High-Grade Bursal Side Rotator-Cuff Repair: A Surgical Outcome Review

Prasetia, Renaldi; Kholinne, Erica; Suvarly, Prettysia; Rosa, Wendy Yolanda; Pratiwi, Yuni Susanti; Herman, Harold; Rasyid, Hermawan Nagar; C้hernchujit, Bancha; Lesmana, Ronny

doi:10.2147/orr.s323092

Cited by 3 publications

(11 citation statements)

References 25 publications

(43 reference statements)

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“…However, according to the literature, this repair method is associated with two potential disadvantages. First, there is the risk of a tension mismatch between the articular and bursal sides, which may result in postoperative stiffness and residual pain 10 . Second, as only the torn bursal‐side rotator cuff is repaired, there is a risk of gap formation between the bursal‐side and articular‐side rotator cuff, which is equal to an intratendinous tear 19 .…”

Section: Discussionmentioning

confidence: 99%

“…Clinical Outcomes of the Repair of Bursal-Side PTRCTs Involving >50% of the Thickness Currently, in situ repair and tear completion before repair are the two most widely used repair methods for bursal-side PTRCTs involving >50% of the thickness. 10 Xiao et al studied a cohort of 59 patients who underwent in situ repair of bursal-side PTRCTs with an average follow-up of 2 years. 11 At the final follow-up, both the UCLA score and Constant-Murley score significantly improved, and the re-tear rate was 16.3%.…”

Section: Main Findings Of the Studymentioning

confidence: 99%

“…Currently, the most widely used repair methods for bursal‐side PTRCTs include in situ repair and tear completion before repair 10 . In situ repair involves preserving the intact articular‐side fibers, while the torn bursal‐side tendon fibers are repaired to the greater tuberosity by one or two suture anchors 11,12 .…”

Section: Introductionmentioning

confidence: 99%

“…In situ repair involves preserving the intact articular‐side fibers, while the torn bursal‐side tendon fibers are repaired to the greater tuberosity by one or two suture anchors 11,12 . Although this repair method can successfully restore the anatomical footprint of the rotator cuff, the main disadvantage is the risk of a tension mismatch between the articular‐side and bursal‐side tendon fibers due to over‐tensioning of the repaired bursal‐side tendon fibers, which may result in postoperative stiffness and residual pain 10,13 . To obviate this problem, some orthopaedic surgeons suggest completing the lesion to a full‐thickness tear, and subsequently performing a standard repair (known as tear completion before repair) 14,15 .…”

Section: Introductionmentioning

confidence: 99%

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Functional and MRI Outcomes After In Situ Repair Versus Tear Completion Before Repair of Bursal‐Side Partial‐Thickness Rotator Cuff Tears

Zhuo

Pan

2023

Orthopaedic Surgery

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ObjectiveThe optimal repair method for bursal‐side partial‐thickness rotator cuff tears (PTRCTs) involving >50% of the thickness remains a controversial topic. The study was aimed to compare the functional and magnetic resonance imaging (MRI) outcomes after in situ repair or tear completion before repair of bursal‐side PTRCTs.MethodsA retrospective clinical study was conducted involving 58 patients who underwent in situ repair or tear completion before repair of bursal‐side PTRCTs between January 2019 and December 2020. These patients were divided into two groups: the in situ repair group and the tear completion before repair group. Functional assessment consisted of active range of motion (ROM), visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Constant–Murley score. The percentages of patients in each group achieving the minimal clinical important difference (MCID) of the functional scores were determined. The healing status of the rotator cuff was assessed by postoperative MRI.ResultsThere were no statistically significant differences between the two groups in terms of demographic data. The mean follow‐up period was 14.53 ± 2.64 months in the in situ repair group and 15.40 ± 2.66 months in the tear completion before repair group. At the final follow‐up, the forward elevation, external rotation, and internal rotation improved significantly in both groups. The VAS, ASES score, and Constant–Murley score improved significantly in the in situ repair group (5.17 ± 2.00 points to 0.11 ± 0.41 points, p = 0.001; 44.04 ± 17.40 points to 95.47 ± 4.32 points, p = 0.001; 49.50 ± 14.38 points to 93.50 ± 3.49 points, p = 0.001) and in the tear completion before repair group (5.43 ± 3.32 points to 0.03 ± 0.18 points, p = 0.001; 41.50 ± 19.59 points to 95.94 ± 2.68 points, p = 0.001; 47.54 ± 17.13 points to 93.97 ± 2.61 points, p = 0.001). Postoperative MRI revealed that the re‐tear rate was 7.1% (2/28) in the in situ repair group and 3.3% (1/30) in the tear completion before repair group. No significant differences were observed in terms of the functional scores, the percentages of patients achieving the MCID of the functional scores, and the re‐tear rate between the two groups (p > 0.05).ConclusionsBoth in situ repair and tear completion before repair yielded satisfactory clinical outcomes for patients with bursal‐side PTRCTs. No significant differences were observed in the functional and MRI outcomes between the two groups.

