Clinical and MRI Outcomes 10 Years After Repair of Massive Posterosuperior Rotator Cuff Tears

Collin, Philippe; Colmar, M.; Thomazeau, H.; Mansat, Pierre; Boileau, Pascal; Valenti, Philippe; Saffarini, Mo; Nover, Luca; Kempf, Jean-François

doi:10.2106/jbjs.17.01190

Cited by 44 publications

(47 citation statements)

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“…Here the percentage of tendon healing was reported as ranging between 68% and 81%, depending on the initial type of tear, 2 and a separate study by the same study group on massive tears indicated a retear rate of 34%. 8 Interestingly, the differences in the retear rate between isolated SSp tears and larger tears with different extension were not found to be significant, although the failure rate was higher in the group with posterior extension. 2 This is in contrast to the results of the present study, where a significant difference in the proportion of intact RC was documented in C1-C2 tears versus C3-C4 (68% vs 29%, P = .0002).…”

Section: Discussionmentioning

confidence: 82%

“…The cohort presented in this study is the first one where ultrasound evaluation was performed to assess RC integrity after arthroscopic repair at a minimum follow-up of 10 years and the third one for which such long-term results are described. 2,8,15,21 Heuberer et al 21 presented in 2017 the results of a case series of 30 patients whose clinical outcomes were collected prospectively 10 years after arthroscopic RC repair with MRI assessment of RC integrity. More recently, several studies originating from the same cohort of patients, enrolled under the direction of the Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT) in 2003, were published.…”

Section: Discussionmentioning

confidence: 99%

“…These studies evaluated different aspects of RC repair and their results, including a relevant fraction of patients who underwent open RC repair. 2,8,15…”

Section: Discussionmentioning

confidence: 99%

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Long-term Results of Arthroscopic Rotator Cuff Repair: Initial Tear Size Matters: A Prospective Study on Clinical and Radiological Results at a Minimum Follow-up of 10 Years

et al. 2019

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Background: Arthroscopic techniques are now considered the gold standard for treatment of most rotator cuff (RC) tears; however, no consensus exists on the maintenance of results over time, and long-term follow-up data have been reported for few cohorts of patients. Purpose: To present the long-term results associated with the arthroscopic treatment of RC tears and to evaluate associations between preoperative factors and RC integrity at final follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 169 patients were contacted at least 10 years after arthroscopic RC surgery and were invited to a clinical evaluation. Information on preoperative conditions, tear size, subjective satisfaction, and functional scores was collected; isometric strength and range of motion were also measured; and each patient underwent an ultrasound examination to evaluate supraspinatus integrity and a shoulder radiograph to evaluate osteoarthritis. Results: A total of 149 patients (88.2% of the eligible patients) were available for a complete telephonic interview, and 102 patients were available for the final evaluation. Ultrasound revealed an intact supraspinatus in 54 patients (53.47%). By adding the 10 patients who underwent revision surgery to the nonintact group, this percentage would drop to 48.65%. Tear size was associated with supraspinatus integrity in univariate analysis (hazard ratio, 3.04; 95% CI, 1.63-5.69; P = .001) and multivariable analysis (hazard ratio, 2.18; 95% CI, 1.03-4.62; P = .04). However, no significant differences were encountered in the subjective and functional scores collected, with the exception of the Constant-Murley Score, which was significantly higher in patients with smaller tears at the index procedure. Strength testing also revealed significantly superior abduction and flexion strength in this group, and radiographs showed a significantly higher acromion-humeral distance and lower grades of osteoarthritis. Patients with an intact supraspinatus at final follow-up showed superior results in all functional scores, greater satisfaction, superior abduction and flexion strength, higher acromion-humeral distance, and lower grades of osteoarthritis. Conclusion: RC tear size at the time of surgery significantly affects supraspinatus integrity at a minimum follow-up of 10 years. However, a larger tear is not associated with an inferior subjective result, although it negatively influences abduction and flexion strength, range of motion, and osteoarthritis progression. Intraoperative efforts to obtain a durable RC repair are encouraged, since supraspinatus integrity at final follow-up influences clinical and functional outcomes, patient satisfaction, and osteoarthritis progression.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Long-term Results of Arthroscopic Rotator Cuff Repair: Initial Tear Size Matters: A Prospective Study on Clinical and Radiological Results at a Minimum Follow-up of 10 Years

et al. 2019

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“…20 Good to excellent outcomes have been reported in the short- and long-term follow-up in most cases. 11,12,45,50 However, despite advances in instrumentation and surgical techniques, a risk of rerupture of 20% to 60% has been observed. 10,14 Although patients whose tendons fail to heal can still have pain relief, most studies have shown that patients with healed repairs achieve higher patient-reported outcome scores.…”

mentioning

confidence: 99%

Current Concepts in Rotator Cuff Repair Techniques: Biomechanical, Functional, and Structural Outcomes

