An isolated bioinductive repair vs. sutured repair for full-thickness rotator cuff tears: 2-year results of a double blinded, randomized controlled trial.

BACKGROUND: Partial-thickness rotator cuff tears treated with an isolated bioinductive repair (IBR) in lieu of a completion-and-repair have shown complete healing. This treatment option is afforded by the remaining tendon's structural integrity, which is similar to that present in small/medium full-thickness tears (FTTs) when the rotator cable remains intact. This randomized controlled trial (RCT) investigated whether an IBR for small/medium FTTs resulted in superior healing and patient-reported outcomes (PROs) compared with a sutured repair. METHODS: This prospective, double blinded (patients and outcome assessors), single-center RCT enrolled patients ≥18 years with a small/medium (≤2.5cm) full thickness supraspinatus tear and intact rotator cable. Patients were randomized and blinded to arthroscopic transosseous-equivalent repair (control, n = 30) or IBR (n = 30). The primary outcome was tendon quality on biopsy at 6 months. Secondary outcomes were PROs (American Shoulder and Elbow Surgeons [ASES], Constant-Murley Shoulder [CMS], and pain visual analogue scale scores) and tendon thickness and healing measured via MRI at 6, 12, and 24 months; satisfaction at 12 and 24 months; and time to return to work. RESULTS: Baseline demographic, tear, and surgical characteristics were comparable between the groups (IBR: mean age, 54.2 years, 14 male; control: mean age, 56.4 years, 16 male). Measured via 6 month biopsy, highly organized, parallel bundles of collagen, without inflammation, were present in all IBR patients, whereas poorly organized, non-parallel collagen fibers were present in 24/30 (80%) of control patients (P < .0001), with 28/30 having minimal to mild inflammation. The increase in tendon thickness measured via MRI at 6 months from baseline was greater in the IBR group (2.0 mm) than in the control group (0.8 mm) (P < .0001). All IBR patients had 100% healing on MRI at 12 and 24 months. Compared with the control group, the IBR group had higher ASES and CMS scores at each evaluation, less pain at 6 and 12 months, and greater satisfaction at 12 and 24 months (P < .0003). The IBR group returned to work significantly faster (median 90 days [IQR, 25] vs. median 163.5 days [IQR, 24]; P < .0001) than the control group. CONCLUSION: Compared with a sutured repair, the IBR treatment resulted in superior tendon quality, patient outcomes, satisfaction, and return to work. The IBR enabled a robust healing response evident through MRI and biopsy evaluation, demonstrating superior tendon quality and healing.

Risk factors of tear progression in symptomatic small to medium-sized full-thickness rotator cuff tear: relationship between occupation ratio of supraspinatus and work level.

BACKGROUND: Previous studies reported that full-thickness rotator cuff tear (FTRCT) is a risk factor for tear progression. However, there is no clear consensus on the risk factors of tear progression in FTRCT. PURPOSE: To identify the demographic and radiologic risk factors of tear progression in small to medium FTRCTs. METHODS: We retrospectively reviewed 81 shoulders of patients diagnosed with small or medium FTRCTs using magnetic resonance imaging (MRI) who underwent conservative treatment from January 2017 to November 2021. Various demographic factors, including patient work level and radiological factors such as atrophy of rotator cuff muscles were analyzed to evaluate their association with tear progression. Work level was divided into high (heavy manual labor), medium (manual labor with less activity), and low (sedentary work activity). The atrophy of rotator cuff muscles was calculated by occupation ratio. RESULTS: Tear progression was observed in 48% (39/81) of patients (criterion for tear progression was medial-lateral or anterior-posterior tear length > 5 mm). In patients with tear progression, the lengths of medial-lateral and anterior-posterior tears progressed by 6 mm and 3 mm, respectively. Among the rotator cuff muscles, fatty degeneration and occupation ratio of the supraspinatus were only worsened (P = .014, P = 0.013, respectively). The mean MRI follow-up duration was 14.8 ± 9.0 months. The significant risk factors of tear progression were high work level (odds ratio [OR], 7.728; 95% CI, 1.204-49.610; P = .031), and occupation ratio of the supraspinatus muscle (OR, 0.308; 95% CI, 0.158-0.604; P = .001). The optimal cutoff value for the occupation ratio of the supraspinatus was 0.55 (sensitivity 74%, specificity 62%). CONCLUSIONS: Tear progression was observed in approximately 50% of patients with symptomatic small to medium FTRCTs. High physical work level and atrophy of the supraspinatus muscle were independent risk factors of tear progression. The risk of tear progression increases with occupation ratio of the supraspinatus muscle < 0.55 and heavy manual labor.

