Augmentation Devices for Rotator Cuff Repair

2011 ◽  
Author(s):  
Kathleen A. Derwin ◽  
Joseph P. Iannotti
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Soft Tissues ◽  
Tendon Repair ◽  
Rotator Cuff Tears ◽  
Common Cause ◽  
The Us ◽  
Cuff Repair ◽  
Cause Of Pain ◽  
Intended Use

Rotator cuff tears affect 40% or more of those over age 60 and are a common cause of pain and disability. Surgical repairs have high failure rates that range from 20 to 90%. Currently, scaffolds derived from various natural and synthetic biomaterials are being marketed as augmentation devices for rotator cuff repairs at the time of surgery 1–3. The US Food and Drug Administration (FDA) has cleared these devices “to support soft tissues where weakness exists” but not “to provide the full mechanical strength for the tendon repair”. Based on the mechanical connotation of their intended use, it is commonly believed that when applied appropriately, these devices may provide some degree of load sharing of forces across the tendon repair site and thus decrease the likelihood of tendon re-tear.

scholarly journals EGR1 Induces Tenogenic Differentiation of Tendon Stem Cells and Promotes Rabbit Rotator Cuff Repair

2015 ◽  
Vol 35 (2) ◽  
pp. 699-709 ◽  
Author(s):  
Xu Tao ◽  
Junpeng Liu ◽  
Lei Chen ◽  
You Zhou ◽  
Kanglai Tang
Keyword(s):  
Stem Cells ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Rabbit Model ◽  
Tendon Repair ◽  
Rotator Cuff Tears ◽  
Rotator Cuff Tendon ◽  
Tenogenic Differentiation ◽  
Tendon Stem Cells ◽  
Cuff Repair

Background/Aims: The rate of healing failure after surgical repair of chronic rotator cuff tears is considerably high. The aim of this study was to investigate the function of the zinc finger transcription factor early growth response 1 (EGR1) in the differentiation of tendon stem cells (TSCs) and in tendon formation, healing, and tendon tear repair using an animal model of rotator cuff repair. Methods: Tenocyte, adipocyte, osteocyte, and chondrocyte differentiation as well as the expression of related genes were determined in EGR1-overexpressing TSCs (EGR1-TSCs) using tissue-specific staining, immunofluorescence staining, quantitative PCR, and western blotting. A rabbit rotator cuff repair model was established, and TSCs and EGR1-TSCs in a fibrin glue carrier were applied onto repair sites. The rabbits were sacrificed 8 weeks after repair operation, and tissues were histologically evaluated and tenocyte-related gene expression was determined. Results: EGR1 induced tenogenic differentiation of TSCs and inhibited non-tenocyte differentiation of TSCs. Furthermore, EGR1 promoted tendon repair in a rabbit model of rotator cuff injury. The BMP12/Smad1/5/8 signaling pathway was involved in EGR1-induced tenogenic differentiation and rotator cuff tendon repair. Conclusion: EGR1 plays a key role in tendon formation, healing, and repair through BMP12/Smad1/5/8 pathway. EGR1-TSCs is a promising treatment for rotator cuff tendon repair surgeries.

scholarly journals Surgical repairs of the Rotator Cuff Tears

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
S M H Jafri ◽  
W A Khan ◽  
M Pervaiz ◽  
A Ghaffar ◽  
S Raziq
Keyword(s):  
Pain Relief ◽  
Rotator Cuff ◽  
Old Age ◽  
Rotator Cuff Repair ◽  
Surgical Repair ◽  
Senior Author ◽  
Rotator Cuff Tears ◽  
Cuff Repair ◽  
Cause Of Pain

Evaluation of 15 cases who underwent surgical rotator cuff repair is presented. This study extends from 1995 to 2001. Cases operated by senior author have been included in this study. The follow up ranges from 9 months to 4 years. Evaluation includes study as regard to pain relief, range of motion and strength achieved after surgery. In all cases acromion- plasty was done. Rotator cuff problem is a well-know cause of pain and disability in shoulder especially in old age. Good results after surgical repair of rupture rotator cuff have been well documented. To our best knowledge this is the first study in this country about results of surgical rotator cuff repair.

scholarly journals Systematic Review of Literature on the Efficiency of Using PRP in Arthroscopic Rotator Cuff Repair

