Single-Row Versus Double-Row Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Study
ABSTRACT The purpose of this study was to compare the clinical outcome of arthroscopic rotator cuff repair with single-row and double-row techniques.
Eighty patients with a full-thickness rotator cuff tear underwent arthroscopic repair with suture anchors. They were divided into 2 groups of 40 patients according to repair technique: single row (group 1) or double row (group 2). Results were evaluated by use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Work-DASH self-administered questionnaires, normalized Constant score, and muscle strength measurement. On analyzing the results at a 2-year follow-up, we considered the following independent variables: baseline scores; age; gender; dominance; location, shape, and area of cuff tear; tendon retraction; fatty degeneration; treatment of biceps tendon; and rotator cuff repair technique (anchors or anchors and side to side). Univariate and multivariate statistical analyses were performed to determine which variables were independently associated with the outcome. Significance was set at P < .05.
Of the patients, 8 (10%) were lost to follow-up. Comparison between groups did not show significant differences for each variable considered. Overall, according to the results, the mean DASH scores were 15.4 +/- 15.6 points in group 1 and 12.7 +/- 10.1 points in group 2; the mean Work-DASH scores were 16.0 +/- 22.0 points and 9.6 +/- 13.3 points, respectively; and the mean Constant scores were 100.5 +/- 17.8 points and 104.9 +/- 21.8 points, respectively. Muscle strength was 12.7 +/- 5.7 lb in group 1 and 12.9 +/- 7.0 lb in group 2. Univariate and multivariate analysis showed that only age, gender, and baseline strength significantly and independently influenced the outcome. Differences between groups 1 and 2 were not significant.
At short-term follow-up, arthroscopic rotator cuff repair with the double-row technique showed no significant difference in clinical outcome compared with single-row repair.
Level I, high-quality randomized controlled trial with no statistically significant differences but narrow confidence intervals.
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ABSTRACT: The incidence of rotator cuff tears and recurrent defects positively correlate with patient age. However, this observation has never been analysed at the cellular level. The present study aims to better understand this correlation by investigating cellular characteristics of rotator cuff tenocytes of different age groups. Additionally, previous studies reported on stimulating effects of Bone Morphogenetic Protein (BMP) -2 and BMP-7 on tenocytes. Thus, the second aim was to investigate, whether the stimulation potential of tenocytes demonstrates age-related differences. Tenocyte-like cells from supraspinatus tendons of young and aged patients were analysed for the following cell biological characteristics: cell density, cell growth, marker expression, collagen-I protein synthesis, stem cell phenotype, potential for multipotent differentiation and self-renewal. To analyse the stimulation potential, cells were treated with BMP-2 and BMP-7 in 2D-/3D-cultures. Measured parameters included cell activity, marker expression and collagen-I protein synthesis. An effect of age was seen for cell growth and stem cell potential but not on extracellular matrix level. Cells from both groups responded to BMP-7 by increasing cell activity, collagen-I expression and protein synthesis. BMP-2 led to smaller increases in these parameters when compared to BMP-7. In general, 3D-cultivation improved the stimulation compared to 2D-culture. The cell biological characteristics of tenocyte-like cells, considered important for successful restoration of the tendon-bone unit, were inferior in elderly donors. This may help explain higher rates of recurrent defects seen in elderly patients. Regarding the stimulation potential, on a cellular level young and aged patients may benefit from biological augmentation with BMPs.European cells & materials 01/2012; 24:74-89. · 4.89 Impact Factor
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ABSTRACT: In this systematic review we assessed effectiveness of non-surgical and (post)surgical interventions for symptomatic rotator cuff tears (RotCuffTear). The Cochrane Library, PubMed, Embase, Cinahl, and Pedro were searched for relevant systematic reviews and randomized controlled trials (RCTs). Two reviewers independently selected relevant studies, extracted data and assessed the methodological quality. Three Cochrane reviews (7 RCTs) and 14 RCTs were included (3 non-surgery, 10 surgery, 8 post-surgery). For small or medium RotCufftears, moderate evidence was found in favour of surgery versus physiotherapy in mid- and long-term. In surgery, tendon-to-bone fixation with one metal suture anchor loaded with double sutures (TB) was more effective (moderate evidence) than a side-to-side repair with permanent sutures (SS) in the mid- and long-term; limited evidence for effectiveness was found in favour of debridement versus anchor replacement and suture repair of the type II SLAP tear in the long-term. Further, no evidence was found in favour of any non-surgical, surgical or post-surgical intervention. In conclusion, although surgery seems to give better results compared to non-surgery and TB is more effective than SS in rotator cuff repair (RCR), it remains hard to draw firm evidence-based conclusions for effectiveness of non-surgical or (post)surgical interventions to treat RotCuffTears. More research is clearly needed.Manual therapy 12/2010; 16(3):217-30. DOI:10.1016/j.math.2010.10.012 · 1.76 Impact Factor
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ABSTRACT: Zusammenfassung Die arthroskopische Rotatorenmanschettennaht ist ein etabliertes Verfahren zur Behandlung von Rotatorenmanschettenrupturen. Die klinischen Ergebnisse sind unabhängig von der verwendeten Nahttechnik sehr gut. Eine kritische Analyse der Ergebnisse bezüglich der Sehnenintegrität zeigte in den frühen klinischen Serien insbesondere für große Rupturen hohe Rerupturraten. Neben biologischen Faktoren wie Patientenalter, Muskelatrophie und fettige Infiltration der Rotatorenmanschette wiesen experimentelle Studien biomechanische Defizite der Einzelreihentechniken nach. Die Doppelreihentechnik mit einer medialen und lateralen Reihe Fadenanker wurde als Verbesserung der Einzelreihentechnik entwickelt und zeigt sich in den meisten Studien biomechanisch dieser überlegen. Die klinische Ergebnisse lassen im kurzzeitigen Follow-up eine Tendenz zu besseren Einheilungsraten gegenüber der Einzelreihentechnik erkennen, ohne dass das klinische Ergebnis weiter verbessert werden konnte. Dass die als Alternative zur klassischen Doppelreihentechnik entwickelte „Suture-bridge-Technik“ dieselben biomechanischen Vorteile oder signifikant höhere Einheilungsraten verglichen mit der Einzelreihentechnik liefert, ist derzeit nicht eindeutig belegt.Obere Extremität 03/2011; 6(1). DOI:10.1007/s11678-011-0102-8