Study on injectable chitosan hydrogel with tendon-derived stem cells for enhancing rotator cuff tendon-to-bone healing / 中国修复重建外科杂志

OBJECTIVE@#To explore the effect of chitosan (CS) hydrogel loaded with tendon-derived stem cells (TDSCs; hereinafter referred to as TDSCs/CS hydrogel) on tendon-to-bone healing after rotator cuff repair in rabbits.@*METHODS@#TDSCs were isolated from the rotator cuff tissue of 3 adult New Zealand white rabbits by Henderson step-by-step enzymatic digestion method and identified by multidirectional differentiation and flow cytometry. The 3rd generation TDSCs were encapsulated in CS to construct TDSCs/CS hydrogel. The cell counting kit 8 (CCK-8) assay was used to detect the proliferation of TDSCs in the hydrogel after 1-5 days of culture in vitro, and cell compatibility of TDSCs/CS hydrogel was evaluated by using TDSCs alone as control. Another 36 adult New Zealand white rabbits were randomly divided into 3 groups ( n=12): rotator cuff repair group (control group), rotator cuff repair+CS hydrogel injection group (CS group), and rotator cuff repair+TDSCs/CS hydrogel injection group (TDSCs/CS group). After establishing the rotator cuff repair models, the corresponding hydrogel was injected into the tendon-to-bone interface in the CS group and TDSCs/CS group, and no other treatment was performed in the control group. The general condition of the animals was observed after operation. At 4 and 8 weeks, real-time quantitative PCR (qPCR) was used to detect the relative expressions of tendon forming related genes (tenomodulin, scleraxis), chondrogenesis related genes (aggrecan, sex determining region Y-related high mobility group-box gene 9), and osteogenesis related genes (alkaline phosphatase, Runt-related transcription factor 2) at the tendon-to-bone interface. At 8 weeks, HE and Masson staining were used to observe the histological changes, and the biomechanical test was used to evaluate the ultimate load and the failure site of the repaired rotator cuff to evaluate the tendon-to-bone healing and biomechanical properties.@*RESULTS@#CCK-8 assay showed that the CS hydrogel could promote the proliferation of TDSCs ( P<0.05). qPCR results showed that the expressions of tendon-to-bone interface related genes were significantly higher in the TDSCs/CS group than in the CS group and control group at 4 and 8 weeks after operation ( P<0.05). Moreover, the expressions of tendon-to-bone interface related genes at 8 weeks after operation were significantly higher than those at 4 weeks after operation in the TDSCs/CS group ( P<0.05). Histological staining showed the clear cartilage tissue and dense and orderly collagen formation at the tendon-to-bone interface in the TDSCs/CS group. The results of semi-quantitative analysis showed that compared with the control group, the number of cells, the proportion of collagen fiber orientation, and the histological score in the TDSCs/CS group increased, the vascularity decreased, showing significant differences ( P<0.05); compared with the CS group, the proportion of collagen fiber orientation and the histological score in the TDSCs/CS group significantly increased ( P<0.05), while there was no significant difference in the number of cells and vascularity ( P>0.05). All samples in biomechanical testing failed at the repair site during the testing process. The ultimate load of the TDSCs/CS group was significantly higher than that of the control group ( P<0.05), but there was no significant difference compared to the CS group ( P>0.05).@*CONCLUSION@#TDSCs/CS hydrogel can induce cartilage regeneration to promote rotator cuff tendon-to-bone healing.