Critical shoulder angle and failure of conservative treatment in patients with atraumatic full thickness rotator cuff tears.

BACKGROUND: Atraumatic full thickness rotator cuff tears (AFTRCT) are common lesions whose incidence increases with age. Physical therapy is an effective conservative treatment in these patients with a reported success rate near 85% within 12 weeks of treatment. The critical shoulder angle (CSA) is a radiographic metric that relates the glenoid inclination with the lateral extension of the acromion in the coronal plane. A larger CSA has been associated with higher incidence of AFTRCT and a higher re-tear rate after surgical treatment. However, no study has yet described an association between a larger CSA and failure of conservatory treatment in ARCT. The main objective of this study is to determine whether there is an association between CSA and failure of physical therapy in patients with AFTRCT. METHODS: We reviewed the imaging and clinical records of 48 patients (53 shoulders), 60% female, with a mean age of 63.2 years (95% CI ± 10.4 years); treated for AFTRCT who also underwent a true anteroposterior radiograph of the shoulder within a year of diagnosis of the tear. We recorded demographic (age, sex, type of work), clinical (comorbidities), and imaging data (CSA, size and location of the tear). We divided the patients into two groups according to success or failure of conservative treatment (indication for surgery), so 21 shoulders (39.6%) required surgery and were classified as failure of conservative treatment. Univariate and multivariate analysis was performed to detect predictors of failure of conservative treatment. RESULTS: The median CSA was 35.5º with no differences between those with failure (median 35.5º, range 29º to 48.2º) and success of conservative treatment (median 35.45º, range 30.2º to 40.3º), p = 0.978. The multivariate analysis showed a younger age in patients with failure of conservative treatment (56.14 ± 9.2 vs 67.8 ± 8.4, p < 0.001) and that male gender was also associated with failure of conservative treatment (57% of men required surgery vs 28% of women, p = 0.035). CONCLUSIONS: It is still unclear if CSA does predict failure of conservative treatment. A lower age and male gender both could predicted failure of conservative treatment in AFTRCT. Further research is needed to better address this subject.

The functional outcome of arthroscopic rotator cuff repair with double-row knotless vs knot-tying anchors.

To date two main techniques are used in arthroscopic full-thickness rotator cuff tears, the conventional knot-tying suture bridge technique and the knotless technique. We evaluated whether there is a difference in clinical outcome using both techniques. Our patients underwent arthroscopic treatment of full-thickness rotator cuff tears, and we retrospectively evaluated clinical function, strength and surgery time. Eighty-three shoulders operated between September 2012 and December 2013 were included in the study. We had nineteen patients in the knotless group, and sixty-four in the knot-tying group. In addition, we performed preoperatively radiological (magnetic resonance imaging-MRI) conformation of full-thickness rotator cuff tear in our patients. For clinical evaluation, we used Quick Disabilities of the Arm, Shoulder and Hand score (q-DASH) and the Shoulder Pain and Disability (SPADI) score, and we measured the strength of a range of motion postoperatively using a conventional dynamometer. The patients were evaluated preoperatively, and at 6, 9, and 12 months postoperatively. The follow-up period was 12 months. The scores in both treatment groups improved at twelve months follow-up, but there was no statistical difference between both groups at twelve months after surgery; q-DASH score between groups (p = 0.092) and SPADI score (p = 0.700). Similarly, there was no statistical difference between the groups in regard to strength, surgery time, and range of motion at the twelve months follow-up. Our data confirm that both techniques may be used successfully to repair full-thickness rotator cuff tears with very good functional outcome.Level of evidence IV.

