Is Posterior Delamination in Arthroscopic Rotator Cuff Repair Hidden to the Posterior Viewing Portal?

Han, Yung; Shin, Jin-Hyup; Seok, Chang-Woo; Lee, Chang‐Hyun; Kim, Seung‐Ho

doi:10.1016/j.arthro.2013.07.024

Cited by 13 publications

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“…This variable rate may be explained by the fact that many surgeons underdiagnose delaminated tears by leaving the arthroscope in the posterior portal when performing a cuff repair. As shown by Han et al, 14 using a 30° scope introduced through the back of the shoulder makes it difficult, if not impossible, to diagnose tendon delamination, which occurs primarily at the level of the infraspinatus. We agree with these authors, who recommend systematically placing the arthroscope in the lateral portal at the time of repair to diagnose delaminated tears.…”

Section: Discussionmentioning

confidence: 99%

“…Tendon delamination was assessed intraoperatively under arthroscopy with the arthroscope placed in the lateral portal. 14 A rotator cuff tear was considered delaminated when a horizontal intratendinous cleavage separated a deep layer and a superficial layer. 34 The size of the tear in the coronal and sagittal planes was assessed intraoperatively with the arthroscope placed in the lateral portal and after debridement of the degenerated tendon edges (Figure 4A).…”

Section: Methodsmentioning

confidence: 99%

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The Effect of Tendon Delamination on Rotator Cuff Healing

et al. 2019

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Background: While patient age, tear size, and muscle fatty infiltration are factors known to affect the rate of tendon healing after rotator cuff repair, the effect of tendon delamination is less known. Purpose: To assess the effect of tendon delamination on rotator cuff healing after arthroscopic single-row (SR) repair. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients (N = 117) with chronic full-thickness rotator cuff tears underwent arthroscopic SR repair with the tension-band cuff repair. The mean ± SD age at the time of surgery was 60 ± 8 years. There were 25 small, 63 medium, and 29 large tears. Tendon delamination was assessed intraoperatively under arthroscopy with the arthroscope placed in the lateral portal. Patients were divided into 2 groups: those with nondelaminated (n = 80) and delaminated (n = 37) cuff tears. The 2 groups were comparable for age, sex, body mass index, preoperative pain, strength, and a Constant-Murley score. Repair integrity was evaluated with sonography (mean, 24 months after surgery; range, 6-62 months) and classified into 3 categories: type A, indicating complete, homogeneous, and thick coverage of the footprint; type B, partial coverage with a thin tendon; and type C, no coverage of the footprint. Results: The prevalence of tendon delamination observed under arthroscopy was 32% (37 of 117), which increased with tear size and retraction: from 15% in small tears to 32% in medium tears and 45% in large tears (P = .028). Postoperatively, 83 patients had complete coverage of footprint (type A = 71%) and the cuff was considered healed, whereas 26 had partial coverage or a thin tendon (type B = 22%) and 8 had no coverage (type C = 7%). Overall, the rate of complete healing was 78% in nondelaminated cuff tears and 57% in the case of tendon delamination (P = .029). In large retracted tears, the healing rate dropped from 81% in the absence of delamination to 39% when the tendons were delaminated (P = .027). Conclusion: Tendon delamination increases with tear size and retraction. Patients with chronic delaminated and retracted rotator cuff tears (stage 2 or 3) are at risk of failure after SR cuff repair, whereas patients with small delaminated rotator cuff tears (stage 1) involving only the supraspinatus can be treated with an SR cuff repair with a high chance of tendon healing. These results suggest that SR cuff repair may be insufficient to treat delaminated chronic cuff tears. To improve the anatomic outcomes of rotator cuff repairs, surgeons should consider treating delaminated tears with a double-row or double-layer repair.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The Effect of Tendon Delamination on Rotator Cuff Healing

et al. 2019

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“…These layers may separate from the humerus as well as each other; when this delamination occurs, the success of arthroscopic repair declines. [21][22][23] The success of open …”

