Prediction of Rotator Cuff Repair Failure by Histological Analysis

Abstract

Background We aimed to determine if recognised histological features seen in specimens taken during rotator cuff repair could predict which tendon repairs were at risk of re‐rupture. Methods Forty rotator cuff tendon edge specimens from 40 patients were analysed histologically following routine mini‐open rotator cuff repair. Thirty‐two patients returned at a mean follow up of 35 months for an ultrasound examination to determine repair integrity. Results Overall there were 8 small tears, 13 medium tears, 15 large tears and 4 massive tears. Of the 32 patients followed up with ultrasound scan (USS) the overall re‐rupture rate was 46%. Small and medium tears had a re‐rupture rate of 35% while 60% of the large and massive tears suffered a re‐rupture. Comparison of histological features and repair integrity revealed that the rotator cuff repairs which remained intact demonstrated a greater reparative response, in terms of increased fibroblast cellularity, cell proliferation and a thickened synovial membrane, than those repairs that re‐ruptured. The larger tears that did remain intact also showed a higher degree of vascularity and a significant inflammatory component than the larger tears that re‐ruptured. Conclusion These results indicate the importance of good tissue quality at the time of surgery but that larger tears can heal if the tissue quality is favourable. Post‐operative histological analysis of tendon tear edge can aid prognosis and has the potential to guide post‐operative immobilization and subsequent physiotherapy.

Shoulder Rotator Cuff Responses to Extracorporeal Shockwave Therapy: Morphological and Immunohistochemical Analysis

“…As expected, these findings indicate an improved tendon tissue 'quality' in Grade III patients and an increased responsiveness to biological inducers of healing response. At the same time, we should expect low reactivity in tendinopathies Grade IV, which is reflected by VVA and concordant with previous results [8]. In tendinopathies Grade III for both Group A and Group B, markers CD34, Tenascin-C, PCNA and D2-40 (p < 0.05) were significantly differentially expressed.…”

“…The anatomical and physiological features of human shoulder rotator cuff are unique [35][36][37] and have been shown to comprise critical determinants of the successful healing of partial-and fullthickness tears after surgical intervention. Matthews et al reviewed a series of cases of re-tears at a histological level and many of the tears demonstrated profound distortion of the tendon tissue [8]. Therefore, augmentation of the 'quality' of tendinopathic tissue is imperative for the later success of re-operative surgery.…”

“…Chronic tendinopathies are well known with respect to the decreased healing capacity of hypocellular tendons. The reported re-tear index after surgical treatment varies from 25% to 95% several months to several years after the operation [6][7][8]. A crucial factor for the success of reparative surgery for rotator cuff tendinopathy is the morphological 'quality' of the tendons.…”

“…Other studies have shown that a significant decrease of oxygen consumption, increased indices of apoptosis and severe metabolic disturbance all negatively impact the capacity of tendon tissue repair [9][10][11][12][13][14]. In a series of patients undergoing surgery for rotator tendinopathy, Matthews et al demonstrated morphologically that 46% of re-tears were associated with previously-mentioned factors associated with an adverse healing response [8]. Therefore, methods to stimulate cellular synthesis and replication, ultimately rapid and robust tendon tissue repair, which could in turn add to the success rate of surgery, are needed.…”

Degeneration Exists along the Entire Length of the Supraspinatus Tendon in Patients with a Rotator Cuff Tear

“…Whereas many histological studies have addressed rotator cuff degeneration and tears, 8,9,[14][15][16][17] few studies have included specimens from a macroscopically intact portions. 13,18,19) Furthermore, it is worth mentioning that all of these studies demonstrated degeneration in macroscopically intact tendon.…”