Rotator cuff repair tension as a determinant of functional outcome

Davidson, Philip A.; Rivenburgh, Dennis W.

doi:10.1067/mse.2000.109385

Cited by 138 publications

(140 citation statements)

References 17 publications

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“…Davidson et al demonstrated that repairs with excessive tension led to inferior Constant scores, decreased isokinetic strength, and increased pain. 8 With the advent of extracellular matrix scaffolds, new treatment strategies have evolved to address both the technical, mechanical and biological healing difficulties associated with primary repair of massive rotator cuff tears. 1,17,21 Prior studies evaluating the efficacy of porcine xenografts to augment rotator cuff tears have had varied results.…”

Section: Dojmentioning

confidence: 99%

“…The Restore TM group had a higher failure rate and lower Overall outcomes and the ability of the rotator cuff to heal, however, can be inversely correlated to the size and amount of retraction of tears as well as the amount of tension applied to the repair. 2,4,8,13 In a recent prospective, randomized trial evaluating the effectiveness of debridement or partial repair of massive rotator cuff tears, patients demonstrated improvements in pain, Constant scores and disabilities of the arm, shoulder and hand (DASH) scores. The partial repair group demonstrated improved outcomes vs the debridement group.…”

Section: Dojmentioning

confidence: 99%

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Management of Massive Rotator Cuff Tears in Active Patients with Minimal Glenohumeral Arthritis: A Prospective Observational Study with Clinical and Radiographic Analyses of Reconstruction using Dermal Tissue Matrix Xenograft

Toth¹,

Gupta²

2013

The Duke Orthopaedic Journal

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Objectives: To evaluate the clinical and radiographic outcomes of patients undergoing interposition reconstruction of massive, otherwise irreparable rotator cuff tears through a mini-open approach with the use of a porcine dermal tissue matrix. Materials and methods:We performed a prospective observational study of 26 patients (27 shoulders) who underwent reconstruction of massive rotator cuff tears using dermal tissue matrix xenograft. Pain level (scale 0-10, 10 = severe pain), active range of motion, and supraspinatus and external rotation strength were assessed. Additional outcome measures included modified American shoulder and elbow score (MASES) and short form-12 (SF-12) score. Clinical and radiographic analyses were performed at an average 32 months follow-up period (minimum 2-year follow-up). Ultrasound imaging (static and dynamic) of the operative shoulder was performed at final followup to assess the integrity of the reconstruction.Results: Mean patient age was 60. Mean pain level decreased from 5.1 to 0.4 (p = 0.002). Mean active forward flexion, abduction, and external rotation motion improved from 138.8 to 167.3 (p = 0.024), 117.9 to 149.3 (p = 0.001) and 57.7 to 64.7°( p = 0.31), respectively. Supraspinatus and external rotation strength improved from 7.2 to 9.4 (p = 0.001) and 7.4 to 9.5 (p = 0.001), respectively. Mean MASES improved from 62.7 to 91.8 (p = 0.0007) and mean SF-12 scores improved from 48.4 to 56.6 (p = 0.044). Twenty-one patients (twenty-two shoulders) returned for a dynamic and static ultrasound of the operative shoulder at a minimum 2-year follow-up. Sixteen (73%) demonstrated a fully intact tendon/graft reconstruction. Five (22%) patients had partially intact reconstructions, and one (5%) had a complete tear at the graft-bone interface due to suture anchor pullout as a result of a fall. There were no cases of infection or tissue rejection. Conclusion:We present a reproducible surgical technique for the management of massive irreparable rotator cuff tears. In our series, patients demonstrated a significant improvement in both subjective and objective clinical outcomes. Radiographic analysis demonstrated that the majority of patients had a fully intact reconstruction at a minimum 2-year follow-up.