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
T M Samy ◽  
A H Khater ◽  
A K M Ahmed
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Bone Repair ◽  
Platelet Rich Plasma ◽  
Tendon Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Abstract Rotator cuff tears are one of the most common shoulder problems and the incidence of this condition is increasing along with an aging population. Despite satisfactory results for rotator cuff repair the quality and speed of healing remain problematic. Several studies have demonstrated that native tendon-bone insertions were not restored after tendon to bone repair. Healing of repaired tendons occurred via fibrous scar tissue formation rather than via the regeneration of a histologically normal insertion, and thus repaired tendons have inferior mechanical properties and are more susceptible to retear. Presumably, this is the most significant reason that account for tendon repair failure. Despite recent biomechanical advances in fixation, rates of retear are still high. Tendons consume little energy, and as a consequence healing is slow after injury. Increasing the speed of healing would allow earlier return to work, sport, and activities of daily living, which would be helpful for both the elite athlete and general public. Platelet rich plasma was first popularized in maxillofacial and plastic surgery, but now is thought to enhance and accelerate the repair and regeneration of a variety of tissues, such as bone, cartilage, tendon, ligament, and muscle. This systematic review reporting the effect of PRP after arthroscopic rotator cuff repair.

Arthroscopic Subscapularis Tendon Repair Using the Mason-Allen Technique

2021 ◽  
Author(s):  
Junqi Huang ◽  
Jiajia Cheng ◽  
Shitian Tang ◽  
Bo Shi ◽  
Gang Liu ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Tendon Repair ◽  
Shoulder Function ◽  
Arthroscopic Rotator Cuff Repair ◽  
Subscapularis Tendon ◽  
Function Recovery ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Abstract Background Arthroscopic rotator cuff repair has recently been popularized for treating tears. In a biomechanical trial, the Mason-Allen stitch improved the fixation quality of poorly vascularized tendons. The use of this technique involving the subscapularis tendon remains rare. The aim of this study was to evaluate the clinical outcomes of Mason-Allen technique repaired subscapularis tendons. Methods A retrospective research of collected data from 98 patients with subscapularis tears who had undergone arthroscopic repair between May 2015 and December 2018. There were 75 males and 23 females. The mean age was 56.4 ± 9.6 years and the mean follow-up was 12.5 ± 4.0 months. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Constant-Murley score were used to analyze shoulder function. An MRI was performed to assess the integrity of the repair. Results Patients had significantly less pain and a better active range of motion compared with preoperative levels. VAS improved significantly from a preoperative mean of 3.42 to a postoperative mean of 1.91. ASES increased significantly from the preoperative mean of 43.6 to the postoperative mean of 74.5. Seven cases suffered from retears, which were confirmed by an MRI examination. Conclusion Arthroscopic rotator cuff repair with the Mason-Allen method resulted in a decreased level of pain and satisfied function recovery.

Freeze-dried chitosan-platelet-rich plasma implants improve supraspinatus tendon attachment in a transosseous rotator cuff repair model in the rabbit

2018 ◽  
Vol 33 (6) ◽  
pp. 792-807 ◽  
Author(s):  
Gabrielle Deprés-Tremblay ◽  
Anik Chevrier ◽  
Martyn Snow ◽  
Scott Rodeo ◽  
Michael D Buschmann
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Platelet Rich Plasma ◽  
Rabbit Model ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Polymorphonuclear Cells ◽  
Post Surgery ◽  
Freeze Dried ◽  
Cuff Repair

Rotator cuff tears result in shoulder pain, stiffness, weakness and loss of motion. After surgical repair, high failure rates have been reported based on objective imaging and it is recognized that current surgical treatments need improvement. The aim of the study was to assess whether implants composed of freeze-dried chitosan (CS) solubilized in autologous platelet-rich plasma (PRP) can improve rotator cuff repair in a rabbit model. Complete tears were created bilaterally in the supraspinatus tendon of New Zealand White rabbits ( n = 4 in a pilot feasibility study followed by n = 13 in a larger efficacy study), which were repaired using transosseous suturing. On the treated side, CS-PRP implants were injected into the transosseous tunnels and the tendon itself, and healing was assessed histologically at time points ranging from one day to two months post-surgery. CS-PRP implants were resident within transosseous tunnels and adhered to tendon surfaces at one day post-surgery and induced recruitment of polymorphonuclear cells from 1 to 14 days. CS-PRP implants improved attachment of the supraspinatus tendon to the humeral head through increased bone remodelling at the greater tuberosity and also inhibited heterotopic ossification of the supraspinatus tendon at two months. In addition, the implants did not induce any detectable deleterious effects. This preliminary study provides the first evidence that CS-PRP implants could be effective in improving rotator cuff tendon attachment in a small animal model.

