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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Available from: Bernhard Jost, Oct 09, 2015
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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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    • "In Liem’s study, shoulder abduction was decreased for cuffs with retear among open and arthroscopically repaired patients, yet significant differences were found only among the latter group. Zumstein et al. and Verma et al. found no difference in the outcome scores and pain level among patients with or without RC retear [7, 18]. In Verma’s study, patients with failed RC repair had significantly lower strength of forward flexion but not external rotation; and that was found regardless of the repair technique (arthroscopic vs. mini-open). "
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    ABSTRACT: The purpose of the study was clinical and advanced biomechanical evaluation of shoulder function with respect to rotator cuff (RC) integrity following repair. This was a retrospective study of 111 cases with solid single row rotator cuff repair and a minimal one-year follow-up. The RC repair was performed as an open procedure in 42 patients, arthroscopically assisted in 34 and fully arthroscopic in 48 cases. Evaluation protocol included ultrasound evaluation of the RC integrity, clinical evaluation using shoulder scores and advanced biomechanical evaluation (isometric and the isokinetic strength testing). Ultrasound evaluation revealed complete retear in 16 %, partial retear in 10 % and intact repair in 74 % of the cases. Isometric testing of flexion and abduction had shown that shoulders with complete retear were weaker by 45 % compared to those with full tendon healing. Isokinetic testing revealed 29-43 % deficits in peak external rotation torque comparing complete retear vs. normal healing. Patients' ability to generate shoulder power and withstand a load proved to be lower in circumstances of a complete lack of healing (40-43 % and 34-55 %, respectively). Partial retears did not have a negative impact on the biomechanical properties of shoulders. Surprisingly, there were no significant differences in the shoulder scores related to the quality of healing. In terms of patient satisfaction the results were good and the patients declared themselves better in all cases, no matter what quality of healing had been recorded ultimately. According to the results of this research rotator cuff integrity after open or arthroscopic repair does not seem to affect clinical scores. Recurrent tears may result in lower muscle performance in terms of active motion, strength and endurance. Advanced shoulder testing may be essential in assessing the patients' ability to return to sports or heavy labour.
    International Orthopaedics 08/2013; 37(12). DOI:10.1007/s00264-013-2024-0 · 2.11 Impact Factor
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