Predictive Factors of Subtle Residual Shoulder Symptoms after Transtendinous Arthroscopic Cuff Repair

Castagna, Alessandro; Rose, Giacomo Delle; Conti, Marco; Snyder, Stephen J.; Borroni, Mario; Garofalo, Raffaele

doi:10.1177/0363546508324178

Cited by 78 publications

(63 citation statements)

References 34 publications

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“…Complete removal of the cuff insertion makes also it difficult to anatomically repair the lesion and restore the native tendon footprint, resulting in biological and mechanical flaws. In transtendon repair, extensive retraction of the tendon may excessively medialise the cuff insertion, and alter both anatomy and mobility of the joint [7]. Pulling a retracted articular layer onto the original footprint may over-tighten the bursal aspect and, consequently, unbalance the tension in the remaining fibres [16], which may explain why transtendon repair is alleged to be more painful, take longer to recover, and be more likely to develop shoulder stiffness.…”

Section: Discussionmentioning

confidence: 99%

“…Debridement, with or without acromioplasty, was advocated [2,3], but the current trend is to repair lesions involving more than 50 % of the tendon thickness, or exceeding 6 mm (Grade 3) of depth [4]. The present evidence favours conversion from partial into full thickness, and repair of the tear in a traditional fashion [5,6], or a trans-tendon repair [7,8]. Both techniques are effective in functional recovery and relief of symptoms, but controversy persists because of the lower morbidity rate and earlier recovery when completing and repairing tear, whereas tendon integrity, native footprint, and biomechanical properties (gapping and mean ultimate failure strength) are better restored when performing a transtendon repair, leaving the bursal side intact [9,10].…”

Section: Introductionmentioning

confidence: 89%

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Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial

Franceschi

Papalia

Buono

et al. 2013

International Orthopaedics (SICOT)

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Purpose To compare two groups of patients who underwent two different arthroscopic procedures for repair of articularsided partial-thickness rotator cuff tears (PTRCTs). Materials this is a comparative prospective study of two methods for repair of partial cuff tears Thirty-two patients underwent arthroscopic rotator cuff repair with a transtendon technique (group 1); 28 underwent arthroscopic full-thickness conversion and repair of the lesion (group 2). ROM measures, clinical findings, MRI features (tendon healing and re-tear), Constant-Murley and ASES scores were assessed pre-and postoperatively and compared. Patients were also asked about return to sport and level of activity. Results At the last appointment, patients of both the groups were significantly improved for clinical findings, ROM measures, imaging features, Constant-Murley and ASES scores than at baseline, without any significant inter-group difference. In group 1, 15 of 20 patients (75 %) who practiced recreational sport activities had returned to sport at the same level as before the onset of symptoms, without any discomfort. In group 2, 12 of 18 patients (67 %) had returned to the same level of sport activity they practiced before symptoms. At the last follow up, MRI showed rotator cuff healing in 31 patients of Group 1 and 27 patients of Group 2 (p=0.83). Conclusions The two procedures are safe, effective, and comparable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 89%

Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial

Franceschi

Papalia

Buono

et al. 2013

International Orthopaedics (SICOT)

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“…The transtendon repair technique allows restoration of the medial side of the footprint while also maintaining the bursal layer of the torn cuff. 15,16 Castagna et al 7 have linked the effectiveness of the transtendon repair technique to decreased tendon retraction, large footprint exposure, younger patients, and a clinical history of trauma. According to another study, the transtendon repair technique reduces pain.…”

Section: E590mentioning

confidence: 99%

“…4 The most recent debate is inclined toward the conversion from a partial-to full-thickness tear and repair of the tear 5,6 or transtendon repair. 7,8 Both methods result in functional recovery and relief, but repairing the tear results in lower morbidity and earlier recovery whereas the tendon integrity, native footprint, and biomechanical properties (gapping and mean ultimate failure strength) are better in the case of transtendon repair, which keeps the bursal side intact. 9 The transtendon repair techniques described so far involve some challenges in surgical implementation and require experience.…”