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Section: Discussionmentioning

confidence: 99%

Section: Main Findings Of the Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Functional and MRI Outcomes After In Situ Repair Versus Tear Completion Before Repair of Bursal‐Side Partial‐Thickness Rotator Cuff Tears

Zhuo

Pan

2023

Orthopaedic Surgery

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“…There is currently insufficient evidence to advocate one specific procedure for the treatment of high-grade partial thickness tears, however irrespective of the technique employed, an improvement in functional outcome can reliably be achieved. 46 Current surgical strategies include tear debridement with or without acromioplasty, conversion to full-thickness defect and repair, in situ repair, and biological augmentation strategies.…”

Section: Arthroscopic Proceduresmentioning

confidence: 99%

Optimal Management of Partial Thickness Rotator Cuff Tears: Clinical Considerations and Practical Management

Thangarajah

2022

ORR

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Partial thickness rotator cuff tears have been diagnosed with increased frequency due to heightened awareness and an improvement in diagnostic modalities. When >50% of the tendon thickness has ruptured, intra-tendinous strain of the residual tendon increases. Surgery is generally confined to patients who have failed non-operative measures and have persistent symptoms. The rationale for repairing partial thickness tears lies in their limited self-healing capacity, and propensity to enlarge over time and progress to a full thickness defect. Although tear debridement and acromioplasty can improve pain and function, tear progression can occur, in addition to worse results being noted in bursal-sided defects. Several surgical strategies have been recommended but there is a lack of evidence to advocate one form of treatment over another. The aim of this narrative review is to discuss the treatment options for partial thickness tears of the rotator cuff.

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The pathology of oxidative stress-induced autophagy in a chronic rotator cuff enthesis tear

Prasetia,

Purwana,

Lesmana

et al. 2023

Front. Physiol.

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Partial-thickness rotator cuff tears (PTRCTs) are often found in daily orthopedic practice, with most of the tears occurring in middle-aged patients. An anaerobic process and imbalanced oxygenation have been observed in PTRCTs, resulting in oxidative stress. Studies have shown the roles of oxidative stress in autophagy and the potential of unregulated mechanisms causing disturbance in soft tissue healing. This article aims to review literature works and summarize the potential pathology of oxidative stress and unregulated autophagy in the rotator cuff enthesis correlated with chronicity. We collected and reviewed the literature using appropriate keywords, in addition to the manually retrieved literature. Autophagy is a normal mechanism of tissue repair or conversion to energy needed for the repair of rotator cuff tears. However, excessive mechanisms will degenerate the tendon, resulting in an abnormal state. Chronic overloading of the enthesis in PTRCTs and the hypovascular nature of the proximal tendon insertion will lead to hypoxia. The hypoxia state results in oxidative stress. An autophagy mechanism is induced in hypoxia via hypoxia-inducible factors (HIFs) 1/Bcl-2 adenovirus E1B 19-kDa interacting protein (BNIP) 3, releasing beclin-1, which results in autophagy induction. Reactive oxygen species (ROS) accumulation would induce autophagy as the regulator of cell oxidation. Oxidative stress will also remove the mammalian target of rapamycin (mTOR) from the induction complex, causing phosphorylation and initiating autophagy. Hypoxia and endoplasmic reticulum (ER) stress would initiate unfolded protein response (UPR) through protein kinase RNA-like ER kinase (PERK) and activate transcription factor 4, which induces autophagy. Oxidative stress occurring in the hypovascularized chronic rotator cuff tear due to hypoxia and ROS accumulation would result in unregulated autophagy directly or autophagy mediated by HIF-1, mTOR, and UPR. These mechanisms would disrupt enthesis healing.

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High-Grade Bursal Side Rotator-Cuff Repair: A Surgical Outcome Review

Cited by 3 publications

References 25 publications

Functional and MRI Outcomes After In Situ Repair Versus Tear Completion Before Repair of Bursal‐Side Partial‐Thickness Rotator Cuff Tears

Functional and MRI Outcomes After In Situ Repair Versus Tear Completion Before Repair of Bursal‐Side Partial‐Thickness Rotator Cuff Tears

Optimal Management of Partial Thickness Rotator Cuff Tears: Clinical Considerations and Practical Management

The pathology of oxidative stress-induced autophagy in a chronic rotator cuff enthesis tear

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