Clinical and anatomic results of surgical repair of chronic rotator cuff tears at ten-year minimum follow-up

Elia, Fanny; Azoulay, Vadim; Lebon, J; Faraud, Amélie; Bonnevialle, Nicolas; Mansat, Pierre

doi:10.1007/s00264-017-3456-8

Cited by 23 publications

(19 citation statements)

References 34 publications

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“…However, since it was not a main aspect of our study to evaluate the previously reported conventional MRI‐based predictors, we cannot rule out that we missed predictive effects due to our small cohort size and herefrom resulting low statistical power for the expected moderate‐to‐weak effects of these parameters. The tendon retear rate within our cohort was relatively high, yet still well in the range of previous reports …”

Section: Discussionsupporting

confidence: 89%

“…Goutallier et al proposed fatty muscle infiltration assessed by computed tomography as one of the first commonly applied predictors for successful tendon healing. Being adapted for the use in MRI, fatty infiltration and other MRI‐based markers such as tear size or tendon retraction represent morphologic parameters, which seem to only partially reflect functional properties and regenerative potential of the musculotendinous SSP system …”

mentioning

confidence: 99%

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Contrast‐Enhanced Ultrasound (CEUS) as Predictor for Early Retear and Functional Outcome After Supraspinatus Tendon Repair

Kamtchouing

Mick

Groß

et al. 2019

Journal Orthopaedic Research

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Supraspinatus (SSP) tendon tears represent a common indication for shoulder surgery. Yet, prediction of postoperative function and tendon retear remains challenging and primarily relies on morphologic magnetic resonance imaging (MRI)-based parameters, supported by patients' demographic data like age, gender, and comorbidities. Considering continuously high retear rates, especially in patients with larger tears and negative prognostic factors, improved outcome prediction could be of high clinical value. Contrastenhanced ultrasound (CEUS) enables an assessment of dynamic perfusion of the SSP muscle. As a potential surrogate for muscle vitality, CEUS might reflect functional properties of the SSP and support improved outcome prediction after tendon repair. Fifty patients with isolated SSP tendon tears were prospectively enrolled. Preoperatively, SSP muscle perfusion was quantified by CEUS and conventional morphologic parameters like tear size, fatty infiltration, and tendon retraction were assessed by MRI. At six months follow-up, shoulder function, tendon integrity, and muscle perfusion were reassessed. The predictive value of preoperative CEUS for postoperative shoulder function and tendon integrity was evaluated. 35 patients entered the statistical analysis. Preoperative CEUS-based assessment of SSP perfusion significantly correlated with early postoperative shoulder function (Constant, r = 0.48, p < 0.018) and tendon retear (r = 0.67, p < 0.001). CEUS-based subgroup analysis identified patients with exceptionally high, respectively low risk for tendon retear. CEUSbased assessment of the SSP seemed to predict early shoulder function and tendon retear after SSP repair and allowed to identify patient subgroups with exceptionally high or low risk for tendon retear.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

Contrast‐Enhanced Ultrasound (CEUS) as Predictor for Early Retear and Functional Outcome After Supraspinatus Tendon Repair

Kamtchouing

Mick

Groß

et al. 2019

Journal Orthopaedic Research

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“…8,9 For the chronic, degenerative tear population, favorable long-term surgical outcomes have been reporteddperhaps slightly diminished when complete healing is not achieved. 10 Chronicity of the tear is a known risk factor for tear reparability. It would follow that delaying repair while the patient responds to steroid injections may be delaying the best treatment option in some instances, particularly if a trial of nonsteroidal agents and physiotherapy has already failed to improve function and reduce pain.…”

Section: See Related Article On Page 706mentioning

confidence: 99%

Editorial Commentary: Steroid Injections Prior to Arthroscopic Rotator Cuff Repair—Is It Time to Rethink a Conservative Treatment Paradigm?

Woolf

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The standard of care for most rotator cuff conditions over the past half century or longer has been a trial of nonoperative treatment including nonsteroidal anti-inflammatory agents, physiotherapy, and steroid injections prior to surgery. There is compelling basic science data to suggest a negative effect of corticosteroids on tissue quality. Chronicity of the tear is a risk factor for unsuccessful repair, but other factors including use of tobacco products, repair technique, and postoperative management all have an impact. Evidence either in favor of or against use of steroid injections as a treatment option is limited or weak at best. Given advances in rotator cuff repair techniques and successful long-term outcomes, treating surgeons should be mindful of how injections might affect surgical outcomes owing to either delayed surgical intervention or a direct effect on tissue quality.

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“…1 Despite this high incidence, RC repair does not always lead to clinically satisfactory outcomes; indeed, the failure rates of RC repair are reportedly 40-50%. [2][3][4] Therefore, RC reattachment to bone following RC repair is a challenging clinical problem. Although numerous repair techniques to reduce the re-tear rate have been reported, these did not significantly reduce the re-tear rates during long-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

Does demineralized bone matrix enhance tendon-to-bone healing after rotator cuff repair in a rabbit model?

Lee¹,

Kim²,

Shin³

et al. 2019

Preprint

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Background The purpose of this study was to compare the histologic outcomes after rotator cuff (RC) repair between with demineralized bone matrix (DBM) augmentation and without DBM and to evaluate the role of DBM for tendon-to-bone (TB) healing in a rabbit model. Methods Twenty-six adult male New Zealand white rabbits were randomly allocated to the control group (n = 13) or the DBM group (n = 13). A chronic RC tear was generated on the right shoulder of all rabbits. In the control group, RC repair was achieved by a standard transosseous technique. In the DBM group, RC repair was achieved using the same technique, and DBM was interposed between the cuff and bone. After 8 weeks, the RC tendon entheses from all rabbits were processed for gross and histologic examination. Results In the control group, the tendon midsubstance was disorganized with randomly and loosely arranged collagen fibers and rounded fibroblastic nuclei. The TB interface was predominantly fibrous with small regions of fibrocartilage, especially mineralized fibrocartilage. In the DBM group, the tendon midsubstance appeared normal and comprised densely arranged collagen fibers, with orientated crimped collagen fibers running in the longitudinal direction of the tendon. These fibers were interspersed with elongated fibroblast nuclei. The TB interface consisted of organized collagen fibers with large quantities of fibrocartilage and mineralized fibrocartilage. Conclusion DBM augmentation at the RC-to-bone interface enhances TB healing after RC repair.

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Clinical and anatomic results of surgical repair of chronic rotator cuff tears at ten-year minimum follow-up

Cited by 23 publications

References 34 publications

Contrast‐Enhanced Ultrasound (CEUS) as Predictor for Early Retear and Functional Outcome After Supraspinatus Tendon Repair

Contrast‐Enhanced Ultrasound (CEUS) as Predictor for Early Retear and Functional Outcome After Supraspinatus Tendon Repair

Editorial Commentary: Steroid Injections Prior to Arthroscopic Rotator Cuff Repair—Is It Time to Rethink a Conservative Treatment Paradigm?

Does demineralized bone matrix enhance tendon-to-bone healing after rotator cuff repair in a rabbit model?

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