We evaluated the clinical outcomes of arthroscopic margin convergence for rotator cuff tears.
Twenty-four consecutive patients with full-thickness rotator cuff tears, in which the free tendon edge could not be reduced to the footprint after the release and mobilization of the rotator cuff tendon, were included. Rotator cuff repair integrity was determined by magnetic resonance imaging or ultrasonography after the operation. The mean age and follow-up period for the patients were 59.6 years (range, forty-eight to seventy-three years) and 30.6 months (range, twenty-four to sixty months), respectively. Five outcome measures were used before surgery and at the time of the final follow-up: a visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California Los Angeles (UCLA), the Constant-Murley score, and the range of shoulder motion.
The follow-up rate for imaging was 95.8%, and the follow-up rate for clinical evaluation was 91.7%. The mean UCLA score (and standard deviation) improved from 17.4 ± 5.5 preoperatively to 31.6 ± 4.0 at the time of the final follow-up (p < 0.001). The mean ASES score improved from 54.9 ± 23.3 to 91.3 ± 11.8, respectively (p < 0.001). The mean Constant-Murley score improved from 45.9 ± 17.6 to 79.1 ± 12.6 (p < 0.001). The mean VAS score improved from 6.5 ± 1.7 to 1.3 ± 1.5 (p < 0.001). The mean range of motion (forward flexion) improved from 117.9° ± 37.7° to 166.8° ± 16.7° (p < 0.001). The postoperative imaging examinations showed cuff integrity without a retear in 52.2% of the shoulders. However, the UCLA, ASES, and Constant-Murley scores were not significantly different between healed and unhealed groups (p = 0.800, p = 0.322, and p = 0.597, respectively).
Reducing tension by margin convergence followed by a repair of the resulting free edge to bone has reasonable short-term clinical results but a substantial retear rate (47.8%). However, the retears tended to be smaller than the original tear size. No significant difference was observed in the short-term clinical results between the groups with or without a retear.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
"Two studies have compared the outcomes of complete repair with partial repair [12,13,33]. Iagulli et al compared 45 patients with a complete repair to 41 patients with a partial repair and found no statistically significant difference in their UCLA at 2 years . "
[Show abstract][Hide abstract] ABSTRACT: Background
The literature has shown good results with partial repairs of large and massive tears of rotator cuff but the role of factors that affect reparability is less clear. The purpose of this study was twofold, 1) to examine clinical outcomes following complete or partial repair of large or massive full-thickness rotator cuff tear, and 2) to explore the value of clinical and surgical factors in predicting reparability.
This was a secondary data analysis of consecutive patients with large or massive rotator cuff tear who required surgical treatment (arthroscopic complete or partial repair) and were followed up for two years. Disability measures included the American Shoulder and Elbow Surgeons (ASES), the relative Constant-Murley score (CMS) and the shortened version of the Western Ontario Rotator Cuff Index (ShortWORC). The relationship between predictors and reparability was examined through logistic regressions and chi-square statistics as appropriate. Within group change over time and between group differences in disability outcomes, range of motion and strength were examined by student’s T-tests and non-parametric statistics.
One hundred and twenty two patients (41 women, 81 men, mean age 64, SD = 9) were included in the analysis. There were 86 large (39 fully reparable, 47 partially reparable) and 36 (10 fully reparable, 26 partially reparable) massive tears. Reparability was not associated with age, sex, or pre-operative active flexion or abduction (p > 0.05) but the fully reparable tear group showed a better pre-operative ASES score (p = 0.01) and better active external rotation in neutral (p = 0.01). Reparability was associated with tear shape (p < 0.0001), size (p = 0.002), and tendon quality (p < 0.0001).
Reparability of large or massive tears is affected by a number of clinical and surgical factors. Patients whose tears could not be fully repaired showed a statistically significant improvement in range of motion, strength and disability at 2 years, although they had slightly inferior results compared to those with complete repairs.
[Show abstract][Hide abstract] ABSTRACT: Human securin, also known as human pituitary tumor-transforming gene 1 (pttg1), plays a key role in cell-cycle regulation. Two homologous genes, pttg2 and pttg3, have been identified although very little is known about their physiological function. In this study, we aimed at the characterization of these two pttg1 homologs. Real-time PCR analysis using specific probes demonstrated that Pttg2 is expressed at very low levels in various cell lines and tissues whereas Pttg3 was largely undetectable. We focused on the study of Pttg2 and found that, unlike PTTG1, PTTG2 lacks transactivation activity and does not bind to separase, making improbable a role in the control of sister chromatids separation. To further investigate the biological role of pttg2, we used short hairpin RNA inhibition of Pttg2 and found that cells with reduced Pttg2 levels assumed a rounded morphology compatible with a defect in cell adhesion and died by apoptosis in a p53- and p21-dependent manner. Using microarray technology, we generated a gene expression profile of Pttg2-depleted cells versus wild-type cells and found that knockdown of PTTG2 results in concomitant downregulation of E-cadherin and elevated vimentin levels, consistent with EMT induction. The observation of aberrant cellular behaviors in Pttg2-silenced cells reveals functions for pttg2 in cell adhesion and provides insights into a potential role in cell invasion.
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