Beneficios de la reparación artroscópica del manguito rotador en octogenarios. Análisis de resultados funcionales y complicaciones / Benefits of arthroscopic rotator cuff repair in octogenar ians. Analysis of functional results and complications

Resumen Introducción: Existe falta de información en la litera tura sobre los resultados de la reparación artroscópica del manguito rotador en pacientes mayores de 80 años. El objetivo de este estudio fue evaluar una serie conse cutiva de pacientes con rupturas del manguito rotador a los que se les realizó la reparación artroscópica del mismo. Métodos: Análisis retrospectivo de pacientes mayores de 80 años a quienes se les realizó reparación artroscó pica de manguito rotador entre junio de 2004 y enero de 2016. El seguimiento mínimo fue de 2 años. Para la evaluación funcional y del dolor se utilizaron las escalas Constant, Dash, UCLA y Escala Visual Análoga (EVA). Resultados: El seguimiento promedio fue de 8.4 años. Se obtuvieron mejoras significativas en la valoración del rango de movilidad y la evaluación de las escalas de Constant, Dash y UCLA, y EVA. No se registraron complicaciones mayores y solo 4 pacientes requirieron una re-operación. Conclusión: Los principales hallazgos obtenidos fue ron la mejoría funcional y del dolor en los pacientes mayores de 80 años operados por una ruptura completa del manguito rotador en forma artroscópica.

Abstract Introduction: There is a lack of information in the literature on the results of arthroscopic rotator cuff re pair in patients older than 80 years. The purpose of this study was to evaluate a consecutive series of patients with rotator cuff tears who underwent arthroscopic rotator cuff repair. Methods: Retrospective analysis of patients older than 80 years who underwent arthroscopic rotator cuff repair between June 2004 and January 2016. The mini mum follow-up was 2 years. For functional and pain assessment, the Constant, Dash, UCLA scale and Visual Analogue Scale (VAS) for pain were used. Results: The average follow-up was 8.4 years. Signifi cant improvements were obtained in the assessment of the range of motion and the evaluation of the Constant, Dash and UCLA scales, as well as in the VAS. No major complications were recorded and only 4 patients re quired a reoperation. Conclusion: The main findings obtained were func tional and pain improvement in patients over 80 years of age operated on for a complete arthroscopic rotator cuff tear.

Meta-analysis of obesity on the outcome of rotator cuff repair / 中国骨伤

OBJECTIVE@#To systematically evaluate obesity on the outcome of rotator cuff repair.@*METHODS@#Literatures on the relationship between obesity and outcomes after rotator cuff repair were searched from PubMed, Embase, Cochrane Library, Web of Science, China biology medicine(CBM), CNKI, Wanfang and VIP databases from building database to August 1, 2022, and were screened independently by two authors according to inclusion and exclusion criteria. Endnote X9 and Excel 2019 were used for literature extraction, management and data entry, and Newcastle-Ottawa Scale (NOS) was used to evaluate quality of the included literatures. STATA 16.0 and RevMan 5.4 softwares were used to evaluate postoperative retear rate, reoperation rate, complication rate, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS), operative time and external rotation angle of shoulder joint pain were analyzed.@*RESULTS@#Totally 13 literatures were included, including 6 retrospective studies, 5 case-control studies, 1 prospective cohort study, and 1 abstract of a study for which the full text was not available, with 85 503 patients (31 973 in obese group and 53 530 in non-obese group). Meta-analysis showed there were statistical differences between two groups in retear rate [OR=2.58, 95%CI(1.23, 5.41), P=0.01], reoperation rate[OR=1.31, 95%CI(1.21, 1.42), P<0.00], complication rate [OR=1.57, 95%CI(1.31, 1.87), P=0.00], ASES score[MD=-3.59, 95%CI(-5.45, -1.74), P=0.00], and VAS[MD=0.24, 95%CI(0.00, 0.49), P=0.05]. While there were no differences between two groups in operative time[MD=6.03, 95%CI(-7.63, 19.69), P=0.39], external rotation angle of shoulder joint[MD=-1.79, 95%CI(-5.30, 1.71), P=0.32].@*CONCLUSION@#Obesity is associated with higher rates of retear, resurgery, complications, poorer shoulder function and pain after rotator cuff repair.