Determining the rate of full-thickness progression in partial-thickness rotator cuff tears: a systematic review.

BACKGROUND: Partial-thickness rotator cuff tears are likely at least as common as full-thickness rotator cuff tears, and it is critical for surgeons to have knowledge of the tear progression rate of partial-thickness rotator cuff tears when determining surgical or nonsurgical treatment. However, a systematic review investigating the rate of tear progression of partial-thickness rotator cuff tears has not been performed. Therefore, the purpose of this study was to systematically review the literature and determine the rate of full-thickness progression in nonoperatively treated partial-thickness rotator cuff tears. METHODS: A systematic review of the literature was performed following the PRISMA guidelines and checklist using the PubMed, MEDLINE, and Cochrane Library databases. English-language studies of Level I through IV evidence examining partial-thickness rotator cuff tears with description of the change in tear size were included. Studies using imaging modalities other than magnetic resonance imaging (MRI) or ultrasonography (US) for serial imaging and studies without description of the number of tears that progressed to full-thickness tears were excluded. The primary outcome was to determine the per-month progression rate from a partial-thickness tear to a full-thickness tear confirmed on either MRI or US. The progression rates, which were divided into 3 groups-symptomatic, asymptomatic and combined (asymptomatic + symptomatic)-were calculated using a random effects model with binomial within-study variance. RESULTS: Four studies were included, and 257 tears were analyzed statistically for tear progression. The average follow-up was 34 months (standard deviation, 19 months). The overall rate of progression to a full-thickness tear was 0.26% per month (95% confidence interval [CI], 0.15%-0.36% per month). In the symptomatic and asymptomatic groups, the rates were 0.22% per month (95% CI, 0.09%-0.34% per month) and 0.32% per month (95% CI, 0.15%-0.49% per month), respectively, which showed no significant difference (P =.341). CONCLUSIONS: This study demonstrated that partial-thickness tears progress to full-thickness tears over time but at a relatively low rate at short- to intermediate-term follow-up. There was no significant difference in the per-month rates of full-thickness progression between symptomatic and asymptomatic tears.

Association between type of rotator cuff tear and functional outcomes in patients with massive and irreparable rotator cuff tear: A pre-post intervention study.

BACKGROUND: The aim of this study was to analyze: (1) the differences in the pre-post change in functional outcomes after a physical therapy program by the type of massive and irreparable rotator cuff tear (MIRCT) controlling for potential confounders, and (2) the influence of lifestyle behaviors and demographic and tear tendon characteristics on function in patients over 60 years of age with conservatively treated MIRCT. MATERIALS AND METHODS: In this pre-post intervention study, 92 patients were prospectively recruited at the Clinical Hospital San Borja Arriaran, with atraumatic MIRCT, between 60 and 75 years of age (mean: 67.9 ± 4.5 years), and the mean of length of symptoms was 16.5 months (±5.7 months). Patients received a physical therapy program consisting of manual therapy and a specific exercise program of 2 sessions per week for 12 weeks. The imaging findings were performed by 2 medical radiologists who classified the rotator cuff tear according to the criteria proposed by Collins. Shoulder function, upper limb function, and pain intensity were assessed with the Constant-Murley; Disabilities of the Arm, Shoulder, and Hand; and visual analog scale (VAS), respectively. Analysis of covariance models were estimated to assess differences in MIRCT categories between functional outcomes. Multiple regression model analysis was used for the association between the change in functional outcomes and lifestyle behaviors, and demographic and tear tendon characteristics. RESULTS: The results showed no pre-post change in functional outcomes by type of MIRCT in all models (P > .05). There is an association between length of symptoms (P = .000), and the baseline values of the 3 functional measures (P = .000) are associated with changes in Constant-Murley; Disabilities of the Arm, Shoulder, and Hand; and VAS. In addition, changes in VAS are associated with body mass index (BMI) (P = .000), and changes in Constant-Murley are associated with gender (P = .023), BMI (P = .000), and tobacco consumption (P = .000). CONCLUSION: There is no difference in functional outcomes by type of MIRCT after a physical therapy program controlling for potential confounders. In addition, there is an association of length of symptoms with all functional outcomes, an association of BMI with VAS and Constant-Murley questionnaire, and an association between tobacco consumption and Constant-Murley questionnaire. Our results could influence the orthopedic surgeon's decisions; thus, not predicting the functional outcome through imaging findings could lead clinicians to reconsider the need for surgery in the treatment algorithm in patients over 60 years with MIRCT. In addition, demographic characteristics and lifestyle behaviors might be considered within the patient's evaluation and follow-up to decide on surgical interventions and evaluate the clinical course of the disease. Further studies measuring additional variables and longer follow-up are needed to confirm these results.

