Factors Affecting Rotator Cuff Healing After Arthroscopic Repair

Chung, Seok Won; Oh, Joo Han; Gong, Hyun Sik; Kim, Joon Yub; Kim, Sae Hoon

doi:10.1177/0363546511415659

Cited by 318 publications

(316 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 was an independent predictors of rotator cuff healing. In a rat rotator cuff repair model, Angeline et al [37] demonstrated that vitamin D deficiency negatively affects the biomechanical and histological properties of rotator cuff repairs during the early phase of healing.…”

Section: Muscle-tendon Unit Retractionmentioning

confidence: 99%

“…The detrimental effect of increasing age on tendon healing after rotator cuff repair may be due to other factors affecting tendon healing rather than to age itself. 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.…”

Section: Agementioning

confidence: 99%

“…Smoking was detrimental to healing Ⅳ Chung et al [14] Retrospective cohort 408 pts/37.2 mo CT arthrogram, US Bone mineral density, as well as FI of the infraspinatus and amount of retraction, was an independent determining factor affecting postoperative rotator cuff healing Ⅲ Abboud et al [38] Case [53] RCT 201 pts/38.5 mo…”

Section: Mrimentioning

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: Muscle-tendon Unit Retractionmentioning

confidence: 99%

Section: Agementioning

confidence: 99%

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Factors affecting healing after arthroscopic rotator cuff repair

Abtahi

Granger

Tashjian

2015

WJO

158

View full text Add to dashboard Cite

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“…Patient factors such as diabetes mellitus, cigarette smoking and osteoporosis have been suggested to negatively affect the clinical outcomes and healing of RCTs [3,14].…”

Section: Comorbiditiesmentioning

confidence: 99%

Complete Rotator Cuff Tear: An Evidence-Based Conservative Management Approach

Abdulwahab¹,

Murrell²,

Jenio³

et al. 2018

Advances in Shoulder Surgery

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Rotator cuff disease accounts for 10% of all shoulder pain and major shoulder disability, with limited information concerning the natural history and treatment approaches for the disorder. Our objective is to assess the available evidence for the efficacy and morbidity of commonly used systemic medications, physiotherapy, and injections alongside evaluating any negative long-term effects. Although there is conflicting literature, there appears to be some consensus on the best indicators for choosing to treat a full-thickness tears (FTT) non-operatively to reduce pain and improve function. The risks associated with these tears include the potential of the progression of the tear, a diminished healing potential due to age or longer symptom duration, muscle atrophy, and fatty infiltration. The indications for surgery following conservative treatment are becoming more defined, and an outline regarding what scenarios warrant a transition from an initial conservative treatment plan has been developed. The developing benefits of using mesenchymal stem cells (MSCs) and other biologics have the potential to be disruptive to current treatment protocols in the approaches to healing rotator cuff tears (RCTs). With improved imaging modalities, diagnostic accuracy, and sensitivity, practitioners of the future will hopefully be able to intervene earlier in the disease pathogenesis cycle.

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“…Although the severity of fatty muscle 2,3 infiltration has important implications on the success of rotator cuff repairs, little longitudinal information regarding the risks for progression of muscle degenerative changes is available. Currently, surgical indications for rotator cuff treatment vary widely.…”

mentioning

confidence: 99%