Surgical repair of the supraspinatus: pre- and postoperative architectural changes in the muscle

INTRODUCTION@#Shortening of the tendon and muscle is recognised as a strong predictor of surgical failure of supraspinatus tendon tears. Changes in muscle architecture following repair have not been thoroughly investigated. Hence, we aimed to compare the pre- and postoperative architecture of the supraspinatus.@*METHODS@#We recruited eight participants with full-thickness supraspinatus tears. Images of the supraspinatus were captured preoperatively (pre-op) and postoperatively at one month (post-op1), three months (post-op2) and six months (post-op3) in relaxed and contracted states (0º and 60º glenohumeral abduction). Fibre bundle length (FBL), pennation angle (PA) and muscle thickness were quantified. Self-reported function, and maximal isometric abduction and external rotation strengths were assessed.@*RESULTS@#The mean FBL increased from pre-op to post-op1 (p = 0.001) in the relaxed state and from pre-op to post-op2 (p = 0.002) in the contracted state. Decrease in FBL was observed from post-op2 to post-op3 in the relaxed state. The mean PA decreased from pre-op to post-op1 (p < 0.001) in the relaxed state, but increased from post-op2 to post-op3 in both relaxed (p = 0.006) and contracted (p = 0.004) states. At post-op3, external rotation (p = 0.009) and abduction (p = 0.005) strengths were greater than at post-op2. Overall function increased by 47.67% from pre-op to post-op3.@*CONCLUSION@#Lengthening of the supraspinatus occurs with surgery, altering the length-tension relationship of the muscle, which can compromise muscle function and lead to inferior surgical outcomes. These findings may guide clinicians to optimise loads, velocities and shoulder ranges for effective postoperative rehabilitation.

Effect of unilateral rotator cuff repair on the contralateral shoulder in patients with bilateral rotator cuff tears / 中国修复重建外科杂志

Objective: To investigate the effect of unilateral rotator cuff repair on the contralateral shoulder in patients with bilateral rotator cuff tears. Methods: A clinical data of 46 patients with bilateral rotator cuff tears met the criteria between May 2016 and May 2019 was retrospectively analyzed. Of 46 patients, 23 patients underwent bilateral conservative treatment (conservation group), 23 patients underwent unilateral arthroscopic rotator cuff repair, and conservative treatment on the contralateral side (operation group). There was no significant difference in gender, age, disease duration, degree of rotator cuff tear, and comorbidities between 2 groups ( P>0.05). Before operation and at 6 and 12 months after operation, the degree of the rotator cuff tear was measured by MRI, and the shoulder function was evaluated by the visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) (forward flexion, external rotation, external rotation at 90° of abduction, and internal rotation). The evaluation results of the non-surgical side of shoulders in the operation group were compared with one side of shoulders in the conservation group. Results: All incisions healed by first intention without any complication after operation. All patients were followed up 12 months. MRI reexamination showed that the degree of rotator cuff tear of the contralateral shoulder in the operation group increased significantly after operation ( P0.05), but the rotator cuff tear of the contralateral shoulder in the operation group was more serious than that of the conservation group at 6 and 12 months after operation ( P0.05). The function scores in the conservation group were better than those in the operation group at 6 and 12 months after operation ( P0.05). Conclusion: For patients with bilateral rotator cuff tears, the unilateral rotator cuff repair can aggravate the rotator cuff tear of contralateral shoulder.

Outcomes after rotator cuff repair in the elderly as assessed by the American Shoulder and Elbow Surgeons shoulder score

Rotator cuff tears are common among the elderly, and studies on the outcomes after rotator cuff repair in the elderly are limited. We carried out this meta-analysis with systematic literature search, aiming to clarify the outcomes after rotator cuff repair in the elderly as assessed by the American Shoulder and Elbow Surgeons (ASES) shoulder score. We conducted a literature search through October 2019 in PubMed and EMBASE databases and performed meta-analysis to calculate the summary mean difference comparing the post- and pre-operation ASES scores under both fixed-effect and random-effect models. Among 4978 studies identified through literature search, four studies (two in the United States, one in France, and one in Republic of Korea) were eligible for the meta-analysis, including 282 patients who were aged over 70 years. These studies had low heterogeneity as measured by Cochran's Q test (p=0.88) and I2 statistic (0%). The ASES scores on average increased by 39.7 (95% confidence interval 28.3-51.1, p<0.001) after rotator cuff repair, in both fixed-effect and random-effect models. No substantial publication bias was indicated. Our findings suggest improved outcomes after rotator cuff repair in the elderly population as measured by the ASES score, and such improvements have been consistent in previous studies.

