Retraction pattern of delaminated rotator cuff tears: dual-layer rotator cuff repair

Won, Sang; Lee, Choon-Ki; Sugaya, Hiroyuki; Kim, Taegyun; Lee, Su Chan

doi:10.1186/s13018-016-0407-9

Cited by 38 publications

(48 citation statements)

References 18 publications

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“…The advancement of the inferior layer to the cartilage-bone interface, where the superior capsule originates, 6 restores the insertion area and the superficial tendinous layer covers the remaining footprint. Because the superior and inferior layers are sometimes retracted in different directions, 14 addressing the 2 layers separately also allows us to reconstruct complex delaminated tears.…”

Section: Discussionmentioning

confidence: 99%

An Arthroscopic Knotless Technique for Anatomical Restoration of the Rotator Cuff and Superior Capsule: The Double-Layer Cinch Bridge

Heuberer

Pauzenberger²,

Smolen³

et al. 2018

Arthroscopy Techniques

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Rotator cuff repairs are the most common procedures in shoulder surgery, but still show long-term retear rates of up to 70%. Nonanatomic reconstruction is one possible cause of repair failure. The rotator cuff histologically consists of 5 separate layers of which 2 are macroscopically identifiable: the superior or tendinous layer and the inferior or capsule-ligamentous layer. In case of rotator cuff tears, these layers are often retracted to different degrees. The intraoperative detectable prevalence of rotator cuff delamination reaches up to 85%. Anatomical rotator cuff repair, which also includes restoration of the layered structure, could re-establish native tendon morphology and thus potentially decreases retear rates. The use of a knotless construct to avoid cuff strangulation and maintaining tendon perfusion could further decrease the risk of repair failure. Double-layer reconstructions are challenging and time consuming because each layer needs to be penetrated separately. Only few studies reported about double-layer reconstruction of the posterosuperior rotator cuff. This Technical Note is the first to present an arthroscopic knotless transosseous-equivalent double-layer repair technique.

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Section: Discussionmentioning

confidence: 99%

An Arthroscopic Knotless Technique for Anatomical Restoration of the Rotator Cuff and Superior Capsule: The Double-Layer Cinch Bridge

Heuberer

Pauzenberger²,

Smolen³

et al. 2018

Arthroscopy Techniques

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show abstract

“…Harryman et al [8] reported that the deep structure of a rotator cuff This may be one of the reasons for the higher incidence of delamination, when accompanied by an infraspinatus tear. Sang et al [10] also found that it is easier to retract backward and inward after tearing of the lower layer. The reason may be that the muscle fibers that constitute the lower layer mainly come from the subscapularis muscle.…”

Section: Discussionmentioning

confidence: 97%

Related Factors and Therapeutic Effect of Rotator Cuff Delamination

Liu

2020

Preprint

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Objective: This study aims to explore the related factors and treatment result of RCT with delamination. Materials and methods: From February 2016 to July 2019, a total 155 patients with RCT were enrolled into the present study. Among these patients, 66 were male and 89 were female, and their an average age was 56.4±7.8 years old (41-75 years old). The medical history of each patient was recorded before the operation, and the joint function was evaluated using the Constant score table. During the operation, the RCT was examined using an arthroscope, the delamination was evaluated, and the RCT type was classified. A proper suture technique was executed for these different types of rotator cuff injuries, and routine functional exercises were performed after the operation. Poisson chi-square test was used to analyze the related factors of delamination, and t-test was used to analyze the result of the treatment. Results: Among the 115 patients, 47 patients had delamination, while 68 cases had no delamination. The larger the RCT size, the greater probability of delamination. Furthermore, the delamination probability of a RCT with subacromial impact would also increase. However, there was no statistical correlation between disease history or trauma and delamination. All patients achieved good therapeutic results. Conclusion: The incidence of rotator cuff delamination remains high, and the occurrence of delamination is correlated to the size of the tear, and the determination of whether this is accompanied by subacromial impact. However, there is no correlation between delamination and trauma or disease duration. For rotator cuff tears with delamination, reasonable surgical techniques can be used to treat the rotator cuff injury, in order to obtain a good effect.Level of evidence: Level III, Retrospective Cohort Design, Treatment Study

