Background: Despite technological advances, the overall retear rate on rotator cuff repair is still high. Patches have shown significant reduction in retear rate and pain scores; however, this is not a universal finding and conflicting results have been shown among functional shoulder scales. Purpose: To analyze previous controlled trials of the literature to bring a consensus about the effectiveness of patch use on rotator cuff repair. Study Design: Systematic review; Level of evidence, 1. Methods: The search was conducted in PubMed, Web of Science, EMBASE, Scopus, and Cochrane in April 2020. The results of rotator cuff repair with patch augmentation versus without augmentation (control) were compared through odds ratio (OR), raw mean difference (RMD), and standardized mean difference (SMD) of retear rate; functional shoulder scales; strength; and range of motion (ROM). Results: Of 733 initial studies, 7 of them met the criteria to be included in the analysis. Compared with the control group, the patch augmentation group had a significantly lower retear rate (OR, 0.32 [95% CI, 0.18 to 0.55]; P < .001), lower pain (SMD, –0.42 [–0.71 to –0.12]; P < .01), a higher University of California Los Angeles Shoulder Rating Scale (RMD, 0.87 [0.15 to 1.60], P = .017), and a trend toward higher strength (SMD, 0.95 [–0.03 to 1.94], P = .05) and lower forward elevation ROM (RMD, –10.50 [–21.86 to 0.67]; P = .06), while no changes were noted for other functional scales or for internal and external rotation ROM. Conclusion: The results point to benefits of patch augmentation in rotator cuff repair, particularly a reduction in retear rate. More interventional studies with better methodological quality should be conducted to confirm the results of this initial review.

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SUMMARY:The aim of this study was to analyze changes in the skeletal muscle tissue of rats after muscle stretch injury using fractal analysis. Nineteen rats were divided into three groups, Control (n= 5) (C), Lesion two days (n= 7) (L2), and Lesion seven days (n= 7) (L7). Histological slides of the gastrocnemius muscle of the animals were prepared and stained with Hematoxylin and eosin for analysis of the inflammatory process, and picrosirius for the demonstration of collagen. The stained slides were subsequently analyzed using Fractal Dimension (FD). The results showed high FD values of the inflammatory process in the experimental groups L2 and L7 in relation to C (p= 0.000). The analysis of collagen in the picrosirius stained slides showed high FD in the L2 group compared to the L7 (p= 0.0001), with no statistically significant difference among other groups. In summary, the present study demonstrated that fractal analysis was able to identify changes in the inflammatory process in injured skeletal muscle tissue.

Objectives: To evaluate alterations from different therapies in muscular injury using the Fractal Dimension (FD) method. Methods: 35 animals were allocated in Control Group (C), Injury Control Group (IC), Injury Low Level Laser Therapy Group (ILT), Injury Platelet Rich Plasma Group (IP), and Injury LLLT and PRP Group (ILP). The animals suffered a stretch injury in gastrocnemius muscle and after that IP and ILP groups received PRP application. The ILT and ILP groups received daily LLLT applications for seven days. After seven days the animals were euthanized and the gastrocnemius muscle removed and frozen. The muscles were stained with Hematoxylin and Eosin (HE) and Picrosirius Red, for observation of the morphology of the injury and semi-quantitative and quantitative analysis through the Fractal Dimension (FD) method. Results: In the qualitative and semi-quantitative analysis, in relation to IC group, the ILT presented a reduction in rounded fibers and the IP in angular fibers. The ILP group demonstrated a reduction in both polymorphic fibers and inflammatory infiltrate. The FD of the muscles stained with HE was higher in the groups that suffered the injury when compared to the C group (p < 0.05); the FD of the collagen demonstrated no statistical difference between the groups. Conclusion: Both treatments were able to accelerate injury repair, and the association of both presented better results than the isolated applications. However, the FD method showed no sensitivity to differentiate the treatments, either in the histological aspects or the injury in collagen.

HighlightsLLLT and PRP can be used to enhance muscle regeneration.The association of LLLT with PRP produces better treatment than their use in isolation.LLLT could modulate the production of collagen during muscle injury.