Objectives . The effects of disease progression and common tendinopathy treatments
on the tissue characteristics of human rotator cuff tendons have
not previously been evaluated in detail owing to a lack of suitable
sampling techniques. This study evaluated the structural characteristics
of torn human
We examined macroscopically and microscopically 55 cadaver rotator-cuff tendons attached to their humeral heads to determine the distance between the edge of the articular cartilage and the tendon insertion of the supraspinatus (the width of the sulcus) and the score of regressive changes at the sulcus. In 33 specimens we measured the tensile strength. The width of the sulcus was correlated with the score of regressive changes and with the ultimate tensile strength of the
Aims. Rotator cuff tear (RCT) is the leading cause of shoulder pain, primarily associated with age-related tendon degeneration. This study aimed to elucidate the potential differential gene expressions in tendons across different age groups, and to investigate their roles in tendon degeneration. Methods. Linear regression and differential expression (DE) analyses were performed on two transcriptome profiling datasets of torn
The purpose of this study was to clarify the effect of delay of the reattachment of the
Aims: The aim of this study was to analyze the morphological features of the human surgical specimens of normal
We hypothesised that diet-induced obesity (DIO) would result in inferior enthesis healing in a rat model of rotator cuff (RC) repair and that dietary intervention in the peri-operative period would improve enthesis healing. A total of 78 male Sprague-Dawley rats were divided into three weight-matched groups from weaning and fed either: control diet (CD), high-fat diet (HFD), or HFD until surgery, then CD thereafter (HF-CD). After 12 weeks, the left
Differential strain has been proposed to be a causative factor in failure of the
Obesity is associated with poor outcomes and increased risk of failure after rotator cuff (RC) repair surgery. The effect of diet-induced obesity (DIO) on enthesis healing has not been well characterised and whether its effects can be reversed with dietary intervention is unknown. We hypothesised that DIO would result in inferior enthesis healing in a rat model of RC repair and that dietary intervention in the peri-operative period would improve enthesis healing. A total of 78 male Sprague-Dawley rats were divided into three weight-matched groups from weaning and fed either: control diet (CD), high-fat diet (HFD), or HFD until surgery, then CD thereafter (HF-CD). After 12 weeks the left
To quantify the variation in strain between the deep and superficial layers of the
Excessive apoptosis has been found in torn supraspinatus tendon1 and mechanically loaded tendon cells2. Following oxidative and other forms of stress, one family of proteins that is often unregulated are Heat Shock Proteins (HSPs). The purpose of this study was to determine if HSPs were unregulated in human and rat models of tendinopathy and to determine if this was associated with increased expression of regulators of apoptosis (cFLIP, Caspases 3&
8). A running rat supraspinatus tendinopathy overuse model 3 was used with custom microarrays consisting of 5760 rat oligonucleotides in duplicate. Seventeen torn
Aim: The purpose of this study was to evaluate the cytokine molecules present in a rat tendinopathy model and in the torn edge of human rotator cuff tendon in an attempt to understand their role in tendon degeneration. Methods: A rat tendon overuse model was used with custom microarrays consisting of 5760 rat oligonucleotide features in duplicate. Seventeen torn
The rotator cuff tendinopathy is one of the most common shoulder problems leading to full-thickness rotator cuff tendon tear and, eventually, to degenerative arthritis. Recent research on rotator cuff tendon degeneration has focused on its relationship to cell death. The types of cell death known to be associated with rotator cuff tendon degeneration are apoptosis, necrosis, and autophagic cell death. The increased incidence of cell death in degenerative tendon tissue may affect the rates of collagen synthesis and repair, possibly weakening tendon tissue and increasing the risk of tendon rupture. The biomolecular mechanisms of the degenerative changes leading to apoptotic cell death in rotator cuff tenofibroblasts have been identified as oxidative-stress-related cascade mechanisms. Furthermore, apoptosis, necrosis, and autophagic cell death are all known to be mediated by oxidative stress, a condition in which ROS (reactive oxygen species) are overproduced. Lower levels of oxidative stress trigger apoptosis; higher levels mediate necrosis. Although the signaltransduction pathway leading to autophagy has not yet been fully established, ROS are known to be essential to autophagy. A neuronal theory regarding rotator cuff degeneration has been developed from the findings that glutamate, a neural transmitter, is present in increased concentrations in tendon tissues with tendinopathy and that it induces rat
Purpose: Partial rotator cuff tears are a frequent source of shoulder pain. At times, diagnosis is difficult and treatment unsuccessful. Historical treatment has involved open debridement when conservative treatment has failed. The purpose of this study was to evaluate the results of arthroscopic treatment of deep partial thickness tears of the
Treatment of massive rotator cuff tears can be challenging. Previous studies with irreparable rotator cuff tears showed good clinical results of tendon healing with the arthroscopic insertion of a protective biodegradable spacer balloon filled with saline solution between the repaired tendon and the acromion [1,2], but so far no scientific evidence has showed how the device alters pressures over the repaired tendon. This biomechanical study investigated the effects of a spacer inserted in the subacromial space on pressures over the repaired rotator cuff tendon in passive motion cycles typical for post-operative rehabilitation routines. Six human cadaveric shoulders were prepared with the humerus cut 15cm below the joint and embedded in a pot, while the scapula fixed at three points on a plate. A rotator cuff tear was simulated and repaired using a suture anchor and a Mason-Allen suture. The specimens were then mounted on a custom-made pneumatic testing rig to induce passive motion cycles of adduction-abduction (90–0°) and flexion-extension (0–40°) with constant glenohumeral and superior loads and tension is exerted on the
We have compared three different methods of treating
symptomatic non-traumatic tears of the
The role of inflammatory cells and their products in tendinopathy is not completely understood. Pro-inflammatory cytokines are upregulated after oxidative and other forms of stress. Based on observations that increased cytokine expression has been demonstrated in cyclically-loaded tendon cells we hypothesised that because of their role in oxidative stress and apoptosis, pro-inflammatory cytokines may be present in rodent and human models of tendinopathy. A rat supraspinatus tendinopathy model produced by running overuse was investigated at the genetic level by custom micro-arrays. Additionally, samples of torn
Critical shoulder angle (CSA), lateral acromial angle (LAA), and acromion index (AI) are common radiologic parameters used to distinguish between patients with rotator cuff tears (RCT) and those with an intact rotator cuff. This study aims to assess the predictive power of these parameters in degenerative RCT. This retrospective study included data from 92 patients who were divided into two groups: the RCT group, which included 47 patients with degenerative full-thickness
We compared time-dependent changes in the biomechanical properties of single-and double-row repair of a simulated acute tear of the rotator cuff in rabbits to determine the effect of the fixation techniques on the healing process. A tear of the