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“…We and others ascertain the directions of movement of layers of delaminated cuffs to determine whether to utilize the DD or SB method. Sugaya et al precisely analyzed the pattern of delamination of RCTs and utilized the DD or SB method depending on the direction of retraction of the delaminated cuff [ 2 ]. They achieved a 7.6% re-tear rate in the two groups combined.…”

Section: Discussionmentioning

confidence: 99%

“…Its incidence was recently shown to be as high as 82.8% of all RCTs. [ 2 ] The directions in which the deep and superficial layers retract may differ in delaminated cuffs. Sugaya et al demonstrated that the double layer, double-row (DD) method of ARCR better achieves structural integrity of a delaminated cuff because it restores each layer to its original anatomical condition separately, [ 3 ] whereas with the SB method sutures are passed through the whole rotator cuff.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of arthroscopic rotator cuff repair: a retrospective comparison of double-layer, double-row and suture bridge methods

Kakoi

Izumi

Fujii

et al. 2018

BMC Musculoskelet Disord

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BackgroundThe suture-bridge (SB) method has recently become the mainstream means of repairing full-thickness rotator cuff tears. However, in some patients the deep and superficial layers have moved in different directions because of delamination of their rotator cuffs. In such cases, a simple suture (double-layer, double-row [DD] method) is used to repair the superficial and deep layers separately. The purpose of this study was to analyze the clinical outcomes and re-tear rates of the DD and SB methods, with patients selected according to the condition of their torn cuffs.MethodsWe retrospectively registered 74 patients with full-thickness rotator cuff tears that had been repaired arthroscopically, 35 shoulders by the DD and 39 by the SB method. Mean ages were 66.1 years in the DD and 62.9 years in the SB group. We evaluated clinical status before and after surgery (Japanese Orthopedic Association [JOA] scores) and re-tear rate. The Wilcoxon signed-ranks test was used to compare JOA scores and active ROM between before and after surgery in each group. Mann–Whitney’s U test was used for comparing JOA scores, active ROM, re-tear rates, size of tear, duration of follow-up, sex, and presence of subscapular muscle repair between the DD and SB groups. A hazard ratio of less than 5% was considered to denote significance.ResultsJOA scores improved significantly in the DD and SB groups from preoperative means of 63.4 and 63.3 points, respectively, to postoperative means of 91.8 and 92.1 points, respectively. The active flexural ROM improved significantly from means of 110.1° and 100.0°, respectively, to postoperative means of 142.3° and 142.7°, respectively; the differences between groups were not significant. Re-tear occurred in 5.9% of the DD (two of 34 shoulders) and 7.9% of the SB group (three of 38 shoulders); its incidence did not differ significantly between the two groups.ConclusionsBoth the DD and SB methods achieve satisfactory clinical outcomes that do not differ significantly. Our results suggest that careful selection of operative method on the basis of the delamination pattern in patients undergoing RCT may reduce the re-tear rate after utilizing the SB method.

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Retraction pattern of delaminated rotator cuff tears: dual-layer rotator cuff repair

Cited by 38 publications

References 18 publications

An Arthroscopic Knotless Technique for Anatomical Restoration of the Rotator Cuff and Superior Capsule: The Double-Layer Cinch Bridge

An Arthroscopic Knotless Technique for Anatomical Restoration of the Rotator Cuff and Superior Capsule: The Double-Layer Cinch Bridge

Related Factors and Therapeutic Effect of Rotator Cuff Delamination

Clinical outcomes of arthroscopic rotator cuff repair: a retrospective comparison of double-layer, double-row and suture bridge methods

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