Evaluation of Muscular Atrophy and Fatty Infiltration Using Time-zero Magnetic Resonance Imaging as Baseline Data, After Rotator Cuff Repair

BACKGROUND: This study evaluated postoperative changes in the supraspinatus from time-zero to 6 months, using magnetic resonance imaging (MRI). We hypothesized that restoration of the musculotendinous unit of the rotator cuff by tendon repair immediately improves the rotator cuff muscle status, and maintains it months after surgery. METHODS: Totally, 76 patients (29 men, 47 women) with rotator cuff tears involving the supraspinatus tendon who underwent arthroscopic rotator cuff repairs were examined. MRI evaluation showed complete repair with intact integrity of the torn tendon at both time-zero and at 6 months follow-up. All patients underwent standardized MRI at our institution preoperatively, at 1 or 2 days postoperative, and at 6 months after surgery. Supraspinatus muscular (SSP) atrophy (Thomazeau grade) and fatty infiltrations (Goutallier stage) were evaluated by MRI. The cross-sectional area of SSP in the fossa was also measured. RESULTS: As determined by MRI, the cross-sectional area of SSP significantly decreased 11.41% from time-zero (immediate repair) to 6 months post-surgery, whereas the Goutallier stage and Thomazeau grade showed no significant changes (p<0.01). Furthermore, compared to the preoperative MRI, the postoperative MRI at 6 months showed a no statistically significant increase of 8.03% in the cross-sectional area. In addition, morphological improvements were observed in patients with high grade Goutallier and Thomazeau at time-zero, whereas morphology of patients with low grade factors were almost similar to before surgery. CONCLUSIONS: Our results indicate that cross-sectional area of the initial repair appears to decrease after a few months postoperatively, possibly due to medial retraction or strained muscle.

Do We Have to Perform Surgical Treatment Simultaneously for Rotator Cuff Tear in Patients with Adhesive Capsulitis? / 대한스포츠의학회지

PURPOSE: Retrospectively, the purpose of this study is to investigate the necessity for early operation for patients with rotator cuff tears and concomitant adhesive capsulitis. METHODS: From March 2013 to March 2017, we conducted a retrospective study on patients with rotator cuff tears and concomitant adhesive capsulitis. We analyzed 32 cases out of 39 cases who have small to medium rotator cuff tears, excluding patients who were unable to follow up over 1 years. We evaluated range of motion, visual analog scale (VAS) score, and Constant score. We compared patients of non-symptom and symptomatic patients related to rotator cuff tear. RESULTS: Among patients in the 32 cases, 21 cases of total patients improved without discomfort after recovering their range of motion and pain (group 1), and 11 cases were developed symptoms related to rotator cuff tear for the last 1 year (group 2). Average age of group 1 patients was 53.4 years old, and recovered from forward elevation 95.5° to 163.2°, external rotation from 8.5° to 68.7°, mean VAS score improved from 6.2 to 1.2. Average age of group 2 patients was 58.4 years old, and recovered from forward elevation 96.2° to 162.2°, external rotation from 8.1° to 67.8°, mean pain VAS score improved from 6.4 to 4.4. But there was statistically significant difference in pain reduction after restoration of motion compared to asymptomatic group. CONCLUSION: We do not need surgical treatment at the same time because the symptoms of rotator cuff tear may not be manifested in patients with rotator cuff tear associated with adhesive capsulitis. Sufficient follow-up should be considered after restoration of shoulder motion related to adhesive capsulitis.

