Postoperative rotator cuff integrity: can we consider type 3 Sugaya classification as retear?

Muniandy, Moganadass; Niglis, Lucas; Dosch, J.C.; Meyer, Nicolás; Kempf, Jean

doi:10.1016/j.jse.2020.05.002

Cited by 27 publications

(21 citation statements)

References 36 publications

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“…Likewise, as the posterior sagittal extent increases, posterior disruption of the rotator cable and infraspinatus tendon involvement are more likely to occur, and such an infraspinatus tear may lead to poor shoulder function. 33 It has been suggested that the extension of a supraspinatus tendon retear into the infraspinatus tendon may increase the severity of fatty infiltration, 33 which is consistent with our findings. In a previous study, an increased AP retear size affected the function of the infraspinatus tendon, 30 and the infraspinatus was explained to be more affected by the AP tear size because it occupies a larger area in the greater tuberosity.…”

Section: Discussionsupporting

confidence: 91%

Prognostic Factors Leading to Good or Poor Outcomes Based on Functional and Radiological Findings After a Rotator Cuff Retear

Kim

Lee

et al. 2022

Am J Sports Med

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Background: A retear after rotator cuff repair is a common problem; however, there is little information related to the prognosis after a retear. In addition, some patients with retears have satisfactory outcomes, which raises the question of whether a retear leads to a poor prognosis. Purpose: To identify radiological factors that influence the prognosis after a retear. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 51 patients with retears confirmed by magnetic resonance imaging at 1 year after arthroscopic rotator cuff repair with a minimum follow-up of 24 months were enrolled in this study. Patients were divided into 2 groups according to whether they achieved the minimal clinically important difference for clinical outcome measures. Range of motion and radiological variables, including preoperative and postoperative anteroposterior (AP) and mediolateral (ML) tear sizes, sagittal extent of the retear, acromiohumeral distance (AHD), and degree of fatty degeneration, were analyzed using magnetic resonance imaging. Results: Overall, 36 patients were allocated to the good prognosis (GP) group and 15 to the poor prognosis (PP) group. The 2 groups had no significant differences in baseline demographics and preoperative radiological parameters. Postoperative range of motion was decreased in the PP group at the last follow-up. The AP and ML retear sizes decreased in both groups after arthroscopic rotator cuff repair, but the retear size was significantly larger in the PP group (both P < .05). The AHD increased in the GP group ( P < .001) but decreased in the PP group ( P = .230) postoperatively. Logistic regression analysis revealed that postoperative AHD ( P = .003), fatty degeneration of the infraspinatus tendon ( P = .001), posterior ( P = .007) and anterior ( P = .025) sagittal extent of the retear, and change in the AP tear size ( P = .017) were related to poor outcomes after a retear. However, change in the ML tear size ( P = .105) and middle sagittal extent of the retear ( P = .878) were not related to a poor prognosis. Also, further analysis showed that posterior ( P = .006) and anterior ( P = .003) sagittal extent of the retear were related to rotator cable involvement. Conclusion: An increased AP retear size and decreased AHD were radiological parameters that were associated with poor clinical outcomes after a retear. In particular, patients who had posterior and anterior sagittal extent of the retear, possibly with rotator cable involvement and more severe fatty degeneration of the infraspinatus tendon, showed worse outcomes.

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Section: Discussionsupporting

confidence: 91%

Prognostic Factors Leading to Good or Poor Outcomes Based on Functional and Radiological Findings After a Rotator Cuff Retear

Kim

Lee

et al. 2022

Am J Sports Med

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“…Grades IV and V were considered retears. 16 Tendon thickness was measured on MRI as the vertical distance from the footprint around the medial anchor hole to the repaired tendon edge (Figure 4).…”

Section: Imaging Assessmentmentioning

confidence: 99%

A Propensity Score–Matched Comparison Between Knotless Layer-by-Layer and En Masse Suture Bridge Techniques for Delaminated Rotator Cuff Tears