Antegrade intramedullary nailing of fractures of the shaft of the humerus is reported to cause impairment of the shoulder joint. We have reviewed 33 patients with such fractures to assess how many had injuries to the ipsilateral shoulder. All had an MR scan of the shoulder within 11 days of injury. The unaffected shoulder was also scanned as a control. There was evidence of abnormality in 21 of the shoulders (63.6%) on the injured side; ten had bursitis of the subacromial space, five evidence of a partial tear of the rotator cuff, one a complete rupture of the
Purpose of this study is to create an experimental model on rats for EMG evaluation of the supraspinatus muscle after traumatic rupture of its tendon. The population of this study consisted of 5 male rats of 300–400g. Under general anaesthesia we proceeded with traumatic rupture of the
In this prospective study of partial articular
We undertook clinical and ultrasonographic examination of the shoulders of 420 asymptomatic volunteers aged between 50 and 79 years. MRI was performed in selected cases. Full-thickness tears of the rotator cuff were detected in 32 subjects (7.6%). The prevalence increased with age as follows: 50 to 59 years, 2.1%; 60 to 69 years, 5.7%; and 70 to 79 years, 15%. The mean size of the tear was less than 3 cm and tear localisation was limited to the
This study looks at the dynamic tendon-to-bone contact properties of rotator cuff (RC) repairs—comparing single row repairs (SRR) with double row transosseous- equivalent (TOE) repairs. It was postulated that relaxation during, and movement following, the repair would significantly compromise contact properties and therefore, the ability of the tendon healing. Simulated tears were created in the
The cellular mechanisms of tendinopathy remain unclear, particularly with respect to the role of inflammation in early disease. We have previously identified increased levels of inflammatory cytokines in an early human model of tendinopathy and sought to extend these studies to the cellular analysis of tissue. Purpose. To characterise inflammatory cell subtypes in early human tendinopathy we explored the phenotype and quantification of inflammatory cells in torn and control tendon samples. Design. Controlled laboratory study. Methods. Torn
Introduction. Following tear of its tendon, the muscle undergoes retraction, atrophy and fatty infiltration. These changes are inevitable and considered irreversible and limit the potential of successful repair of musculotendinous units. It was the purpose of this study to test the hypothesis that administration of anabolic steroids can prevent these muscular changes following experimental
Introduction and Objectives: Damage of the
Purpose of this study is to create an experimental model of electrophysologic evaluation of the supraspinatus muscle on rats, after traumatic rupture of its tendon. The population of this study consisted of 10 male Sprague Dawley rats weighting 300–400g. Under general anaesthesia we proceeded with traumatic rupture of the
Aim: We hypothesize that anabolic steroid administration enhances matrix remodelling and improves the biomechanical properties of bio-artificially engineered human
This in-vitro study was conducted to determine the effect of rotator cuff tears on joint kinematics. A shoulder simulator produced unconstrained active abduction of the humerus. Three sequential 1cm lesions were created, the first two in the
Summary Statement. Tendon-bone interface becomes matured with the perforating fiber and the cells striding over the bone area. We suggest that both “perforating fiber” and “cell stride” could play a crucial role in regeneration after rotator cuff repair. Introduction. To obtain a successful outcome after rotator cuff repair, repaired tendon requires to be anchored biologically to the bone. However, it is well known that the histological structure of the repaired tendon-bone insertion is totally different from the normal insertion. This morphological alteration may contribute to biological instability after surgical repair. To address these issues, it is fundamental to clarify the difference of the structure between the normal and the repaired insertion in detail. Surprisingly, few studies on the tendon-bone insertion using electron microscopy has been performed so far, since the insertion area is solid (bone/cartilage) and extremely limited for the analysis. Recently, a new scanning electron microscopical method (FIB/SEM tomography) has been developed, making it possible to analyze the wider area with the higher resolution and reconstruct 3D ultrastructures. The purpose of this study was to analyze the ultrastructure of the repaired supraspinatus tendon-bone insertion in rat using FIB/SEM tomography. Materials and Methods. Adult Sprague-Dawley rats underwent complete cuff tear and subsequent repair of the
Aim To determine if tissue metabolism varies in
Aim: We hypothesized that anabolic steroid, combined with substrate strain upregulates expression of gap junction protein Connexin 43 (Cnx43) and increases cell-to-cell communication in human
This study aimed to quantify the relationship between passive tension of rotator cuff repair and arm position intraoperatively and to examine the effect of the passive tension on gap formation in cadaveric rotator cuff repairs. Five patients undergoing open surgical reconstruction of the rotator cuff were recruited. The operations were performed by a single surgeon using a standardised technique, which was acromioplasty, minimal debridement, mobilisation of tissue, bone troughs and transosseous suture tunnels. A Differential Variable Reluctance Transducer (DVRT) was placed at the apex of the debrided tendon. An in situ calibration was performed to relate the output from the DVRT to actual tension in the tendon. The tension generated was recorded as the
Reliable soft tissue attachment to prosthetic implants remains a great clinical challenge in adult reconstruction and oncology. Past efforts using tendon alone have been universally disappointing. With the introduction of trabecular metals, new possibilities present them selves in dealing with this problem. Using an established canine
Purpose: We present the results of subacromial decompression and repair of the rotator cuff through a minimal deltoid-on approach. Material and Method: Eighty-seven patients with longstanding shoulder pain were evaluated in two years (1999–2000) in our department. In sixty -eight of them symptoms were due to impigment syndrome. Eight patients with follow up time less than six months were excluded from this study, twenty were treated conservatively and the remaining forty (22 female, 18 male, mean age 50.3) underwent surgery. Three x-ray views were obtained in all patients, i.e. standard AP, true AP, and subacromial space projection. MRI was also obtained in all patients. MRI revealed calcific tendinitis in fifteen patients, osteophytes of the acromioclavicular joint in thirteen, a hooked (type III) acromion in ten and partial tear of the
The retear of the rotator cuff (RC) repair is a significant problem. Usually it is the effect of poor quality of the tendon. The aim was to evaluate histologically two types of RC reconstruction with scaffold. We have chosen commercially available scaffold polycaprolactone based poly(urethane urea). Rat model of
1. In a series of one hundred personal cases of "painful shoulder" rupture of the musculotendinous cuff was proved by operation in eighteen cases and was presumed in eight further cases, namely, in about one quarter of the series. 2. Of the eighteen cases treated by operation through the transacromial approach, perfect results were obtained only in four. The other results were unsatisfactory. In five, movement was good but there was pain or weakness of the limb. In nine the condition was unaltered or made worse. 3. Conservative treatment of traumatic lesions of the
