Repair Integrity and Functional Outcome After Arthroscopic Double-Row Rotator Cuff Repair

Sugaya, Hiroyuki; Maeda, Kazuhiko; Matsuki, Keisuke; Moriishi, Joji

doi:10.2106/jbjs.f.00512

Cited by 693 publications

(611 citation statements)

References 27 publications

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“…The failure rate in other studies similar to ours is around 15 % in most [4,10,19,24]. Follow-up time is also an important aspect for evaluation of these results, but it is a fact about which there is no clear consensus.…”

Section: Discussionsupporting

confidence: 63%

“…Recent arthroscopic repair techniques for rotator cuff tears have emphasised the potential for a double-row repair to add strength to the repair and hopefully decrease the anatomical failure rate [1,11,13,14,24,25]. Several studies have indicated that results in cases of anatomical failure, although clinically improved, are not as good as those that are anatomically intact, especially if strength measurements are made [1,2].…”

Section: Discussionmentioning

confidence: 99%

“…However, the technique using a double row of anchors is reported to re-establish the normal rotator cuff footprint and increase the contact area for healing [8,13,23] making the anatomical and biomechanical outcomes are better than with the single-row technique [3,6,15,18]. Although a few studies have compared single-row repair and double-row repair with regard to clinical aspects [5,7,17,19,21,24], no articles have been published that support the superior clinical outcomes of double-row fixation over single-row fixation. This prospective randomised clinical trial was performed to address the question of whether a double-row rotator cuff anchor repair gives results superior to a single-row anchor repair in clinical outcome scores and in magnetic resonance imaging (MRI) evaluation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: a prospective randomized clinical study

Carbonel

Martı́nez

Calvo

et al. 2012

International Orthopaedics (SICOT)

110

121

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Purpose The purpose of this study was to compare arthroscopic rotator cuff repair with single-row and double-row techniques because research has demonstrated the superiority of double-row repair from a biological and mechanical point of view but there is no evidence of clinical superiority. Methods A total of 160 patients with a full-thickness rotator cuff tear underwent arthroscopic repair with suture anchors. They were randomised into two groups of 80 patients according to the repair technique: single-row (group 1) and double-row (group 2). Results were evaluated by use of the University of California, Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES) and Constant questionnaires, the Shoulder Strength Index (SSI) and range of motion. Follow-up time was two years. Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively and two years after repair. Results One hundred per cent of the patients were followed up. All measurements showed significant improvement compared with the preoperative status. The UCLA score showed significant improvement in group 2. In over 30-mm tears UCLA and ASES showed significant differences. SSI showed significant improvement in group 2. Range of motion showed significant improvements in flexion and abduction in group 2. In under 30-mm tears group 2 showed also significant improvement in internal and external rotation. In MRI studies there were no significant differences.Conclusions At two years follow-up the double-row repair technique showed a significant difference in clinical outcome compared with single-row repair and this was even more significative in over 30-mm tears. No MRI differences were observed.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: a prospective randomized clinical study

Carbonel

Martı́nez

Calvo

et al. 2012

International Orthopaedics (SICOT)

110

121

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“…28 Higher rates of re-rupture are associated with repairs of larger tears, increased patient age and increased fatty degeneration of the cuff muscles. [29][30][31][32] Partial tears are most commonly managed without repair, but some authors advocate repair to prevent progression to full-thickness tears. The evidence supporting this approach is weak.…”

Section: Surgical Managementmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]

Carr

Cooper

Campbell

et al. 2015

Health Technol Assess

110

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BackgroundUncertainty exists regarding the best management of patients with degenerative tears of the rotator cuff.ObjectiveTo evaluate the clinical effectiveness and cost-effectiveness of arthroscopic and open rotator cuff repair in patients aged ≥ 50 years with degenerative rotator cuff tendon tears.DesignTwo parallel-group randomised controlled trial.SettingNineteen teaching and district general hospitals in the UK.ParticipantsPatients (n = 273) aged ≥ 50 years with degenerative rotator cuff tendon tears.InterventionsArthroscopic surgery and open rotator cuff repair, with surgeons using their usual and preferred method of arthroscopic or open repair. Follow-up was by telephone questionnaire at 2 and 8 weeks after surgery and by postal questionnaire at 8, 12 and 24 months after randomisation.Main outcome measuresThe Oxford Shoulder Score (OSS) at 24 months was the primary outcome measure. Magnetic resonance imaging evaluation of the shoulder was made at 12 months after surgery to assess the integrity of the repair.ResultsThe mean OSS improved from 26.3 [standard deviation (SD) 8.2] at baseline to 41.7 (SD 7.9) at 24 months for arthroscopic surgery and from 25.0 (SD 8.0) at baseline to 41.5 (SD 7.9) at 24 months for open surgery. When effect sizes are shown for the intervention, a negative sign indicates that an open procedure is favoured. For the intention-to-treat analysis, there was no statistical difference between the groups, the difference in OSS score at 24 months was –0.76 [95% confidence interval (CI) –2.75 to 1.22;p = 0.452] and the CI excluded the predetermined clinically important difference in the OSS of 3 points. There was also no statistical difference when the groups were compared per protocol (difference in OSS score –0.46, 95% CI –5.30 to 4.39;p = 0.854). The questionnaire response rate was > 86%. At 8 months, 77% of participants reported that shoulder problems were much or slightly better, and at 24 months this increased to 85%. There were no significant differences in mean cost between the arthroscopic group and the open repair group for any of the component resource-use categories, nor for the total follow-up costs at 24 months. The overall treatment cost at 2 years was £2567 (SD £176) for arthroscopic surgery and £2699 (SD £149) for open surgery, according to intention-to-treat analysis. For the per-protocol analysis there was a significant difference in total initial procedure-related costs between the arthroscopic group and the open repair group, with arthroscopic repair being more costly by £371 (95% CI £135 to £607). Total quality-adjusted life-years accrued at 24 months averaged 1.34 (SD 0.05) in the arthroscopic repair group and 1.35 (SD 0.05) in the open repair group, a non-significant difference of 0.01 (95% CI –0.11 to 0.10). The rate of re-tear was not significantly different across the randomised groups (46.4% and 38.6% for arthroscopic and open surgery, respectively). The participants with tears that were impossible to repair had the lowest OSSs, the participants with re-tears had slightly higher OSSs and the participants with healed repairs had the most improved OSSs. These findings were the same when analysed per protocol.ConclusionIn patients aged > 50 years with a degenerative rotator cuff tear there is no difference in clinical effectiveness or cost-effectiveness between open repair and arthroscopic repair at 2 years for the primary outcome (OSS) and all other prespecified secondary outcomes. Future work should explore new methods to improve tendon healing and reduce the high rate of re-tears observed in this trial.Trial registrationCurrent Controlled Trials ISRCTN97804283.FundingThis project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 80. See the NIHR Journals Library website for further project information.

