Clinical and Radiographic Outcomes After Arthroscopic Lamina-Specific Double-Row Repair of Large Delaminated Rotator Cuff Tears in Active Patients

Daisuke, Mori; Kizaki, Kazuha; Funakoshi, Noboru; Yamashita, Fumiyoshi; Mizuno, Yasuyuki; Shirai, Toshiharu; Kobayashi, Masahiko

doi:10.1177/2325967119838249

Cited by 5 publications

(6 citation statements)

References 33 publications

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“…Comparisons between patients with intact and retorn tendons in the active group suggested that shoulder activity had a generally negative effect on shoulder function in patients with retears, supporting the conclusions of previous studies. 23,33,34 Notably, patients with retears and high VAS scores for pain were only observed in the active group, indicating that the pain is probably enhanced by shoulder activities. The above findings of this study helped reconcile the contradicting results of previous studies 9,19,20,32,38 on the relationship between shoulder function and retears, as the activity levels of the patients in these investigations, although not clearly reported, could have been different.…”

Section: Discussionmentioning

confidence: 98%

“…In addition, this method has been used by other investigators and has been shown to be reliable. 33,34 Second, the number of retears was small, which might weaken the statistical power of related analyses. However, this was mainly the result of the low retear rate of the sedentary group.…”

Section: Discussionmentioning

confidence: 99%

“…6 At the final follow-up, patients were interviewed regarding their shoulder activity levels after surgery. On the basis of the modified criteria of Galatz et al, 15 Mori et al, 33 and Kim et al, 23 shoulder activity was divided into 4 categories (sports, job, activities of daily life, and weight of general lifting). Each category was rated as sedentary, light, moderate, or strenuous (Table 1) according to the most intensive activities that the patient had performed since 6 months after surgery.…”

Section: Patient Enrollmentmentioning

confidence: 99%

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Retears and Concomitant Functional Impairments After Rotator Cuff Repair: Shoulder Activity as a Risk Factor

Chen

Jiang

et al. 2020

Am J Sports Med

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Background: Most patients return successfully to shoulder involving sports or activity after rotator cuff repairs. It has not been decided yet whether postoperative participation in shoulder activity adds to the risk of retear. Purpose/Hypothesis: The purpose was to verify whether patients who participate in shoulder activities after rotator cuff repair have a higher risk of structural failure than nonactive patients and to investigate the relationship between postoperative shoulder function and tendon integrity in active and nonactive patients. The hypotheses were that (1) active patients have a higher retear rate than nonactive patients and (2) structural failure is associated with worse functional outcomes in active patients. Study Design: Cohort study; Level of evidence, 3. Methods: A cohort study was performed using 145 patients who underwent arthroscopic rotator cuff repair from 2015 to 2017. Functional assessments and magnetic resonance imaging were performed at least 24 months postoperatively. Shoulder activities since 6 months after surgery were rated in 4 categories (sports, job, activities of daily life, and weight of general lifting) as sedentary, light, moderate, or strenuous. The activity level of each patient was defined by the highest rated category. Patients who were involved in light, moderate, and strenuous activity were identified as active for the present study, and the rest were defined as sedentary. The proportion of retears between groups and the functional conditions between retorn and intact tendons were compared. Results: A total of 48 patients were enrolled in the active group, and 97 were enrolled in the sedentary group. The active group demonstrated a significantly higher retear rate than the sedentary group (27.1% vs 11.3%, respectively; P = .016; risk ratio, 2.39 [95% CI, 1.16-4.93]). In the active group, patients with retears showed higher visual analog scale scores for pain, decreased abduction strength, and lower shoulder functional scores (American Shoulder and Elbow Surgeons score, Fudan University Shoulder Score, and Constant-Murley score) than those with healed tendons, whereas in the sedentary group, functional outcomes were generally similar across patients with and without retears. Conclusion: Shoulder activity after the early postoperative period was associated with a high risk of retears in patients who underwent rotator cuff repair. A correlation between inhibited function and structural failure was detected but only in active patients, while sedentary patients with retears retained functional improvements similar to those with intact tendons.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Patient Enrollmentmentioning

confidence: 99%

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Retears and Concomitant Functional Impairments After Rotator Cuff Repair: Shoulder Activity as a Risk Factor

Chen

Jiang

et al. 2020

Am J Sports Med

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“…Arthroscopic rotator cuff repair using suture-bridge technique can achieve good to excellent clinical results. The shoulder functional outcomes were signi cantly improved even in the absence of RC healing [1,18]. The patient satisfaction rate was above 80% after the surgery.…”

Section: Discussionmentioning

confidence: 90%

Five Years Follow-up After Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique: Evaluation of the Retear Rate and the Impairment of the Shoulder Function

