Pre-operative factors correlated with arthroscopic reparability of large-to-massive rotator cuff tears

Kuptniratsaikul, Vanasiri; Laohathaimongkol, Thongchai; Umprai, Vantawat; Yeekian, Chuenrutai; Prasathaporn, Niti

doi:10.1186/s12891-019-2485-4

Cited by 35 publications

(21 citation statements)

References 35 publications

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“…24 Pre-operative factors associated with the inferior reparability of large and massive tears include age greater than 65 years, mediolateral tear size of 36 mm, anteroposterior tear size of 22 mm, and stage 3 and 4 supraspinatus fatty infiltration. 25 Consequently, the potential benefits of early intervention need to be discussed with patients and future research assessing the effects of immediate versus delayed repair is required.…”

Section: Patient Factors and Clinical Decision Makingmentioning

confidence: 99%

Use of biologics in rotator cuff disorders: Current concept review

Rohman

Snow

2021

Journal of Clinical Orthopaedics and Trauma

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Poor tendon to bone healing following rotator cuff repair has led to the continued interest and investigation into biological augmentation. The biology of tendinopathy is not fully understood and consequently the availability of disease modifying therapeutic targets is limited. A ceiling of benefit has been reached by mechanical optimisation of rotator cuff repair and thus, in order to improve healing rates, a biological solution is required. This review focuses on the strategies to biologically augment rotator cuff disorders with an emphasis on rotator cuff repair. Leucocyte rich platelet rich plasma has been shown to improve healing rates without clinically relevant improvements in outcome scores. Similarly, improved healing rates have also been reported with bone marrow stimulation and in long-term follow-up with bone marrow concentrate. Extracellular matrix (ECM) and synthetic scaffolds can increase healing through mechanical and or biological augmentation. A potential third category of scaffold is bioinductive and has no mechanical support. Studies involving various scaffolds have shown promising results for augmentation of large to massive tears and is likely to be most beneficial when tendon quality is poor, however level I evidence is limited.

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Section: Patient Factors and Clinical Decision Makingmentioning

confidence: 99%

Use of biologics in rotator cuff disorders: Current concept review

Rohman

Snow

2021

Journal of Clinical Orthopaedics and Trauma

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“…Therefore, the resulting area calculation assumes a square, 2-dimensional tear shape, while shape variations in individual tear defect configurations exist. Still, the authors felt that the arthroscopically determined square centimeter measurements of tear size were an improvement over other methods, such as nonquantitative, unidirectional, or solely derived from magnetic resonance imaging, to describe rotator cuff tear size 25 , 26 , 27 and allowed the authors to reproducibly define both the initial and residual rotator cuff tear defects that were present. Also, the arthroscopic measurements were taken to an accuracy of 1 cm, thus introducing a “rounding error” that contributes to inaccuracy within the tear area calculation.…”

Section: Discussionmentioning

confidence: 99%

Partial Rotator Cuff Repair for Massive Tears Rarely Require Revision Surgery

Hallock

Parsell

Field

2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To determine the significance of initial and residual rotator cuff tear defect size on the need for revision surgery or additional nonsurgical therapy, in a consecutive group of patients undergoing partial repair of massive rotator cuff tears. Methods A retrospective chart review was carried out for all arthroscopic rotator cuff repairs performed by a single surgeon between January of 2013 and December of 2016. All patients with massive rotator cuff tears (>30 cm 2 ) who underwent partial repair were included in the study. Outcomes for the surgical procedure were measured based on the necessity for revision surgery or adjunct therapy, including steroid injections or additional physical therapy after initial release from care. Results In total, 1954 patients who underwent arthroscopic rotator cuff repair were identified. Thirty-eight of these met the inclusion criteria. Those patients undergoing revision surgery represented 5.2% (2/38) of the series and had an average initial/residual tear defect area of 45.0/7.0 cm 2 . Patients requiring adjunct therapy represented 7.9% (3/38) of the series and possessed an average initial/residual tear defect size of 40.0/16.0 cm 2 . The remaining 33 (86.9%) patients did not require revision surgery or adjunct therapy at a minimum follow-up of 2 years. There was no significance between initial and/or residual rotator cuff tear defect size and the need for revision surgery. However, there was a significant difference in the mean residual defect size in the patients requiring additional nonoperative treatment after initial release from care ( P = .012). Conclusions There was no relationship between residual defect size after partial repair and the need for revision surgery. Patients who returned for additional nonoperative treatment after being released from care were noted to have a statistically larger residual defect size at the time of index surgical intervention. Only 5% of patients underwent subsequent surgery at an average of more than 4 years’ follow-up, suggesting that partial repair of massive rotator cuff tears can provide a durable, joint-preserving intervention. Level of Evidence Level IV, Therapeutic Case Series

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“…Approximately 40% of all RCTs were found to be large-to-massive in an observational study [ 5 ]. In order to improve shoulder pain and shoulder function, most patients with symptomatic large-to-massive RCTs are willing to undergo surgical repair; however, the degree of rotator cuff muscle atrophy and fatty infiltration affects surgical reparability [ 6 ]. Large-to-massive RCTs can be repaired completely in some clinical situations, but are sometimes irreparable because of severe muscle atrophy or poor tissue quality.…”

Section: Introductionmentioning

confidence: 99%

Predicting the surgical reparability of large-to-massive rotator cuff tears by B-mode ultrasonography: a cross-sectional study

Chen

et al. 2022

Ultrasonography

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To compare the predictability for surgical reparability of B-mode ultrasound and magnetic resonance imaging (MRI) in patients with large-to-massive rotator cuff tears (RCTs). MethodsThis was a cross-sectional study. Participants with large-to-massive RCTs who underwent arthroscopic repair were included. B-mode ultrasound and MRI were conducted prior to arthroscopic repair. B-mode ultrasound was used to evaluated the echogenicity of rotator cuff muscle using the Heckmatt scale. The intra-rater and inter-rater reliabilities were examined by two independent physicians. MRI was used to evaluate the degrees of tendon retraction, fatty Conclusion B-mode ultrasound was a reliable examination tool and had a similar predictive ability of surgical reparability to that of MRI among patients with large-to-massive RCTs.

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Pre-operative factors correlated with arthroscopic reparability of large-to-massive rotator cuff tears

Cited by 35 publications

References 35 publications

Use of biologics in rotator cuff disorders: Current concept review

Use of biologics in rotator cuff disorders: Current concept review

Partial Rotator Cuff Repair for Massive Tears Rarely Require Revision Surgery

Predicting the surgical reparability of large-to-massive rotator cuff tears by B-mode ultrasonography: a cross-sectional study

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