Section: Discussionmentioning

confidence: 99%

Dual-Camera Technique for Arthroscopic Rotator Cuff Repair

Tuttle

Ramos

DaSilva

2014

Arthroscopy Techniques

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An all-arthroscopic rotator cuff repair demands a high level of technical skill and is associated with a steep learning curve. It is well accepted that small rotator cuff tears or partial tears can be more difficult than large or even massive tears to repair. Part of the reason is the difficulty in visualizing the tear, as well as important surrounding structures, during repair. To improve visibility during the repair process, we have introduced a second arthroscopic camera. Two cameras allow the surgeon to observe the rotator cuff from both the articular and bursal sides. We find this technique has merit in small or partial-thickness rotator cuff tears; however, there may be other applications.

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“…2,6,15,21,22 A recent study showed that the detection of delamination depends on the viewing portal. 6 Only 11% of delaminations were detectable with just a posterior viewing portal, whereas from a lateral viewing portal, 100% of the delaminated tendons were visible. 6 The superior layer represents the rotator cuff tendon, whereas the inferior layer is the superior joint capsule.…”

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confidence: 99%

Delaminated Rotator Cuff Tears Showed Lower Short-term Retear Rates After Arthroscopic Double-Layer Repair Versus Bursal Layer–Only Repair: A Randomized Controlled Trial

et al. 2020

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Background: The rotator cuff is known to consist of 2 macroscopically visible layers that have different biomechanical properties. Sometimes the inferior layer may be neglected during rotator cuff repair. However, it is controversial whether double-layer (DL) repair is superior to single-layer (SL) repair in terms of retear rate and outcome. Purpose: To investigate whether DL as compared with SL repair could decrease retear rates after arthroscopic reconstruction of posterosuperior rotator cuff tears. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 70 patients were 1:1 randomized to receive an arthroscopic DL reconstruction (study group: DL suture-bridge repair) or SL reconstruction (control group: SL suture-bridge repair) for posterosuperior tears of the rotator cuff between 2.0 and 3.5 cm of the footprint detachment. Exclusion criteria were subscapularis tendon rupture (Lafosse >1°), fatty muscular infiltration >2°, and nondelaminated tendons. Tendon integrity according to Sugaya, fatty degeneration, and muscular atrophy were evaluated by magnetic resonance tomography. Pre- and postoperative evaluations included the Constant score, range of motion, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, subjective shoulder value, and postoperative satisfaction with the procedure. Complications were monitored throughout the study. Results: Ninety percent of patients (n = 34, DL; n = 29, SL) were followed-up. There were no significant group differences regarding baseline characteristics and pre- and postoperative fatty degeneration of the supraspinatus and atrophy of the supraspinatus and infraspinatus. The rate of magnetic resonance–verified intact repairs (Sugaya grades 1 + 2) was significantly higher in the DL group (70.6%) than in the SL group (44.8%; P = .045). One patient in the control group with a retear underwent revision. All functional and subjective scores improved significantly pre- to postoperatively in both groups ( P < .05). No significant group differences were detected regarding postoperative Constant score, forward flexion, external rotation, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, subjective shoulder value, and visual analog scale and between intact and retorn tendons. The majority of patients were very satisfied or satisfied with their arthroscopic procedure (DL, 94.1%; SL, 92.9%). Conclusion: This randomized controlled trial showed significantly lower retear rates after DL repair as compared with SL repair in delaminated rotator cuff tears. Clinical short-term outcome was not different between the DL and SL repair groups. Registration: NCT003362320 (ClinicalTrials.gov identifier).

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Is Posterior Delamination in Arthroscopic Rotator Cuff Repair Hidden to the Posterior Viewing Portal?

Cited by 13 publications

References 0 publications

The Effect of Tendon Delamination on Rotator Cuff Healing

The Effect of Tendon Delamination on Rotator Cuff Healing

Dual-Camera Technique for Arthroscopic Rotator Cuff Repair

Delaminated Rotator Cuff Tears Showed Lower Short-term Retear Rates After Arthroscopic Double-Layer Repair Versus Bursal Layer–Only Repair: A Randomized Controlled Trial

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