The natural course of and risk factors for tear progression in conservatively treated full-thickness rotator cuff tears.

BACKGROUND: The natural course of and risk factors for tear progression in full-thickness rotator cuff tears (FTRCTs) have not been clarified yet. The study's purpose was to retrospectively evaluate tear progression in FTRCTs by using magnetic resonance imaging (MRI) and to identify risk factors that are relevant to such tear progression. METHODS: Between June 2010 and September 2019, a total of 345 patients with FTRCTs who had been diagnosed via MRI were treated conservatively. Of these, 48 patients who underwent post-treatment follow-up MRI were retrospectively enrolled. Tear progression was defined as significant when the tear size increased by >5 mm. RESULTS: The mean MRI follow-up duration was 22 ± 14 months (range, 12-65 months). Among the 48 patients (mean age, 69 years; range, 53-81), 26 (54%) and 20 (41%) showed medial-lateral (M-L) and anterior-posterior (A-P) tear progression on MRI follow-up. Multivariate analysis revealed that MRI follow-up duration (P = .011), diabetes mellitus (P = .017), and infraspinatus muscle atrophy (P = .011) were independent risk factors for tear progression in the A-P plane. A high critical shoulder angle (P = .011) and supraspinatus (P = .024) and infraspinatus (P = .020) muscle atrophy were risk factors associated with M-L tear progression. CONCLUSION: Among the assessed patients, a considerable number of FTRCTs increased in size during the follow-up period. Severe infraspinatus muscle atrophy was the independent risk factor for exacerbation of A-P and M-L tear progression.

Interobserver reliability of the rotator cable and its relationship to rotator cuff congruity.

BACKGROUND: This study evaluated the presence of the rotator cable intraoperatively and compared its prevalence according to both patient age and rotator cuff integrity. The study hypothesis was that the cable would be more prevalent in older patients and patients with partial-thickness tears. METHODS: Patients who were undergoing shoulder arthroscopy and were aged at least 16 years were included in this study, whereas those who had a cuff tear of more than 1 tendon or who had a video with poor visualization of the rotator cuff insertion were excluded. Intraoperative videos were collected, deidentified, and distributed to 7 orthopedic surgeons to define rotator cable and cuff tear characteristics. RESULTS: A total of 58 arthroscopic videos (average patient age, 46 years; range, 16-75 years) were evaluated. The observers were in the most agreement on identifying the presence of a cable, with a κ coefficient of 0.276. Patients with the rotator cable were significantly older than those without it (mean age, 52.1 years vs. 42.5 years; P = .008), and a positive and significant correlation was found between rotator cable presence and increasing patient age (r = 0.27, P = .04). A significant association was noted between tear degree and cable presence (P = .002). There was no significant association with cable presence in patients with a full-thickness tear. CONCLUSIONS: In this study, an intraoperative analysis was performed to define the presence of the rotator cable and correlate this with both patient age and rotator cuff integrity. The hypothesis was confirmed in that patients older than 40 years had a significantly higher rotator cable prevalence.

Is the arthroscopic modified tension band suture technique suitable for all full-thickness rotator cuff tears?