Revisional Rotator Cuff Repair / 대한정형외과학회잡지

Most patients experience pain relief and functional improvement after arthroscopic rotator cuff repair. In some patients, however, symptoms still remain after surgery. Failed rotator cuff repair is a complex outcome of biological, technical, and traumatic factors. Moreover, re-tears might or might not be the main cause for patients with persistent pain after rotator cuff repair. Therefore, a thorough understanding of the patient's history, physical examination, and appropriate imaging studies will be needed to evaluate and manage these patients. The patient's age, functional requirement, quality of the rotator cuff, preoperative range of motion, quality of the deltoid, and glenohumeral arthritis are factors to consider before performing revisional rotator cuff repair. Preoperative patient education is as important as the surgical technique for successful revisional rotator cuff repair.

What Influences Rehabilitation Outcomes after Arthroscopic Rotator Cuff Repair? Investigation of Risk Factors for Prolonged Rehabilitation / The Japanese Journal of Rehabilitation Medicine

Purpose：Good functional results have been reported for arthroscopic repair of rotator cuff tears (ARCR) by several orthopedic surgeons, but few studies have examined the factors affecting rehabilitation outcomes.This study was conducted to identify the factors associated with clinical outcome and the duration of rehabilitation after ARCR.Subjects and methods：This was a retrospective evaluation of 576 patients who underwent ARCR between January 2009 and December 2013 (Men：331, Women：245；mean age：63.9±12.3 years).Patients were divided into groups based on the duration of rehabilitation：less than or more than 6 months. Preoperative and postoperative evaluations, including outcome assessments and physical examination parameters, were reviewed：① type of insurance, ② duration of illness, ③ pain on motion, ④ Japanese Orthopaedic Association Score, ⑤ site of cuff tear, ⑥ thickness of cuff tear, ⑦ repair conditions, ⑧ range of motion (ROM) before surgery, ⑨ ROM at 3 months after surgery, ⑩ ROM at 6 months after surgery, ⑪ muscle strength before surgery, and ⑫ muscle strength at 6 months after surgery．Results：Factors influencing the duration of rehabilitation included traffic accident and workman's compensation insurance coverage, thickness of tear, range of motion of flexion and external rotation at 3 months after surgery, and strength on abduction at 6 months after surgery.Conclusions：When beginning rehabilitation, the type of insurance and thickness of tear must be considered；during rehabilitation, ROM at 3 months and strength at 6 months after surgery must be considered.

Effectiveness of rotator cuff repair with manipulation release and arthroscopic debridement for rotator cuff tear with shoulder stiffness / 中国修复重建外科杂志

Objective: To investigate effectiveness of rotator cuff repair with manipulation release and arthroscopic debridement for rotator cuff tear with shoulder stiffness.

Effects of a Trunk Stabilization Exercise with Gym Ball on Scapular Position for Patients with Arthroscopic Rotator Cuff Repair

PURPOSE: The present study was to investigate effects of scapular position and pain on a trunk stabilization exercise with gym ball for patients with arthroscopic rotator cuff repair. METHODS: Subjects were patients after 2 weeks of rotator cuff repairs. Subjects were randomly assigned to conservative treatment group (CTG, n=10) or trunk stabilization with gym ball group (SBG, n=10), and participated one of those groups for 2 weeks. Measurements about pain and scapular position were assessed in before and after treatment programs. RESULTS: Pain reduced in both rest and night in SBG compared to CTG. In the case of scapular position, decreased scapular retraction (increased protraction) was found in CTG and vice versa in SBG. Reduced scapular anterior tilting was also found on SBG. CONCLUSION: The present study showed that early performed trunk stabilization with gym ball could bring a scapular alignment that increases subacromial space and reduces pain. This suggests early trunk stabilization with gym ball programs to restore shoulder functions for patients with rotator cuff repair.