2022

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Background: Because the articular layer is more prone to retraction than the bursal layer of the supraspinatus tendon, it is important to restore each layer anatomically while repairing delaminated rotator cuff tears (RCTs). Purpose: To compare clinical outcomes and tendon integrity between knotless layer–by–layer and conventional en masse repair techniques for delaminated RCTs. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed data from 174 consecutive patients with delaminated RCTs treated by arthroscopic suture bridge repair. Only 115 patients with medium to large supraspinatus tears with delamination were included. The 33 patients treated using the knotless layer–by–layer technique (group 2) were matched 1:1 with patients treated using en masse repair with the suture bridge technique (group 1) based on propensity scores. Tendon thickness was measured on magnetic resonance imaging (MRI). Signal changes in the bursal, articular, and intratendinous layers were assessed using T2-weighted MRI. Results: Postoperatively, statistically significant improvements were seen in both groups compared with preoperatively functional scores. At the final follow–up, there was a statistically significant difference in the Constant score, which was higher in group 2 than in group 1 (91.4 ± 6.0 and 84.3 ± 16.4, respectively; P = .005). There was 1 case of a retear in each group, representing a 3% retear rate. Group 2 had thicker tendons than group 1 (6.9 ± 1.1 and 6.0 ± 1.2 mm, respectively; P = .017). On T2-weighted MRI, a low signal intensity in the articular layer was more common in group 2 ( P = .046). Conclusion: En masse repair using the suture bridge technique and the knotless layer–by–layer technique were both effective. Regarding tendon healing, no significant differences were seen in retear rates. However, superior results in terms of the Constant score, tendon thickness, and signal intensity in the articular layer were observed using the knotless layer–by–layer technique.

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“…However, this study was conducted for patients with large to massive RCTs and there was no statistically significant difference (P=0.205) in terms of tendon healing. In our study, the retear rate changed according to whether Sugaya type 3 was assigned to the retear group [ 25 ]. The retear rate was 16.7% (4/24) if Sugaya type 3 was categorized as intact and 25% (6/24) if Sugaya type 3 was categorized in the retear group.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, although male patients had significantly higher postoperative satisfaction than female patients, the occurrence of retear did not show any correlation with sex and whether the subscapularis was repaired concomitantly. Whether to judge Sugaya type 3 as retear is controversial [ 25 ], but it may be meaningful to investigate risk factors for retear. When Sugaya type 3 was regarded as retear as well as type 4 and 5, that is, when 6 cases were retorn, only the degree of pain improvement was correlated.…”

Section: Discussionmentioning

confidence: 99%

Onlay patch augmentation in rotator cuff repair for moderate to large tears in elderly patients: clinical and radiologic outcomes

Hong

Lee

Hahm

et al. 2023

Clin Shoulder Elbow

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Background: This study evaluated the clinical and radiologic outcomes of onlay patch augmentation in rotator cuff repair for moderate-to-large tears in elderly patients. Methods: We reviewed 24 patients who underwent onlay augmentation with dermal allograft after arthroscopic rotator cuff repair from January 2017 to March 2020. Inclusion criteria were patients aged >65 years with tears >2.5 cm, who were followed for >12 months after surgery, and patients who could raise their arms above 90° preoperatively. American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, Pain visual analog scale (VAS), and VAS for satisfaction were used as clinical outcomes. For the evaluation of cuff integrity, magnetic resonance imaging scans were performed every 3 months after surgery. The results were compared before and after surgery in all patients and between the retear and intact groups. Results: The average follow-up period was 16.38 months, and the mean age of patients was 71.05 years. All patients showed significant improvement in ASES score, Constant-Murley score, and pain VAS at the last evaluation. The average value of satisfaction VAS was 7.27/10. The retear rate was 25% (6/24) if Sugaya type 3 was categorized in the retear group, otherwise 16.7% (4/24), if Sugaya type 3 was categorized into the intact group. Irrespective of Sugaya type 3 being included in the retear group, there was no significant difference in outcome variables between the intact and retear groups during follow-up. Conclusions: In moderate-to-large rotator cuff tear in elderly patients, onlay patch augmentation improved clinical outcomes. Retear did not adversely affect clinical outcomes.

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Postoperative rotator cuff integrity: can we consider type 3 Sugaya classification as retear?

Abstract: et e francaise de chirurgie orthop edique et traumatologique (SoFCOT)

Cited by 27 publications

References 36 publications

Prognostic Factors Leading to Good or Poor Outcomes Based on Functional and Radiological Findings After a Rotator Cuff Retear

Prognostic Factors Leading to Good or Poor Outcomes Based on Functional and Radiological Findings After a Rotator Cuff Retear

A Propensity Score–Matched Comparison Between Knotless Layer-by-Layer and En Masse Suture Bridge Techniques for Delaminated Rotator Cuff Tears

Onlay patch augmentation in rotator cuff repair for moderate to large tears in elderly patients: clinical and radiologic outcomes

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