BACKGROUND: We aimed to identify the clinical and structural outcomes after arthroscopic repair of full-thickness rotator cuff tears of all sizes with a modified tension band suture technique. METHODS: Among 63 patients who underwent arthroscopic rotator cuff repair for a full-thickness rotator cuff tear with the modified tension band suture technique at a single hospital between July 2011 and March 2013, 47 were enrolled in this study. The mean follow-up period was 29 months. Visual analog scale scores, range of motion, American Shoulder and Elbow Surgeons scores, Constant scores, and Shoulder Strength Index were measured preoperatively and at the final follow-up. For radiologic evaluation, we conducted magnetic resonance imaging 6 months postoperatively and ultrasonography at the final follow-up. We allocated the small and medium tears to group A and the large and massive tears to group B and then compared clinical outcomes and repair integrity. RESULTS: Postoperative clinical outcomes at the final follow-up showed significant improvements compared with those seen during preoperative evaluations (P < .001). However, group B showed worse clinical results than group A. Evaluation with magnetic resonance imaging performed 6 months postoperatively and ultrasonography taken at the final follow-up revealed that group B showed a significantly higher retear rate than did group A (69% vs. 6%, respectively; P < .001). CONCLUSION: Arthroscopic repair with the modified tension band suture technique for rotator cuff tears was a more suitable method for small to medium tears than for large to massive tears.

Effect of surgeon-sonographer interaction on ultrasound diagnosis of rotator cuff tears: a five-year cohort study in 775 shoulders.

BACKGROUND: Ultrasonography for the diagnosis of rotator cuff tears has been a topic of debate for years. The literature shows promising results for the diagnostic utility of ultrasonography for rotator cuff tears. This study assessed the effect of a surgeon-sonographer interaction on the ability of ultrasonography to predict the presence or absence of rotator cuff tears. METHODS: This study was a temporal cohort analysis of 775 patients to detect the diagnostic accuracy of ultrasonography at predicting a rotator cuff tear. The surgeon-sonographer interaction had three components: (1) presence of an ultrasound machine and ultrasonographer within a shoulder clinic, (2) the ultrasonographer attends shoulder operations, (3) and the ultrasonographer reviews patients preoperatively and postoperatively. Comparisons of 2 variables-presence and size of a tear-were made between the preoperative ultrasonographic findings with arthroscopic findings (gold standard). RESULTS: The diagnostic utility for the detection of rotator cuff tears by ultrasonography at the start of the study was 93% sensitive and 68% specific, and at the end of the study was 99% sensitive and 93% specific. There was an improvement in the correlation of the ability to estimate the size of rotator cuff tears from ultrasonography to surgery in both full- and partial-thickness tears. CONCLUSIONS: The surgeon-sonographer interaction improved the diagnostic utility of an office-based ultrasonographer over time, particularly with respect to the overall accuracy of ultrasonography for the detection of rotator cuff tears and for the ability to predict the size of full- and partial-thickness rotator cuff tears.

Anatomic Total Shoulder Arthroplasty Versus Reverse Total Shoulder Arthroplasty in Patients Aged Over 70 Without a Full-Thickness Rotator Cuff Tear: A Systematic Review and Meta-Analysis.

Introduction: This systematic review and meta-analysis compared the revision rates, complications, and outcomes in anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA) performed for primary glenohumeral osteoarthritis in patients aged over 70 years without a full-thickness rotator cuff tear. Materials and Methods: We performed a systematic literature search identifying comparative studies meeting the above patient criteria and published from January 2010 to May 2022 from 3 databases: MEDLINE, EMBASE, and Cochrane Library. We performed the systematic review in accordance with PRISMA guidelines and the study was prospectively registered on PROSPERO. Results: From the 1798 studies identified from the initial literature search, 4 met our inclusion criteria. Two thousand seven hundred thirty-one shoulder arthroplasties (1472 aTSA and 1259 rTSA) were evaluated with a minimum follow up of 2 years. A statistically significant lower revision rate was observed in rTSA compared to aTSA (odds ratio [OR] 0.50, 95% confidence interval [CI]: 0.30, 0.84, p < .05). No significant difference was noted between aTSA and rTSA in overall complication rate (OR 0.98, 95% CI 0.34, 2.86, p = .97) while aTSA displayed a statistically significant improved postoperative Constant-Murley score [aTSA: 80(75; 82), rTSA: 68(66; 76.5), p < .001]. Conclusion: Higher revision rates were identified following aTSA in our study population, although admittedly this is within retrospective studies. aTSA displayed equal functional results and postoperative complications compared to rTSA in patients over 70 without a full-thickness rotator cuff tear. Given these similar results a shoulder surgeon must carefully consider each patient individually prior to deciding the optimal form of arthroplasty to offer.

