subacromial balloon spacer is a minimally invasive, technically simple procedure with favorable patient-reported outcomes at limited short-term follow-up. However, inherent methodological limitations and patient heterogeneity between studies may impair our ability to fully characterize the longer term efficacy, particularly relative to other potential surgical options. Further prospective randomized or comparative studies are warranted to ascertain clinical outcomes of subacromial balloon spacer in the management of massive and irreparable RCTs.

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General Problems and Complications

Holschen

Agneskirchner²

2019

Complications in Arthroscopic Shoulder Surgery

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Clinical and anatomic results of rotator cuff repair at 10 years depend on tear type

Abstract: IV.

Cited by 42 publications

References 34 publications

Long-term Results of Arthroscopic Rotator Cuff Repair: Initial Tear Size Matters: A Prospective Study on Clinical and Radiological Results at a Minimum Follow-up of 10 Years

Long-term Results of Arthroscopic Rotator Cuff Repair: Initial Tear Size Matters: A Prospective Study on Clinical and Radiological Results at a Minimum Follow-up of 10 Years

Outcomes of Subacromial Balloon Spacer Implantation for Massive and Irreparable Rotator Cuff Tears: A Systematic Review

General Problems and Complications

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