Introduction: Restoration of original humeral head geometry in shoulder arthroplasty is a necessary requirement and may have a bearing on the longevity of the implant. Modern, adaptable, prosthetic components are believed to allow restoration of the individual’s proximal humeral anatomy, provided a precise osteotomy of the humeral head at the level of the anatomical neck is performed. The osteotomy and reconstruction of the humeral head is based on the assumption that the resected articular segment corresponds to a segment of a sphere oriented, identically, in inclination and retroversion to the original humeral head. Resection, along the mid-anterior portion of the cartilage/calcar border, is understood to create a surface that enables a prosthetic component to be mounted, retroverted and inclinated to the same degree as the original head geometry. The objective of this study was to determine the degree of variation in humeral head retroversion relative to the superior and inferior borders of the proximal humeral articular surface. Methods: Twenty-eight fresh frozen human cadaveric full arms were dissected free of soft tissue to expose the proximal humerus. The distal end of the humeral shaft was potted in PMMA and fixed rigidly in a custom–built jig. The following points and lines were identified and marked on each specimen:. the circumference of the anatomical neck;. (H) as the most superior point of the articular surface at the insertion of the
PEMF is currently approved by the FDA for adjunctive treatment of lumbar/cervical spine fusion and for treatment of long-bone non-unions. Soft tissues are a potential new therapeutic application for PEMF due to pre-clinical studies showing a reduction of inflammatory markers following PEMF exposure. The aim was therefore to investigate the structural/functional effects of PEMFs on tendon-to-bone and tendon-to-tendon healing in a rotator-cuff (RC) and Achilles tendon (AT) repair model, respectively. RC study: Adult male rats (n=280), underwent bi-lateral
Surgical repair of rotator cuff tears have high failure rates (20–70%), often due to a lack of biological healing. Augmenting repairs with extracellular matrix-based scaffolds is a common option for surgeons, although to date, no commercially available product has proven to be effective. In this study, a novel collagen scaffold was assessed for its efficacy in augmenting rotator cuff repair. The collagen scaffold was assessed in vitro for cytocompatability and retention of tenocyte phenotype using alamarBLUE assays, confocal imaging and real-time PCR. Immunogenicity was assessed in vitro by the activation of pre-macrophage cells. In vivo, using a modified rat rotator cuff defect model,
Our aim in this prospective study was to evaluate the outcome of total shoulder replacement in the treatment of young and middle-aged active patients with primary glenohumeral osteoarthritis. We reviewed 21 patients (21 shoulders) with a mean age of 55 years (37 to 60). The mean follow-up was seven years (5 to 9). The same anatomical, third-generation, cemented implant had been used in all patients. All the patients were evaluated radiologically and clinically using the Constant and Murley score. No patients required revision. In one a tear of the
We have studied cellular and vascular changes in different stages of full thickness tears of the rotator cuff. We examined biopsies from the
Bone marrow concentrates are being used to augment soft tissue healing. However, only 0.01% of these cells meet the criteria of a mesenchymal stem cell (MSC), which likely accounts for the variability in reported results. Previous studies using an established rat rotator cuff repair model have demonstrated that bone marrow-derived MSCs had no effect on healing. In this study we evaluated the effect of purified human MSCs on rotator cuff healing in an athymic rat model. Hypothesis: Purified human MSCs added to the repair site will improve biomechanical strength and fibrocartilage formation of the healing tendon. Fifty-two athymic rats underwent unilateral detachment and repair of the
Rotator cuff pathology is the main cause of shoulder pain and dysfunction in older adults. When a rotator cuff tear involves the subscapularis tendon, the symptoms are usually more severe and the prognosis after surgery must be guarded. Isolated subscapularis tears represent 18% of all rotator cuff tears and arthroscopic repair is a good alternative primary treatment. However, when the tendon is deemed irreparable, tendon transfers are the only option for younger or high-functioning patients. The aim of this review is to describe the indications, biomechanical principles, and outcomes which have been reported for tendon transfers, which are available for the treatment of irreparable subscapularis tears. The best tendon to be transferred remains controversial. Pectoralis major transfer was described more than 30 years ago to treat patients with failed surgery for instability of the shoulder. It has subsequently been used extensively to manage irreparable subscapularis tendon tears in many clinical settings. Although pectoralis major reproduces the position and orientation of the subscapularis in the coronal plane, its position in the axial plane – anterior to the rib cage – is clearly different and does not allow it to function as an ideal transfer. Consistent relief of pain and moderate recovery of strength and function have been reported following the use of this transfer. In an attempt to improve on these results, latissimus dorsi tendon transfer was proposed as an alternative and the technique has evolved from an open to an arthroscopic procedure. Satisfactory relief of pain and improvements in functional shoulder scores have recently been reported following its use. Both pectoralis minor and upper trapezius transfers have also been used in these patients, but the outcomes that have been reported do not support their widespread use. Cite this article:
Alarmins- also referred to as damage associated molecular patterns (DAMPS)- are endogenous molecules mobilized in response to tissue damage known to activate the innate immune system and regulate tissue repair and remodelling. The molecular mechanisms that regulate inflammatory and remodelling pathways in tendinopathy are largely unknown therefore identifying early immune effectors is essential to understanding the pathology. S100A8 and S100A9 are low molecular weight calcium binding proteins primarily released by activated phagocytes in an inflammatory setting and also secreted as a heterodimeric complex that exhibits cytokine like functions. Based on our previous investigations we sought evidence of S100A8/A9 expression in human tendinopathy and thereafter, to explore mechanisms whereby S100 proteins may regulate inflammatory mediators and matrix regulation in human tenocytes. Torn
Favourable short-term outcomes have been reported following latissimus dorsi tendon transfer for patients with an irreparable subscapularis (SSC) tendon tear. The aim of this study was to investigate the long-term outcomes of this transfer in these patients. This was a retrospective study involving 30 patients with an irreparable SSC tear and those with a SSC tear combined with a reparable supraspinatus tear, who underwent a latissimus dorsi tendon transfer. Clinical scores and active range of motion (aROM), SSC-specific physical examination and the rate of return to work were assessed. Radiological assessment included recording the acromiohumeral distance (AHD), the Hamada grade of cuff tear arthropathy and the integrity of the transferred tendon. Statistical analysis compared preoperative, short-term (two years), and final follow-up at a mean of 8.7 years (7 to 10).Aims
Methods
It has been established that mechanical stimulation benefits tendon-bone (T-B) healing, and macrophage phenotype can be regulated by mechanical cues; moreover, the interaction between macrophages and mesenchymal stem cells (MSCs) plays a fundamental role in tissue repair. This study aimed to investigate the role of macrophage-mediated MSC chondrogenesis in load-induced T-B healing in depth. C57BL/6 mice rotator cuff (RC) repair model was established to explore the effects of mechanical stimulation on macrophage polarization, transforming growth factor (TGF)-β1 generation, and MSC chondrogenesis within T-B enthesis by immunofluorescence and enzyme-linked immunosorbent assay (ELISA). Macrophage depletion was performed by clodronate liposomes, and T-B healing quality was evaluated by histology and biomechanics. In vitro, bone marrow-derived macrophages (BMDMs) were stretched with CELLOAD-300 load system and macrophage polarization was identified by flow cytometry and quantitative real-time polymerase chain reaction (qRT-PCR). MSC chondrogenic differentiation was measured by histochemical analysis and qRT-PCR. ELISA and qRT-PCR were performed to screen the candidate molecules that mediated the pro-chondrogenic function of mechanical stimulated BMDMs.Aims
