Journal ArticleDOI
Graft Augmentation of Repairable Rotator Cuff Tears: An Algorithmic Approach Based on Healing Rates
Reads0
Chats0
TLDR
In this article , the authors provide an algorithm for tissue augmentation of rotator cuff repairs based on the current available evidence regarding rotator tendon healing, which can determine a patient's surgical treatment that will yield the maximum healing rate.Abstract:
We provide our algorithm for tissue augmentation of rotator cuff repairs based on the current available evidence regarding rotator cuff healing. A variety of factors are associated with healing following rotator cuff repair. Increasing tear size and retraction as well as severe fatty degeneration have been associated with worsening rates of tendon healing. Given the correlation between tendon healing and postoperative outcomes, it is important to identify patients at high risk for failure and to modify their treatment accordingly to minimize the risk of early biomechanical failure and maximize the potential for structural healing. One approach that may be used to improve healing is tissue augmentation. Tissue augmentation is the use of tissue patches and scaffolds to provide rotator cuff reinforcement. Surgical management for rotator cuff tears (RCTs) continues to be a challenging task in orthopaedic surgery today. Appropriate treatment measures require an in depth understanding and consideration of the patient's prognostic factors such as age, fatty infiltration of the rotator cuff muscles, bone mineral density, rotator cuff retraction, anteroposterior tear size, work activity, and degenerative changes of the joint. Using these factors within the Rotator Cuff Healing Index, we can determine a patient's surgical treatment that will yield the maximum healing rate. For nonarthritic RCTs, joint-preserving strategies should be first-line treatment options. For young, active patients with a reparable RCT and minimal fatty infiltration, a complete repair can be effective. For young patients with irreparable RCTs, superior capsular reconstructions, and tendon transfers are viable options. For elderly patients with low work activity, an irreparable RCT and significant fatty infiltration, a partial repair with or without graft augmentation can be attempted if minimal to no arthritic changes are seen. LEVEL OF EVIDENCE: Level V, expert opinion. read more
Citations
More filters
Journal ArticleDOI
Dermal Allograft Augmentation for Rotator Cuff Tears.
TL;DR: In this paper , the rotator cuff healing index was used to assess for patients with Hamada grades 1 and 2 with elevated retear risk and potential indications for repair with graft augmentation.
Journal ArticleDOI
Arthroscopic Superior Capsule Reconstruction With Combined Fascia Lata Autograft and Synthetic Scaffold Patch Graft for the Treatment of Irreparable Rotator Cuff Tears Yields Favorable Clinical and Radiographic Outcomes at Minimum Two-Year Follow-Up
TL;DR: In this paper , the authors report the results of the arthroscopic superior capsule reconstruction (ASCR) technique with a combined fascia lata autograft and synthetic scaffold patch graft for irreparable massive rotator cuff tears (RCTs).
Journal ArticleDOI
Early Treatment of Shoulder Pathology Is Necessary but Not Enough Is Being Performed.
TL;DR: In this article , the authors discuss the problem of delayed treatment of shoulder pathology, and propose education and research investigation to solve the problem, which can result in less-optimal outcomes.
Journal ArticleDOI
Compressed Biceps Autograft Augmentation of Arthroscopic Rotator Cuff Repair
TL;DR: In this paper , a technique in which biceps tendon autograft is harvested after tenodesis is described, which is then compressed into a patch that is placed over the repaired rotator cuff tendon.
Journal ArticleDOI
Acellular Dermal Allograft and Tensor Fascia Lata Autograft Show Similar Patient Outcome Improvement and High Rates of Complications and Failures at a Minimum 2-Year Follow-Up: A Systematic Review
TL;DR: A literature search was performed by querying Scopus, EMBASE, and PubMed computerized databases from database inception through September 2022 in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines as mentioned in this paper .
References
More filters
Journal ArticleDOI
Fatty Infiltration and Atrophy of the Rotator Cuff Do Not Improve After Rotator Cuff Repair and Correlate With Poor Functional Outcome
TL;DR: It is suggested that repairs should be performed, if possible, before more significant deterioration in the cuff musculature in order to optimize outcomes, and that understanding the degree of muscle atrophy and fatty infiltration before surgery can help guide patient expectations.
Journal ArticleDOI
Partial repair of irreparable rotator cuff tears
Stephen S. Burkhart,Wesley M. Nottage,Darrell Ogilvie-Harris,Harvey S. Kohn,Anthony F. Pachelli +4 more
TL;DR: It is suggested that partial repair of massive irreparable rotator cuff tears should supplant tendon transposition as the procedure of choice for this condition.
Journal ArticleDOI
Superior Capsule Reconstruction to Restore Superior Stability in Irreparable Rotator Cuff Tears A Biomechanical Cadaveric Study
Teruhisa Mihata,Teruhisa Mihata,Teruhisa Mihata,Michelle H. McGarry,Michelle H. McGarry,Joseph M. Pirolo,Joseph M. Pirolo,Mitsuo Kinoshita,Thay Q. Lee,Thay Q. Lee +9 more
TL;DR: Cutting the supraspinatus tendon significantly increased superior translation, significantly increased subacromial contact pressure, and significantly decreased glenohumeral compression force, compared with values for intact rotator cuffs.
Journal ArticleDOI
Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. A randomized, controlled trial.
Joseph P. Iannotti,Michael J. Codsi,Young W. Kwon,Kathleen A. Derwin,James Ciccone,John J. Brems +5 more
TL;DR: Augmentation of the surgical repair of large and massive chronic rotator cuff tears with porcine small intestine submucosa did not improve the rate of tendon-healing or the clinical outcome scores and is not recommended.
Journal ArticleDOI
Mode of failure for rotator cuff repair with suture anchors identified at revision surgery.
TL;DR: The results of this study suggest that the weak link in rotator cuff repairs with suture anchors and horizontal mattress sutures, as determined at revision surgery, is the tendon-suture interface.