Magnetic Resonance Imaging of Arthroscopic Supraspinatus Tendon Repair

Liem, Dennis; Lichtenberg, Sven; Magosch, Petra; Habermeyer, Peter

doi:10.2106/jbjs.f.00749

Cited by 221 publications

(147 citation statements)

References 25 publications

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“…Fatty infiltration and rotator cuff atrophy have been shown to affect healing and functional outcomes following rotator cuff repair [10,22,23] . Thomazeau et al [22] demonstrated that more severe preoperative atrophy was associated with worse postoperative repair integrity in 30 open repairs of chronic supraspinatus [10] , in a series of 53 arthroscopic repairs of isolated supraspinatus tears, reported that both supraspinatus atrophy and fatty infiltration were predictive of healing.…”

Section: Fatty Infiltration and Rotator Cuff Atrophymentioning

confidence: 99%

“…Thomazeau et al [22] demonstrated that more severe preoperative atrophy was associated with worse postoperative repair integrity in 30 open repairs of chronic supraspinatus [10] , in a series of 53 arthroscopic repairs of isolated supraspinatus tears, reported that both supraspinatus atrophy and fatty infiltration were predictive of healing. Goutallier et al [23] , in a series of 220 shoulders, demonstrated that the likelihood of recurrent tear was greater in patients whose muscle demonstrated more advanced degrees of fatty atrophy.…”

Section: Fatty Infiltration and Rotator Cuff Atrophymentioning

confidence: 99%

“…Patients with a greater degree of fatty degeneration, however, were less likely to benefit from surgical intervention than those with less fatty degeneration [24] . Other studies have also shown that patients with fatty infiltration and rotator cuff atrophy have lower rates of tendon healing associated with inferior clinical outcomes [10,25] . Goutallier grade 2 or higher degrees of fatty infiltration are significantly associated with poorer healing after repair [10] .…”

Section: Fatty Infiltration and Rotator Cuff Atrophymentioning

confidence: 99%

“…Other studies have also shown that patients with fatty infiltration and rotator cuff atrophy have lower rates of tendon healing associated with inferior clinical outcomes [10,25] . Goutallier grade 2 or higher degrees of fatty infiltration are significantly associated with poorer healing after repair [10] . Although rotator cuff atrophy and fatty infiltration are both considered part of the same process, they have been found to independently predict outcome following rotator cuff repair [25] .…”

Section: Fatty Infiltration and Rotator Cuff Atrophymentioning

confidence: 99%

“…Failure of tendon healing does not necessarily preclude satisfactory results, although improved results have been associated with intact repairs [9,10] . There is a large body of literature demonstrating that a number of different factors may influence the results following rotator cuff repair.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Fatty Infiltration and Rotator Cuff Atrophymentioning

confidence: 99%

Section: Fatty Infiltration and Rotator Cuff Atrophymentioning

confidence: 99%

Section: Fatty Infiltration and Rotator Cuff Atrophymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Factors affecting healing after arthroscopic rotator cuff repair

Abtahi

Granger

Tashjian

2015

WJO

162

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Refixation of the supraspinatus tendon in a rat model—influence of continuous growth factor application on tendon structure

Buchmann

Sandmann

Walz

et al. 2012

Journal Orthopaedic Research

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ABSTRACT:The purpose was to evaluate histological changes of the supraspinatus tendon (SSP) after refixation under continuous growth factor application over 20 days in comparison to the native healing process. In a chronic rat tendon tear model (15 rats/group), a transosseous SSP refixation was performed and growth factors (control, G-CSF, b-FGF, combination) were continuously released into the subacromial space by an osmotic pump. Tendon healing was evaluated histologically by a modified MOVIN-Score, and Collagen I/ III content was determined by immunohistology at 6 weeks. A modified MOVIN sum score showed significant lower counts for G-CSF and b-FGF in comparison to the control group (p ¼ 0.050/p ¼ 0.027) and the combined group (p ¼ 0.050/p ¼ 0.043). Collagen III was significantly reduced in the combined group compared to the control group (p ¼ 0.028). Collagen I showed no significant differences. The Collagen I/III ratio was nearly doubled for b-FGF and the combined group compared to the control. At the study endpoint, 33% of pump dislocations were detected. The continuous application of both isolated growth factors (G-CSF/b-FGF) achieved improved tendonremodeling. However, the continuous application via an osmotic pump showed a relative high dislocation rate when applied in the rat model. ß

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Botulinum toxin is detrimental to repair of a chronic rotator cuff tear in a rabbit model

Gilotra

Nguyen

Christian

et al. 2015

Journal Orthopaedic Research

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Re-tear continues to be a problem after rotator cuff repair. Intramuscular botulinum toxin (Botox) injection can help optimize tension at the repair site to promote healing but could have an adverse effect on the degenerated muscle in a chronic tear. We hypothesized that Botox injection would improve repair characteristics without adverse effect on the muscle in a chronic rotator cuff tear model. The supraspinatus tendon of both shoulders in 14 rabbits underwent delayed repair 12 weeks after transection. One shoulder was treated with intramuscular Botox injection and the other with a saline control injection. Six weeks after repair, outcomes were based on biomechanics, histology, and magnetic resonance imaging. Botox-treated repairs were significantly weaker (2.64 N) than control repairs (5.51 N, p ¼ 0.03). Eighty percent of Botox-treated repairs and 40% of control repairs healed with some partial defect. Fatty infiltration of the supraspinatus was present in all shoulders (Goutallier Grade 3 or 4) but was increased in the setting of Botox. This study provides additional support for the rabbit supraspinatus model of chronic cuff tear, showing consistent fatty infiltration. Contrary to our hypothesis, Botox had a negative effect on repair strength and might increase fatty infiltration. Keywords: chronic rotator cuff tear; rotator cuff repair; botulinum toxin; fatty infiltration; rabbit model Rotator cuff symptoms are the most commonly presenting complaints regarding the shoulder.1 Failure of rotator cuff repair continues to be a problem that has both clinical and economic implications.2 Chronic tears often lead to fatty degeneration of muscle, which is a poor prognostic factor for healing. [3][4][5] Modulating the mechanical environment has been postulated as a way of overcoming rotator cuff biology and improving results after chronic repair. Botulinum toxin A (Botox) has been explored as a means of bioprotection or partial paralytic internal immobilization in the setting of tendon healing, with conflicting results. [6][7][8][9] In the setting of a rodent acute rotator cuff model, however, healing occurs quickly and it is difficult to assess a re-tear. 9No published studies to date have explored the effect of Botox on chronic rotator cuff repair. Our main goal was to explore the effects of a single intramuscular Botox injection at the time of chronic rotator cuff repair in a well-established rabbit model. 10,11 We hypothesized that Botox injection into the rabbit supraspinatus muscle reduces the active contractile force of the muscle, allowing for improved healing at the rotator cuff insertion in a chronic repair model. We also thought that the muscle with baseline fatty atrophy after chronic injury would not suffer further permanent injury after the chemically denervating effects of botulinum toxin.

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Magnetic Resonance Imaging of Arthroscopic Supraspinatus Tendon Repair

Cited by 221 publications

References 25 publications

Factors affecting healing after arthroscopic rotator cuff repair

Factors affecting healing after arthroscopic rotator cuff repair

Refixation of the supraspinatus tendon in a rat model—influence of continuous growth factor application on tendon structure

Botulinum toxin is detrimental to repair of a chronic rotator cuff tear in a rabbit model

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