scholarly journals Outcome and Structural Integrity of Rotator Cuff after Arthroscopic Treatment of Large and Massive Tears with Double Row Technique: A 2-Year Followup

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Ignacio Carbonel ◽  
Angel A. Martínez ◽  
Elisa Aldea ◽  
Jorge Ripalda ◽  
Antonio Herrera
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Functional Outcome ◽  
Rotator Cuff Repair ◽  
Structural Integrity ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Double Row ◽  
Massive Rotator Cuff Tears ◽  
Cuff Repair

Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears.Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI), and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively and 2 years after repair.Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (P<0.001). Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (P<0.001). MRI studies showed 24 cases of tear after repair (29%). Only 8 cases were a full-thickness tear.Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity.

scholarly journals Rotátorköpeny-szakadás után kialakult zsíros degeneráció változása az ín rekonstrukcióját követően, 65 éves kor után

2019 ◽  
Vol 160 (14) ◽  
pp. 533-539
Author(s):  
Imre Sallai ◽  
Márton Weidl ◽  
Attila Szatmári ◽  
Imre Antal ◽  
Gábor Skaliczki
Keyword(s):  
Rotator Cuff ◽  
Muscle Atrophy ◽  
Rotator Cuff Repair ◽  
Constant Score ◽  
Fatty Degeneration ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Before And After ◽  
Cuff Repair

Abstract: Introduction: In the case of rotator cuff tears, the severity of the muscle atrophy and fatty degeneration has an effect on the success of the repair and on the functional outcome after surgery. Aim: The ability of regeneration reduces with ageing; therefore, the study examined the atrophy and the fatty degeneration after rotator cuff repair in patients over 65. Method: Eleven patients over 65 years of age were involved whose surgery was performed at the Department of Orthopaedics of Semmelweis University between 2012 and 2015. Their average age was 71.9 years and the average follow-up period was 39.9 months. Tear sizes were C1 in 3 cases, C2 in 3 cases, C3 in 4 cases, and C4 in 1 case. Each patient had magnetic resonance examination before and after the repair; the muscle atrophy and fatty degeneration were evaluated together with the type of the tear. Visual analogue scale and Constant score were used for the assessment of the pain and the shoulder function. Results: The average Constant score was 75 points. The occupancy ratio – referring to the severity of the atrophy – did not show significant improvement. The change in fatty degeneration and the atrophy were examined in different groups according to the size of the tears. In each group, the results showed progression. Conclusions: After rotator cuff repair in patients over 65, fatty degeneration and muscle atrophy also show progression. No significant relationship was found between the size of the tear and fatty degeneration or between the size of the tear and muscle atrophy. Orv Hetil. 2019; 160(14): 533–539.

Delamination Does Not Affect Outcomes After Arthroscopic Rotator Cuff Repair as Compared With Nondelaminated Rotator Cuff Tears: A Study of 1043 Consecutive Cases

