Prospective Evaluation of the Effect of Rotator Cuff Integrity on the Outcome of Open Rotator Cuff Repairs

Klepps, Steven; Bishop, Julie Y.; Lin, Jason; Cahlon, Oren; Strauss, Alyssa; Hayes, Patrick; Flatow, Evan L.

doi:10.1177/0363546504265262

Cited by 229 publications

(166 citation statements)

References 38 publications

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“…4,5 Although small rotator cuff tears have better outcomes, surgical repairs of large tears show failure rates as high as 90% due to muscle contraction, decreased range of joint motion, neurovascular damage, or altered shoulder mechanics. 6,7 Consequently, tendon repairs often require tissue grafts. Allografts are used but can lead to immune rejection.…”

Section: Introductionmentioning

confidence: 99%

What We Should Know Before Using Tissue Engineering Techniques to Repair Injured Tendons: A Developmental Biology Perspective

Liu

Aschbacher-Smith

Barthelery

et al. 2011

Tissue Engineering Part B: Reviews

141

120

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Section: Introductionmentioning

confidence: 99%

What We Should Know Before Using Tissue Engineering Techniques to Repair Injured Tendons: A Developmental Biology Perspective

Liu

Aschbacher-Smith

Barthelery

et al. 2011

Tissue Engineering Part B: Reviews

141

120

View full text Add to dashboard Cite

“…Retear rates reportedly range from 15% to 90% [1,2,11,20], with approximately 4% of failures being attributed to metal anchor pullout from bone at the time of revision surgery [5,6]. The pullout rates for bioabsorbable anchors reportedly are much higher, with as much as 30% of painful shoulders showing anchor pullout on MRI after cuff repair [12].…”

Section: Introductionmentioning

confidence: 99%

Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

Oshtory¹,

Lindsey

Giori

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Failure of suture anchor fixation in rotator cuff repair can occur at different interfaces. Prior studies show fixation at the bone-anchor interface can be augmented using polymethylmethacrylate (PMMA) cement, and screw fixation into bone can be strengthened using bioabsorbable tricalcium phosphate cement. Questions/purposes We wished to determine whether augmentation of suture anchor fixation using bioabsorbable tricalcium phosphate cement would increase pullout strength of suture anchors from bone and the number of cycles to failure, to determine the mode of failure after cement augmentation, and to compare strength and mode of failure with those after augmentation with PMMA.Methods We used 10 matched pairs of cadaveric proximal humeri and implanted a metal screw-type suture anchor in one side and on the other side injected tricalcium phosphate cement into the anchor holes before anchor placement. We tested all specimens to failure using a ramped cyclic loading protocol. Results Tricalcium phosphate cement augmentation increased the final load to failure by 29% and the number of cycles to failure by 20%. Visual inspection confirmed that failure occurred at the cement-bone interface. Conclusions Tricalcium phosphate cement appears to augment suture anchor fixation into bone, reducing the risk of anchor pullout and failure. Clinical Relevance When relying on suture anchor fixation in bone of questionable quality, we suggest considering augmentation of suture anchor fixation with bioabsorbable cement. This method also provides potential for bioabsorbability and may be more amenable to arthroscopic application.

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“…Their mean age at surgery was 52 years. The minimum followup was 16 years (mean, 20 years; range [16][17][18][19][20][21][22][23][24][25] …”

Section: Methodsmentioning

confidence: 99%

Pain Relief, Motion, and Function after Rotator Cuff Repair or Reconstruction May Not Persist after 16 Years

Borgmästars

Paavola

Remes

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Short-to medium-term rotator cuff repair reportedly relieves pain in 82% to 97% of patients and provides normal or almost normal shoulder function in 82% to 92%. However, it is unknown whether pain relief and function persist long term. Questions/purposes We asked whether, after rotator cuff repair or reconstruction, pain relief, ROM, shoulder strength, and function remained over the long term. Patients and MethodsWe retrospectively reviewed 75 patients who underwent rotator cuff repair between 1980 and 1989. There were 55 men and 20 women. Their mean age at surgery was 52 years. The minimum followup was 16 years (mean, 20 years; range 16-25 years). Results Twenty-eight of the 75 patients (37%) had persistent relief of pain lasting for 20 years. In the remaining 47 patients, alleviation of pain lasted, on average, 14 years (range, 0-24 years). Mean flexion and abduction strength increased postoperatively but during long-term followup decreased to less than preoperative levels. External rotation also decreased. At the last followup, the Constant-Murley score averaged 66 (range, 10-98) in men and 60 (range, 29-89) in women. In the Simple Shoulder Test questionnaire, the mean number of yes answers was eight of 12. Of the 75 patients, 32 (43%) reported impairment in activities of daily living owing to an index shoulder complaint. Severe degenerative changes of the glenohumeral joint were evident in 14 patients (19%). Conclusions The early high functional scores after primary rotator cuff repair or reconstruction of the types we performed in the 1980s did not persist. The function achieved postoperatively was lost, as ROM and strength decreased to less than preoperative values. However, alleviation of pain was long-standing in most patients. Based on our data, we should warn patients to expect less than permanent relief with those repairs. We cannot say whether the same will apply to currently performed types of repairs.

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Prospective Evaluation of the Effect of Rotator Cuff Integrity on the Outcome of Open Rotator Cuff Repairs

Cited by 229 publications

References 38 publications

What We Should Know Before Using Tissue Engineering Techniques to Repair Injured Tendons: A Developmental Biology Perspective

What We Should Know Before Using Tissue Engineering Techniques to Repair Injured Tendons: A Developmental Biology Perspective

Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

Pain Relief, Motion, and Function after Rotator Cuff Repair or Reconstruction May Not Persist after 16 Years

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