Methods
Introduction. Platelet Rich Plasma (PRP) is widely used in clinical praxis. Especially the effects in musculoskeletal repair studies are diverse and an augmentation of healing processes stays questionable. However, diverse cell culture studies reported promising results, which seem not be transferable into the clinical situation. We therefore performed a cell culture study which better reflects the clinical situation: the autologous stimulation of human tendon cells with PRP. Materials and Methods. Human tenocyte-like cells (hTLCs) from 24 donors (12 male/female) with
We discuss aspects of glenohumeral instability and rotator cuff tears in a clinically orientated approach, presenting a new way of quantifying structural bone loss from the anterior glenoid and defining the Glenoid Index as an indicator of the appropriate surgical approach to address anterior instability. Repair of the rotator cuff depends on viable and functional muscular tissue. We discuss the potential for repair of the
Anatomy of the rotator cuff tendons, their relationship to the greater tuberosity, and the tensile and compressive properties of the cuff tendons have been extensively studied recently. From these anatomical and biomechanical studies, it has been clarified that stress concentration at the anterior portion of the
We report an unusual case of knee disease where calcific tendonitis occurring in both quadriceps and patellar tendon simultaneously in the same knee. A 47 year old female presented to orthopaedics outpatient clinic with acute onset of swelling and knee pain with no history of trauma. She was found to have a moderate effusion of the knee joint with mild tenderness over the mid quadriceps tendon. Active flexion of the knee joint was painful with a range of motion between 0-90 degrees. She is otherwise healthy with no past medical history. Plain radiographs and Magnetic Resonance Imaging (MRI) Scan revealed calcification of both tendons. Calcific tendonitis is classically found in the
The assessment of the arthroscopic findings in patients suffering from impingement syndrome and partial tear of the
Using 26 cadaver shoulders, we produced a standard defect in the
1. The "frozen" shoulder syndrome is due to an inflammatory lesion in the musculotendinous cuff invoked by a local area of degeneration. 2. The available evidence suggests that the primary site of the degenerative lesion is in the
Previous perfusion studies of the rotator cuff have demonstrated an area of hypovascularity in the distal part of the
1. Three cases of localised deposition of calcium salts deep to the origin of the common extensors of the forearm with acute symptoms clinically indistinguishable from "tennis elbow" are described. 2. Reports of nine similar cases have been found in the literature. 3. It is suggested that "tennis elbow" is caused by a lesion, probably an adventitial bursa, in the tissue space between the tendon of origin of the forearm extensors and the capsule of the radio-humeral joint; and that it is the sudden precipitation of calcium phosphate at this site which causes the lesion here described. 4. Acute calcification near the elbow joint is compared with the similar calcification which may occur in the insertion of the
We describe 11 cases of posterior fracture-dislocation of the shoulder that required open reduction and fixation. Difficulties with access through anterior approaches led us to use the superior subacromial approach. This is an extension of the approach often used to expose the rotator cuff; the joint is opened by splitting the
Ninety-seven patients suffering from painful arc syndrome of the shoulder were studied. Local anaesthetic and radiographic contrast investigations were carried out. One-third of the patients had lesions in the posterior part of the rotator cuff which resolved after injections of local anaesthetic and steroid. One-third had anterior lesions in the subscapularis tendon: almost all resolved under the same regime but two required division of the coraco-acromial ligament. The remaining third had lesions of the
INTRODUCTION. Rotator cuff tears are common injuries which often require surgical repair. Unfortunately, repairs often fail [1] and improved repair strength is essential. P2 Porous titanium (DJO Surgical, Austin TX) has been shown to promote osseointegration [2,3] and subdermal integration [4]. However, the ability of P2Porous titanium to aid in supraspinatus tendon-to-bone repair has not been evaluated. Therefore, the purpose of this study was to investigate P2 implants used to augment supraspinatus tendon-to-bone repair in a rat model [5]. We hypothesized that supraspinatus tendon-to-bone repairs with P2 implants would allow for ingrowth and increased repair strength when compared to standard repair alone. METHODS. Thirty-four adult male Sprague-Dawley rats were used (IACUC approved). Rats received bilateral supraspinatus detachment and repair with one limb receiving P2 implant. Animals were sacrificed at time 0 (n=3), 2 weeks (n=8), 4 weeks (n=9) and 12 weeks (n=14). Limbs were either dissected for histological and SEM analysis or mechanical testing as described previously [5]. Specimens for histology and SEM were embedded in PMMA for tissue-implant interface analysis. Specimens were first viewed in SEM under BSE to detect bony ingrowth, then stained with Sanderson's Rapid Bone Stain and viewed under transmitted and polarized light for tissue ingrowth. Comparisons were made using Student's t-tests with significance at p≤0.05. RESULTS. No differences in cross-sectional area were detected at any time point (Fig 1A). Percent relaxation was significantly increased in the P2 group at 2 weeks, but not at 4 and 12 weeks (Fig 1B). Maximum load was significantly increased in the P2 group at 2 weeks, but not at 4 weeks (Fig 1C – maximum load not reported due to failure at grip at 12 weeks). Modulus was significantly increased in the P2 group at 4 weeks, but not at 2 or 12 weeks (Fig 1D). No differences were detected in stiffness at any time point (data not shown). BSE analysis demonstrated bone ingrowth (Fig 2) and histological analysis showed soft tissue integration (Fig 3). DISCUSSION. Results indicate superior mechanical properties in the P2 group at 2 and 4 weeks, and tissue ingrowth at all time points. Importantly, at 2 weeks, the P2group had 76% increased maximum load compared to standard repair. As
The aim of this study was to find evidence of tissue hypoxia and apoptosis (programmed cell death) have on a human model of rotator cuff failure. We studied twenty seven patients with no tear mild impingment (3), no tear moderate impingment (3), no tear severe impingment (3), partial tear (3), small tear (3), moderate tear (3), large tear (3), massive tear (3) and control (3) who were undergoing shoulder arthroscopy, subacromial decompression and potential rotator cuff repair. A
Aims: The roentgenologic morphology of symptomatic calcified deposits of the rotator cuff can be classified according Gärtner (1993, Z Orthop Ihre Grenzgebiete 131: 461–469). This classification influences therapeutic procedures and prognosis of clinical outcome in these patients. In the present study intraoberserver-reproducibility and interobserver-reliability of Gärtner’s classification were tested. Methods: Plane radiographs of 100 patients with calcifications of the
The objective was to seek evidence of hypoxia in early human tendinopathy and thereafter, to explore mechanisms whereby tissue hypoxia may regulate apoptosis, inflammatory mediators and matrix regulation in human tenocytes. Fifteen torn