2019 ◽  
Vol 47 (3) ◽  
pp. 674-681 ◽  
Author(s):  
Jieun Kwon ◽  
Ye Hyun Lee ◽  
Sae Hoon Kim ◽  
Jung Hoon Ko ◽  
Byung Kyu Park ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Fatty Infiltration ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Symptom Duration ◽  
Negative Prognostic Factor ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Limited information is available regarding the characteristics of delaminated rotator cuff tears as compared with nondelaminated tears. Furthermore, there is conflicting information regarding the effects of delamination on the anatomic healing of repaired cuffs. Purpose: To evaluate the characteristics and anatomic outcomes of delaminated rotator cuff tears in comparison with nondelaminated tears to determine whether delamination is a negative prognostic factor affecting rotator cuff repair outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2010 and 2014, 1043 patients were enrolled in the study to assess the prevalence of delamination. Among them, the findings from 531 patients who underwent magnetic resonance imaging or computed tomographic arthrography at least 1 year after surgery were included to determine whether delamination was a negative prognostic factor affecting the anatomic outcomes of arthroscopic rotator cuff repair. Delamination was assessed intraoperatively and defined by distinguishable edge cleavage tearing or interstitial horizontal gap between the articular and bursal surfaces of the torn tendon. One of 3 repair techniques (modified Mason Allen, single row, or double row) was used according to tear configuration and tendon mobilization. The authors evaluated visual analog scale scores for pain and satisfaction and American Shoulder and Elbow Surgeons scores to quantify clinical outcomes. Results: The incidence of delamination was 42.9% (447 of 1043). As compared with those with nondelaminated tears, patients with delaminated tears were older ( P < .001) and had longer symptom duration ( P = .019), larger tear sizes and retractions ( P < .001 for both), higher grades of fatty infiltration of the rotator cuff muscles (all P < .001), and poorer tendon quality ( P < .001). The overall healing failure rate was 19.0% (101 of 531). In univariate analysis, the rate of healing failure for the repaired cuffs was significantly higher in the delaminated group (delaminated tears, 60 of 238, 25.2%; nondelaminated tears, 41 of 293, 14.0%; P = .001). However, results of subgroup and multivariate analyses showed that the presence of delamination was ultimately not an independent risk factor for the failure of cuff healing. Between the delaminated and nondelaminated groups, there was no significant difference in postoperative functional outcomes. Conclusion: The results suggest that delaminated rotator cuff tears might represent chronic degenerative tears of longer symptom duration, with larger tear sizes and higher grades of fatty infiltration in older patients. It appears that delamination could be a confounding factor, not an independent prognostic factor, affecting rotator cuff healing.

scholarly journals Epidemiological Analysis of Changes in Clinical Practice for Full-Thickness Rotator Cuff Tears From 2010 to 2015

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984591 ◽  
Author(s):  
Avinesh Agarwalla ◽  
Gregory L. Cvetanovich ◽  
Anirudh K. Gowd ◽  
Anthony A. Romeo ◽  
Brian J. Cole ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Management Practices ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Biceps Tenodesis ◽  
Rotator Cuff Injuries ◽  
Cuff Repair ◽  
Corticosteroid Injections

Background: Rotator cuff injuries are a leading cause of shoulder disability among adults. Surgical intervention is a common treatment modality; however, conservative management has been described for the treatment of rotator cuff tears. As the cost of health care increases, the industry has shifted to optimizing patient outcomes, reducing readmissions, and reducing expenditure. In 2010, the American Academy of Orthopaedic Surgeons created clinical practice guidelines (CPGs) to guide the management of rotator cuff injuries. Since their publication, there have been several randomized controlled trials assessing the management of rotator cuff injuries. Purpose: To quantitatively describe changes in the management of full-thickness rotator cuff tears over time with regard to the publication of the CPGs and prospective clinical trials. Study Design: Cohort study; Level of evidence, 3. Methods: Included in the study were Humana-insured patients in the PearlDiver database with the diagnosis of a full-thickness rotator cuff tear from 2010 to 2015. Patients undergoing rotator cuff repair (CPT-29827, CPT-23410, CPT-23412, CPT-23420) and patients undergoing nonoperative management in the queried years were identified. The incidence of physical therapy (PT), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections was assessed. Results: In 2015, patients with full-thickness rotator cuff tears were less likely to receive a corticosteroid injection (16.5% vs 23.9%, respectively; odds ratio [OR], 0.6; P < .001) or undergo PT (7.8% vs 12.1%, respectively; OR, 0.6; P < .001) before rotator cuff repair in comparison with 2010. Additionally, patients were no more likely to be prescribed NSAIDs before rotator cuff repair in 2015 in comparison with 2010 (OR, 1.0; P = .6). Patients with full-thickness rotator cuff tears were less likely to undergo acromioplasty in 2015 in comparison with 2010 (48.2% vs 76.9%, respectively; OR, 0.4; P < .001); however, the rate of concomitant biceps tenodesis slightly increased (14.8% vs 14.6%, respectively; OR, 1.1; P = .01). Conclusion: From 2010 to 2015, there were changes in the management of full-thickness rotator cuff tears, including decreased preoperative utilization of corticosteroid injections and PT as well as a decrease in concomitant acromioplasty, and the rate of biceps tenodesis slightly increased. As CPGs and prospective investigations continue to proliferate, management practices of patients with full-thickness rotator cuff tears continue to evolve.

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