Zhang¹,

Shi²,

Liu³

et al. 2020

Preprint

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Purpose: To evaluate the retear rate after arthroscopic rotator cuff repair using a suture bridge (SB) technique for patients with full thickness rotator cuff tears and whether the non- healing cuff impaired the shoulder function.Methods: From January 2013 to January 2014, 92 patients in our institution underwent arthroscopic double-row suture bridge repair for the treatment of full-thickness rotator cuff tear 55 patients who have completed the 5 years follow-up were enrolled in this study. There were 36 female and 19 male patients, and the average age was 58.6 years (range, 41- 70 years). The tears were classified into small (<1 cm), medium (1-3 cm), large (3-5 cm), and massive (> 5 cm) according to the classification of DeOrio and Cofield. According to the intraoperative measurement, small tears were found in 5 shoulders (9%), medium tears in 19 shoulders (34.5%), large tears in 23 shoulders (41.8%), and massive tears in 8 shoulders (14.5%). The mean follow-up was 71.2 months (range, 66-78 months). Post-operative cuff integrity was evaluated with ultrasound (US) according to the published literature which was comparable to Sugaya MRI classification. Types I-III indicated cuff healing and types IV or V indicated retear. The retear patterns were divided into type 1 (failure at the original repair site) or 2 (failure around the medial row). At baseline and final follow-up, shoulder functional outcomes were measured using validated, shoulder-specific outcome scores, including the Constant-Murley score (CS) and the American Shoulder and Elbow Score (ASES). The difference in abduction muscle strength was also evaluated between the integrity and the retear group.Results: At final follow-up, the rotator cuff was completely healed in 45 of the 55 shoulders. There were recurrent tears in 10 shoulders, and the retear rate was 18.2%. The type 1 re- tear pattern was found in 4 shoulders (40%), and type 2 in 6 shoulders (60%). The Constant and ASES scores improved from 41.00 to 92.00, and from 41.33 to 88.00, respectively. The mean differences in shoulder scaption strength between the healing and the retear group were 1.1±0.82Kg and 3.0±0.88Kg respectively. The difference in muscle strength between the retear and the healing group was statistically significant (p<0.001).Conclusion: Arthroscopic suture bridge repair of full-thickness rotator cuff tears led to excellent improvement in shoulder function, but maintained a high retear rate. Although the retear group had inferior muscle strength, the patients were still satisfied, and shoulder function was improved due to pain relief. Whether such changes in muscle strength impair patients' long-term quality of life and shoulder function remains to be discussed.Level of evidence IV

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“…Therefore, the resulting area calculation assumes a square, 2-dimensional tear shape, while shape variations in individual tear defect configurations exist. Still, the authors felt that the arthroscopically determined square centimeter measurements of tear size were an improvement over other methods, such as nonquantitative, unidirectional, or solely derived from magnetic resonance imaging, to describe rotator cuff tear size 25 , 26 , 27 and allowed the authors to reproducibly define both the initial and residual rotator cuff tear defects that were present. Also, the arthroscopic measurements were taken to an accuracy of 1 cm, thus introducing a “rounding error” that contributes to inaccuracy within the tear area calculation.…”

Section: Discussionmentioning

confidence: 99%

Partial Rotator Cuff Repair for Massive Tears Rarely Require Revision Surgery

Hallock

Parsell

Field

2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To determine the significance of initial and residual rotator cuff tear defect size on the need for revision surgery or additional nonsurgical therapy, in a consecutive group of patients undergoing partial repair of massive rotator cuff tears. Methods A retrospective chart review was carried out for all arthroscopic rotator cuff repairs performed by a single surgeon between January of 2013 and December of 2016. All patients with massive rotator cuff tears (>30 cm 2 ) who underwent partial repair were included in the study. Outcomes for the surgical procedure were measured based on the necessity for revision surgery or adjunct therapy, including steroid injections or additional physical therapy after initial release from care. Results In total, 1954 patients who underwent arthroscopic rotator cuff repair were identified. Thirty-eight of these met the inclusion criteria. Those patients undergoing revision surgery represented 5.2% (2/38) of the series and had an average initial/residual tear defect area of 45.0/7.0 cm 2 . Patients requiring adjunct therapy represented 7.9% (3/38) of the series and possessed an average initial/residual tear defect size of 40.0/16.0 cm 2 . The remaining 33 (86.9%) patients did not require revision surgery or adjunct therapy at a minimum follow-up of 2 years. There was no significance between initial and/or residual rotator cuff tear defect size and the need for revision surgery. However, there was a significant difference in the mean residual defect size in the patients requiring additional nonoperative treatment after initial release from care ( P = .012). Conclusions There was no relationship between residual defect size after partial repair and the need for revision surgery. Patients who returned for additional nonoperative treatment after being released from care were noted to have a statistically larger residual defect size at the time of index surgical intervention. Only 5% of patients underwent subsequent surgery at an average of more than 4 years’ follow-up, suggesting that partial repair of massive rotator cuff tears can provide a durable, joint-preserving intervention. Level of Evidence Level IV, Therapeutic Case Series

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Clinical and Radiographic Outcomes After Arthroscopic Lamina-Specific Double-Row Repair of Large Delaminated Rotator Cuff Tears in Active Patients

Cited by 5 publications

References 33 publications

Retears and Concomitant Functional Impairments After Rotator Cuff Repair: Shoulder Activity as a Risk Factor

Retears and Concomitant Functional Impairments After Rotator Cuff Repair: Shoulder Activity as a Risk Factor

Five Years Follow-up After Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique: Evaluation of the Retear Rate and the Impairment of the Shoulder Function

Partial Rotator Cuff Repair for Massive Tears Rarely Require Revision Surgery

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