Delayed Lateral Row Anchor Failure in Suture Bridge Rotator Cuff Repair: A Report of 3 Cases

Compared to single row repair, use of lateral row anchors in suture bridge rotator cuff repair enhances repair strength and increases footprint contact area. If a lateral knotless anchor (push-in design) is inserted into osteoporotic bone, pull-out of the lateral row anchor can developed. However, failures of lateral row anchors have been reported at several months after surgery. In our cases, even though complete cuff healing occurred, delayed pull-out of the lateral row anchor in the suture bridge repair occurred. In comparison to a conventional medial anchor, further biomechanical evaluation of the pull-out force, design, and insertion angle of the lateral anchor is needed in future studies. We report three cases with delayed pull-out of lateral row anchor in suture bridge rotator cuff repair with a literature review.

Clinical Outcomes of Arthroscopic Rotator Cuff Repair Using Poly Lactic-co-glycolic Acid Plus β-tricalcium Phosphate Biocomposite Suture Anchors

BACKGROUND: This study is performed to evaluate anchor-related outcomes and complications after arthroscopic rotator cuff repair using 30% β-tricalcium phosphate (β-TCP) with 70% poly lactic-co-glycolic acid (PLGA) biocomposite suture anchors. METHODS: A total of 78 patients (mean age, 61.3 ± 6.9 years) who underwent arthroscopic medium-to-large full-thickness rotator cuff tear repair were enrolled. The technique employed 30% β-TCP with 70% PLGA biocomposite suture anchors at the medial row (38 patients, Healix BRTM anchor [Healix group]; 40 patients, Fixone anchor B [Fixone group]). The radiologic outcomes (including perianchor cyst formation or bone substitution) and anatomical outcomes of the healing failure rate were evaluated using magnetic resonance imaging at least 6 months after surgery, the pain visual analogue scale at 3, 6 months, and final follow-up visit, and American Shoulder and Elbow Surgeons scores at least 1 year postoperatively. Anchor-related complications were also evaluated. RESULTS: The perianchor cyst formation incidence was similar for both groups (60.5%, Healix group; 60.0%, Fixone group; p=0.967), although severe perianchor cyst incidence was slightly lower in the Fixone group (15.0%) than in the Healix group (21.1%). There was no occurrence of anchor absorption and bone substitution. No differences were observed in the healing failure rate (13.2%, Healix group; 15.0%, Fixone group; p=0.815) and functional outcome between groups (all p>0.05). Anchor breakage occurred in 5 patients (2 Healix anchors and 3 Fixone anchors); however, there were no major anchor-related complications in either group. CONCLUSIONS: No differences were observed in the clinical outcomes of the Healix and Fixone groups, neither were there any accompanying major anchor-related complications.

Roturas masivas del manguito de los rotadores: resultados clínicos de la reparación artroscópica con técnica doble MAC / Massive rotator cuff tears: Clinical outcomes of arthroscopic repair using a double MAC technique

Introducción Las roturas masivas del manguito de los rotadores representan una de las lesiones más complejas a las cuales se puede enfrentar el ortopedista especialista en hombro y son un gran reto cuando se desean lograr resultados clínicos satisfactorios. El objetivo del trabajo es describir los resultados clínicos de una nueva técnica quirúrgica para la reparación artroscópica de lesiones grandes y masivas del manguito de los rotadores (MR) utilizada en una clínica ortopédica especializada durante un período de 3 años. Materiales y métodos Se realizó un estudio descriptivo de una cohorte de pacientes con lesiones grandes y masivas del MR, diagnosticados mediante artrorresonancia directa y que cumplían criterios para reparación artroscópica, a los cuales se les realizó la reparación mediante una nueva técnica denominada doble MAC. Se analizaron como desenlaces la escala de Constant postoperatoria, la existencia de complicaciones y el grado de satisfacción de los pacientes con el procedimiento. Resultados Se evaluó a 21 pacientes (10 hombres y 11 mujeres) con una media de edad de 59,4 años (DE: 8,2) en el momento de la cirugía. Las roturas comprometieron el músculo supraespinoso en todos los casos y en el 42,8% el infraespinoso con un tamaño medio de rotura de 34,5 mm (DE: 11,2). El tiempo entre la cirugía y la evaluación fue, por término medio, de 9 meses. La escala de Constant postoperatoria fue, por término medio, de 77,4 (DE: 9,0). No se presentaron complicaciones en la cirugía o falla de los anclajes. Solo un paciente presentó capsulitis adhesiva temprana, que se trató con movilización articular, con la cual se logró normalizar todos los arcos de movilidad. Discusión La técnica doble MAC para la reparación artroscópica de las lesiones grandes y masivas del manguito de los rotadores es una técnica segura y efectiva, con buenos resultados funcionales evaluados a medio plazo y un porcentaje de satisfacción superior al 90%. Nivel de evidencia clínica Nivel IV.

