The Clinical and Structural Long-Term Results of Open Repair of Massive Tears of the Rotator Cuff

Department of Orthopedics, University of Zurich, Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 12/2008; 90(11):2423-31. DOI: 10.2106/JBJS.G.00677
Source: PubMed


At a mean follow-up of 3.1 years, twenty-seven consecutive repairs of massive rotator cuff tears yielded good and excellent clinical results despite a retear rate of 37%. Patients with a retear had improvement over the preoperative state, but those with a structurally intact repair had a substantially better result. The purpose of this study was to reassess the same patients to determine the long-term functional and structural results.
At a mean follow-up interval of 9.9 years, twenty-three of the twenty-seven patients returned for a review and were examined clinically, radiographically, and with magnetic resonance imaging with use of a methodology identical to that used at 3.1 years.
Twenty-two of the twenty-three patients remained very satisfied or satisfied with the result. The mean subjective shoulder value was 82% (compared with 80% at 3.1 years). The mean relative Constant score was 85% (compared with 83% at 3.1 years). The retear rate was 57% at 9.9 years (compared with 37% at 3.1 years; p = 0.168). Patients with an intact repair had a better result than those with a failed reconstruction with respect to the mean absolute Constant score (81 compared with 64 points, respectively; p = 0.015), mean relative Constant score (95% and 77%; p = 0.002), and mean strength of abduction (5.5 and 2.6 kg; p = 0.007). The mean retear size had increased from 882 to 1164 mm(2) (p = 0.016). Supraspinatus and infraspinatus muscle fatty infiltration had increased (p = 0.004 and 0.008, respectively). Muscles with torn tendons preoperatively showed more fatty infiltration than muscles with intact tendons preoperatively, regardless of repair integrity. Shoulders with a retear had a significantly higher mean acromion index than those without retear (0.75 and 0.65, respectively; p = 0.004).
Open repair of massive rotator cuff tears yielded clinically durable, excellent results with high patient satisfaction at a mean of almost ten years postoperatively. Conversely, fatty muscle infiltration of the supraspinatus and infraspinatus progressed, and the retear size increased over time. The preoperative integrity of the tendon appeared to be protective against muscle deterioration. A wide lateral extension of the acromion was identified as a previously unknown risk factor for retearing.

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    • "Among various surgical options available, open or arthroscopic rotator cuff repair is favorably performed for small to large size tears (Buess et al., 2005, Galatz et al., 2004, Harryman et al., 1991). Although advanced repair techniques and devices have been proposed, relatively high prevalence of re-tear after surgery is still remaining (Bartl et al., 2012, Khazzam et al., 2012, Miller et al., 2011, Zumstein et al., 2008). Among multiple factors leading to re-tear, stiffness of the cuff muscles has been a recent focus for failure. "
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    ABSTRACT: Ultrasound imaging has been used to evaluate various shoulder pathologies, whereas, quantification of the rotator cuff muscle stiffness using shear wave elastography (SWE) has not been verified. The purpose of this study was to investigate the reliability and feasibility of SWE measurements for the quantification of supraspinatus (SSP) muscle elasticity. Thirty cadaveric shoulders (18 intact and 12 with torn rotator cuff) were used. Intra- and inter-observer reliability was evaluated on an established SWE technique for measuring the SSP muscle elasticity. To assess the effect of overlying soft tissues above the SSP muscle, SWE values were measured with the transducer placed on the skin, on the subcutaneous fat after removing the skin, on the trapezius muscle after removing the subcutaneous fat, and directly on the SSP muscle. In addition, SWE measurements on 4 shoulder positions (0°, 30°, 60°, and 90° abduction) were compared in those with/without rotator cuff tears. Intra- and inter-observer reliability of SWE measurements were excellent for all regions in SSP muscle. Also, removing the overlying soft tissue showed no significant difference on SWE values measured in the SSP muscle. The SSP muscle with 0° abduction showed large SWE values, whereas, shoulders with large-massive tear showed smaller variation throughout the adduction-abduction positions. SWE is a reliable and feasible tool for quantitatively assessing the SSP muscle elasticity. This study also presented SWE measurements on the SSP muscle under various shoulder abduction positions which might help characterize patterns in accordance to the size of rotator cuff tears.
    Journal of Biomechanics 10/2015; DOI:10.1016/j.jbiomech.2015.09.038 · 2.75 Impact Factor
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    • "Une étude réalisée par Yamamoto et al. [7] a rapporté une incidence de 5,1 % pour les patients âgés entre 20 et 50 ans. De nombreux travaux ont rapporté des résultats satisfaisants chez les patients âgés, quelle que soit la technique utilisée : ciel ouvert, mini-open et arthroscopie [8] [9] [10] [11] [12]. En revanche, peu d'études ont évalué les résultats des réparations (sous-arthroscopie ou à ciel ouvert) des ruptures, partielles ou complètes, chez une population plus jeune [13] [14] [15] [16] [17] [18] [19] [20] [21] [22]. "
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    ABSTRACT: Rotator cuff tears are classically considered to result from a degenerative process. Many studies have reported satisfactory outcome for surgical treatment in older patients. Information is scarce however on partial or total cuff repairs, using arthroscopic or open procedures, in younger populations. The purpose of this work was to analyze the literature on rotator cuff repair in patients aged less than 50 years.
    Journal de Traumatologie du Sport 05/2015; 32(2). DOI:10.1016/j.jts.2015.04.001
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    • "Surgical methods are often used to reattach torn tendon to the bone. However, surgery often has a poor clinical outcome, with repair failure rates of massive rotator cuff tendon tears exceeding 80%, for instance [2]. This is generally attributed to insufficient restoration of native biochemical and mechanical properties at the injury site, where a multitissue interface comprises a cellular and tissue transition from the tendon itself, to a fibrocartilage region, followed by bone. "
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    ABSTRACT: Polycaprolactone (PCL)/Pluronic F127 membrane with reverse gradients of dual platelet-derived growth factor-β (PDGF-BB) and bone morphogenetic protein 2 (BMP-2) concentrations was fabricated using a diffuse method to investigate the effect of reverse gradients of dual growth factor concentrations on adipose-derived stem cell (ASC) differentiations, such as tenogenesis and osteogenesis. The PDGF-BB and BMP-2 were continuously released from the membrane for up to 35 days, with reversely increasing/decreasing growth factors along the membrane length. Human ASCs were seeded on the membrane with reverse PDGF-BB and BMP-2 gradients. The cells were confluent after 1 week of culture, regardless of growth factor types or concentrations on the membrane. Gene expression (RT-PCR), Western blot, and immunohistological analyses after 1 and 2 weeks of ASC culture showed that the membrane sections with higher PDGF-BB and lower BMP-2 concentrations provided a better environment for ASC tenogenesis, while the membrane sections with higher BMP-2 and lower PDGF-BB concentrations were better for promoting osteogenesis. The results suggest that the membrane with reverse gradients of PDGF-BB and BMP-2 may be promising for tendon-to-bone repair, as most essential biological processes are mediated by gradients of biological molecules in the body.
    Acta biomaterialia 12/2013; 10(3). DOI:10.1016/j.actbio.2013.12.031 · 6.03 Impact Factor
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