The Clinical and Structural Long-Term Results of Open Repair of Massive Tears of the Rotator Cuff

Zumstein, Matthias A.; Jost, Bernhard; Hempel, Julia; Hodler, Juerg; Gerber, Christian

doi:10.2106/jbjs.g.00677

Cited by 417 publications

(336 citation statements)

References 20 publications

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“…We cannot explain why we found different results in our study when comparing our findings to some reports currently discussed in the literature [15][16][17][18][19]32]; although, we consider that one important factor to explain the divergent results, is the fact that the imaging X-rays studies will unavoidably present bias amongst the projection of the X-ray beam in the patient, the spatial position of the evaluated joint, the morphology of the patient and finally the bias amongst evaluators of the indexes to be measured. Further studies are needed to support this hypothesis.…”

Section: Discussioncontrasting

confidence: 82%

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The acromial index is not predictive for failed rotator cuff repair

Meleán

Lichtenberg²,

Montoya

et al. 2013

International Orthopaedics (SICOT)

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Background The main objective of this study was to evaluate the association between the acromial index (AI) and the incidence of recurrent tears of the rotator cuff (RC) in a cohort of patients with full thickness tears who underwent arthroscopic primary repair. Methods A prognostic study of a prospective case series of 103 patients with full thickness RC tears was undertaken. The average age was 59.5 years (39-74) and follow-up was 30.81-months (12-72). True anterior-posterior X-rays were obtained during the pre-operative evaluation. Pre and post-operative magnetic resonance imaging (MRI) were recorded. Results Eighteen cases with recurrent tears (17.4 %) were seen on post-operative MRI. The average AI for patients with recurrent tears was 0.711±0.065 and for patients without recurrent tears 0.710±0.064 (p<0.05). A positive association between age and recurrent tears of the RC was noted (average ages: recurrent tears group 63±5.9 years; group without recurrent tears 58.8±7.5 years) (r=−0.216; p=0.029). We did not find an association between size of the primary tear and recurrent tears (r=−0.075; p<0.05) or between degrees of retraction of the primary and recurrent tears of the cuff (r=−0.073; p<0.05). We observed that 38.9 % of the recurrent tears cases presented with more than one tendon affected before the arthroscopy. At follow-up, none of these recurrent tears showed more than one tendon affected on MRI evaluation. ConclusionIn this study, we found that the AI radiological measurement is not a predictor for recurrent tears of the RC after primary arthroscopic repair.

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Section: Discussioncontrasting

confidence: 82%

“…Afterwards, Zumstein et al [32] reported a cohort of patients who underwent open repair of the RC at a mean follow-up of 9.9 years. They found a larger AI in patients with recurrent tears of the RC compared to those without failure.…”

Section: Discussionmentioning

confidence: 99%

The acromial index is not predictive for failed rotator cuff repair

Meleán

Lichtenberg²,

Montoya

et al. 2013

International Orthopaedics (SICOT)

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“…16 Although structural failure after large or massive rotator cuff repairs does not necessarily imply a poor clinical outcome, 7,14 failure has been shown to be associated with inferior restoration of strength, lower shoulder scores, and more rapid progression of degenerative joint changes than structural healing of repairs. 8,22 Hence, successful repair of a rotator cuff tear is desirable. Intuitively, it would appear reasonable to assume that with repair of the torn tendon end to its original insertion site, anatomic restoration of the musculotendinous unit should be possible.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Muscle and Tendon Retraction in Chronic Rotator Cuff Tears