Age-related localised deposition of amyloid in connective tissue has been found in degenerative articular and periarticular tissue. Biopsies of the
The aim of this study was to understand the role tissue hypoxia and apoptosis have on a human model of rotator cuff failure. We studied twenty seven patients with no tear mild impingment (3), no tear moderate impingment (3), no tear severe impingment (3), partial tear (3), small tear (3), moderate tear (3), large tear (3), massive tear (3) and control (3). A
Introduction: Reconstruction of the original footprint of the
The
Summary Statement. The peripheral neuronal phenotype is significantly altered in rotator cuff tendinopathy (RCT) with a clear upregulation of the Glutaminergic system being present in disease. Introduction. Shoulder pain is the third most frequent cause of chronic musculoskeletal pain in the community and is usually caused by rotator cuff tendinopathy (RCT). The central and peripheral nervous system play an important role in both tissue homoeostasis and tendon healing. The Glutaminergic system is of key importance in driving the peripheral and central neuronal changes which increase the body's sensitivity to pain (1, 2). No study to date has investigated the role of the glutaminergic system in human RCT. We hypothesised that the peripheral neuronal phenotype would be altered in RCT, and would vary according to disease stage as measured by size of tear. The term ‘peripheral neuronal phenotype’ is used to refer to refer to specific characteristics of the peripheral nervous system, neuronal mediators and the receptors for these mediators in peripheral tissue. Methods. Rotator cuff tendon specimens were obtained from 64 patients undergoing the surgical repair of rotator cuff tears. Control
Tendon is a bradytrophic and hypovascular tissue, hence, healing remains a major challenge. The molecular key events involved in successful repair have to be unravelled to develop novel strategies that reduce the risk of unfavourable outcomes such as non-healing, adhesion formation, and scarring. This review will consider the diverse pathophysiological features of tendon-derived cells that lead to failed healing, including misrouted differentiation (e.g. de- or transdifferentiation) and premature cell senescence, as well as the loss of functional progenitors. Many of these features can be attributed to disturbed cell-extracellular matrix (ECM) or unbalanced soluble mediators involving not only resident tendon cells, but also the cross-talk with immigrating immune cell populations. Unrestrained post-traumatic inflammation could hinder successful healing. Pro-angiogenic mediators trigger hypervascularization and lead to persistence of an immature repair tissue, which does not provide sufficient mechano-competence. Tendon repair tissue needs to achieve an ECM composition, structure, strength, and stiffness that resembles the undamaged highly hierarchically ordered tendon ECM. Adequate mechano-sensation and -transduction by tendon cells orchestrate ECM synthesis, stabilization by cross-linking, and remodelling as a prerequisite for the adaptation to the increased mechanical challenges during healing. Lastly, this review will discuss, from the cell biological point of view, possible optimization strategies for augmenting Achilles tendon (AT) healing outcomes, including adapted mechanostimulation and novel approaches by restraining neoangiogenesis, modifying stem cell niche parameters, tissue engineering, the modulation of the inflammatory cells, and the application of stimulatory factors. Cite this article:
This study was carried out to determine the incidence of shoulder injuries in the ipsilateral shoulder of patients who attended our unit with fractures of the humeral diaphysis. This was a prospective study. 22 patients with fractures of the humeral diaphysis had an early (within 10 days of injury) MRI scan of the shoulder. The contralateral shoulder was also scanned as an internal control. There were 10 male and 12 female patients. The average age was 45 years. 20 were treated non-operatively, and 2 had retrograde intra-medullary nailing of the humerus. 6 patients in our study had a symmetrical MRI scan. The remaining 16 patients had some acute abnormality evident in the ipsilateral shoulder. 11 patients had a significant subacromial bursitis. 2 of these patients had a tear of the
Introduction. Many literatures regarding more specific tests to diagnose the
Aim To evaluate the functional results of rotator cuff function and integrity after arthroscopic excision of calcium and decompression with a minimum follow up of two years. Methods Between 2002 and 2004, sixty consecutive patients with calcific tendinitis underwent arthroscopic excision of calcium and subacromial decompression. Their average age was 51 years (range 28 to 78). The male to female ratio was 2:3. All patients were retrospectively reviewed by an independent observer. Functional outcome was assessed objectively by Constant scoring system and subjectively by Oxford Shoulder Questionnaire. The integrity of the rotator cuff was assessed by ultrasound scan. (Sonosite). Operative technique After arthroscopic subacromial decompression, all calcific deposits were excised with an arthroscopic rotating blade. The resultant cuff defect was left to heal and no cuff repair was performed. Other intra-articular pathology including SLAP lesions were treated at the same time. Postoperatively, early mobilization of the shoulder was encouraged. Results The mean Constant score at follow-up was 82 (range 63 to 100). Fifty-four patients (90%) had good or excellent results and six patients (10%) had a fair score. Ultrasound assessment showed intact rotator cuff with no residual defect in forty-three patients, partial thickness tears in twelve, and small full thickness tears in three. Two patients had recurrence of calcium. Only four of the fifteen patients who had ultrasound evidence of rotator cuff tear were symptomatic. Conclusion Arthroscopic excision of calcium and subacromial decompression is an effective method of pain relief in calcific tendinitis of the shoulder. 75% of the rotator cuff appeared to have healed after two years. Of the remaining 25% patients who had a defect in their
There is no non-invasive gold standard for measuring gap formation following rotator cuff repair; re-tears are reported both on MRI and Ultrasound. Roentgen Stereophotogrammetric Analysis (RSA) has previously been used to monitor microscopic migration of markers in rigid bodies. We present a novel RSA technique using a combination of 1mm tantalum beads and metal sutures to allow accurate monitoring of gap formation following rotator cuff repair. The RSA system combines a commercially made calibration cage with software developed at Imperial College. We verified the RSA system by analysing a movable glass phantom and comparing the data with precise physical measurements of the same object: it identified a 2mm distraction of the phantom to within 0.05mm. In vitro work involved cadaveric human shoulders. We placed three 1mm RSA tantalum beads in the greater tuberosity and three metal sutures in
The February 2023 Shoulder & Elbow Roundup360 looks at: Arthroscopic capsular release or manipulation under anaesthesia for frozen shoulder?; Distal biceps repair through a single incision?; Distal biceps tendon ruptures: diagnostic strategy through physical examination; Postoperative multimodal opioid-sparing protocol vs standard opioid prescribing after knee or shoulder arthroscopy: a randomized clinical trial; Graft healing is more important than graft technique in massive rotator cuff tear; Subscapularis tenotomy versus peel after anatomic shoulder arthroplasty; Previous rotator cuff repair increases the risk of revision surgery for periprosthetic joint infection after reverse shoulder arthroplasty; Conservative versus operative treatment of acromial and scapular spine fractures following reverse total shoulder arthroplasty.
