Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial

Franceschi, Francesco; Papalia, Rocco; Buono, Angelo Del; Vasta, Sebastiano; Costa, Vincenzo; Maffulli, Nicola; Denaro, Vincenzo

doi:10.1007/s00264-013-1882-9

Cited by 83 publications

(82 citation statements)

References 25 publications

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“…On the other hand, when the lesion is smaller than one centimetre, such a procedure may weaken the bone and compromise the site where the anchors have to be implanted. The strength of the repair depends on the state of the tendon-bone interface [18]. Many factors may compromise the healing process at the tendon-bone interface [19,20].…”

Section: Discussionmentioning

confidence: 99%

Microfractures at the rotator cuff footprint: a randomised controlled study

Osti

Buono

Maffulli

2013

International Orthopaedics (SICOT)

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Purpose Microfractures at the footprint may be a potential additional source of growth factor and enhance the tendon healing at the bone-tendon junction when repairing rotator cuff tears. Methods Fifty-seven patients who underwent shoulder arthroscopy for repair of complete rotator cuff tears were randomly divided into two groups, using a block randomisation procedure. Patients underwent microfracture at the footprint in the treatment group. The patients in the control group (n=29) did not receive that treatment. All patients had the same post-operative rehabilitation protocol. Results The two groups were homogeneous. There was a significant improvement from baseline to the last minimum follow-up of two years. At three months from the index procedure, visual analogue scale (VAS), range of motion (ROM) and University of California at Los Angeles (UCLA) and Constant scores were significantly better in group 1 than in group 2 (P<.05). At the last follow-up (minimum two years), clinical and functional outcomes were further improved in both the groups but inter-group differences were not significant. No technique-related complications were recorded. Conclusions Microfractures at the footprint are simple, safe, inexpensive and effective at producing less pain in the short term in patients who undergo rotator cuff repair, but at two years they do not result in significantly different outcomes, either clinically or at imaging, compared to traditional rotator cuff repair.

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Section: Discussionmentioning

confidence: 99%

Microfractures at the rotator cuff footprint: a randomised controlled study

Osti

Buono

Maffulli

2013

International Orthopaedics (SICOT)

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“…Repair of PTRCTs can either be performed with an in-situ ("trans-cuff") repair technique (leaving the intact cuff portion intact) or with a tear conversion into a full-thickness cuff tear and subsequent repair. Successful functional and structural outcome [23][24][25][26] after repair of Ellman grade 3 tears could be shown with both repair techniques. Interestingly, current literature suggests an evidence for inferior outcomes and higher failure rates after arthroscopic debridement of bursal-sided PTRCTs compared to articular-sided lesions [3] .…”

Section: Surgical Techniquesmentioning

confidence: 91%

“…Several surgical techniques of in-situ repair have been described [23][24][25][26][30][31][32] , however, with no superiority of one specific technique to the others (Figure 3). A proposed advantage of transtendinous repair techniques with preservation of the intact rotator cuff tendon integrity on the bursal side is the maintenance of the original footprint and therefore a more anatomic repair.…”

Section: In-situ Repair Versus Tear Completion Into Full-thickness Cumentioning

confidence: 99%

Surgical Treatment Options for Partial Rotator Cuff Tears: A Review of the Literature

Borbas

Hoy

2019

International Journal of Orthopaedics

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Partial-thickness rotator cuff tears (PTRCT) can be articularsided, bursal-sided or intratendinous. New research suggests that a considerable proportion (up to 30%) of cuff thickness on the articular side is taken up histologically by the superior joint capsule conjoined to the rotator cuff tissue. This means that newer reviews of the surgical options may be required to complement the Ellman classification which grades lesions as grade 1 (less than 25% of tendon thickness involved), grade 2 (25-50%) or grade 3 (greater than 50% of tendon thickness). If primary non-operative treatment fails, many surgical options can be considered. The surgical technique chosen has been based on depth of the tear and the tear location. Surgical treatment can be distinguished between debridement and repair of PTRCT's, as well as biologically active experimental techniques showing some promise. Debridement can be successfully performed for bursal-sided Ellman grade 1 tears and articular-sided grade 1 and 2 tears. All other techniques show better results with a repair technique, which can be either performed with an in-situ or trans-cuff repair technique (leaving the intact rotator cuff portion intact) or with tear conversion to a full-thickness cuff tear and subsequent repair. Successful functional and structural outcome after repair of Ellman grade 3 tears can be shown with both repair techniques. The current literature also suggests evidence for inferior outcomes and higher failure rates after arthroscopic debridement of bursal-sided partial-thickness rotator cuff tears compared to articularsided lesions, which may reflect the contribution of capsule to the tear. Articular-sided partial cuff tears are frequently seen in overhead athletes and should be treated non-operatively whenever possible. If conservative treatment fails, debridement seems to be a better surgical choice in most cases, as only a half of professional athletes return to the same level of play after repair of partial-thickness rotator cuff tears.

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“…However, two randomized clinical studies failed to show a difference in clinical outcome scores or re-tear rates between the two groups [58,59]. Both studies did show significant improvements in VAS, ASES, and Constant scores as well as similarly low re-tear rates on follow-up MRIs in both groups.…”

Section: Partial-thickness Rotator Cuff Tearsmentioning

confidence: 98%

Partial and Full-Thickness RCT: Modern Repair Techniques

Nathani

Smith

Wang

2018

Curr Rev Musculoskelet Med

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Purpose of Review The purpose of this article is to review the recent literature concerning modern repair techniques related to partial-and full-thickness rotator cuff tears. Recent Findings The understanding of rotator cuff pathology and healing continues to evolve, beginning with emerging descriptions of the anatomic footprint and natural history of rotator cuff tears. Significant controversy remains in treatment indications for partial-thickness rotator cuff lesions as well as optimal surgical repair techniques for both partial-and full-thickness tears. Techniques such as margin convergence and reduction of the so-called "comma" tissue have improved the ability to anatomically reduce large and retracted tears. Repair strength and contact pressures are improved with double-row repairs and transosseusequivalent techniques compared to traditional single-row repairs. Future work is directed towards obtaining reliable radiographic healing and demonstrating clinical superiority and cost-effectiveness of a single technique. Summary Much recent work regarding rotator cuff anatomy and pathology has been reported. Newer techniques improve repair strength. Despite these advances, significant questions remain concerning surgical indications and clinical outcomes.

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Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial

Cited by 83 publications

References 25 publications

Microfractures at the rotator cuff footprint: a randomised controlled study

Microfractures at the rotator cuff footprint: a randomised controlled study

Surgical Treatment Options for Partial Rotator Cuff Tears: A Review of the Literature

Partial and Full-Thickness RCT: Modern Repair Techniques

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