Evaluating strategies and outcomes following rotator cuff tears

Abstract

Introduction: Rotator cuff tear surgical repair techniques have significantly progressed. However, tendon retear following primary repair persistently occurs at high rates. Rehabilitation protocols, surgical fixation techniques, biologic therapy with scaffolds, platelet-rich plasma, and even stem cell applications are under study to promote adequate tendon healing. Methods: A nonsystematic query of the PubMed database was conducted in July 2016 utilizing the search terms ''rotator cuff repair,'' ''tear,'' ''rehabilitation,'' ''scaffold,'' ''platelet-rich plasma,'' and ''stem cell'' to identify, analyze, and summarize relevant studies. Conclusion: Individualized rehabilitation protocols may be the best approach for small to medium sized tears. Surgical fixation will continue to be debated as modifications to single-row technique and increases in suture number have improved tensile strength. Double-row repairs have been associated with higher costs. Transosseous equivalent technique exhibits comparable subjective and objective outcomes to single-and double-row repair at two-year follow-up. Biocompatible scaffold augmentation has showed inconsistent short-term results. Platelet-rich plasma has lacked uniformity in treatment preparation, administration, and outcome measurement with mixed results. Few human studies have suggested decreased retear rates and improved repair maintenance following bone marrow-derived mesenchymal stem cell augmentation. This review reiterated the necessity of additional high-quality, large-sample studies to develop any final verdict regarding efficacy.

Assessment of abduction motion in patients with rotator cuff tears: an analysis based on inertial sensors

“…In this line, the present multivariate model could be employed to shoulder assessment along the time or after treatment. For example, shoulder healing after surgery is of great interest to determine which surgical repair techniques are the best for tendon repair [39] or to maintain its integrity [40]. Furthermore, it is important to determine the effect of post-surgical rehabilitation [41–43], and current research is focused on clinical outcomes including both PRO and ROM [44, 45].…”

The role of scapular dyskinesis on rotator cuff tears: a narrative review of the current knowledge

“…Tear severity can be considered a determining factor: individualized early rehabilitation protocols may be the best approach to promote an early functional shoulder for small to medium tears, but delayed therapy is preferred for large tears in the postoperative period, to provide adequate time for tendon healing. 35 …”

“…The reported retear risk following RCT surgical reparation varied from 10.3% to 94%. 35 , 40 , 41 This disparity present across studies probably results from a non-uniformity regarding the retear definition, tear sizes considered, surgical and postoperative imaging techniques, and many other criteria, and reflects the multifactorial character of retearing. 35 , 40 , 41 …”

Artroplastia reversa de ombro: Avaliação dos resultados clínicos e funcionais de acordo com a etiologia

“…A artroplastia reversa do ombro (ARO) foi desenvolvida em 1985 por Grammont et al 1 Seu princípio se baseia na medialização e inferiorização do centro de rotação da articulação glenoumeral, mecanismo que aumenta o braço de alavanca e o momento de força do deltoide, compensando o manguito rotador (MR) insuficiente. 1,2 Além da artropatia do manguito rotador (AMR), [3][4][5] atualmente suas indicações incluem lesões extensas do MR, 3,5,6 sequelas de fraturas, 3,7 artropatias inflamatórias, 3 fraturas graves da extremidade proximal do úmero, 3,5 revisão de artroplastias primárias 3,5 e reconstrução após ressecção tumoral. 3,5 Este procedimento é indicado principalmente aos pacientes idosos com função do ombro diminuída e elevação anterior ativa menor que 90°, 3 sendo contraindicado caso haja ausência ou comprometimento grave da contração do deltoide.…”