Two fixation devices for rotator cuff repair were compared in a sheep model. Surgical transection of the supra-spinatus tendon insertion was repaired using metallic OBL suture anchors or Suretac II anchors. Twelve weeks postoperatively the repair site was assessed using histology, polarized light microscopy and biomechanical testing. No important differences were found between these two repair methods. The purpose of this study was to compare traditional rotator cuff fixation devices with bioabsorbable press-fit tacks. Sixteen sheep were assigned to OBL (n=8) or Suretac (n=8) treatment groups. Four sheep shoulder joints were used as unoperated controls. Treated sheep underwent general anesthesia and a lateral arthrotomy using aseptic technique to allow transection of the
Rotator cuff (RC) tears are common musculoskeletal injuries which often require surgical intervention. Noninvasive pulsed electromagnetic field (PEMF) devices have been approved for treatment of long-bone fracture nonunions and as an adjunct to lumbar and cervical spine fusion surgery. This study aimed to assess the effect of continuous PEMF on postoperative RC healing in a rat RC repair model. A total of 30 Wistar rats underwent acute bilateral supraspinatus tear and repair. A miniaturized electromagnetic device (MED) was implanted at the right shoulder and generated focused PEMF therapy. The animals’ left shoulders served as controls. Biomechanical, histological, and bone properties were assessed at three and six weeks.Aims
Methods
This study compared patients who underwent arthroscopic repair of large to massive rotator cuff tears (LMRCTs) with isolated incomplete repair of the tear and patients with incomplete repair with biceps tendon augmentation. We aimed to evaluate the additional benefit on clinical outcomes and the capacity to lower the re-tear rate. We retrospectively reviewed 1,115 patients who underwent arthroscopic rotator cuff repair for full-thickness tears between October 2011 and May 2019. From this series, we identified 77 patients (28 male, 49 female) with a mean age of 64.1 years (50 to 80). Patients were classified into groups A (n = 47 incomplete) and B (n = 30 with biceps augmentation) according to the nature of their reconstruction. Clinical scores were checked preoperatively and at six months, one year, and two years postoperatively. In preoperative MRI, we measured the tear size, the degree of fatty infiltration, and muscle volume ratio of the supraspinatus. In postoperative MRI, the integrity of the repaired rotator cuff tendon was assessed using the Sugaya classification. Tendon thickness at the footprint was evaluated on T2-weighted oblique coronal view.Aims
Methods
A revision for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) has a major effect on the patient’s quality of life, including walking capacity. The objective of this case control study was to investigate the histological and ultrastructural changes to the gluteus medius tendon (GMED) in patients revised due to a PJI, and to compare it with revision THAs without infection performed using the same lateral approach. A group of eight patients revised due to a PJI with a previous lateral approach was compared with a group of 21 revised THAs without infection, performed using the same approach. The primary variables of the study were the fibril diameter, as seen in transmission electron microscopy (TEM), and the total degeneration score (TDS), as seen under the light microscope. An analysis of bacteriology, classification of infection, and antibiotic treatment was also performed.Aims
Methods
The aim of this study is to provide a detailed description of cases combining bridging patch repair with artificial ligament “internal brace” reinforcement to treat irreparable massive rotator cuff tears, and report the preliminary results. This is a retrospective review of patients with irreparable massive rotator cuff tears undergoing fascia lata autograft bridging repair with artificial ligament “internal brace” reinforcement technique between January 2017 and May 2018. Inclusion criteria were: patients treated arthroscopically for an incompletely reparable massive rotator cuff tear (dimension > 5 cm or two tendons fully torn), stage 0 to 4 supraspinatus fatty degeneration on MRI according to the Goutallier grading system, and an intact or reparable infraspinatus and/or subscapularis tendon of radiological classification Hamada 0 to 4. The surgical technique comprised two components: first, superior capsular reconstruction using an artificial ligament as an “internal brace” protective device for a fascia lata patch. The second was fascia lata autograft bridging repair for the torn supraspinatus. In all, 26 patients with a mean age 63.4 years (SD 6.2) were included.Aims
Methods
Purpose of the study: Muscles contract after a full thickness tear their tendon. The muscle then undergoes atrophy and fatty degeneration. These changes produce effects well described by histology, computed tomography and magnetic resonance imaging (MRI). To date however, the correlation of this process with the future conractile force of the muscle and the prognosis after cuff repain has been poorly understood. Material and methods: Thirteen patients with a full thickness tear of the supraspinatus muscle were treated surgically by cuff suture. The shoulders were examined clinically and MRI. During the operation, the supra-scapular nerve was stimulated with a supramaximal voltage to obtain maximal muscle contraction which was measured. Biopsy specimens of the supraspinatus were taken before and after surgical repair in order to determine whether muscle activity during stimulation have any histological impact. The intraoperative measurements were compared with the MRI findings and the physical examination performed preoperative and at six weeks, six months and twelve months after surgery. Results: Maximal force of the supraspinatus muscle was 200N, which is greater than the force of a direct suture repair. The maximal force was clearly correlated with muscle atrophy and fatty degeneration: by surface area, force was 12N/cm. 2. for Goutallier grade 3 and 42 N/m. 2. for grade 0. Five of the thirteen repairs ended with a secondary tear, the muscle in four of the five patients was among the six strongest muscles. The fifth case was the weakest muscle of all. The histological study revealed a larger quantity of lipofuchin in the muscle with atrophy and a change in the fiber structure. Analysis of the results did not demonstrate any lesions caused by the tension during the operation. MRI demonstrated one case of repair without secondary tear, the fatty infiltration had not improved and the atrophy only partially. In muscles with secondary tears, atrophy and fatty degeneration progressed significantly. Discussion and conclusion: There is a risk of rupture of the
The practice of rotator cuff repair rapidly moves towards arthroscopic techniques especially for single tendon tears. Although the clinical results are relatively well established, the structural results of open rotator cuff repair and their correlation with the clinical outcome are poorly known. In order to provide a baseline for future studies using other repair techniques, this study was carried out to assess the structural changes in the repaired musculotendinous unit and to correlate these findings with the clinical outcome after rupture and repair of an isolated full thickness single tendon tear of the rotator cuff. To prospectively assess the quality of an open rotator cuff tendon repair technique, to determine how structural changes of rotator cuff muscles are affected by tendon repair, and to correlate the structural results of MRI studies with the clinical outcome. Direct open repair of a complete, isolated single tendon tear of the rotator cuff resulted in significant improvement in function and objective evidence of tendon healing on MRI. Successful direct repair was not associated with recovery of preoperative muscular atrophy or fatty infiltration when comparing Goutallier stage fatty infiltration between pre and postoperative patients. The age and gender-adjusted Constant score increased significantly from an average of 63.9% preoperatively to 94.5% postoperatively (p<
0.0001). Pain improved significantly from 6.8 points to 13.2 points on a visual analogue scale. (p<
0.0001). Activities of daily living increased from 11.2 points preoperatively to 17.9 points postoperatively (p<
0.0001). Anterior elevation, abduction and internal rotation improved significantly for subscapularis and supraspinatus repairs, but there was no significant change in external rotation. The overall rerupture rate was 12.5%. There was no significant improvement or recovery of muscular atrophy or fatty infiltration after tendon repair. Thirty-two consecutive open repairs of a single tendon tear of the rotator cuff were analysed. The
