Is the Supraspinatus Muscle Atrophy Truly Irreversible after Surgical Repair of Rotator Cuff Tears?

Chung, Seok Won; Kim, Sae Hoon; Tae, Suk Kee; Yoon, Jong Pil; Choi, Jung Ah; Oh, Joo Han

doi:10.4055/cios.2013.5.1.55

Cited by 46 publications

(37 citation statements)

References 27 publications

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“…Fatty infiltration was not reversible but progressed less in patients with intact repairs. Chung et al [28] reported, in a series of 191 patients who underwent arthroscopic rotator cuff repair, that 42.4% of patients showed improvement of atrophy and 17.3% of patients showed worsening. The change in atrophy was related to repair integrity.…”

Section: Fatty Infiltration and Rotator Cuff Atrophymentioning

confidence: 99%

Factors affecting healing after arthroscopic rotator cuff repair

Abtahi

Granger

Tashjian

2015

WJO

162

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Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymal stem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair. Core tip: Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscletendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing after rotator cuff repair. Smoking cessation and blood glucose and cholesterol control are methods to potentially improve healing rates. Slower, less aggressive rehabilitation programs may improve healing rates with no negative effect on final range of motion and are therefore recommended after arthroscopic repair of most full thickness tears. Finally, no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates after rotator cuff repair. Routine use of these adjuvants is therefore not currently recommended.

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Section: Fatty Infiltration and Rotator Cuff Atrophymentioning

confidence: 99%

Factors affecting healing after arthroscopic rotator cuff repair

Abtahi

Granger

Tashjian

2015

WJO

162

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“…A recent study reported that muscle atrophy measured with occupation ratio was reversible. 30) They showed that 42.4% of patients had improved and 17.3% had worsened at minimum 1-year follow-up, while in the current study, 26.6% and 21.5% of patients showed improvement and worsening, respectively. They concluded that muscle atrophy could be improved in cases of successful rotator cuff repair.…”

Section: Discussionmentioning

confidence: 70%

Minimal Medial-row Tie with Suture-bridge Technique for Medium to Large Rotator Cuff Tears

Lee

Ryu²,

Shim

et al. 2015

Clinics in Shoulder and Elbow

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Background: The purpose of this study was to evaluate the postoperative magnetic resonance imaging (MRI) results of minimal-tying (one medial-row tie among 4 medial-row sutures) on the medial-row in double-row suture-bridge configuration (2×2 anchor with 4×4 suture stands). Methods: From 2011 March to 2012 July, 79 patients underwent arthroscopic rotator cuff repair using 2×2 anchor double-row configuration. The mean age was 61.3 years (range, 31-81 years). Two double-loaded suture anchors were used for medial-row. Four medialrow stitches were made with only one medial-row knot-tying (the most anterior suture). Lateral-row was secured using the conventional suture-bridge anchor technique; all 4 strands were used for each anchor. Repair integrity was evaluated with MRI at mean 6.2 months postoperatively. Retear and the pattern of retear, change of fatty infiltration, and muscle atrophy of supraspinatus were evaluated using pre-and postoperative MRI. Results: Repaired tendon integrity was 38 for type I, 30 for type II, 6 for type III, 4 for type IV, and 1 for type V, according to Sugaya classification. Considering type IV/V as retear, the rate was 6.3% (5 out of 79 patients). Medial cuff failure was observed in 4 patients. Fatty atrophy of supraspinatus was significantly improved postoperatively according to Goutallier grading (p=0.01). The level of muscle atrophy of supraspinatus was not changed significantly after surgery. Conclusions: Minimal tying technique with suture configuration of four-by-four strand double-row suture-bridge yielded a lower retear rate (6.3%) in medium to large rotator cuff tears. (Clin Shoulder Elbow 2015;18(4):197-205)

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“…There are conflicting data on the progression of atrophy following rotator cuff repairs: some studies report muscle atrophy worsens and does not improve after successful repair 35,36 , while other studies report muscle atrophy improves after successful cuff repair [37][38][39] . In our acute repair sheep model, we observed significant increases in atrophy-related gene expression of MuRF-1 and MAFbx.…”

Section: Discussionmentioning

confidence: 99%

Muscle atrophy and fatty infiltration after an acute rotator cuff repair in a sheep model

Liu

Easley

Ravishankar

et al. 2015

MLTJ

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Muscle atrophy and fatty infiltration after an acute rotator cuff repair in a sheep model tration, and fibrosis related genes. Significantly increased adipocytes, muscle fatty infiltration, and collagen deposition was observed in rotator cuff muscles in the tendon repair group compared to the control group. Conclusions: rotator cuff muscle undergoes degradation changes including fatty infiltration and fibrosis even after the tendons are repair immediately after rupture. Level of Evidence: Basic Science Study. IntroductionRotator cuff tears (RCTs) are the most common shoulder injury seen by orthopedic surgeons and are especially frequent among the aging patient population. The prevalence of full thickness RCTs is estimated between 15 and 51%, with higher rates in the elderly population 1 . Although repair of small tears is successful in alleviating pain and improving shoulder biomechanics, successful repair of larger RCTs still remains a challenge 2,3 . As the incidence of rotator cuff injuries continues to rise with an aging patient population, management and knowledge of the etiopathogenesis of RCTs 4 is a topic of concern. Several muscle-based factors have been identified to affect the outcome of rotator cuff repairs. It has been demonstrated that the degree of atrophy correlates with the size of the tear and, more importantly, with clinical outcomes 5,6 . Similarly, fatty infiltration has been shown to also correlate with poor outcomes following rotator cuff repair 6,7 . Although the clinical effects of muscle fibrosis on rotator cuff injuries are not well quantified, muscle fibrosis is an important contributor to muscle stiffness and is seen in many other muscle injury models 8 . Thus, these three physiological traits, muscle atrophy, fatty infiltration, and muscle fibrosis, are likely key factors governing outcome after rotator cuff injury and repair. Animal models are useful tools to study the molecular mechanisms of muscle atrophy, fatty infiltration, and fibrosis that are observed in the setting of rotator cuff tears in patients. While there are multiple RCTs studies conducted in rat or mouse models 9-12 , the sheep model, as a larger animal model, may more closely mirror the pathophysiologic changes observed in human RCTs 13 since the infraspinatus tendons of sheep SummaryIntroduction: rotator cuff tears (RCTs) are the most common tendon injury seen in orthopedic patients. Muscle atrophy and fatty infiltration of the muscle are crucial factors that dictate the outcome following rotator cuff surgery. Though less studied in humans, rotator cuff muscle fibrosis has been seen in animal models as well and may influence outcomes as well. The purpose of this study was to determine if the rotator cuff would develop muscle changes even in the setting of an acute repair in a sheep model. We hypothesized that fatty infiltration and fibrosis would be present even after an acute repair six months after initial surgery. Methods: twelve female adult sheep underwent an acute rotator cuff tear and immediate repair on ...

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Is the Supraspinatus Muscle Atrophy Truly Irreversible after Surgical Repair of Rotator Cuff Tears?

Cited by 46 publications

References 27 publications

Factors affecting healing after arthroscopic rotator cuff repair

Factors affecting healing after arthroscopic rotator cuff repair

Minimal Medial-row Tie with Suture-bridge Technique for Medium to Large Rotator Cuff Tears

Muscle atrophy and fatty infiltration after an acute rotator cuff repair in a sheep model

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