Repair Integrity and Functional Outcomes for Arthroscopic Margin Convergence of Rotator Cuff Tears

Kim, Kyung Cheon; Shin, Hyun Dae; Min, Soo; Kim, Joung Hun

doi:10.2106/jbjs.l.00397

Cited by 60 publications

(45 citation statements)

References 18 publications

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“…16 The biological healing of the repaired rotator cuff tendon to the humerus is estimated to require a minimum of 8 to 12 weeks. 20 In recent histological evaluations of rotator cuff repair in a primate model, the fibers holding the bonetendon junction together did not appear in considerable numbers before 12 weeks. By 15 weeks, the bone-tendon junctions were almost, but not quite, mature.…”

mentioning

confidence: 98%

Retear Rate in the Late Postoperative Period After Arthroscopic Rotator Cuff Repair

et al. 2014

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mentioning

confidence: 98%

Retear Rate in the Late Postoperative Period After Arthroscopic Rotator Cuff Repair

et al. 2014

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“…In addition to these three MC techniques, two suture anchors (SwiveLock; Arthrex, Naples, FL) for footprint repair were placed at the level of the original footprint, 10 and 20 mm posterior to the bicipital groove. After these three types of MC techniques were completed, single-row footprint repair was performed to restore the footprint area with no gap, as previously described [15, 16] (1-, 2-, or 3-suture MC with footprint repairs; Fig 2D, 2E and 2F). In this study, one limb of the suture pairs from each anchor was passed though the tendon at the midpoint of both sides of the triangular gap originating after the MC suture process, and tied to the other end of the suture strand.…”

Section: Methodsmentioning

confidence: 99%

“…This technique was suggested to prevent the apex of the tear from excessive tension and to provide an advantageous environment for intact healing in the post-repaired tendon [12–14]. In addition to clinical reports with satisfactory outcomes [15, 16], one biomechanical study previously investigated the effect of MC techniques on strain changes in rotator cuff tendons [17]. On the other hand, there have been no biomechanical studies evaluating the effect of the MC techniques on the muscular properties in repaired rotator cuff structures.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Effect of Margin Convergence Techniques: Quantitative Assessment of Supraspinatus Muscle Stiffness

et al. 2016

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Although the margin convergence (MC) technique has been recognized as an option for rotator cuff repair, little is known about the biomechanical effect on repaired rotator cuff muscle, especially after supplemented footprint repair. The purpose of this study was to assess the passive stiffness changes of the supraspinatus (SSP) muscle after MC techniques using shear wave elastography (SWE). A 30 × 40-mm U-shaped rotator cuff tear was created in 8 cadaveric shoulders. Each specimen was repaired with 6 types of MC technique (1-, 2-, 3-suture MC with/without footprint repair, in a random order) at 30° glenohumeral abduction. Passive stiffness of four anatomical regions in the SSP muscle was measured based on an established SWE method. Data were obtained from the SSP muscle at 0° abduction under 8 different conditions: intact (before making a tear), torn, and postoperative conditions with 6 techniques. MC techniques using 1-, or 2-suture combined with footprint repair showed significantly higher stiffness values than the intact condition. Passive stiffness of the SSP muscle was highest after a 1-suture MC with footprint repair for all regions when compared among all repair procedures. There was no significant difference between the intact condition and a 3-suture MC with footprint repair. MC techniques with single stitch and subsequent footprint repair may have adverse effects on muscle properties and tensile loading on repair, increasing the risk of retear of repairs. Adding more MC stitches could reverse these adverse effects.

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“…When conservative therapy fails to improve symptoms, surgery is performed to suture the tear to the enthesis; however, the retear rate is high, occurring in 18.6-47.6% of cases. [1][2][3][4] After surgery, repair of the tendon-to-bone insertion takes several months. 5 If range of motion and muscle training is resumed too soon after surgery, retearing at the tendon-to-bone insertion can occur.…”

mentioning

confidence: 99%

Stimulation of Rotator Cuff Repair by Sustained Release of Bone Morphogenetic Protein-7 Using a Gelatin Hydrogel Sheet

Kabuto

Morihara

Sukenari

et al. 2015

Tissue Engineering Part A

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Bone morphogenetic protein-7 (BMP-7) promotes not only osteogenesis but also matrix production in chondrocytes and tenocytes. However, because of its short half-life, maintaining local concentrations of BMP-7 is difficult. We examined the use of a gelatin hydrogel sheet (GHS) for the sustained release of BMP-7 in stimulating rotator cuff repair at the tendon-to-bone insertion. Twelve-week-old male Sprague-Dawley rats were used. Radiolabeled BMP-7 ((125)I-BMP-7) was injected into the subacromial bursa in the (125)I-BMP-7 group, whereas a GHS impregnated with (125)I-BMP-7 was implanted on the tendon attached to the tendon-to-bone insertion in the (125)I-BMP-7+GHS group. Levels of (125)I-BMP-7 in the tendon-to-bone insertion were assessed at 1, 3, 7, 14, and 21 postoperative days. The BMP-7 concentrations were significantly higher in the (125)I-BMP-7+GHS group than in the (125)I-BMP-7 group. Next, the bilateral supraspinatus tendons were resected and sutured to the greater tuberosity of the humerus using the Mason-Allen technique. Treatment groups were created as follows: either phosphate-buffered saline (PBS) or BMP-7 was injected into the subacromial bursa in the PBS and BMP-7 groups, whereas a GHS impregnated with either PBS or BMP-7 was implanted on the repaired tendon attached to the tendon-to-bone insertion in the PBS+GHS and BMP-7+GHS groups. The resected specimens were stained at 2, 4, and 8 postoperative weeks with hematoxylin and eosin as well as Safranin O, and tissue repair was evaluated histologically by using the tendon-to-bone maturing score. Tissue repair was assessed biomechanically at 4 and 8 postoperative weeks. The BMP-7+GHS group at 8 postoperative weeks demonstrated a favorable cartilage matrix production and tendon orientation; moreover, the tendon-to-bone maturing score and the ultimate force-to-failure were the highest in this group. The ability of GHS to provide controlled release of various growth factors has been previously reported. We confirmed that the GHS releases BMP-7 in a sustained manner in the rat shoulder joint. At 8 postoperative weeks, the repaired tissue was mostly restored, both histologically and biomechanically, in the BMP-7+GHS group. We therefore conclude that the sustained release of BMP-7 from a GHS can stimulate rotator cuff repair.

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Repair Integrity and Functional Outcomes for Arthroscopic Margin Convergence of Rotator Cuff Tears

Cited by 60 publications

References 18 publications

Retear Rate in the Late Postoperative Period After Arthroscopic Rotator Cuff Repair

Retear Rate in the Late Postoperative Period After Arthroscopic Rotator Cuff Repair

Biomechanical Effect of Margin Convergence Techniques: Quantitative Assessment of Supraspinatus Muscle Stiffness

Stimulation of Rotator Cuff Repair by Sustained Release of Bone Morphogenetic Protein-7 Using a Gelatin Hydrogel Sheet

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