Partial and Full-Thickness RCT: Modern Repair Techniques

Nathani, Amit; Smith, Kevin M.; Wang, Yichen

doi:10.1007/s12178-018-9465-4

Cited by 16 publications

(12 citation statements)

References 93 publications

(67 reference statements)

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“…The understanding of rotator cuff pathology and healing continues to evolve, beginning with emerging descriptions of the anatomic footprint and natural history of rotator cuff tears [1]. Shoulder anatomy, pathology, and biomechanics place unique stress on the rotator cuff tendons during sports activity [2], whereas smoking, hypercholesterolemia, and genetics have all been shown to influence the development of rotator cuff tearing [3].…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic partial repair for massive rotator cuff tears: does it work? A systematic review

Malahias

Kostretzis²,

Chronopoulos

et al. 2019

Sports Med - Open

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Background While arthroscopic complete repair of massive rotator cuff tears (MRCT) back to their anatomic footprint is preferential, there are cases where this type of repair is not applicable due to the contraction of the torn tendons. In such cases, a non-anatomic incomplete or partial repair can be performed. A number of clinical studies have investigated the clinical and functional outcomes of arthroscopic partial repair for irreparable MRCT. To our knowledge, no systematic review has been published yet to synthetically evaluate these results. Methods Two reviewers independently conducted the search in a PRISMA-compliant systematic way using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms “arthroscopy”[MeSH Terms] OR arthroscopic surgical procedure [Text Word (tw)] AND massive rotator cuff tears [tw] AND arthroscopic partial repair [tw]. Results From the 55 initial studies, we finally chose 11 clinical studies which were eligible to our inclusion-exclusion criteria. The mean modified methodology Coleman score was 58/100, whereas it ranged from 41/100 to 78/100. In total, 643 patients were included in this review. All postoperative mean clinical and functional subjective scores, as well as muscle strength of patients treated with arthroscopic partial repair, were found significantly improved, when compared with the respective mean preoperative values. The rate of structural failure of the partial repair, as it was estimated by postoperative imaging modalities, was 48.9%. The overall reoperations’ rate was 2.9% regarding the patients who were treated with partial repair. Conclusions Arthroscopic partial repair might be a safe and effective alternative treatment for irreparable contracted MRCT, where a complete repair cannot be performed. The methodological quality of the relevant, available literature is low to moderate; therefore, further studies of higher quality are required to confirm these results.

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Section: Introductionmentioning

confidence: 99%

Arthroscopic partial repair for massive rotator cuff tears: does it work? A systematic review

Malahias

Kostretzis²,

Chronopoulos

et al. 2019

Sports Med - Open

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“…The superiority of TTR or TCR for PT-RCT is still controversial as both techniques have yielded good results [ 27 , 28 , 45 ]. Kim et al compared TTR and TCR techniques in a prospective randomised controlled study reporting no differences in functional outcome but a significantly higher retear rate for bursal-side tears in TCR repair (23.3% vs. 3.3%) [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Mid-Term Outcomes after Arthroscopic “Tear Completion Repair” of Partial Thickness Rotator Cuff Tears

et al. 2021

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Background and Objectives: Different arthroscopic procedures are used for partial-thickness rotator cuff tears (PT-RCTs), but there is still no evidence on the superiority of one procedure over the other. The aim of this study was to evaluate the clinical outcomes and the rate of complications of a tear completion repair (TCR) technique. Materials and Methods: Patients who had undergone arthroscopic TCR technique for PT-RCTs with a follow-up of at least 2-years after surgery were included. The TCR technique involved the removal of the “critical zone” and creating microfractures to biologically support tendon healing. Functional outcomes were assessed prospectively by the Constant score (CS) and active and passive range of movement (ROM). Pain and patient satisfaction were measured using a visual analog scale (VAS). Complication rates were recorded, and tendon integrity was assessed with magnetic resonance imaging (MRI) or ultrasound performed at least 2-years after surgery. Results: Eighty-seven patients with a median age of 57 years were followed-up for a median of 5 years. The CS score improved from 53.5 preoperatively to 94.0 postoperatively (p < 0.001). Median VAS score decreased from 8.6 to 1.0 (p < 0.0001). Median patient satisfaction was 9.3. The overall complication rate was 14.9%. Conclusions: Patients with PT-RCTs of the supraspinatus tendon treated by the TCR technique with “critical zone” removal and biological stimulation by microfractures showed good functional results with excellent strength recovery, a high degree of patient satisfaction, and resolution of painful symptoms at mid-term follow-up.

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“…Rotator cuff tears may cause significant pain, decreased shoulder mobility, and irreparable damage to the glenohumeral joint. 37 Rotator cuff disorders are highly prevalent and represent the most common cause of shoulder disability in the United States. They are responsible for approximately 30% to 70% of shoulder pain-related conditions and 70% of shoulder-related physician visits while accounting for >4.5 million annual visits in the United States.…”

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confidence: 99%

“…31,48,56 Reimbursement from the Centers for Medicare & Medicaid Services for a hospital-based shoulder MRI (Current Procedural Terminology code 73221) ranges from $303.51 to $387.01, while reimbursement for a hospital-based shoulder US (Current Procedural Terminology code 76881) ranges from $144 to $189. 37. Studies have suggested that this difference may be even greater within private insurance, where the average MRI reimbursement is $999.67 per patient.…”

mentioning

confidence: 99%

Diagnostic Accuracy of Ultrasonography for Rotator Cuff Tears: A Systematic Review and Meta-analysis

Farooqi

Lee

Novikov

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears. Purpose: To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published between January 1, 2010, and April 1, 2020. The inclusion criteria were studies that evaluated the diagnostic accuracy of US for rotator cuff tears or biceps tendon tears utilizing arthroscopy as the reference standard. The exclusion criteria were studies with <10 patients, studies including massive tears without reporting diagnostic data for specific tendons, and studies lacking diagnostic outcome data. Extracted outcomes included diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value. The mean difference and 95% confidence interval were calculated for both US and MRI diagnostic values, and meta-analysis was conducted using the Mantel-Haenszel random-effects model. Results: In total, 23 eligible studies involving 2054 shoulders were included. US demonstrated a higher median diagnostic accuracy for supraspinatus tendon tears (0.83) and biceps tendon tears (0.93) as compared with subscapularis tendon tears (0.76). US was found to have a higher median accuracy (0.93) for full-thickness supraspinatus tears than partial-thickness tears (0.81). US had superior median sensitivity for partial-thickness supraspinatus tears when performed by radiologists as opposed to surgeons (0.86 vs 0.57). Meta-analysis of the 5 studies comparing US and MRI demonstrated no statistically significant difference in diagnostic sensitivity, specificity, or accuracy for any thickness supraspinatus tears (P = .31-.55), full-thickness tears (P = .63-.97), or partial-thickness tears ( P = .13-.81). Conclusion: For experienced operators, US is a highly sensitive and specific diagnostic modality for the diagnosis of supraspinatus tears and demonstrates statistically equivalent capability to MRI in the diagnosis of both full- and partial-thickness rotator cuff tears.

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Partial and Full-Thickness RCT: Modern Repair Techniques

Cited by 16 publications

References 93 publications

Arthroscopic partial repair for massive rotator cuff tears: does it work? A systematic review

Arthroscopic partial repair for massive rotator cuff tears: does it work? A systematic review

Mid-Term Outcomes after Arthroscopic “Tear Completion Repair” of Partial Thickness Rotator Cuff Tears

Diagnostic Accuracy of Ultrasonography for Rotator Cuff Tears: A Systematic Review and Meta-analysis

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