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Section: Dojmentioning

confidence: 99%

Section: Dojmentioning

confidence: 99%

Management of Massive Rotator Cuff Tears in Active Patients with Minimal Glenohumeral Arthritis: A Prospective Observational Study with Clinical and Radiographic Analyses of Reconstruction using Dermal Tissue Matrix Xenograft

Toth¹,

Gupta²

2013

The Duke Orthopaedic Journal

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“…To describe the chronological changes of the elasticity after cutting the supraspinatus tendon, eight rabbits reported that the tension after repair directly correlate with the surgical outcome (Davidson and Rivenburgh 2000). Generally speaking, the tension after repair is mainly determined by the elasticity of the tendon-muscle unit and the size of tear.…”

Section: Preparation Of Specimens For Sam Measurementsmentioning

confidence: 99%

“…In other words, the tissue elasticity strongly influenced the tension of the repair at the time of surgery. Davidson and Rivenburgh (2000) investigated the relationship between the repair tension and the clinical outcome in 67 rotator cuff tear patients. They found that high repair tension measured intraoperatively was associated with poor subjective and objective outcomes (Davidson and Rivenburgh 2000).…”

Section: F = Ea ∆L Equation 2 Lmentioning

confidence: 99%

“…Davidson and Rivenburgh (2000) investigated the relationship between the repair tension and the clinical outcome in 67 rotator cuff tear patients. They found that high repair tension measured intraoperatively was associated with poor subjective and objective outcomes (Davidson and Rivenburgh 2000). Bassett and Cofield (1983) reported that the postoperative pain relief was acceptable when the surgery was performed within 3-months from the injury.…”

Section: F = Ea ∆L Equation 2 Lmentioning

confidence: 99%

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Elasticity of the Supraspinatus Tendon-muscle Unit is Preserved after Acute Tendon Tearing in the Rabbit

Mineta

Sano

Ichinose

et al. 2008

Tohoku J. Exp. Med.

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Effects of selective paralysis of the supraspinatus muscle using botulinum neurotoxin a in rotator cuff healing in rats

Ficklscherer

Hartl

Scharf

et al. 2012

Journal Orthopaedic Research

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We hypothesized that a temporary rotator cuff paralysis using botulinum-neurotoxin A (BoNtA) would lead to an improved tendon-to-bone healing after repair of supraspinatus lesions. One hundred sixty Sprague-Dawley rats were randomly assigned to either the BoNtA or the control (saline) group. BoNtA/saline-solution was injected into the supraspinatus muscle 1 week prior to surgery. A supraspinatus defect was made; we distinguished between a lesion with normal and increased repair load. Furthermore, one subgroup had the operated shoulder immobilized in a cast. Histologic analysis and biomechanical testing followed. Specimens from the BoNtA-group, which were treated with an increased repair load, showed less cellularity and more organization in the interface tissue compared to the saline control group. In addition, we found that the collagen 1-3 quotient in the BoNtA specimen was significantly (p ¼ 0.0051) higher than in the control group. Ultimate load at failure between the groups was not significantly different (p > 0.05). We did not observe any significant differences between the mobilized and immobilized specimen (p ¼ 0.2079). The study shows that tendon-to-bone healing after rotator cuff repair can be altered positively using BoNtA pre-operatively. Tears with increased repair load seem to benefit the most-at least histologically. Keywords: rotator cuff tear; tendon-healing; biologic tendon repair; bioprotection; botulinum neurotoxin A Rotator cuff tears are one of the most common degenerative diseases of the upper extremity and are seen in up to 30% of the population aged older than 65 years.

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Rotator cuff repair tension as a determinant of functional outcome

Cited by 138 publications

References 17 publications

Management of Massive Rotator Cuff Tears in Active Patients with Minimal Glenohumeral Arthritis: A Prospective Observational Study with Clinical and Radiographic Analyses of Reconstruction using Dermal Tissue Matrix Xenograft

Management of Massive Rotator Cuff Tears in Active Patients with Minimal Glenohumeral Arthritis: A Prospective Observational Study with Clinical and Radiographic Analyses of Reconstruction using Dermal Tissue Matrix Xenograft

Elasticity of the Supraspinatus Tendon-muscle Unit is Preserved after Acute Tendon Tearing in the Rabbit

Effects of selective paralysis of the supraspinatus muscle using botulinum neurotoxin a in rotator cuff healing in rats

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