et al. 2011

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BACKGROUND: Musculotendinous retraction is a limiting factor for repair of long-standing rotator cuff tears. However, it is currently unknown to what extent the muscle and tendon contribute to the degree of total retraction. Further understanding of this may possibly influence the strategy of musculotendinous reconstruction. PURPOSE: To analyze the contribution of muscle and tendon to the process of myotendinous retraction. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Magnetic resonance imaging of 130 shoulders with intact (n = 20) or completely torn supraspinatus tendons was analyzed. Fatty infiltration of the supraspinatus muscle was graded according to Goutallier stages. The degree of retraction of the tendon stump and of the musculotendinous junction was assessed. RESULTS: There were 30 shoulders without evidence of supraspinatus fatty infiltration, 25 with stage 1, 23 with stage 2, 25 with stage 3, and 15 with stage 4 changes. The corresponding tear sizes (distance of tendon end from greater tuberosity) were 4, 21, 27, 37, and 41 mm; the distance of the myotendinous junction from the greater tuberosity was 22, 33, 39, 48, and 48 mm; and the length of the tendons (distance of tendon end to myotendinous junction) was 19, 13, 12, 11, and 8 mm, respectively. In Goutallier stage 3 and above, and in case of a positive tangent sign, the musculotendinous junction was, in 90% of the cases, retracted to or beyond the glenoid. CONCLUSION: Musculotendinous retraction in chronic rotator cuff tears results mainly from shortening of the muscle fibers but in advanced stages results also from shortening of the tendon tissue itself. The present data demonstrate, for the first time, that the residual tendon stump in a tendon tear does not have the length of the original tendon and is further shortened over time. Therefore, direct anatomic tendon reinsertion will result in lengthening of the supraspinatus muscle greater than what it would have been before the tear. Background: Musculotendinous retraction is a limiting factor for repair of long-standing rotator cuff tears. However, it is currently unknown to what extent the muscle and tendon contribute to the degree of total retraction. Further understanding of this may possibly influence the strategy of musculotendinous reconstruction.

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“…Bond et al [7] showed repairing massive rotator cuff tears with allogenic augmentation (GraftJacket 1 ) yielded a failure rate of 19%. This result is lower than the 38% to 95% failure rate demonstrated in several studies evaluating unaugmented massive rotator cuff repairs [5,20,21,60]. A histologic assessment of one patient's allogenically augmented rotator cuff repair (GraftJacket 1 ) demonstrated no calcification, infection, or inflammatory response at 3 months.…”

Section: Ecm Augmentationmentioning

(Expert classified)

“…Postoperative rotator cuff retears occur in as little as 11% to as much as 94% of rotator cuff repair surgeries, perhaps depending on the size of the tear and the level of tendon degeneration [5,6,19,21,33,34,60]. Retearing correlates with decreased functional outcome after rotator cuff repair [53].…”

Section: Introductionmentioning

confidence: 99%

Strategies in Biologic Augmentation of Rotator Cuff Repair: A Review

Cheung

Silverio

Sperling

2010

Clinical Orthopaedics &Amp; Related Research

146

101

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Background Degenerative rotator cuff tears are increasing with the aging population, and healing is not uniform after surgery. Rotator cuffs may show improved healing when biologic factors are added during surgery. Questions/purposes We asked: (1) What cellular processes are involved in normal bone-to-tendon healing? (2) What approaches are being developed in tendon augmentation? (3) What approaches are being developed with the addition of growth factors? Methods We reviewed research in relating to biologic augmentation and cellular processes involved in rotator cuff repair, focusing on animal models of rotator cuff repair and nonrandomized human trials. Results Regular bone-to-tendon healing forms a fibrous junction between tendon and bone that is distinct from the original bone-to-tendon junction. Tendon augmentation with cellular components serves as scaffolding for fibroblastic cells and a possible source of growth factors and fibroblastic cells. Extracellular matrices provide a scaffold for incoming fibroblastic cells, although current research does not conclusively confirm which if any of these scaffolds enhance repair owing in part to intermanufacturer variations and the limited human research. Growth factors and platelet-rich-plasma are established in other fields of research and may enhance repair but have not been rigorously tested. Conclusions There is potential application of biologic augmentation to improve healing after rotator cuff repair. However, research in this field is still inconclusive and has not been sufficiently demonstrated to merit regular clinical use. Future human trials can elucidate the use of biologic augmentation in rotator cuff repairs.

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The Clinical and Structural Long-Term Results of Open Repair of Massive Tears of the Rotator Cuff

Cited by 417 publications

References 20 publications

The acromial index is not predictive for failed rotator cuff repair

The acromial index is not predictive for failed rotator cuff repair

Quantitative Analysis of Muscle and Tendon Retraction in Chronic Rotator Cuff Tears

Strategies in Biologic Augmentation of Rotator Cuff Repair: A Review

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