Clinical Outcomes, Tendon Integrity, and Shoulder Strength After Revision Rotator Cuff Reconstruction: A Minimum 2 Years’ Follow-up

Willinger, Lukas; Lacheta, Lucca; Beitzel, Knut; Buchmann, Stefan; Woertler, Klaus; Imhoff, Andreas B.; Scheiderer, Bastian

doi:10.1177/0363546518786006

Cited by 25 publications

(24 citation statements)

References 45 publications

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“…Mean preoperative functional scores of affected shoulders were 43 ± 24 (CS), respectively 35 ± 17 (ASES), being in line with the previous reports . At six months follow‐up, the mean shoulder function significantly improved to 68 ± 25 (CS), respectively, 71 ± 24 (ASES).…”

Section: Resultssupporting

confidence: 89%

Contrast‐Enhanced Ultrasound (CEUS) as Predictor for Early Retear and Functional Outcome After Supraspinatus Tendon Repair

Kamtchouing

Mick

Groß

et al. 2019

Journal Orthopaedic Research

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Supraspinatus (SSP) tendon tears represent a common indication for shoulder surgery. Yet, prediction of postoperative function and tendon retear remains challenging and primarily relies on morphologic magnetic resonance imaging (MRI)-based parameters, supported by patients' demographic data like age, gender, and comorbidities. Considering continuously high retear rates, especially in patients with larger tears and negative prognostic factors, improved outcome prediction could be of high clinical value. Contrastenhanced ultrasound (CEUS) enables an assessment of dynamic perfusion of the SSP muscle. As a potential surrogate for muscle vitality, CEUS might reflect functional properties of the SSP and support improved outcome prediction after tendon repair. Fifty patients with isolated SSP tendon tears were prospectively enrolled. Preoperatively, SSP muscle perfusion was quantified by CEUS and conventional morphologic parameters like tear size, fatty infiltration, and tendon retraction were assessed by MRI. At six months follow-up, shoulder function, tendon integrity, and muscle perfusion were reassessed. The predictive value of preoperative CEUS for postoperative shoulder function and tendon integrity was evaluated. 35 patients entered the statistical analysis. Preoperative CEUS-based assessment of SSP perfusion significantly correlated with early postoperative shoulder function (Constant, r = 0.48, p < 0.018) and tendon retear (r = 0.67, p < 0.001). CEUS-based subgroup analysis identified patients with exceptionally high, respectively low risk for tendon retear. CEUSbased assessment of the SSP seemed to predict early shoulder function and tendon retear after SSP repair and allowed to identify patient subgroups with exceptionally high or low risk for tendon retear.

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Section: Resultssupporting

confidence: 89%

Contrast‐Enhanced Ultrasound (CEUS) as Predictor for Early Retear and Functional Outcome After Supraspinatus Tendon Repair

Kamtchouing

Mick

Groß

et al. 2019

Journal Orthopaedic Research

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“…The high retear rate after rRCR in the current study (50%) is similar to that reported in previous original studies, ranging from 40% to 55.5%. 19,36,41 Brochin et al, 2 in a systematic review, analyzed 9 studies for outcomes after arthroscopic rRCR and reported a retear rate of 13.7% (range, 0%-48%). 2 Another important finding of this study was that the retear rate after revision surgery was not different from that after the primary repair done for mRCTs.…”

Section: Discussionmentioning

confidence: 99%

Revision Rotator Cuff Repair Versus Primary Repair for Large to Massive Tears Involving the Posterosuperior Cuff: Comparison of Clinical and Radiological Outcomes

Meshram

Liu

Kim

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The retear rate after revision rotator cuff repair (rRCR) ranges from 50% to 90%. Patients who undergo primary RCR (pRCR) for large to massive rotator cuff tear (mRCT) also have unpredictable outcomes. Purpose: To compare the clinical outcomes after rRCR for a posterosuperior rotator cuff tear of any size with those after pRCR for mRCT and to identify the risk factors for poor outcomes and retear after rRCR. Study Design: Cohort study; Level of evidence, 3. Methods: Among patients with posterosuperior cuff tear treated between 2010 and 2017, the clinical outcomes of 46 patients who underwent rRCR were compared with 106 patients who underwent pRCR for mRCT. Between-group differences in patient-reported outcomes (visual analog scale [VAS] for pain, VAS for satisfaction and American Shoulder and Elbow Surgeons [ASES] and Constant scores) at final follow-up were evaluated and compared with previously published minimal clinically important difference (MCID) values. Radiological outcomes were evaluated using magnetic resonance imaging or ultrasonography at a minimum 1-year follow-up. Multivariate linear regression analysis was performed to identify the risk factors for poor ASES score, and multivariate logistic regression analysis was used to assess the risk factors for retear after rRCR. Results: The mean follow-up was 26.4 months (range, 24-81 months). Although final VAS for pain, VAS for satisfaction, and ASES scores in the rRCR group were significantly worse than those in the pRCR group, the Constant score was similar between the groups. These differences in outcomes did not exceed the MCID threshold. The retear rate in the rRCR group was 50% compared with 39% for the pRCR group ( P = .194). In the rRCR group, risk factors for worse ASES score were retear ( P = .043; r = –11.3), lower body mass index ( P = .032; r = 1.9), and lower preoperative VAS for pain ( P = .038; r = 2.3), and risk factors for retear were preoperative high-grade fatty degeneration (Goutallier grades 3 and 4) of the supraspinatus muscle ( P = .026; odds ratio, 5.2) and serum hyperlipidemia ( P = .035; odds ratio, 11.8). Conclusion: Both study groups had similar clinical and radiological outcomes. Patients with symptomatic failed rotator cuff repairs having high-grade fatty degeneration of the supraspinatus muscle and/or serum hyperlipidemia had a greater likelihood of retear after rRCR.

