Abstract:BackgroundIt is a challenge for orthopaedic surgeons to treat massive rotator cuff tears. The optimal management of massive rotator cuff tears remains controversial. Therefore, the goal of this study was to compare arthroscopic single- versus double-row rotator cuff repair with a larger sample size.Material/MethodsOf the subjects with massive rotator cuff tears, 146 were treated using single-row repair, and 102 were treated using double-row repair. Pre- and postoperative functional outcomes and radiographic im… Show more
44Background: Rotator cuff tears are the commonest tendon injury in the adult 45 population, resulting in substantial morbidity. The optimum management for these 46 patients is not known. The natural history of patients with rotator cuff tears included in RCTs is to improve 68 over time, whether treated operatively or non-operatively. 69
70What is known about the subject: Rotator cuff tears represent the commonest tendon 71 injury in the adult population, however the optimum management of these patients is 72 not known. In other chronic musculoskeletal conditions, it has been shown that there 73 is improvement in clinical outcome measures with all treatments over time. However, 74 it is not known if this is also true for rotator cuff tears. 75
76What this study adds to existing knowledge: This review found there is consistent 77 improvement in Constant score, irrespective of intervention given whether it is 78 operative, or non-operative treatments. Patient outcomes at 12 months are highly 79 predictive of outcomes at 24 months, suggesting that 12-month should be used as a 80 primary outcome time point for future randomised controlled trials in full-thickness 81 rotator cuff tears. 82
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44Background: Rotator cuff tears are the commonest tendon injury in the adult 45 population, resulting in substantial morbidity. The optimum management for these 46 patients is not known. The natural history of patients with rotator cuff tears included in RCTs is to improve 68 over time, whether treated operatively or non-operatively. 69
70What is known about the subject: Rotator cuff tears represent the commonest tendon 71 injury in the adult population, however the optimum management of these patients is 72 not known. In other chronic musculoskeletal conditions, it has been shown that there 73 is improvement in clinical outcome measures with all treatments over time. However, 74 it is not known if this is also true for rotator cuff tears. 75
76What this study adds to existing knowledge: This review found there is consistent 77 improvement in Constant score, irrespective of intervention given whether it is 78 operative, or non-operative treatments. Patient outcomes at 12 months are highly 79 predictive of outcomes at 24 months, suggesting that 12-month should be used as a 80 primary outcome time point for future randomised controlled trials in full-thickness 81 rotator cuff tears. 82
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“…A total of 1407 studies (283, 321, 803 and 818 from the Cochrane Register of Controlled Trials, PUBMED, EMBASE and Scopus, respectively) were originally included in this study. After two researchers read the full-texts, twenty-one studies 6 , 25 – 44 (nine RCTs 6 , 25 – 27 , 29 , 30 , 34 , 35 , 38 and twelve observational comparative studies 28 , 31 – 33 , 36 , 37 , 39 – 44 ) were considered relevant and included in this meta-analysis. Figure 1 Selection flow of the studies included in the meta-analysis.…”
Rotator cuff tears are common and are associated with shoulder pain, disability, and dysfunction. Previous studies that have reported different arthroscopic techniques are controversial. A network meta-analysis with indirect and direct evidence was performed to compare the effectiveness of arthroscopic techniques for the treatment of rotator cuff tears. PUBMED, the Cochrane Register of Controlled Trials, EMBASE and Scopus were searched based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and related studies that evaluated arthroscopic techniques for the treatment of rotator cuff tears were identified in May 2018. The primary outcome measure was the retear rate. The secondary outcome measures included the constant score and the range of motion (forward flexion and external rotation). Twenty-one trials comprising 1815 shoulders were included in the study. This study indicated that single-row (SR) repair resulted in a higher retear rate than suture bridge (SB) and double-row (DR) repairs. Moreover, the SR and DR repairs resulted in higher incidences of retear than SB repair. The ranking of the treatments based on the constant score and external rotation was SB repair, SR repair and DR repair, whereas the treatment ranking according to forward flexion was SB repair, DR repair and SR repair. In summary, this network meta-analysis provides evidence that SB repairs might be the best choice to improve the postoperative recovery of function and decrease the retear rate.
“…This goal is being realized, primarily with respect to re-tear rates. 24,25 However, even with advanced techniques, there are still relatively high rates of failure reported, with increasing patient age serving as one of the primary negative prognostic factors. 26 An older patient population is associated with decreased bone mass and strength, and postmenopausal females have decreased bone quality; these factors are associated with higher rotator cuff failure rates due to poor tendon healing, with anchor fixation failure also playing a role.…”
The aim of this study was to assess the efficacy and safety of a novel magnesium-based resorbable bone cement (OsteoCrete, Bone Solutions Incorporated) for anchor and tendon fixation. Cadaveric humeral testing involved straight pull-to-failure of rotator cuff suture anchors; OsteoCrete was injected through one anchor, and a second anchor served as the uninjected control. Testing was conducted 15 minutes post-injection. A canine preclinical model was used to evaluate the safety of the following parameters: Rotator cuff repair: A double-row technique was used to repair transected infraspinatus tendons; OsteoCrete was injected through both anchors in one limb, and the contralateral limb served as the uninjected control. Biceps tenodesis: The transected biceps tendon was implanted into a proximal humeral socket with a transcortical button; OsteoCrete was injected into the socket of one limb, and a screw was used for final fixation in the contralateral control limb. Nondestructive biomechanical testing and histologic assessment were performed after 12 weeks. OsteoCrete-augmented anchors showed significantly higher load-to-failure compared to that with uninjected controls. In cadaveric humeri with reduced bone quality, OsteoCrete increased the mean load-to-failure by 99%. Within the preclinical model, there were no complications or statistically significant biomechanical/histologic differences between the techniques. OsteoCrete has the potential for safely providing improved suture anchor and tissue fixation in patients with poor bone or tissue quality.
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