Relationship between postoperative retear and preoperative fatty degeneration in large and massive rotator cuff tears: quantitative analysis using T2 mapping

Iijima, Yuki; Matsuki, Keisuke; Hoshika, Shota; Ueda, Yusuke; Hamada, Hiroshige; Tokai, Morihito; Takahashi, Norimasa; Sugaya, Hiroyuki; Watanabe, Atsuya

doi:10.1016/j.jse.2019.04.036

Cited by 17 publications

(18 citation statements)

References 26 publications

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“…15,17 Studies have supported that repair of large rotator cuff tears are associated with decreased healing rates. 18,19 In one study, the risk of retear was increased 2.29 times with every 1 cm of increased tear size. 20 While variability in tissue quality exists, one strategy to mitigate failure risk is to increase the number of points of fixation with 3 medial anchors, given that the weak link in rotator cuff repair is the sutureetendon interface.…”

Section: Discussionmentioning

confidence: 99%

Three Medial All Suture Anchors Improves Contact Force Compared to Two Hard Body Anchors in a Biomechanical Two-Tendon Rotator Cuff Tear Model

Hoffman¹,

Lamplot²,

McClish³

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Section: Discussionmentioning

confidence: 99%

Three Medial All Suture Anchors Improves Contact Force Compared to Two Hard Body Anchors in a Biomechanical Two-Tendon Rotator Cuff Tear Model

Hoffman¹,

Lamplot²,

McClish³

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Rotator cuff tendons were repaired using the medial knot-tying after suture-bridge lateral-row repair techniques. 13 , 25 , 27 One to 3 triple-loaded suture anchors were inserted at the medial border of the footprint in accordance with tear size, and two different sutures were passed through the rotator cuff at a time. Suture-bridge lateral-row fixation was initially performed using 2 of 3 sutures from an anchor.…”

Section: Methodsmentioning

confidence: 99%

“… 3 Other authors have also demonstrated that more degenerative changes of the GT are associated with larger RCTs. 2 , 16 Tear size 17 and fatty degeneration of the rotator cuff muscles 9 , 13 are the important factors, related to repaired cuff integrity; preoperative atrophy and fatty degeneration of the cuff muscles predict poor postoperative outcomes. 8 Considering these facts, a question was raised whether we could choose arthroscopic rotator cuff repair for shoulders with advanced GT degenerative changes.…”

mentioning

confidence: 99%

Relationship between the morphology of the greater tuberosity and radiological and clinical outcomes after arthroscopic rotator cuff repair

et al. 2021

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Background Degenerative greater tuberosity (GT) changes are often associated with rotator cuff tears. However, little is known about the impact of GT morphology on surgical outcomes. The aim of this study was to examine the relationship between clinical and radiological outcomes, after rotator cuff repair, and GT morphology. Methods We retrospectively investigated shoulders that underwent arthroscopic repair of nontraumatic full-thickness supra-/infraspinatus tears. The exclusion criteria were a lack of either radiographs or magnetic resonance images, revision surgery, partial repair, complications such as infection or dislocation, and follow-up < 2 years. GT morphology on radiographs was classified into 5 groups: normal, sclerosis, bone spur, roughness, and femoralization. The acromiohumeral interval (AHI) was measured on anteroposterior radiographs. Fatty degeneration of the cuff muscles was evaluated using the global fatty degeneration index (GFDI). Postoperative cuff integrity was classified using Sugaya's classification at 2 years after surgery. Clinical outcomes were assessed preoperatively and at postoperative 2 years with the Japanese Orthopaedic Association score and the University of California, Los Angeles shoulder rating scale. Results The study included 220 shoulders in 212 patients (104 men and 108 women), with a mean age of 66 years (range 43-85). The mean follow-up period was 28 months (range, 24-60 months). Seven shoulders (3.2%) were classified as normal, 65 (29.5%) as sclerosis, 55 (25.0%) as bone spur, 78 (34.5%) as roughness, and 15 (6.8%) as femoralization. The preoperative AHI, in the roughness and femoralization groups, was significantly smaller than that in the sclerosis ( P < .01) and bone spur groups ( P < .001). The roughness and femoralization groups had a greater number of large tears ( P = .006). In the roughness and femoralization groups, mean GFDI was significantly higher than that in the sclerosis group ( P < .001 for both). Repaired cuff integrity was not different between all groups, respectively. Both Japanese Orthopaedic Association and University of California, Los Angeles scores improved postoperatively from 73.3 to 95.6 points and 18.2 to 34.0 points ( P < .001 for both), respectively, and there were no significant differences between all groups, respectively. Conclusion Roughness or femoralization of the GT was related to larger tears, with smaller AHI and higher GFDI. Repaired cuff integrity and clinical outcomes in shoulders with roughness or femoralization of the GT were not inferior to shoulders with the other types of GT morphologies in this study. Arthroscopic repair can be indicated for shoulders with advanced changes of the GT, if fatty degeneration of the cuff muscles is not severe.