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“…We report a retear rate of 57% in revision, 2-tendon repairs augmented with dermal allografts. When evaluating revision repairs of all sizes, Willinger et al 33 reported a retear rate of 56% and Shamsudin et al 29 reported a retear rate of 40% without graft augmentation. 29,33 When specifically evaluating 2-tendon, revision repairs, Keener et al 17 reported a retear rate of 73%.…”

Section: Discussionmentioning

confidence: 99%

“…When evaluating revision repairs of all sizes, Willinger et al 33 reported a retear rate of 56% and Shamsudin et al 29 reported a retear rate of 40% without graft augmentation. 29,33 When specifically evaluating 2-tendon, revision repairs, Keener et al 17 reported a retear rate of 73%. Data on revision rotator cuff repair augmented with human dermal allograft are limited to a study by Hohn et al 14 The authors evaluated all revision repairs .2 cm and reported a retear rate of 31%.…”

Section: Discussionmentioning

confidence: 99%

Healing and Functional Results of Dermal Allograft Augmentation of Complex and Revision Rotator Cuff Repairs

et al. 2021

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Background: Primary rotator cuff repairs in complex cases (older patient age, larger tear sizes, chronic tears) and revision repairs are at high risk for failure of healing. Purpose: To examine clinical outcomes and healing rates in complex and revision rotator cuff repairs with dermal allograft augmentation. Study Design: Case series; Level of evidence, 4. Methods: A retrospective study was made of cases performed by 3 fellowship-trained surgeons via a uniform technique involving rotator cuff repairs with allograft augmentation. In all cases, a 1.5-mm, human, decellularized dermal graft was tied on top of the tendon at the medial row and compressed to the rotator cuff footprint using a double-row technique. Postoperative magnetic resonance imaging (MRI) was performed at a minimum of 6 months and American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and 12-Item Short Form Health Survey scores were collected at a minimum of 2 years postoperatively. Results: A total of 35 patients (23 revision repairs, 12 primary complex repairs) were included. The mean patient age was 57.9 years (range, 41.0-70.5 years). All shoulders had 2-tendon tears (supraspinatus and infraspinatus), and 8 included the upper 50% of the subscapularis. At a minimum of 2 years after surgery (mean, 3.2 years), mean ASES and SANE scores improved from 42.4 and 35.3 to 77.6 and 73.5, respectively ( P < .001). In the 23 patients (66%) with postoperative MRI evaluation, 11 (48%) had images showing the tendons were retorn. ASES (89.7 vs 66.4; P = .04) and SANE (84.1 vs 50.5; P = .02) scores were higher in healed patients than those with retears. The retear group had a higher degree of preoperative fatty atrophy of the infraspinatus ( P = .024). Conclusion: Double-row arthroscopic repair with dermal allograft augmentation of complex and revision rotator cuff tears led to improved functional outcomes. Approximately half of patients experienced a failure of healing, which was associated with poorer functional results.

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Clinical Outcomes, Tendon Integrity, and Shoulder Strength After Revision Rotator Cuff Reconstruction: A Minimum 2 Years’ Follow-up

Cited by 25 publications

References 45 publications

Contrast‐Enhanced Ultrasound (CEUS) as Predictor for Early Retear and Functional Outcome After Supraspinatus Tendon Repair

Contrast‐Enhanced Ultrasound (CEUS) as Predictor for Early Retear and Functional Outcome After Supraspinatus Tendon Repair

Revision Rotator Cuff Repair Versus Primary Repair for Large to Massive Tears Involving the Posterosuperior Cuff: Comparison of Clinical and Radiological Outcomes

Healing and Functional Results of Dermal Allograft Augmentation of Complex and Revision Rotator Cuff Repairs

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