Factors Related to Symptomatic Failed Rotator Cuff Repair Leading to Revision Surgeries After Primary Arthroscopic Surgery

Lee, Sanghyeon; Park, In; Lee, Hye Ah; Shin, Sang-Jin

doi:10.1016/j.arthro.2020.04.016

Cited by 35 publications

(47 citation statements)

References 32 publications

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“…Because of the lack of cultures obtained during revision surgery, the incidence is very likely underestimated. 21 Unfortunately, these data were not presented for group 1 in the study by Lee et al 5 In our experience, low-grade shoulder infection can be a reason for failure and poor outcomes after cuff repair.…”

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confidence: 82%

“…The first group of patients in the study by Lee et al 5 ended up with larger tears than they started with. These were the patients with poor outcomes.…”

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confidence: 99%

“…The study by Lee et al 5 helps to identify patients in whom we should not perform rotator cuff repair because the chance of success is low. In future research, we should attempt to increase inclusions in these studies (big data) to further select patients with a good chance of success after our surgical interventions.…”

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confidence: 99%

“…The best treatment option for relatively large rotator cuff tears remains a challenge for the treating shoulder surgeon, especially in young patients. And the question is whether large cuff tears, as presented in the study by Lee et al 5 with infraspinatus fatty infiltration exceeding 50%, should be considered massive irreparable posterosuperior rotator cuff tears. Reverse shoulder prosthesis is probably the most reliable option for elderly patients with such tears but is not an attractive option for young patients because the shoulder joint is sacrificed.…”

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confidence: 99%

“…The choice of the right treatment for patients with large rotator cuff tears is not always evident. In the study presented by Lee et al, 5 the patients in the failed cuff repair group underwent the second operation on average 15 months after the primary cuff repair. Even if they do well after revision surgery, their rehabilitation time will be around 2 to 2.5 years.…”

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confidence: 99%

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Editorial Commentary: Rotator Cuff Tear: Know When Not to Operate So You Don't Make It Worse

Heerspink

Dorrestijn²

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Shoulder rotator cuff repair results in significantly improved outcomes compared with conservative treatment, but some repairs result in retear and, worst of all, enlarged retears (i.e., tears larger after surgery than primarily). Elevated serum total cholesterol and low-density lipoprotein levels and fatty infiltration of the infraspinatus are significantly related to symptomatic failed rotator cuff repair. Hypertension could also be a risk factor. In such cases, nonoperative treatment, reverse shoulder prosthesis (in older patients), or alternative joint-preserving procedures (superior capsular reconstruction, subacromial balloon spacer, multiple-tendon interposition autografts, augmentation of the long head of the biceps, or tendon transfers such as latissimus dorsi transfer and lower trapezius transfer) could be considered or are worthy of future investigation.

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confidence: 82%

“…The first group of patients in the study by Lee et al 5 ended up with larger tears than they started with. These were the patients with poor outcomes.…”

Section: See Related Article On Page 2080mentioning

confidence: 99%

Section: See Related Article On Page 2080mentioning

confidence: 99%

Section: See Related Article On Page 2080mentioning

confidence: 99%

Section: See Related Article On Page 2080mentioning

confidence: 99%

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Editorial Commentary: Rotator Cuff Tear: Know When Not to Operate So You Don't Make It Worse

Heerspink

Dorrestijn²

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Factors associated with genetic markers for rotator cuff disease in patients with atraumatic rotator cuff tears

Yanik,

Saccone,

Aleem

et al. 2023

Journal Orthopaedic Research

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For atraumatic rotator cuff tears, genetics contributes to symptomatic tear risk and may influence rotator cuff healing after surgical repair. But little is known about how genetic factors influence rotator cuff tear patient characteristics at presentation. We collected saliva samples for genotyping from atraumatic rotator cuff tear patients. We examined nine single nucleotide polymorphisms (SNPs) associated with cuff tears in prior literature. We estimated associations of SNP dosage with (1) age at tear diagnosis, (2) bilateral atraumatic tear prevalence, and (3) tear size. Linear regression was used to estimate associations with diagnosis age adjusted for sex and principal components. Logistic regression and ordinal logistic regression were used to estimate associations with bilateral tear prevalence and tear size category, respectively, adjusting for age, sex, and principal components. Of 344 eligible patients, 336 provided sufficient samples for genotyping. Median age at tear diagnosis was 61, 22% (N = 74) had bilateral atraumatic tears, and 9% (N = 29) had massive tears. SNP rs13107325 in the SLC39A8 gene and rs11850957 in the STXBP6 gene were associated with younger diagnosis age even after accounting for multiple comparisons (rs13107325: −4 years, 95% CI = −6.5, −1.4; rs11850957: −2.7 years, 95% CI = −4.3, −1.1). No other significant associations were observed with diagnosis age, tear size, or bilateral tear prevalence. SLC39A8 encodes a Mn transporter. STXBP6 may play a role in inflammatory responses by altering phagocytosis and antigen presentation of monocytes and macrophages. Further research is needed to determine if genetic markers can be used alongside patient characteristics to aid in identifying optimal surgical repair candidates.

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Patch augmentation does not provide better clinical outcomes than arthroscopic rotator cuff repair for large to massive rotator cuff tears

Choi

Kim

Lee

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Patch augmentation for large and massive rotator cuf tears (LMRCTs) has been suggested as a repair strategy that can mechanically reinforce tendons and biologically enhance healing potential. The purpose of this study was to determine whether patients who underwent patch augmentation would have lower rates of retears and superior functional outcomes. Methods Patients who underwent arthroscopic rotator cuf repair (ARCR) with patch augmentation (group A) were matched by age, sex, degree of retraction, and supraspinatus muscle occupation ratio to those treated with ARCR without using a patch (group B) with a minimum follow-up of 24 months. The retear (Sugaya IV or V) rates were evaluated by magnetic resonance imaging at 3 and 12 months post-surgery. The Constant-Murley Score (CMS), Korean Shoulder Score (KSS), and University of California-Los Angeles Shoulder Rating Scale (UCLA) score were retrospectively analyzed. Results This study included 34 patients (group A, n = 17; group B, n = 17). The mean follow-up period was 46.5 ± 17.4 months. At postoperative 1-year follow-up, group B (6 patients, 35.3%) showed higher rates of retears than group A (1 patient, 5.9%), which was statistically signiicant (P = 0.034). However, the postoperative CMS, KSS, and UCLA scores did not difer between the two groups at 3 months, 12 months, and the inal follow-up. Additionally, the clinical outcomes of patients with retear were not signiicantly diferent from those of the healed patients in both groups. Conclusion The use of an allodermal patch for LMRCT is efective in preventing retears without complications. However, the clinical outcomes of ARCR using allodermal patch augmentation were not superior to those of only ARCR. Level of evidence III.

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Factors Related to Symptomatic Failed Rotator Cuff Repair Leading to Revision Surgeries After Primary Arthroscopic Surgery

Cited by 35 publications

References 32 publications

Editorial Commentary: Rotator Cuff Tear: Know When Not to Operate So You Don't Make It Worse

Editorial Commentary: Rotator Cuff Tear: Know When Not to Operate So You Don't Make It Worse

Factors associated with genetic markers for rotator cuff disease in patients with atraumatic rotator cuff tears

Patch augmentation does not provide better clinical outcomes than arthroscopic rotator cuff repair for large to massive rotator cuff tears

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