Background Massive ruptures of the rotator cuff represent one of the most complex lesions that can be faced by the orthopaedic shoulder surgeon, and pose a great challenge to achieve satisfactory clinical results. The aim of this study is to describe the clinical outcomes of a new surgical technique for the repair of large and massive rotator cuff injuries used in a specialised orthopaedic clinic during a period of 3 years. Materials and methods A descriptive study was carried out on a cohort of patients with large and massive lesions of the rotator cuff, diagnosed by direct arthro-resonance, and who met criteria for arthroscopic repair. They underwent repair using a new technique called double MAC (Mason-Allen configuration). The post-surgical outcomes were measured using the Constant scale, and the presence of complications and the level of patient satisfaction with the procedure were analysed as outcomes. Results There were 21 patients (10 men and 11 women) with mean age of 59.4 (SD: 8.2) years at the time of surgery. A supraspinatus rupture was present in all (100%) of patients, and an infraspinatus rupture was present in 42.8%.. The mean size of the tear was 34.5 mm (SD: 11.2). Mean time between surgery and assessment was 9 months. Mean post-operative Constant score was 77.4 (SD: 9.0). There were no surgical complications or anchor failure. An early adhesive capsulitis was diagnosed and managed with articular mobilisation, with subsequent improvement in range of motion. Discussion Double MAC technique for arthroscopic repair of large and massive RCT is a safe and effective technique, with good clinical outcomes in the medium term and a patient satisfaction of over 90%. Evidence Level IV.

Observations on the Efficacy of Shoulder-three-points Warm Needling Moxibustion plus Conventional Rehabilitation in Recovery from Rotator Cuff Repair / 上海针灸杂志

Objective To investigate the clinical efficacy of shoulder-three-points warm needling moxibustion plus conventional rehabilitation in recovery from arthroscopic rotator cuff repair.Method Seventy patients who had undergone arthroscopic rotator cuff repair for rotator cuff injury were enrolled and randomly allocated to groups A and B, 35 cases each. Group A received conventional rehabilitation and group B, shoulder-three-points warm needling moxibustion in addition. Functional activity and pain in the affected shoulder were scored using the American Shoulder Elbow Scale (ASES), the University of California at Los Angeles (UCLA) Shoulder Scale and the Constant-Murley Shoulder Outcome Score in the two groups before and after treatment.Result There were statistically significant pre-/post-treatment differences in the ASES, UCLA and Constant-Murley scores in the two groups (P0.05) and a significant difference in the UCLA pain subscore (P<0.01) between groups A and B. Conclusion shoulder-three-points warm needling moxibustion plus conventional rehabilitation training can markedly promote postoperative rehabilitation and especially relieve postoperative pain in patients with rotator cuff injury. It provides a new idea for clinical shoulder rehabilitation in the future.