Mesenchymal Stem Cells From a Hypoxic Culture Can Improve Rotator Cuff Tear Repair.

A rotator cuff tear is an age-related common cause of pain and disability. Studies including our previously published ones have demonstrated that mesenchymal stem cells cultured under hypoxic conditions [hypoxic multipotent stromal cells (MSCs)] facilitate the retention of transplanted cells and promote wound healing. However, there are very few, if any, reports targeting the punctured supraspinatus tendons to create more or equally serous wounds as age-related tears of rotator cuff. It remains to be determined whether transplantation of bone-marrow-derived hypoxic MSCs into the punctured supraspinatus tendon improves tendon repair and, when combined with ultrasound-guided delivery, could be used for future clinical applications. In this study, we used a total of 33 Sprague-Dawley rats in different groups for normal no-punched control, hypoxic MSC treatment, nontreated vehicle control, and MSC preparation, and then evaluated treatment outcomes by biomechanical testing and histological analysis. We found that the ultimate failure load of the hypoxic MSC-treated group was close to that of the normal tendon and significantly greater than that of the nontreated vehicle control group. In vivo tracking of cells labeled with superparamagnetic iron oxide (SPIO) nanoparticles revealed an enhanced retention of transplanted cells at the tear site. Our study demonstrates that hypoxic MSCs improve rotator cuff tear repair in a rat model.

Conservative management in a patient with massive rotator cuff tear and rheumatoid arthritis.

BACKGROUND: Shoulder pain is one of the most common problems affecting people older than 60 years. Among the shoulder pathologies, the disorders of the periarticular soft tissue (e.g. rotator cuff) are considered to be the most common; moreover, these disorders are found in approximately 75% of patients with seropositive rheumatoid arthritis. The incidence of structural rotator cuff tendon pathology, including full-thickness rotator cuff tendon tears, increases with age. Recent researchers suggested that non-operative treatment of full-thickness rotator cuff tears could be successful in some patients; furthermore, in rheumatoid arthritis patients, there was a greater possibility of developing surgical complications compared with non-rheumatoid arthritis patients. MATERIALS AND METHODS: A case report of a woman, 72 years old, with rheumatoid arthritis, shoulder pain and pseudo-paralytic arm presented with a massive tear of Supraspinatus and Infraspinatus tendon. In accordance with evidence, the case was managed using pain education and exercise therapy for 2.5 months. The shoulder pain, the function and the range of motion improved following a physiotherapy program. CONCLUSION: Pain education in combination with exercise therapy was effective for improving pain and function in a full-thickness tear of Supraspinatus and Infraspinatus tendon in a patient also suffering from rheumatoid arthritis.

EXERCISE THERAPY IN THE NON-OPERATIVE TREATMENT OF FULL-THICKNESS ROTATOR CUFF TEARS: A SYSTEMATIC REVIEW.