Rotator cuff tears are common in middle-aged and elderly patients. Despite advances in the surgical repair of rotator cuff tears, the rates of recurrent tear remain high. This may be due to the complexity of the tendons of the rotator cuff, which contributes to an inherently hostile healing environment. During the past 20 years, there has been an increased interest in the use of biologics to complement the healing environment in the shoulder, in order to improve rotator cuff healing and reduce the rate of recurrent tears. The aim of this review is to provide a summary of the current evidence for the use of forms of biological augmentation when repairing rotator cuff tears. Cite this article:
Purpose. Full-thickness tendon tears of the supraspinatus (SP) are common and can have a significant impact on shoulder function. To optimally treat
Summary. Strong mechanical fixation is critical to the success of rotator cuff repairs. In this comparative study in cadaveric shoulders, single-tendon full-thickness supraspinatus tears were repaired using two different types of PEEK knotless suture anchors-ReelX STT (Stryker) and Opus Magnum PI (Arthrocare)-using a single-row technique in both instances. Cyclic testing was performed followed by loading until mechanical failure. No significant difference was observed in gap formation, measured as the distance between the
The incidence of rotator cuff tears increases with age, thus the rotator cuff tear is often associated with osteoporotic or osteopenic bone in the proximal humerus, especially with female patients. For testing of fixation devices such as suture anchors used in rotator cuff repair often animal bones are used. They are easily to obtain, inexpensive and some have been found to be similar to human bone. But can we rely on the results drawn from these studies in our daily surgical practice?. The purpose of this study was to compare the trabecular bone mineral density, the trabecular bone volume fraction and the cortical layer thicknes in the greater tubercle in different species to evaluate their infiuence on primary stability of suture anchors under a cyclic loading protocol representing the physiologic forces placed on rotator cuff repairs in vivo. We hypothezised that maximum pullout forces as well as the modes of failure are different for a suture anchors in different humeri. The available three different types of anchor fixation design (screw: Spiralok 5mm, Super Revo 5mm, press-fit: Bioknotless RC, wedging: Ultrasorb) were tested. The bone mineral density (BMD) of the humeri was measured by a 64-slice-computed tomography system. Each anchor was tested individually until failure. The sutures were pulled at 135° to the axis of the humeral shaft, simulating the physiological pull of the
Objectives. Although many clinical and experimental investigations have shed
light on muscle atrophy and intramuscular accumulation of fat after
rotator cuff disruption, none have reported on their onset in the
absence of muscle retraction. Methods. In 30 rabbits, we detached one
1. The avascular zone in the tendon of the supraspinatus near its insertion was not seen in the other tendons comprising the rotator cuff, except for the superior portion of the insertion of the infraspinatus which, on occasions, showed a small avascular area. The biceps tendon, however, also showed an avascular zone as it coursed over the head of the humerus. It is suggested that the anatomical disposition of these tendons makes them subject to constant pressure from the head of the humerus, which tends to wring out the blood supply to these tendons when the arm is held in the resting position of adduction and neutral rotation. 2. Although this study did not produce any evidence that the relative avascularity of the tendons over a prolonged period could be indicted as the sole cause of the degenerative changes that so commonly occur, it was noted that the degenerative changes occurred first and that they were always most extensive in the areas of avascularity. It was also observed that the zones of relative avascularity preceded, and were not the result of, the degenerative changes. 3. With the onset of tendon degeneration, secondary vascular phenomena were observed. Firstly, there was a reaction that appeared to be a foreign body inflammatory response with the development of vascular tufts of granulation tissue. It was thought that these vascular changes were secondary to the breakdown in the tendons and were not the cause of the breakdown as previously suggested by Anderson and Moore. it was noted, moreover, that with the progression of degenerative changes in the
Rotator cuff (RC) injuries are characterized by tendon rupture, muscle atrophy, retraction, and fatty infiltration, which increase injury severity and jeopardize adequate tendon repair. Epigenetic drugs, such as histone deacetylase inhibitors (HDACis), possess the capacity to redefine the molecular signature of cells, and they may have the potential to inhibit the transformation of the fibro-adipogenic progenitors (FAPs) within the skeletal muscle into adipocyte-like cells, concurrently enhancing the myogenic potential of the satellite cells. HDACis were added to FAPs and satellite cell cultures isolated from mice. The HDACi vorinostat was additionally administered into a RC injury animal model. Histological analysis was carried out on the isolated supra- and infraspinatus muscles to assess vorinostat anti-muscle degeneration potential.Aims
Methods
Purpose: Synovium proliferation of rheumatoid arthritis (RA) is a key role in development of destruction in articular joints. Arthroscopic synovectomy is quite useful for resection synovium less invasively for RA patients. However there are few papers about shoulder joint synovectomy of rheumatoid arthritis. Ho-YAG laser is also effective to decrease synovium proliferation. The advantage of using Ho-YAG laser is effective to pannus even in deep zone of bone erosion. In this paper, we treated 13 shoulders of 11 patients of RA by using Ho-YAG laser to assess whether Ho-YAGH laser is effective in shoulder arthroscopic synovectomy of RA. Materials and Methods: We treated 13 shoulders in 11 patients of RA, including 8 in stage II, 4 in stage III, 1 in stage IV. The duration of RA is an average of 4, 6 years. The follow-up period is an average of 14 months. We compared CRP, DAS28 and MRI findings before and after surgery. Those patients were taking DMARDs such as MTX in 8 patients, steroid in 3 patients infliximab in 1 patient and etanercept in 1 patient. We used 4.0 mm arthroscope, VAPR and shaver for synovectomy. Ho-YAG laser set to 10W to bone erosion area to reach deep zone of pannus and to resect synovium. Results: We found villous synovium proliferation with vascularity in rotator interval and
Purpose: Many different rotator cuff repairs have been advocated in previous publications without experimental evidence. Our aim was to mechanically test the static tensile properties and cyclical loading to failure of a single row lateral anchor repair and a double row medial and lateral anchor repair. Method: Fresh frozen cadaveric shoulders were mounted on a rig and a mini-open deltoid split used to visualise the supraspinatus. A standardised full thickness incision of 2 cms was made with a scalpel across the
Purpose: The aetiology of primary omarthrosis is still unclear. Typical radiological changes are joint space narrowing and the development of caudal osteophytes. The objective of the study is the analysis of the joint space of the shoulder in four different age groups. Materials and Methods: Retrospective analysis of n=342 standardized X-rays (2002–2009) (true ap, axillary). Inclusion criteria: normal adulthood group I (n=60), instability group II (n=53), calcifying tendonitis of the
