Effectiveness of arthroscopic "hybrid" suture for delaminated rotator cuff tear: A prospective randomized controlled study / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of "hybrid" suture with en masse combined with double-layer repair under arthroscopy in repair of delaminated rotator cuff tear by comparison with en masse suture.@*METHODS@#Fifty-six patients with delaminated rotator cuff tears met selection criteria between June 2020 and January 2022 were included in the study. Patients were divided into two groups ( n=28) using a random number method. The patients in trial group underwent arthroscopic "hybrid" suture with the combination en masse and double-layer suture. The patients in control group underwent en masse suture under arthroscopy. There was no significant difference between the two groups ( P>0.05) in terms of gender, age, rotator cuff tear side, tear size, cause of injury, disease duration, and preoperative American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, visual analogue scale (VAS) score, and shoulder range of motion (forward flexion and lateral external rotation). The operation time, the difference of ASES score, UCLA score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) between pre- and post-operation were recorded and compared between the two groups ( P>0.05). The rotator cuff healing was examined by MRI and evaluated based on the classification criteria of rotator cuff healing proposed by Sugaya et al.@*RESULTS@#Three cases (1 case in the trial group and 2 cases in the control group) were excluded from the study due to loss of follow-up. Twenty-seven cases in the trial group and 26 cases in the control group were included in the final study analysis. All operations of the two groups were completed successfully. There was no significant difference in the operation time between groups ( P>0.05). The follow-up time was 10-12 months (mean, 10.9 months) in the trial group and 10-13 months (mean, 11.4 months) in the control group. All incisions healed by first intention. No surgery-related complications occurred. The UCLA score, ASES score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) of both groups at 9 months after operation were significantly superior to those before operation ( P<0.05). The difference of UCLA score, ASES score, and VAS score between before and after operation in the trial group were significantly better than those in the control group ( P<0.05). There was no significant differences between the two groups in the difference of shoulder range of motion (forward flexion and lateral lateral rotation) ( P>0.05). At 9 months after operation, according to the classification criteria of rotator cuff healing proposed by Sugaya et al, MRI showed that the rotator cuff healing of the trial group was significantly better than that of the control group ( P<0.05).@*CONCLUSION@#Compared with en masse suture, arthroscopic "hybrid" suture for the repair of delaminated rotator cuff tear has advantages in relieving pain and improving shoulder joint function, and the rotator cuff healing is better.

Delaminated Rotator Cuff Tear: Concurrent Concept and Treatment

Delaminated rotator cuff tear pertains to the horizontal split of the tendon substance. As reported previously, the presence of a delaminated tear and incidence of delaminated rotator cuff tear ranges from 38% to 92%. The different strain intensities applied across the rotator cuff tendon, and the shear stress between the bursal and articular layers seem to play a role in its pathogenesis. In a delaminated rotator cuff tear, the degree and direction of retraction between two layers differ, with accompanying intrasubstance cleavage. A surgeon therefore needs to consider and carefully evaluate the tear characteristics when repairing delaminated rotator cuff tear. Delaminated rotator cuff tear is considered to be a poor prognostic factor after rotator cuff repair, but numerous surgical repair techniques have been introduced and applied to resolve this problem. Recent literature has reported good clinical outcomes after delaminated rotator cuff repair.

Comparison of Clinical and Anatomical Outcomes between Delaminated Rotator Cuff Tear and Single Layer Rotator Cuff Tear