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“…A 3.5-mm slice thickness with a 1-mm gap between slices was used, and T1-weighted oblique sagittal images were routinely obtained to assess fatty degeneration of the rotator cuff muscle. 7,18 The MRI parameters of the T2-weighted coronal scans were as follows: repetition time (TR)/echo time (TE), 5000/100 ms; field of view (FOV), 160 mm; matrix, 512 Â 800. For the T2 sagittal scans, the parameters were: TR/TE, 4147/100 ms; FOV, 160 mm; matrix, 384 Â 720.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…We performed suture bridging in every case before tying medial sutures. 7 We retrieved 2 pairs of suture limbs and fixed them with a lateral-row anchor inserted into the greater tuberosity, and 1 suture was left untied for each anchor. We typically used 1 to 3 lateral-row anchors for suture bridging.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Return to Sport After Arthroscopic Rotator Cuff Repair in Middle-Aged and Elderly Swimmers

Shimada

Sugaya

Takahashi

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: No reports have been published on the clinical outcomes, including return to sport, after rotator cuff repair in middle-aged and elderly swimmers with rotator cuff tears. Purpose: To retrospectively investigate clinical outcomes and return to sport after arthroscopic rotator cuff repair in middle-aged and elderly swimmers. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent arthroscopic rotator cuff repair and met the following criteria were included: (1) age older than 45 years, (2) rotator cuff tears confirmed during surgery, (3) arthroscopic suture bridge rotator cuff repair, (4) primary surgery, and (5) swam more than once a week before surgery. The exclusion criteria were as follows: (1) irreparable large and massive tears, (2) shoulder instability, (3) arthritis or rheumatic disorders, or (4) less than 2-year follow-up. We investigated functional outcomes including range of motion; the University of California, Los Angeles (UCLA) score; the American Shoulder and Elbow Surgeons (ASES) score; return to swimming; and the return rates for each style of swimming. In addition, the functional outcomes and findings of magnetic resonance imaging were compared between the group with complete return and the group with incomplete or failed return. Results: A total of 32 shoulders in 31 middle-aged and elderly swimmers (5 males, 26 females) were included. The mean age was 65 years (range, 47-78 years), and the mean follow-up was 47 months (range, 24-86 months). Return to swimming was achieved in 31 (97%) shoulders at a mean of 8 months (range, 3-24 months), and complete return was achieved in 18 (56%) shoulders at a mean of 12 months (range, 3-24 months). The return rate was 97% for freestyle, 83% for breaststroke, 74% for backstroke, and 44% for butterfly stroke. Postoperative UCLA and ASES scores were significantly higher in the group with complete return than in the group with incomplete or failed return ( P = .001 and .01, respectively). Postoperative forward elevation was significantly better in the complete return group ( P = .01). Conclusion: This study demonstrated that 97% of elderly swimmers who underwent arthroscopic rotator cuff repair could return to swimming. The complete return rate was 56%; however, the group with incomplete or failed return showed poorer active forward elevation. Freestyle had the highest complete return rate, whereas the butterfly stroke had the lowest return rate. It may be important to achieve good active forward elevation postoperatively to return to swimming.

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Relationship between postoperative retear and preoperative fatty degeneration in large and massive rotator cuff tears: quantitative analysis using T2 mapping

Cited by 17 publications

References 26 publications

Three Medial All Suture Anchors Improves Contact Force Compared to Two Hard Body Anchors in a Biomechanical Two-Tendon Rotator Cuff Tear Model

Three Medial All Suture Anchors Improves Contact Force Compared to Two Hard Body Anchors in a Biomechanical Two-Tendon Rotator Cuff Tear Model

Relationship between the morphology of the greater tuberosity and radiological and clinical outcomes after arthroscopic rotator cuff repair

Return to Sport After Arthroscopic Rotator Cuff Repair in Middle-Aged and Elderly Swimmers

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