Comparison of Structural Integrity and Functional Outcome Between Delaminated and Nondelaminated Rotator Cuff Tears After En Masse Arthroscopic Repair: A Retrospective Cohort Study With Propensity Score Matching

Kim, Young-Kyu; Jung, Kyu-Hak; Kwon, Hyuk-Min

doi:10.1177/0363546519838257

Cited by 14 publications

(17 citation statements)

References 49 publications

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“…For convenient statistical analysis of internal rotation at the back, vertebral levels were assigned the following numbers: levels above T12 as 5, T12-L1 as 4, L2-L3 as 3, L4-L5 as 2, and levels below the sacrum as 1. 11…”

Section: Methodsmentioning

confidence: 99%

“…Multivariate logistic regression was used to calculate propensity scores based on patient-related factors that affect rotator cuff healing. 11 These factors were age, sex, dominant hand, smoking status, sports activity, occupation, diabetes mellitus, and tear size. Sports activity was categorized as contact sports, overhead activities with objects (ie, baseball, badminton, and tennis), fitness or swimming, and never.…”

Section: Propensity Score-matched Groupmentioning

confidence: 99%

“…21 En masse repair is performed by passing a suture through the bursal and articular layers simultaneously. 19 Although en masse repair shows favorable results, 10,11,19 individual repair of each layer, known as layer-by-layer repair, has been recommended for anatomic restoration. 7,25 The goal of layered repair is to prevent tension and length mismatch between the layers.…”

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confidence: 99%

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A Propensity Score–Matched Comparison Between Knotless Layer-by-Layer and En Masse Suture Bridge Techniques for Delaminated Rotator Cuff Tears

2022

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Background: Because the articular layer is more prone to retraction than the bursal layer of the supraspinatus tendon, it is important to restore each layer anatomically while repairing delaminated rotator cuff tears (RCTs). Purpose: To compare clinical outcomes and tendon integrity between knotless layer–by–layer and conventional en masse repair techniques for delaminated RCTs. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed data from 174 consecutive patients with delaminated RCTs treated by arthroscopic suture bridge repair. Only 115 patients with medium to large supraspinatus tears with delamination were included. The 33 patients treated using the knotless layer–by–layer technique (group 2) were matched 1:1 with patients treated using en masse repair with the suture bridge technique (group 1) based on propensity scores. Tendon thickness was measured on magnetic resonance imaging (MRI). Signal changes in the bursal, articular, and intratendinous layers were assessed using T2-weighted MRI. Results: Postoperatively, statistically significant improvements were seen in both groups compared with preoperatively functional scores. At the final follow–up, there was a statistically significant difference in the Constant score, which was higher in group 2 than in group 1 (91.4 ± 6.0 and 84.3 ± 16.4, respectively; P = .005). There was 1 case of a retear in each group, representing a 3% retear rate. Group 2 had thicker tendons than group 1 (6.9 ± 1.1 and 6.0 ± 1.2 mm, respectively; P = .017). On T2-weighted MRI, a low signal intensity in the articular layer was more common in group 2 ( P = .046). Conclusion: En masse repair using the suture bridge technique and the knotless layer–by–layer technique were both effective. Regarding tendon healing, no significant differences were seen in retear rates. However, superior results in terms of the Constant score, tendon thickness, and signal intensity in the articular layer were observed using the knotless layer–by–layer technique.

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Section: Methodsmentioning

confidence: 99%

Section: Propensity Score-matched Groupmentioning

confidence: 99%

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confidence: 99%

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A Propensity Score–Matched Comparison Between Knotless Layer-by-Layer and En Masse Suture Bridge Techniques for Delaminated Rotator Cuff Tears

2022

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“…For internal rotation at the back, we converted the vertebral level to a number for convenience of statistical analysis of internal rotation as follows: levels above T12 were numbered 5, levels T12 to L1 as 4, L2 to L3 as 3, L4 to L5 as 2, and levels below sacrum as 1. 16,21 Also, functional scores including American Shoulder and Elbow Surgeons (ASES) score, Constant shoulder score, and University of California Los Angeles (UCLA) scores were evaluated preoperatively and at final follow-up (minimum follow-up of 2 years, mean follow-up 32 months).…”

Section: Clinical Assessmentmentioning

confidence: 99%

“…9,24,26 Delamination is a concern because it is considered a negative prognostic factor after rotator cuff repair. 16,25 In a histologic study by Sonnabend et al, 27 synovium-like cells reportedly lined the delaminated layer, which could interrupt tendon-to-bone healing after repair. Boileau et al 3 showed that tendon healing was negatively affected when the infraspinatus tendon was delaminated.…”

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confidence: 99%

Surgical Treatment Outcomes for Everted Bursal Flap of Delaminated Supraspinatus Tear