BACKGROUND: Delaminated rotator cuff tear is known to be a degenerative tear having a negative prognostic effect. This study undertook to compare the anatomical and clinical outcomes of delaminated tears and single layer tears. METHODS: Totally, 175 patients with medium to large rotator cuff tears enrolled for the study were divided into 2 groups, based on the tear pathology: single layer tear (group 1) and delaminated tear (group 2). Preoperatively, length of the remnant tendon, muscle atrophy of supraspinatus (SS), and fatty degeneration of SS and infraspinatus (IS) muscles were assessed on magnetic resonance imaging (MRI). For follow-up, the repair integrity of the rotator cuff was evaluated by ultrasonography. Clinical outcomes were assessed by evaluating the Constant score (CS) and Korean Shoulder Score (KSS). RESULTS: Retears were detected in 6 cases of group 1 (6.5%) and 11 cases of group 2 (13.3%). Although higher in group 2, the retear rate was significantly not different (p=0.133). Preoperative MRI revealed length of remnant tendon to be 15.46 ± 3.60 mm and 14.17 ± 3.16 mm (p=0.013), and muscle atrophy of SS (occupation ratio) was 60.54 ± 13.15 and 56.55 ± 12.88 (p=0.045), in group 1 and group 2, respectively. Fatty degeneration of SS and IS in both groups had no significant differences. Postoperatively, no significant differences were observed for CS and KSS values between the groups. CONCLUSIONS: Delaminated rotator cuff tears showed shorter remnant tendon length and higher muscle atrophy that correlate to a negative prognosis. These prognostic effects should be considered during delaminated rotator cuff tear treatment.

Síntesis y caracterización de bentonita modificada con especies de TiO2 y Fe-TiO2 obtenidas del mineral ilmenita / Synthesis and characterization of modified-bentonite with TiO2 and Fe-TiO2 species obtained from ilmenite / Síntese e caracterização de bentonita modificada com espécies de TiO2 e Fe-TiO2 obtidas do mineral ilmenita

Se sintetizó una serie de sólidosnanoestructurados obtenidos de laintercalación de nanopartículas de TiO2y Fe-TiO2 en los espacios interlaminaresde un mineral de arcilla esmectítico. Losnuevos materiales se prepararon mediantela modificación simultánea de dos mineralesnaturales: bentonita e ilmenita. Los materialesobtenidos se caracterizaron por fluorescenciade rayos X (FRX), espectroscopia infrarroja(IR), difracción de rayos X (DRX),microscopia electrónica de barrido (SEM)y sortometría de nitrógeno. Los resultadosdel análisis químico (FRX) confirmaronclaramente la incorporación de titanio y dehierro en los materiales sintetizados. Losanálisis por DRX, SEM y sortometría denitrógeno verificaron la modificación delmineral de arcilla por incorporación deespecies de dióxido de titanio y la generaciónde estructuras mesoporosas delaminadas oexfoliadas con incremento en los valores deárea superficial y porosidad controlada.

A set of nanostructured porous solids was synthesized by intercalation of TiO2 and Fe- TiO2 into the interlayer sites of a smectite clay mineral. The new materials were prepared through simultaneous modification of two natural minerals: bentonite and ilmenite. Synthesized materials were characterized by X-ray fluorescence (XRF), infrared spectroscopy (IR), X-ray powder diffraction (XRD), scanning electron microscopy (SEM) and N2-adsorption technique. Results of chemical analysis (XRF) clearly confirmed the incorporation of titanium and iron in the synthesized materials. Modification of clay mineral by incorporation of titanium dioxide species was verified by XRD, SEM and N2- adsorption analyses, showing the formation of mesoporous delaminated structures with increased surface areas and controlled porosity.

Uma serie de sólidos nanoestruturadosforam sintetizados, obtidos pela intercalaçãode nanopartículas de TiO2 e Fe-TiO2 nosespaços interlaminares de um mineralde argila esmectítica. Os novos materiaisforam preparados mediante a modificaçãosimultânea de dois minerais naturais:uma bentonita e uma ilmenita. Osmateriais obtidos foram caracterizadospor fluorescência de raios X (FRX),espectroscopia infra-vermelho (IR), difraçãode raios X (DRX), microscopia eletrônica devarredura (SEM) e sortometria de nitrogênio.Os resultados da análise química (FRX)confirmaram claramente a incorporação detitânio e de ferro nos materiais sintetizados.A análise por DRX, SEM e sortometriade nitrogênio verificaram a modificaçãodo mineral de argila por incorporação deespécies de dióxido de titânio, demonstrandoa geração de estruturas mesoporosasdelaminadas ou esfoliadas com incrementonos valores de área superficial e porosidade controlada.