BACKGROUND: Although commonly prescribed, the evidence to support exercises therapy (ET) and conservative management for the treatment of full-thickness rotator cuff tears (FTT) is equivocal. PURPOSE: The purpose of this systematic review of the literature was to determine the current level of evidence available for ET in the treatment of FTT and to provide a formal Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group of recommendation. METHODS: Five databases were systematically searched to evaluate the effectiveness of ET for FTT. Inclusion criteria: experimental or observational studies of adults clinically diagnosed with FTT, or massive, or inoperable tears that contained a treatment group that received ET for FTT. Exclusion criteria included: history of surgical repair, concurrent significant trauma, neurological impairment, and level V studies. Articles were assessed for quality, the level of evidence (I - V) and GRADE of recommendation (A to F) was determined. Data extraction included: demographics, specific interventions, and outcomes. RESULTS: One thousand, five-hundred and sixty-nine unique citations were identified, 35 studies were included: nine randomized controlled studies, six cohort studies, 15 case series and five case reports. There were 2010 shoulders in 1913 subjects with an average age of 64.2 years, 54% males, 73% of tears were > 1 cm and 37% were classified as massive. Based on studies that reported, >58% of tears were > 1 year and 73% were atraumatic. Of the non-operatively treated cohorts that reported the respective outcomes: 78% improved in pain (9/10 cohorts that reported statistically significant differences [stat-sig] p<0.05), 81% improved in ROM (14/14 cohorts that reported, met stat-sig), 85% improved in strength (7/8 cohorts that reported, met stat-sig), 84% improved in functional outcomes (17/17 cohorts that reported, met stat-sig). Dissatisfied outcomes occurred in 15% of patients, who then transitioned to surgery. CONCLUSION: The current literature indicates GRADE B recommendation (moderate strength) to support the use of ET in the management of FTT. There is further need for well-designed randomized controlled trials. LEVEL OF EVIDENCE: 2a.

Biomechanical Test for Repair Technique of Full-thickness Rotator Cuff Tear

The arthroscopic rotator cuff repair is now considered a mainstream technique with highly satisfactory clinical results. However, concerns remain regarding healing failures for large and massive tears and high revision rate. In recent decades, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. The focus of biomechanical test in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. Recent studies have shown that a transosseous tunnel technique provides improved contact area and pressure between rotator cuff tendon and insertion footprint, and the technique of using double rows of suture anchors to recreate the native footprint attachment has been recently described. The transosseous equivalent suture bridge technique has the highest contact pressure and fixation force. In this review, the biomechanical tests about repair techniques of rotator cuff tear will be reviewed and discussed.

Biomechanical Test for Repair Technique of Full-thickness Rotator Cuff Tear

The arthroscopic rotator cuff repair is now considered a mainstream technique with highly satisfactory clinical results. However, concerns remain regarding healing failures for large and massive tears and high revision rate. In recent decades, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. The focus of biomechanical test in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. Recent studies have shown that a transosseous tunnel technique provides improved contact area and pressure between rotator cuff tendon and insertion footprint, and the technique of using double rows of suture anchors to recreate the native footprint attachment has been recently described. The transosseous equivalent suture bridge technique has the highest contact pressure and fixation force. In this review, the biomechanical tests about repair techniques of rotator cuff tear will be reviewed and discussed.

All Arthroscopic Repairs with Massive Cuff Stitch in Medium-sized Full Thickness Rotator Cuff Tears / 대한정형외과학회잡지

PURPOSE: We wanted to evaluate the usefulness of arthroscopic repair using the modified Mason-Allen Massive Cuff Stitch for medium sized full thickness rotator cuff tear. We verified the clinical results and evaluated the repair integrity after short term follow up. MATERIALS AND METHODS: Twenty-three cases of arthroscopically repaired full thickness tear of the rotator cuff of an estimated medium size were evaluated between December 2004 to May 2005. The average patient age was 54 years old (range: 43-69 years old), and the mean follow-up was 14 months (range: 12-17 months). We analyzed the results by paired t-test. The follow up MRIs were checked in 11 cases. RESULTS: The VAS pain score was improved from a preoperative average of 7.0 to a postoperative average of 0.9, the ADL was improved from 11.1 to 26.0 and the UCLA score was improved from 13.6 to 32.5 (all p<0.05). 91.3% showed an excellent or good result at the final follow-up. The satisfied rate was 95.7% (22 cases). There was re-rupture of the repaired rotator cuff in one out of 11 cases (9.1%). CONCLUSION: Arthroscopic repairs using a modified Mason-Allen Massive Cuff Stitch for full thickness rotator cuff tear of an estimated medium size showed good clinical outcomes.