mentioning

confidence: 99%

Rotator Cerclage Technique for Partial Rotator Cuff Ruptures

Bozkurt

Fırat

Gürsoy

et al. 2015

Arthroscopy Techniques

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The frequency of partial rotator cuff tears is gradually increasing because of the advancements in imaging methods and arthroscopy techniques. One of the repair techniques is repair of the partial rotator cuff tear by conversion to a full-thickness tear. Another technique, the transtendon technique, has some practical challenges and risks. We attempted to develop a practical and easy technique with low morbidity to repair partial tears called the rotator cerclage technique.T he level of knowledge and the rate of establishing a distinctive diagnosis for partial rotator cuff tears have increased in line with widespread adoption of humeral arthroscopy and advanced magnetic resonance imaging methods. The best treatment plan for symptomatic partial rotator cuff tears remains uncertain. 1 Previously, debridementdboth with and without acromioplastydwas the standard treatment, 2,3 but this is being replaced by the repair of lesions in excess of 6 mm (grade 3) or those larger than 50% of the tendon thickness. 4 The most recent debate is inclined toward the conversion from a partial-to full-thickness tear and repair of the tear 5,6 or transtendon repair. 7,8 Both methods result in functional recovery and relief, but repairing the tear results in lower morbidity and earlier recovery whereas the tendon integrity, native footprint, and biomechanical properties (gapping and mean ultimate failure strength) are better in the case of transtendon repair, which keeps the bursal side intact. 9 The transtendon repair techniques described so far involve some challenges in surgical implementation and require experience. Our goal is to develop a practical technique with easy implementation through which a partial tear can be repaired through interventions performed only from the bursal side without converting the tear to a full-thickness tear after the partial tear is identified intra-articularly (Table 1). TechniqueAfter induction of anesthesia, the patient is placed in the beach-chair position. A standard diagnostic arthroscopy is performed with 30 arthroscopic visualization through a posterior portal with a pump (FMS DUO Fluid Management System; DePuy Mitek, Raynham, MA) maintaining a pressure of 50 mm Hg. The supraspinatus insertion to the humerus is inspected in the neutral position with abduction and external rotation of the arm because most tears can be clearly seen at this position (Fig 1). After examination of all glenohumeral structures, the articular-sided supraspinatus tear is debrided with a 5-mm full-radius shaver (DePuy Mitek). The extent of the tear can be estimated based on the size of a shaver blade (the width of the articular side of the supraspinatus is estimated by comparing it with the known width of a 5-mm shaver) or with an arthroscopic ruler. Then, the surgeon inserts Prolene suture (Ethicon, Somerville, NJ) from an 18-gauge spinal needle stretching from the subacromial zone to the joint, ensuring that it passes from the supraspinatus articular tear area, and the Prolene suture proceeds inside the joi...

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“…15 Other studies have supported the idea that transtendinous techniques result in a lower rate of failure while suggesting that the functional outcomes and patient satisfaction after transtendinous repair may be higher than previously thought. 16,17 One study found 1 failure and good to excellent results in 93% of cases at 12 years' follow-up of PASTA lesions repaired with a transtendinous technique. 16 We developed a novel inside-out repair technique for partial articular surface supraspinatus tears.…”

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confidence: 99%

A Novel Arthroscopic Inside-Out Repair Technique for PASTA Lesions

Caldwell

Elfar

2014

Arthroscopy Techniques

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There is no current consensus in the literature on the optimal technique for surgical treatment of partial articular-sided supraspinatus tendon avulsion (PASTA) lesions, although most techniques described to date require takedown of the partially torn tendon or passage of an anchor through the already damaged tendon. We describe a novel inside-out repair technique for partial articular surface supraspinatus tears that does not require further disruption of the partially torn tendon by passage of an anchor.P artial-thickness rotator cuff tears (PTRCTs) have long been recognized as distinct from full-thickness rotator cuff tears. They have been noted in as many as 26% of asymptomatic patients aged 40 to 60 years 1 but can present with a wide spectrum of symptoms including a higher level of reported pain than fullthickness tears. 2 They have also been noted to occur in the younger population, particularly overhead throwing athletes. 3 Only recently, however, has the literature recognized articular-sided PTRCTs as distinct from bursal-sided PTRCTs in both mechanism and potential treatment modalities. 4 Articular surface PTRCTs are reported 2 to 3 times more commonly than bursal-only PTRCTs in the literature. 5 More partial-thickness tears in older patients are articular-sided supraspinatus tears than bursal sided, and the most commonly reported tear in younger overhead throwing athletes is on the articular side at the supraspinatus-infraspinatus junction. 4 It has been noted that there is a relative hypovascularity of the articular surface of the supraspinatus tendon compared with the bursal surface, which may contribute to the higher incidence of degenerative tearing of the articular surface at the insertion of the supraspinatus. 6 The articular and bursal sides of the supraspinatus differ in their histology as well: The bursal side of the cuff contains mainly tendinous bundles, giving it a greater tensile strength, whereas the articular side is a more complex mixture of ligament, capsule, and tendon. 7 Although the initial treatment for most articular-sided PTRCTs is nonoperative and symptomatically oriented, the natural history of these lesions remains unclear. Cadaveric studies have shown an increase in strain on the remaining intact supraspinatus tendon during abduction when a 33% thickness partial articular-sided supraspinatus avulsion (PASTA) lesion is created, 8 and a serial arthrography study found that 27% of articular-sided tears progressed to full-thickness tears over a 1-year period whereas only 10% appeared to heal completely. 9 This finding suggests that even when nonoperative treatment is successful in resolving symptoms, it is unlikely that this represents healing of the tear. Failure of conservative management is considered an indication for surgical intervention.There is no consensus in the literature regarding the ideal technique for treatment of PASTA lesions, although many techniques have been described, including simple debridement, tear completion and complete repair, and a variety ...

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Predictive Factors of Subtle Residual Shoulder Symptoms after Transtendinous Arthroscopic Cuff Repair

Cited by 78 publications

References 34 publications

Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial

Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial

Rotator Cerclage Technique for Partial Rotator Cuff Ruptures

A Novel Arthroscopic Inside-Out Repair Technique for PASTA Lesions

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