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“…Gemäß der Klassifikation von Sugaya et al [16] lag in jeweils 2 Fällen eine Reruptur Typ IV (geringe Diskontinuität) und V (deutliche Diskontinuität) vor. In einem Fall lag ein Typ III mit ausgedünn-ter, aber in der Kontinuität erhaltenen Supraspinatussehne vor.…”

Section: Materials Und Methodikunclassified

Transossäre Nahttechnik bei kompletten Rotatorenmanschettenrupturen

Tauber¹,

Resch

2012

Arthroskopie

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Die arthroskopische Versorgung von Läsionen der Rotatorenmanschette (RM) konnte dank technischer Weiterentwicklungen von Instrumenten und Ankersystemen zur Fixation desSehnenstumpfs am Knochen kontinuierlich verbessert werden. In den letzten Jahren galt das Hauptaugenmerk wissenschaftlicher Bemühungen der Optimierung biomechanischer Eigenschaften des Nahtkonstrukts, um die Primärstabilität und Ausrissfestigkeit der Sehnennaht zu verbessern. Gleichzeitig sollten Anpressdruck und Kontaktfläche zwischen Sehne und knö-chernem Footprint maximiert werden. Von der Einzelreihennaht über die Doppelreihennaht bis hin zur transossär-äqui-valenten Fixierung im Sinne der SutureBridge-Technik konnten biomechanische Parameter wie primäre Stabilität, Steifigkeit und maximale Ausrisskraft stetig gesteigert werden. Nach wie vor müssen sich arthroskopische Techniken der RMRekonstruktion am offenen Goldstandard messen, welcher von McLaughlin 1944 erstmals beschrieben wurde [13], mit transossär geführten Nahtfäden am Tuberculum majus. Die arthroskopische Versorgung bietet mehrere Vorteile: geringes Weichteiltrauma, reduziertes Infektrisiko, kosmetisch günstiges Ergebnis und geringere postoperative Schmerzsituation. Demgegenüber sind eine flachere Lernkurve, län-gere Operationsdauer und höhere Kosten aufgrund des Implantatbedarfs als Nachteile zu erwähnen.In letzter Zeit gewinnt der Ansatz des "biological repair" an Bedeutung. Damit ist gemeint, dass biologischen Faktoren im Heilungsprozess wie Vaskularität, Stammzellaktivierung und Gewebeanfrischung mehr Rechnung getragen wird. Somit ist zusätzlich zu einer hohen Primärstabi-lität auch eine Reihe an lokalen, histologischen und zellulären Faktoren für eine erfolgreiche Rekonstruktion der RM mit ausschlaggebend. Es liegt in der Hand des Chirurgen so auf verschiedenen Ebenen eine günstige Ausgangssituation für eine verlässliche Sehnenheilung zu schaffen, nachdem die Literatur eindeutig belegt, dass das klinische Ergebnis mit der Sehnenheilung positiv korreliert.Seit Beginn der Ära der Arthroskopie Anfang der 1990er Jahren hatte man versucht, den Goldstandard der offenen RMNaht als arthroskopische Technik zu imitieren, allerdings ohne durchschlagenden Erfolg. Die Ankertechniken in all ihren Modifikationen haben sich weltweit bahnbrechend durchgesetzt und gelten heute als Standardverfahren bei der arthroskopischen RM-Rekonstruktion.

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Repair Integrity and Functional Outcome After Arthroscopic Double-Row Rotator Cuff Repair

Cited by 693 publications

References 27 publications

Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: a prospective randomized clinical study

Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: a prospective randomized clinical study

Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]

Transossäre Nahttechnik bei kompletten Rotatorenmanschettenrupturen

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