Síntesis de matrriales microcompuestos de poliailina/arcilla: caracterización y evaluación de su actividad como agentes anticorrosioos / Synthesi of polyyanilineclay microcomposite materials: characterizationn and assessment of its activity as anticorrosive agetss / Síntese d materiiais micro-compostos de polianilina/argila: caracterização e avaliação da sua atividade como agentes anti-corossivos

En el presente trabajo se realiza la síntesis de materiales “microcompuestos” a partir de polianilina en su forma esmeraldina base y dos montmorillonitas colombianas. Las arcillas naturales fueron sometidas a intercambio catiónico con una sal de amonio cuaternaria para obtener arcillas organofílicas que posteriormente fueron modificadas con polianilina mediante polimerización oxidativa in situ. La caracterización de los sólidos mediante espectroscopía infrarroja (FT-IR), difracción de rayos X (DRX), SEM y DSC evidencia la síntesis exitosa de los materiales mediante intercalación o delaminación de los minerales de arcilla. Los sólidos sintetizados se evaluaron como agentes anticorrosivos mediante mediciones electroquímicas de potencial de corrosión, resistencia de polarización y corriente de corrosión sobre electrodos de acero cold-rolled 1020 (AISI-SAE). Se encontró que los microcompuestos sintetizados brindan protección a la superficie del acero contra los agentes corrosivos, obteniendo diferencias significativas entre los materiales microcompuestos de polianilina/ arcilla, sin que éstos superen el potencial anticorrosivo de la polianilina en su forma esmeraldina base pura.

In the present work microcomposites-materials from polyaniline as emeraldine- base and two Colombian montmorillonites were synthesized. The natural clays were subjected to cationic exchange with an ammonium quaternary salt in order to obtain organophilic clays to be modified with polyaniline by an “in situ” oxidative polymerization. Characterization by infrared spectroscopy (FT-IR), X-ray diffraction analysis (XRD), SEM and DSC reveals the successful synthesis of materials by means of intercalation or delamination of the clay minerals. The synthesized solids were assessed as anticorrosive agents by electrochemical measurements of corrosion potential, polarization resistance and corrosion current on electrodes of cold-rolled 1020 (AISI-SAE) steel. It was found that the synthesized microcomposites provide protection to the surface of steel against corrosive agents, obtaining in this way important difference between the microcomposites materials of polyaniline/ clay, without they can surpass the anticorrosive potential of the polyaniline in the pure emeraldine-base form.

No presente trabalho realizou-se a síntese de materiais “micro-compostos” a partir de polianilina em sua forma esmeraldina base e duas montmorillonitas colombianas. As argilas naturais foram submetidas a intercâmbio catiónico com uma sal da amônia quaternaria para obter argilas organofílicas que foram modificadas posteriormente com polianilina mediante polimerização oxidativa “in situ”. A caracterização dos sólidos mediante espectroscopia de absorção na região de infravermelho (FT-IR), difração de raios X (DRX), microscopia eletrônica de varredura (SEM) e DSC evidência a síntese exitosa dos materiais mediante intercalação ou elaminação dos minerais da argila. Os sólidos sintetizados foram avaliados como agentes anti-corrosivos mediante medidas eletroquímicas do potencial da corrosão, resistência do polarização e corrente da corrosão sobre elétrodos de aço cold-rolled 1020 (AISI-SAE). Encontrou-se que os micro-compostos sintetizados oferecem proteção à superfície do aço contra os agentes corrosivos, obtendo-se diferenças importantes entre os materiais micro-compostos de polianilina/ argila, sem que estes superem o potencial anti-corrosivo da polianilina em sua forma esmeraldina base pura.