Efficacy and Safety of Combined Subacromial and Intravenous Patient-controlled Analgesia after Arthroscopic Rotator Cuff Repair

BACKGROUND: This study investigated the efficacy and safety of combined subacromial and intravenous patient-controlled analgesia for control of postoperative pain after arthroscopic rotator cuff repair. METHODS: Between May 2012 and August 2014, 60 patients who underwent arthroscopic rotator cuff repair with acromioplasty and received patient-controlled analgesia were studied prospectively. Cases were divided into 2 groups: combined subacromial and intravenous infusion group (group A, 30 cases) and solitary intravenous infusion group (group B, 30 cases). The visual analogue scale was used to record the patient's level of pain every 12 hours during postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. RESULTS: The mean preoperative visual analogue scale score was 7.8 in group A and 7.6 in group B, and the immediate postoperative visual analogue scale score was 7.9 and 8.1 for each group. At postoperative time (From 12 hours to 72 hours after operation), the scores of combined subacromial and intravenous infusion were significantly lower than those of solitary intravenous infusion. Significant difference in the frequency of supplemental analgesic injections was observed between group A and group B (p=0.008). However, no significant difference in complication rate was observed between the two groups (p=0.562). CONCLUSIONS: Combined subacromial and intravenous patient-controlled analgesia after arthroscopic rotator cuff repair is more effective than solitary intravenous infusion without significantly increasing complications. Therefore, combined subacromial and intravenous patient-controlled analgesia could be a effective pain control method.

New Retear Pattern after Rotator Cuff Repair at Previous Intact Portion of Rotator Cuff

Retear patterns after arthroscopic rotator cuff repair are classified into two patterns according to retear location. Type 1 is when the retear pattern occurs directly on the tendon at the bone repair site using the suture anchor repair method. Type 2 is when the retear pattern occurs at the musculocutaneous junction with a healed footprint in patients who undergo the suture bridge method. Here, the authors report another retear pattern, which was identified as a type 2 retear on magnetic resonance imaging in patients who had undergone arthroscopic rotator cuff repair by the suture-bridge technique. This pattern was different from the type 2 retear and occurred at the portion of the cuff away from the healed rotator cuff under the view of the arthroscope.

Biomechanical Test for Repair Technique of Full-thickness Rotator Cuff Tear

The arthroscopic rotator cuff repair is now considered a mainstream technique with highly satisfactory clinical results. However, concerns remain regarding healing failures for large and massive tears and high revision rate. In recent decades, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. The focus of biomechanical test in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. Recent studies have shown that a transosseous tunnel technique provides improved contact area and pressure between rotator cuff tendon and insertion footprint, and the technique of using double rows of suture anchors to recreate the native footprint attachment has been recently described. The transosseous equivalent suture bridge technique has the highest contact pressure and fixation force. In this review, the biomechanical tests about repair techniques of rotator cuff tear will be reviewed and discussed.

Efficacy and Safety of Combined Subacromial and Intravenous Patient-controlled Analgesia after Arthroscopic Rotator Cuff Repair

BACKGROUND: This study investigated the efficacy and safety of combined subacromial and intravenous patient-controlled analgesia for control of postoperative pain after arthroscopic rotator cuff repair. METHODS: Between May 2012 and August 2014, 60 patients who underwent arthroscopic rotator cuff repair with acromioplasty and received patient-controlled analgesia were studied prospectively. Cases were divided into 2 groups: combined subacromial and intravenous infusion group (group A, 30 cases) and solitary intravenous infusion group (group B, 30 cases). The visual analogue scale was used to record the patient's level of pain every 12 hours during postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. RESULTS: The mean preoperative visual analogue scale score was 7.8 in group A and 7.6 in group B, and the immediate postoperative visual analogue scale score was 7.9 and 8.1 for each group. At postoperative time (From 12 hours to 72 hours after operation), the scores of combined subacromial and intravenous infusion were significantly lower than those of solitary intravenous infusion. Significant difference in the frequency of supplemental analgesic injections was observed between group A and group B (p=0.008). However, no significant difference in complication rate was observed between the two groups (p=0.562). CONCLUSIONS: Combined subacromial and intravenous patient-controlled analgesia after arthroscopic rotator cuff repair is more effective than solitary intravenous infusion without significantly increasing complications. Therefore, combined subacromial and intravenous patient-controlled analgesia could be a effective pain control method.