How Much Will High Tension Adversely Affect Rotator Cuff Repair Integrity?

Park, Sam-Guk; Shim, Bum-Jin; Seok, Hyun-Gyu

doi:10.1016/j.arthro.2019.05.049

Cited by 42 publications

(32 citation statements)

References 26 publications

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“…A recent study by Park et al 20 found that the repair tension was the most important factor for the integrity of rotator cuff repair. Consequently, a medial row sutures tied over an anatomically reduced tendon without over tension is the main goal.…”

Section: Discussionmentioning

confidence: 97%

Arthroscopic Linked Triple Row Repair for Large and Massive Rotator Cuff Tears

Morsy

Gawish

Galal

2021

Arthroscopy Techniques

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Recently, many arthroscopic techniques have been described to improve the outcomes in rotator cuff repair of large and massive tears; these include conventional double-row, suture bridge, and triple-row techniques, in an effort to optimally reconstruct the rotator cuff footprint and improve fixation. This report describes a modified triple-row repair technique that links the double-row and suture-bridge techniques in one construct, merging the advantages of both to maximize the footprint contact area and contact pressure, which may lead to better healing and faster rehabilitation.

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Section: Discussionmentioning

confidence: 97%

Arthroscopic Linked Triple Row Repair for Large and Massive Rotator Cuff Tears

Morsy

Gawish

Galal

2021

Arthroscopy Techniques

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“…This is attainable by placing a repositioning or reduction anchor before tying the medial row. A recent study by Park et al 29 found that repair tension was the most important factor for the integrity of rotator cuff repair.…”

Section: Discussionmentioning

confidence: 97%

Outcomes of the Star Repair for Large and Massive Rotator Cuff Tears: A Modified Triple-Row Technique

Morsy

Gawish

Galal

2020

Orthopaedic Journal of Sports Medicine

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Background: Large and massive rotator cuff repairs constitute a true challenge for arthroscopic shoulder surgeons. Retear rates as high as 20% have been reported after arthroscopic double-row and suture-bridge techniques used for these tears. Hypothesis: A modified triple-row repair will provide satisfactory clinical results with lower risk for retear. Study Design: Case series; Level of evidence, 4. Methods: Between March 2016 and August 2017, a total of 52 patients with large and massive rotator cuff tears received a modified triple-row cuff repair. A middle repositioning anchor was inserted between the medial and the lateral rows. The middle anchor sutures were loaded to lateral knotless anchors in a star-shaped configuration. Functional evaluation was performed using the American Shoulder and Elbow Surgeons score, University of California, Los Angeles score, Constant-Murley score, and Simple Shoulder Test. Subjective evaluation was carried out using a visual analog scale for pain and a subjective shoulder value score. Health-related as well as disease-specific quality-of-life scores were also used. Retear rates were assessed by means of musculoskeletal ultrasonography. Patients were evaluated for a minimum of 24 months. Results: This study included 34 female and 18 male patients with a mean age of 57.17 ± 6.7 years. There were 35 patients (67.3%) with large tears and 17 patients (32.7%) with massive tears. Significant improvement from preoperative values was seen in all functional and subjective scores ( P < .001). The mean forward flexion was 163° ± 9.7°, and the mean lateral abduction was 159.4° ± 9.4°. All patients had excellent scores on the general health-related and disease-specific quality-of-life scales. No retears were reported at the end of the follow-up period. Conclusion: The star-shaped, modified triple-row cuff repair is a valid and effective solution for surgical management of large and massive rotator cuff tears, providing excellent results and low risk for retears.

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“…I n their article "How Much of a High Tension Will Adversely Affect the Rotator Cuff Repair Integrity?" 1 Park, Shim, and Seok, from the Republic of Korea, have provided a quantitative perspective to the case for making every effort to minimize the tension required to approximate our rotator cuff repairs. In a single-surgeon series of 50 repairs of >3 cm tears that needed extensive soft-tissue releases to approximate the rotator cuff to the greater tuberosity, they found that when they applied the receiver operating curve method of statistical analysis to tendons that were healed versus those that re-tore (based on magnetic resonance imaging at more than 1 year postoperatively), the repairs that had greater tension (measured at the time of repair) were more often re-torn, with 35 N being the number bracketed by statistics as the bar to try to get below.…”

Section: See Related Article On Page 2992mentioning

confidence: 99%

“…The low end of their confidence interval is where I'm happiest with repair tension (5 N is a little over a pound) and is a number that those who measure tension intraoperatively should shoot for. Park et al 1 should be congratulated for beginning the process of nailing down the threshold tension, and I hope others measure and publish their results so that we can narrow the confidence intervals and increase our intraoperative confidence that we're doing everything possible to promote healing. Like other authors, Park et al 1 also found that even the patients who re-tore their cuffs did well according to patient-reported outcome measures, so we shouldn't abandon a repair attempt if things get tense.…”

Section: See Related Article On Page 2992mentioning

confidence: 99%

“…Park et al 1 should be congratulated for beginning the process of nailing down the threshold tension, and I hope others measure and publish their results so that we can narrow the confidence intervals and increase our intraoperative confidence that we're doing everything possible to promote healing. Like other authors, Park et al 1 also found that even the patients who re-tore their cuffs did well according to patient-reported outcome measures, so we shouldn't abandon a repair attempt if things get tense. I'm hoping my colleagues in Korea and throughout the world can next come up with novel ways to decrease the tension on our rotator cuff repairs at time zero so I and my patients can both feel more relaxed.…”

Section: See Related Article On Page 2992mentioning

confidence: 99%

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