The indications for use of a glenoid component are: 1.) sufficient degenerative changes on the glenoid to expose the subchondral bone 2.) the glenoid should have sufficient glenoid bone stock to allow for secure and longterm fixation of the component, and 3.) the rotator cuff should be intact or repairable and the humeral head should be centred within the glenoid component. Other factors that secondarily affect the decision to use a glenoid component, include the patient’s age and activity level, which should be such that they are not likely to result in multiple revisions for glenoid wear or loosening. Given these factors most patients with osteoarthritis, the leading indication for prosthetic replacement for arthritis should undergo a total shoulder replacement. Patients with acute proximal humeral fractures, the overall leading indication for prosthetic arthroplasty, should have a hemiarthroplasty. Patients with rotator cuff tear arthropathy or crystalline arthropathy are indicated for hemiarthroplasty due to the massive irreparable cuff tears present in these conditions. Patients with rheumatoid arthritis have variable diseases affecting the rotator cuff and variable degrees of bone loss resulting in the need to individualise the indications for the use of a glenoid to the patient’s pathoanatomy. The reason for use of a glenoid component, when indicated, is the fact that pain relief and function is predictably better when compared to hemiarthroplasty for the same indication and pathoanatomy. Proper insertion of a glenoid component requires wide exposure of the glenoid fossa and bone preparation, which for most general orthopaedic surgeons is difficult and not reproducible. This is, in my opinion, the primary reason that hemiarthroplasty or bipolar arthroplasty is used for treatment of many patients with primary osteoarthritis. Both of these procedures result, on average, in a less favourable outcome than non-constrained total shoulder arthroplasty. Osteoarthritis is characterised by flattening and enlargement of the humeral head and is associated with peripheral osteophyte formation. Loss of articular cartilage results in eburnated bone and on the glenoid side posterior bone loss. Capsular contracture results in loss of passive arcs of motion, particularly anteriorly with loss of external rotation. Posterior subluxation of the humeral head can occur, associated with anterior soft tissue contracture and/or posterior glenoid bone loss. The severity of this pathoanatomy is variable among patients with primary osteoarthritis and each of these factors will have a variable effect on outcome of shoulder arthroplasty as well as the indication for hemiarthroplasty versus total shoulder arthroplasty. In a 2–7 year follow-up multicentre study using the DePuy Global Shoulder in 127 patients, those cases with osteoarthritis without humeral head subluxation, severe glenoid bone loss, or rotator cuff tears had the best results, for pain relief and function, with total shoulder arthroplasty. In patients with severe glenoid bone loss total shoulder has improved function when compared to hemiarthroplasty. This finding supports the data of others that demonstrate less favourable results of hemiarthroplasty for treatment of osteoarthritis in cases with eccentric glenoid wear. Patients with humeral head subluxation have less favourable results regardless of the use of a hemiarthroplasty or total shoulder arthroplasty. The presence of a full thickness reparable rotator cuff tear limited to the
Leakage after simple suture repair of rotator cuff tears depends on the overall preoperative fatty degeneration index (FDI) of the muscles and preoperative fatty degeneration (FD) of the infraspinatus. When the FDI is = 2, cuff leakage is always observed after repair. The risk of recurrent tears of the supraspinus is high if the FD of the infraspinatus is >
1. However if the FDI is very low or nil, the rate of recurrent tears is 15%. These tears can be explained by tension on sutures in macroscopically and histologically abnormal tendons. Purpose: The purpose of this study was to determine whether repair of rotator cuff tears using sutures without tension after removal of abnormal tendon stumps, a technique requiring tendon plasty, can improve the leakage rate. Material and methods: Total repair of 24 rotator cuff tears was performed without tension on the sutures after resection of at least one centimetre of the
Purpose. Chronic massive rotator cuff tears are challenging to repair completely because of the development of tendon retraction with inelasticity, muscle atrophy and fatty infiltration. The objective of this study was to investigate the clinical outcome and MRI findings after arthroscopic superior capsule reconstruction (ASCR) for symptomatic irreparable rotator cuff tears. Methods. From 2011 to 2013, 12 shoulders in 12 consecutive patients (mean, 70.8 years) with irreparable massive rotator cuff tears underwent ASCR using fascia lata. We used suture anchors to attach the graft medially to the glenoid superior tubercle and laterally to the greater tuberosity as same technique by Mihata et al. We added side-to-side sutures between the graft and infraspinatus tendon and between the graft and residual anterior
Indocyanine green (ICG) fluorescence angiography is an emerging technique that can provide detailed anatomical information during surgery. The purpose of this study is to determine whether ICG fluorescence angiography can be used to evaluate the blood flow of the rotator cuff tendon in the clinical setting. Twenty-six patients were evaluated from October 2016 to December 2017. The participants were categorized into three groups based on their diagnoses: the rotator cuff tear group; normal rotator cuff group; and adhesive capsulitis group. After establishing a posterior standard viewing portal, intravenous administration of ICG at 0.2 mg/kg body weight was performed, and fluorescence images were recorded. The time from injection of the drug to the beginning of enhancement of the observed area was measured. The hypovascular area in the rotator cuff was evaluated, and the ratio of the hypovascular area to the anterolateral area of the rotator cuff tendon was calculated (hypovascular area ratio).Objectives
Methods
Failure of healing is a well-known problem after repair of the rotator cuff. This study aimed to investigate if early repair of trauma-related full-thickness rotator cuff tears (FTRCTs) could prevent this failure. In this prospective trial, 62 consecutive patients (14 women (23%), 48 men (77%); median age 61 years (interquartile range (IQR) 54 to 65)) with trauma-related FTRCT underwent arthroscopic single-row repair within six weeks of trauma. Tendon integrity was assessed one year after surgery using the Sugaya score on MR images. Patients were followed up with Western Ontario Rotator Cuff (WORC) index, EuroQol visual analogue scale (EQ VAS), and the Constant–Murley score (CS) two years after repair.Aims
Patients and Methods
Many biomechanical studies have shown that the weakest biomechanical point of a rotator cuff repair is the suture-tendon interface at the medial row. We developed a novel double rip-stop (DRS) technique to enhance the strength at the medial row for rotator cuff repair. The objective of this study was to evaluate the biomechanical properties of the DRS technique with the conventional suture-bridge (SB) technique and to evaluate the biomechanical performance of the DRS technique with medial row knots. A total of 24 fresh-frozen porcine shoulders were used. The infraspinatus tendons were sharply dissected and randomly repaired by one of three techniques: SB repair (SB group), DRS repair (DRS group), and DRS with medial row knots repair (DRSK group). Specimens were tested to failure. In addition, 3 mm gap formation was measured and ultimate failure load, stiffness, and failure modes were recorded.Aims
Methods
The purpose of this study was to compare the effectiveness of surgical repair to conservative treatment and subacromial decompression for the treatment of chronic/degenerative tears of the rotator cuff. PubMed, Cochrane database, and Medline were searched for randomized controlled trials published until March 2018. Included studies were assessed for methodological quality, and data were extracted for statistical analysis. The systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.Aims
Materials and Methods
The aim of this study was to analyze the results of reverse shoulder
arthroplasty (RSA) in patients with type 1 sequelae of a fracture
of the proximal humerus in association with rotator cuff deficiency
or severe stiffness of the shoulder. A total of 38 patients were included: 28 women and ten men. Their
mean age at the time of arthroplasty was 73 years (54 to 91). Before
the RSA, 18 patients had been treated with open reduction and internal
fixation following a fracture. A total of 22 patients had a rotator
cuff tear and 11 had severe stiffness of the shoulder with < 0°
of external rotation. The mean follow-up was 4.3 years (1.5 to 10).
The Constant score and the range of movement of the shoulder were
recorded preoperatively and at final follow-up. Preoperatively, radiographs in two planes were performed, as
well as CT or arthro-CT scans; radiographs were also performed at
final follow-up.Aims
Patients and Methods
Platelet-rich fibrin matrix (PRFM) has been proved to enhance tenocyte proliferation but has mixed results when used during rotator cuff repair. The optimal PRFM preparation protocol should be determined before clinical application. To screen the best PRFM to each individual’s tenocytes effectively, small-diameter culture wells should be used to increase variables. The gelling effect of PRFM will occur when small-diameter culture wells are used. A co-culture device should be designed to avoid this effect. Tenocytes harvested during rotator cuff repair and blood from a healthy volunteer were used. Tenocytes were seeded in 96-, 24-, 12-, and six-well plates and co-culture devices. Appropriate volumes of PRFM, according to the surface area of each culture well, were treated with tenocytes for seven days. The co-culture device was designed to avoid the gelling effect that occurred in the small-diameter culture well. Cell proliferation was analyzed by water soluble tetrazolium-1 (WST-1) bioassay.Objectives
Methods