Morphologic Factors Related to Repair Outcomes for Delaminated Rotator Cuff Tears: A Minimum 2-Year Retrospective Comparison Study

Kim, Young-Kyu; Jung, Kyu-Hak; Park, Chang-Kyu; Yun, Su-Beom

doi:10.1016/j.arthro.2018.08.040

Cited by 12 publications

(15 citation statements)

References 26 publications

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“…Several studies address repairing the “deep lamina” either in layers or en masse at ARCR. 17 , 18 , 19 , 20 One study noted “delamination” after ARCR as a negative prognostic factor but also noted that delamination was frequently missed. 18 Only one study addresses repairing the “superior capsule” specifically as part of ARCR.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are several studies that address repairing the “deep lamina” in ARCR, and 1 study that addresses repairing the superior capsule in ARCR. 16 , 18 , 19 , 20 Knowledge is limited on the details of specifically identifying ACTs as distinct injuries at the time of ARCR. Consequently, there is little known on the effect of specifically repairing the anterior cable tear as part of ARCR.…”

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confidence: 99%

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Anterior Cable Tears in Arthroscopic Rotator Cuff Repairs

Roache

2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To determine whether anterior cable tears could be identified at the time of arthroscopic rotator cuff repair and determine the characteristics of the anterior cable tears identified. Methods From 2016 to 2017 all shoulder arthroscopies had data collected prospectively at the time of surgery, specifically including injury to the capsular and tendon zones of insertion on the greater tuberosity. Anterior cable position and degree of injury and medialization were recorded, as well as complete findings of the diagnostic arthroscopy. The inclusion criterion was primary shoulder arthroscopy. The exclusion criterion was any revision shoulder arthroscopy. All arthroscopic rotator cuff repairs (ARCR) were grouped together and all other nonarthroscopic rotator cuff repair surgeries (non-ARCR) were grouped together. Results In total, 118 shoulder arthroscopies had data collected prospectively at the time of surgery: 90 primary shoulder arthroscopies met the inclusion criteria; 28 were excluded because they were revision surgeries. There were 42 patients in the ARCR group (Group 1). Six of these were partial tears, and 36 were full-thickness tears. There were 48 patients in the non-ARCR group (Group 2). The non-ARCR Group 2 served as an anatomic baseline for ARCR Group 1. In all 90 shoulders, the rotator cable and anterior cable were identified. Group 1 (ARCR) incidence of anterior cable tears with abnormal position was 71.4% compared to 2.1% in group 2 (non-ARCR) ( P < .001) Group 1 (ARCR) incidence of anterior cable tears with normal anterior cable position (n = 12) was compared to abnormal anterior cable position (n = 30). Injury to the anterior footprint capsular and tendon zones were compared. Normal anterior cable position correlated with no or low-grade injury to anterior footprint capsular zone. (Nimura zone C1). Abnormal anterior cable displacement graded as moderate (n = 20) and severe (n = 10) were compared for injury to the anterior footprint. Moderate displacement correlated with complete or high grade injury to C1 in 85% and complete injury to R1 in 45% ( P < .001 and .049). In severe displacement complete C1 injury was 100%, and complete R1 injury was 100% ( P < .001 and .001). Conclusions Anterior cable tears are universally identified in ARCR. Three patterns of medial displacement severity correlated with injury to a crucial insertion zone (C1) at the anterior footprint. The degree of anterior cable disruption at the anterior footprint and displacement was commonly disproportionately greater than the injury to the supraspinatus. Level of Evidence Level III, diagnostic study.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Anterior Cable Tears in Arthroscopic Rotator Cuff Repairs

Roache

2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…On the basis of recent studies in the literature, the incidence of delamination ranges between 37% and 92%. 1 Although the role of delamination is still under debate, large to massive tears are surely more likely to retear, and delamination is a common finding in patients with partially healed defects. 13,14 Therefore, it is our opinion that the arthroscopic cuff-plus technique can lower the cuff retear rate, especially in the case of large to massive tears when the residual cuff looks insufficient or too thin and reduction of the articular layer is not possible or, even worse, it requires extensive mobilization, which basically will make the repaired tissue even weaker.…”