Kim

Byun

Han

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Although everted bursal flaps of delaminated tears have been reported, few studies have reported radiologic images, arthroscopic findings, and clinical results after repair. Purpose: To compare the repair outcomes of everted delaminated tears with those of classic delaminated supraspinatus tears. Study Design: Cohort study; Level of evidence, 3. Methods: Among 153 patients who underwent arthroscopic rotator cuff repair for a delaminated supraspinatus tear, everted bursal flap tears were observed in 24 patients upon arthroscopy (group A). Another 24 patients with classic delaminated supraspinatus tears, matched for age and sex, were selected for group B. Magnetic resonance imaging (MRI) and ultrasonography were performed preoperatively and postoperatively. Patients were evaluated using a visual analog scale (VAS) for pain as well as functional scores (American Shoulder and Elbow Surgeons [ASES] score, Constant score, and University of California Los Angeles shoulder score). Scores were compared preoperatively and at final follow-up (mean follow-up, 32 months). Results: Patients in both groups A and B reported improved VAS and functional scores at the final follow-up. In group A, preoperative VAS scores were higher and functional scores were poorer than in group B. Subacromial effusions with tendon swelling on preoperative MRI were more common in group A. During follow-up ultrasonography, group A patients exhibited persistent subacromial effusion. However, VAS scores at final follow-up were significantly better in group A (0.4 ± 0.7) than in group B (1.6 ± 1.4) ( P < .001), and ASES scores at final follow-up were better in group A (84.3 ± 4.3) than in group B (77.0 ± 10.2) ( P = .005). Conclusion: Everted bursal flap delaminated tears were associated with higher VAS scores and poorer functional scores preoperatively. Although subacromial effusions were experienced by group A during the early postoperative period, clinical outcomes at final follow-up were significantly better for everted delaminated tears compared with classic delaminated tears.

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Delamination of rotator cuff tears: Real‐time dynamic ultrasound findings

Wang

Teng

Fang

et al. 2023

J of Clinical Ultrasound

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Purpose The purpose of this study was to evaluate the value of diagnosing delaminated tears and ultrasonic characteristics on real‐time dynamic ultrasound. Materials and Methods We enrolled 143 consecutive patients who underwent arthroscopic rotator cuff repair between April 2020 and January 2021. All patients were examined using real‐time dynamic ultrasound of the shoulder within 2 weeks before arthroscopy. In our study, delaminated tears were defined as intratendinous horizontal splitting with or without the retraction of the articular or bursal layer of tendon. Delaminated tears were classified into three types on the basis of their shape: greater retraction of the articular layer (type I), greater retraction of the bursal layer (type II), and equal retraction of both layers (type III). The sensitivity and specificity of real‐time dynamic ultrasound for evaluation of delaminated tears were calculated using arthroscopy findings as the gold standard. Ultrasonic imaging appearances of delaminated rotator cuff tears were further described. Results Of the 143 patients, 47 (32.9%) had delaminated tears as confirmed by arthroscopy; 35 of these tears involved the supraspinatus tendon and 12 involved both supraspinatus and infraspinatus tendons. Real‐time dynamic ultrasound correctly diagnosed 36 of 47 delaminated tears with sensitivity 72.0% (57.2%–83.3%) and specificity 96.7% (90.2%–99.2%). Moreover, type I tear (n = 32) was more common than type II (n = 11) and type III tears (n = 4). Real‐time dynamic ultrasound evaluated shape of type I, type II, and type III with a sensitivity and specificity of 56% and 80%, 72% and 83%, and 100% and 98%, respectively. Anechoic horizontal linear splitting of tendon, unequal retraction of the bursal and articular layers, and thinning of the suffering tendon were the three signs observed during real‐time dynamic ultrasound examination. These three signs were indicative of a diagnosis of delaminated rotator cuff tears with high specificities (100.0%, 100.0%, and 97.9%, respectively) but relatively low sensitivities (25.5%, 25.5%, and 36.2%, respectively). Conclusion Real‐time dynamic ultrasound can be practically used for diagnosing delamination of rotator cuff tears with medium sensitivity and high specificity. Anechoic horizontal linear splitting of tendon, unequal retraction of the bursal and articular layers, and thinning of the involved tendon are the three important ultrasonic signs for diagnosis of delaminated rotator cuff tears.

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Comparison of Structural Integrity and Functional Outcome Between Delaminated and Nondelaminated Rotator Cuff Tears After En Masse Arthroscopic Repair: A Retrospective Cohort Study With Propensity Score Matching

Cited by 14 publications

References 49 publications

A Propensity Score–Matched Comparison Between Knotless Layer-by-Layer and En Masse Suture Bridge Techniques for Delaminated Rotator Cuff Tears

A Propensity Score–Matched Comparison Between Knotless Layer-by-Layer and En Masse Suture Bridge Techniques for Delaminated Rotator Cuff Tears

Surgical Treatment Outcomes for Everted Bursal Flap of Delaminated Supraspinatus Tear

Delamination of rotator cuff tears: Real‐time dynamic ultrasound findings

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