Cuff integrity after arthroscopic versus open rotator cuff repair: A prospective study

Bishop, Julie Y.; Klepps, Steven; Lo, Ian K.Y.; Bird, Justin E.; Gladstone, James N.; Flatow, Evan L.

doi:10.1016/j.jse.2005.09.017

Cited by 521 publications

(396 citation statements)

References 54 publications

(81 reference statements)

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“…Retear rates reportedly range from 15% to 90% [1,2,11,20], with approximately 4% of failures being attributed to metal anchor pullout from bone at the time of revision surgery [5,6]. The pullout rates for bioabsorbable anchors reportedly are much higher, with as much as 30% of painful shoulders showing anchor pullout on MRI after cuff repair [12].…”

Section: Introductionmentioning

confidence: 99%

Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

Oshtory¹,

Lindsey

Giori

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Failure of suture anchor fixation in rotator cuff repair can occur at different interfaces. Prior studies show fixation at the bone-anchor interface can be augmented using polymethylmethacrylate (PMMA) cement, and screw fixation into bone can be strengthened using bioabsorbable tricalcium phosphate cement. Questions/purposes We wished to determine whether augmentation of suture anchor fixation using bioabsorbable tricalcium phosphate cement would increase pullout strength of suture anchors from bone and the number of cycles to failure, to determine the mode of failure after cement augmentation, and to compare strength and mode of failure with those after augmentation with PMMA.Methods We used 10 matched pairs of cadaveric proximal humeri and implanted a metal screw-type suture anchor in one side and on the other side injected tricalcium phosphate cement into the anchor holes before anchor placement. We tested all specimens to failure using a ramped cyclic loading protocol. Results Tricalcium phosphate cement augmentation increased the final load to failure by 29% and the number of cycles to failure by 20%. Visual inspection confirmed that failure occurred at the cement-bone interface. Conclusions Tricalcium phosphate cement appears to augment suture anchor fixation into bone, reducing the risk of anchor pullout and failure. Clinical Relevance When relying on suture anchor fixation in bone of questionable quality, we suggest considering augmentation of suture anchor fixation with bioabsorbable cement. This method also provides potential for bioabsorbability and may be more amenable to arthroscopic application.

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Section: Introductionmentioning

confidence: 99%

Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

Oshtory¹,

Lindsey

Giori

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…Bond et al [7] showed repairing massive rotator cuff tears with allogenic augmentation (GraftJacket 1 ) yielded a failure rate of 19%. This result is lower than the 38% to 95% failure rate demonstrated in several studies evaluating unaugmented massive rotator cuff repairs [5,20,21,60]. A histologic assessment of one patient's allogenically augmented rotator cuff repair (GraftJacket 1 ) demonstrated no calcification, infection, or inflammatory response at 3 months.…”

Section: Ecm Augmentationmentioning

confidence: 64%

“…Postoperative rotator cuff retears occur in as little as 11% to as much as 94% of rotator cuff repair surgeries, perhaps depending on the size of the tear and the level of tendon degeneration [5,6,19,21,33,34,60]. Retearing correlates with decreased functional outcome after rotator cuff repair [53].…”

Section: Introductionmentioning

confidence: 99%

Strategies in Biologic Augmentation of Rotator Cuff Repair: A Review

Cheung

Silverio

Sperling

2010

Clinical Orthopaedics &Amp; Related Research

146

103

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Background Degenerative rotator cuff tears are increasing with the aging population, and healing is not uniform after surgery. Rotator cuffs may show improved healing when biologic factors are added during surgery. Questions/purposes We asked: (1) What cellular processes are involved in normal bone-to-tendon healing? (2) What approaches are being developed in tendon augmentation? (3) What approaches are being developed with the addition of growth factors? Methods We reviewed research in relating to biologic augmentation and cellular processes involved in rotator cuff repair, focusing on animal models of rotator cuff repair and nonrandomized human trials. Results Regular bone-to-tendon healing forms a fibrous junction between tendon and bone that is distinct from the original bone-to-tendon junction. Tendon augmentation with cellular components serves as scaffolding for fibroblastic cells and a possible source of growth factors and fibroblastic cells. Extracellular matrices provide a scaffold for incoming fibroblastic cells, although current research does not conclusively confirm which if any of these scaffolds enhance repair owing in part to intermanufacturer variations and the limited human research. Growth factors and platelet-rich-plasma are established in other fields of research and may enhance repair but have not been rigorously tested. Conclusions There is potential application of biologic augmentation to improve healing after rotator cuff repair. However, research in this field is still inconclusive and has not been sufficiently demonstrated to merit regular clinical use. Future human trials can elucidate the use of biologic augmentation in rotator cuff repairs.

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“…to the orthopedic community, as evidenced by the 20% to 90% repair failure rates reported after rotator cuff repair 1,6,7,[12][13][14]16 surgery. High surgical failure rates can be attrib uted to a number of biologic, anatomic, and mechanical factors, which include inferior tissue quality, tendon retrac tion, muscle atrophy and fatty infiltration, undue tension at the repair site in the early postoperative period, and the environment.…”

mentioning

confidence: 99%