Prognostic factors affecting structural integrity after arthroscopic rotator cuff repair: a clinical and histological study

Wang, Pei Wei; Jo, Chris Hyunchul

doi:10.5397/cise.2022.01137

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…Management of MRCTs is a challenge, and different open and arthroscopic procedures have been described [15], including partial RC repair, use of autograft or allograft (decellularised patches, fascia lata or dermal grafts), tendon (latissimus dorsi muscle, pectoralis major or minor muscles) transfers, subacromial balloon spacers and reverse total shoulder arthroplasty [23,45,46,54]. Tendon-to-bone repair is advocated, showing better long-term results, but muscle fatty infiltration, excessive chronic retraction of the tendons, and their degeneration remain the main risk factors for failure of the repair [29,57].…”

Section: Introductionmentioning

confidence: 99%

Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved

Savarese,

Aicale,

Torsiello

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeManagement of massive rotator cuff tears (MRCTs) remains debated, and various arthroscopic and open techniques have been described for their management. Nevertheless, the optimal strategy remains unclear. The present study evaluated the clinical results in patients managed arthroscopically for MRCTs augmented with the long head biceps tendon (LHBT) at a minimum 1‐year follow‐up, considering different type of tears, demographic data and number of torn tendons.MethodsPatients treated in a secondary referral centre from January 2021 to April 2022 were enroled prospectively. Inclusion criteria were pain, inability to fully elevate the affected shoulder, irreparable tears and active and motivated patients. All patients were managed within 2 months from diagnosis in a single centre by the same surgeons. Preoperative shoulder radiographs and magnetic resonance imaging (MRI) were collected, and clinical assessment was also performed using the Numerical analogue scale (NAS), Constant score (CS) American Shoulder and Elbow Surgeons Shoulder Score (ASES). Tissue retraction and tendon fatty infiltration were evaluated using Patte and Fuchs scale, respectively. Clinical assessment was performed using the same scales at 3–6 months and 1‐year follow‐up.ResultsA total of 55 patients (31 female and 24 male) with a mean age of 60 ± 7.1 years were enroled for a mean follow‐up of 18.2 ± 4.3 months. The mean preoperative NAS was 7.8 ± 0.6, CS was 20.5 ± 7.6 and ASES was 22.6 ± 9.2, increasing, respectively, to 0.3 ± 0.6, 91.5 ± 6.9 and 94.2 ± 6.7. No adverse side effects (infection, rejection, allergy) were reported during the study period. All patients were evaluated after surgery at 3 and 6 months and 1 year with statistically significant improvement for each score at the first and last follow‐up (p < 0.05).ConclusionsThe use of LHBT augmentation in patients with MRCTs in appropriately selected patients is safe and effective and can lead to pain relief and acceptable clinical outcomes. Furthermore, its use carries low donor site morbidity and is cost effective. Comparative studies, including randomised controlled trials, with other proposed techniques are needed to confirm these findings.Level of EvidenceLevel IV.

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Section: Introductionmentioning

confidence: 99%

Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved

Savarese,

Aicale,

Torsiello

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“… 3 15 16) If we can predict the destiny of untreated subscapularis after repair of the torn supraspinatus and identify factors related to the pathologic changes in the subscapularis, it could aid in the detection of a concealed lesion or indications for voluntary treatment of the subscapularis along with supraspinatus repair. 17 18 19) The purpose of this study was to evaluate the changes in an untreated subscapularis tendon in patients who underwent repair of a full-thickness tear on the supraspinatus and to evaluate the factors related to these changes. We hypothesized that there would be overall changes in the preserved subscapularis after supraspinatus repair and that the preoperative condition of the subscapularis might have a correlation with postoperative changes in an untreated subscapularis.…”