Section: Discussionmentioning

confidence: 99%

“…Excessive tension on the repair, poor tissue quality, and a possible mismatch in the tension of the articular and bursal layers of the cuff in large delaminated tears are surely possible mechanisms of failure. 1 In the past decade, a deeper insight into the anatomy of the rotator cuff tendons has clearly elicited the role of the superior capsule. Clinical and biomechanical studies have shown that superior capsule reconstruction (SCR) with autologous fascia lata graft is a viable jointpreserving option in treating irreparable cuff tears.…”

mentioning

confidence: 99%

Augmented Repair of Large to Massive Delaminated Rotator Cuff Tears With Autologous Long Head of the Biceps Tendon Graft: The Arthroscopic “Cuff-Plus” Technique

Milano

Marchi

Bertoni

et al. 2020

Arthroscopy Techniques

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An anatomic and tension-free repair is the goal of arthroscopic rotator cuff repair. However, this purpose is not always achievable in large and massive tears, and sometimes, even when intraoperative results seem acceptable, clinical and radiologic outcomes can be disappointing shortly afterward. Superior capsule reconstruction has been claimed as a valid and viable joint-preserving option for treating irreparable rotator cuff tears. However, the role of the superior capsule in repairable cuff tears has also been questioned. The aim of this article is to present the so-called arthroscopic cuff-plus technique. This technique consists of superior capsule reconstruction using the proximal part of the long head of the biceps tendon associated with a tension-free repair of the rotator cuff tendons in large to massive delaminated tears.

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“…For those cases, we applied the Fisher’s exact test. In cases that the data table was larger than 2×2, the Freeman-Halton extension of the Fisher’s exact test was used, instead of the traditional Fisher’s exact test [ 15 ]. Univariate binary logistic regression analysis was used to analyze the effect of spur on the bursal side rotator cuff tears.…”

Section: Methodsmentioning

confidence: 99%

Relationship of the Shape of Subacromial Spur and Rotator Cuff Partial Thickness Tear

Kim

Jung

Kang

et al. 2019

Clin Shoulder Elbow

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Background: The present study was undertaken to evaluate the relationship between location of the rotator cuff tear and shape of the subacromial spur.Methods: Totally, 80 consecutive patients who underwent arthroscopic repair for partial thickness rotator cuff tear were enrolled for the study. Bigliani’s type of the acromion, type of subacromial spur, and location of partial thickness tear of the rotator cuff were evaluated using plain X-ray and magnetic resonance imaging. We then compared the groups of no spur with spur, and heel with traction spur.Results: Of the 80 cases, 25 cases comprised the no spur group, and 55 cases comprised the spur group. There was a significant difference in type of tear (p=0.0004) between these two groups. Bursal side tears were significantly greater (odds ratio=6.000, p=0.0007) in the spur group. Subjects belonging to the spur group were further divided into heel (38 cases) and traction spur (17 cases). Comparing these two groups revealed significant differences only in the type of tear (p=0.0001). Furthermore, the heel spur had significantly greater bursal side tear (odds ratio=29.521, p=0.0005) as compared to traction spur.Conclusions: The heel spur is more associated to bursal side tear than the traction spur, whereas the traction spur associates greater to the articular side tear.

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Morphologic Factors Related to Repair Outcomes for Delaminated Rotator Cuff Tears: A Minimum 2-Year Retrospective Comparison Study

Cited by 12 publications

References 26 publications

Anterior Cable Tears in Arthroscopic Rotator Cuff Repairs

Anterior Cable Tears in Arthroscopic Rotator Cuff Repairs

Augmented Repair of Large to Massive Delaminated Rotator Cuff Tears With Autologous Long Head of the Biceps Tendon Graft: The Arthroscopic “Cuff-Plus” Technique

Relationship of the Shape of Subacromial Spur and Rotator Cuff Partial Thickness Tear

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