Rossi

Rodeo

Chahla

et al. 2019

Orthopaedic Journal of Sports Medicine

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There is substantial evidence indicating that double-row (DR) repair restores more of the anatomic rotator cuff footprint and is biomechanically superior to single-row (SR) repair. Transosseous-equivalent (TOE) techniques have shown biomechanical advantages when compared with traditional DR, including increased contact at the rotator cuff footprint, higher pressure at the tendon-bone interface, and increased failure strength. Several meta-analyses of evidence level 1 and 2 studies have shown a lower rate of failed/incomplete healing when DR repair was compared with SR repair types. There is some limited evidence that TOE techniques improve healing rates in large and massive tears as compared with SR and DR. Overall, most level 1 and 2 studies have failed to prove a significant difference between SR and DR repairs in terms of clinical outcomes. However, most studies include only short-term follow-up, minimizing the impact that the higher rate of retears/failed healing seen with SR repairs can have in the long term. There are no high-quality clinical studies comparing different DR configurations, and there are currently not enough clinical data to determine the functional advantages of various DR technique modifications over one another. Although numerous biomechanical and clinical studies comparing different rotator cuff repair techniques have been published in the past decade, none has achieved universal acceptance. It is essential for the orthopaedic surgeon to know in detail the available literature to be able to apply the most appropriate and cost-effective technique in terms of healing and functional outcomes. This review provides a critical analysis of the comparative biomechanical and clinical studies among SR, DR, and TOE techniques reported in the literature in the past decade.

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“… 18 – 20 , 22 , 28 , 35 However, the retear rate in large/massive rotator cuff repair remains very high. 10 , 15 , 18 – 20 This could be ascribed to various factors such as poor tendon quality, high tension between tendon and suture, inferior fixation strength, and the slow healing process of the bone-tendon interface (BTI). 1 , 7 , 21 , 25 , 34 To reduce the retear rate and promote BTI healing, various biological and engineered patches have been developed, such as human acellular dermal allografts, 1 , 33 , 36 , 37 small intestinal submucosa, 8 , 12 , 14 , 30 and biodegradable synthetic polymers.…”

mentioning

confidence: 99%

Biomechanical Comparison of Augmentation of Engineered Tendon-Fibrocartilage-Bone Composite With Acellular Dermal Graft Using Double Rip-Stop Technique for Canine Rotator Cuff Repair

Wang

Long

Amadio

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The retear rate after rotator cuff repair remains unacceptably high. Various biological engineered scaffolds have been proposed to reduce the retear rate. We have developed a double rip-stop repair with medial row knot (DRSK) technique to enhance suture-tendon strength and a novel engineered tendon-fibrocartilage-bone composite (TFBC) for rotator cuff repair. Hypothesis: DRSK rotator cuff repair augmented with TFBC will have better biomechanical properties than that of DRSK repair with an acellular dermal graft (DG). Study Design: Controlled laboratory study. Methods: Fresh-frozen canine shoulders (n = 30) and knees (n = 10) were used. TFBCs were harvested from the patellar tendon–tibia complex and prepared for rotator cuff repair. The infraspinatus tendon was sharply detached from its bony attachment and randomly assigned to the (1) control group: DRSK repair alone, (2) TFBC group: DRSK repair with TFBC, and (3) DG group: DRSK repair with DG. All specimens were tested to failure, and videos were recorded. The footprint area, tendon thickness, load to create 3-mm gap formation, failure load, failure modes, and stiffness were recorded and compared. Data were recorded as mean ± SD. Results: The mean load to create a 3-mm gap in both the control group (206.8 ± 55.7 N) and TFBC group (208.9 ± 39.1 N) was significantly higher than that in the DG group (157.7 ± 52.3 N) ( P < .05 for all). The failure load of the control group (275.7 ± 75.0 N) and TFBC group (275.2 ± 52.5 N) was significantly higher compared with the DG group (201.5 ± 49.7 N) ( P < .05 for both comparisons). The stiffness of the control group (26.4 ± 4.7 N/mm) was significantly higher than of the TFBC group (20.4 ± 4.4 N/mm) and the DG group (21.1 ± 4.8 N/mm) ( P < .05 for both comparisons). Conclusion: TFBC augmentation showed superior biomechanical performance to DG augmentation in rotator cuff tears repaired using the DRSK technique, while there was no difference between the TFBC and control groups. Clinical Relevance: TFBC may help to reduce retear or gap formation after rotator cuff repair using the DRSK technique.

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Clinical and MRI Outcomes 10 Years After Repair of Massive Posterosuperior Rotator Cuff Tears

Abstract: OATAO is an open access repository that collects the work of some Toulouse researchers and makes it freely available over the web where possible.

Cited by 44 publications

References 43 publications

Long-term Results of Arthroscopic Rotator Cuff Repair: Initial Tear Size Matters: A Prospective Study on Clinical and Radiological Results at a Minimum Follow-up of 10 Years

Long-term Results of Arthroscopic Rotator Cuff Repair: Initial Tear Size Matters: A Prospective Study on Clinical and Radiological Results at a Minimum Follow-up of 10 Years

Current Concepts in Rotator Cuff Repair Techniques: Biomechanical, Functional, and Structural Outcomes

Biomechanical Comparison of Augmentation of Engineered Tendon-Fibrocartilage-Bone Composite With Acellular Dermal Graft Using Double Rip-Stop Technique for Canine Rotator Cuff Repair

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