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confidence: 99%

The Destiny of the Subscapularis Tendon after Arthroscopic Supraspinatus Repair

Kim,

Cho

et al. 2024

Clin Orthop Surg

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Background The purpose of this study was to identify the changes in untreated subscapularis in patients who underwent supraspinatus repair and to evaluate the factors related to the changes in the subscapularis. Methods A cohort of patients who underwent isolated supraspinatus repair with preservation of the subscapularis was reviewed. Changes in the subscapularis, including any newly formed lesion and aggravation of an existing lesion, were evaluated 12 months postoperatively on magnetic resonance imaging along with an examination to identify causative factors after supraspinatus repair. Clinical scores were compared between patients with and without subscapularis changes. Results A total of 528 patients were reviewed. Changes in the subscapularis, including newly formed lesions and aggravation of an existing lesion, were shown in 90 patients (17.0%). Upon regression analysis, changes in the subscapularis were associated with the initial existence of a subscapularis lesion (grade I: p = 0.042, grade II: p = 0.025), an accompanying biceps lesion ( p = 0.038), and a retear of the repaired supraspinatus ( p = 0.024). No significant differences were shown in clinical scores between patients with and without subscapularis changes after supraspinatus repair. Conclusions Untreated asymptomatic subscapularis may undergo morphological changes even after repair of the torn supraspinatus. Preoperative subscapularis lesions, biceps long head pathology, and retears of the repaired supraspinatus were associated with subscapularis pathology in patients who underwent supraspinatus repair.

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“…However, the clinical implications of structural integrity have been debated for a long time. 9,17,22,23 These controversies have arisen because there are some patients who do well with a retear 2,17 and some patients who do not do well with healing. 8,20 In the majority of extant literature, postoperative evaluation of structural integrity after rotator cuff repair has been bifurcated into 1 of 2 outcomes: healing or retear.…”

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confidence: 99%

Effects of Quality of Integrity on Clinical and Structural Outcomes of Rotator Cuff Repair: A Retrospective Cohort Study of 504 Cases

Jo,

Lee,

Kim

et al. 2024

Am J Sports Med

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Background: The clinical implications of structural integrity have been a subject of long debate. The oversimplified binary categorization of structural integrity into either healing or retear, along with faulty preoperative baselines for comparison, may contribute to the controversy. Purpose: To determine how the quality of structural integrity in a repaired cuff tendon affects both clinical and structural outcomes by dividing the patients into groups based on integrity and using the immediate postoperative baseline (time zero). Study design: Cohort study; Level of evidence, 3. Methods: A total of 504 patients with a full-thickness rotator cuff tear who underwent arthroscopic rotator cuff repair and were followed up for at least a year with magnetic resonance imaging (MRI) were included. The quality of structural integrity was graded using the Sugaya classification. To evaluate clinical outcomes, pain, range of motion, strength, functional scores, and overall satisfaction and function were used for within- and between-group analyses at the last follow-up. For the assessment of structural outcomes, the Goutallier classification for fatty infiltration (FI) and the tangent sign, occupation ratio, and normalized cross-sectional area for muscle atrophy (MA) were used. The baselines for these structural measurements were both the preoperative and the time-zero MRI scans. Results: The mean clinical follow-up period was 31.8 ± 27.5 months, and the MRI follow-up period was 10.9 ± 5.3 months. There were 178 (35.3%), 228 (45.2%), 58 (11.5%), 14 (2.8%), and 26 (5.2%) shoulders with Sugaya grades 1, 2, 3, 4, and 5, respectively. Regardless of structural integrity, all clinical outcomes at a mean follow-up of 31.8 months after repair significantly improved compared with those before repair. Only in shoulders with Sugaya grade 1 did the FI of the supraspinatus muscle improve significantly from baseline. FI of the infraspinatus muscle did not change significantly in those with grades 1 and 2 but worsened in those with grades 3 and 5. MA measured using the occupation ratio improved significantly in shoulders with Sugaya grades 1 and 2 but declined in those with grade 5. Conclusion: This study established a correlation between improved structural integrity of the repaired cuff tendon and enhanced structural outcomes in rotator cuff muscles. Furthermore, the findings revealed that both FI and MA could be reversed in patients exhibiting high-quality structural integrity. However, these structural improvements were not mirrored in the clinical outcomes.

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Prognostic factors affecting structural integrity after arthroscopic rotator cuff repair: a clinical and histological study

Cited by 6 publications

References 29 publications

Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved

Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved

The Destiny of the Subscapularis Tendon after Arthroscopic Supraspinatus Repair

Effects of Quality of Integrity on Clinical and Structural Outcomes of Rotator Cuff Repair: A Retrospective Cohort Study of 504 Cases

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