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Surgical Results of Delaminated Rotator Cuff Repair Using Suture-Bridge Technique With All-Layers or Bursal Layer-Only Repair

Authors
 Sung-Jae Kim  ;  Yun-Rak Choi  ;  Hyun-Hee Lee  ;  Yong-Min Chun 
Citation
 AMERICAN JOURNAL OF SPORTS MEDICINE, Vol.44(2) : 468-473, 2016 
Journal Title
AMERICAN JOURNAL OF SPORTS MEDICINE
ISSN
 0363-5465 
Issue Date
2016
MeSH
Adult ; Aged ; Arthrography/methods ; Arthroscopy/methods* ; Arthroscopy/rehabilitation ; Cohort Studies ; Feasibility Studies ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multimodal Imaging ; Postoperative Care/methods ; Range of Motion, Articular/physiology ; Rotator Cuff/surgery* ; Rupture/surgery ; Shoulder Joint/surgery ; Suture Techniques* ; Sutures ; Tomography, X-Ray Computed ; Treatment Outcome ; Wound Healing/physiology
Keywords
delamination ; repair ; rotator cuff tear ; shoulder
Abstract
BACKGROUND: There are no known studies that have investigated the effect on delaminated rotator cuff tears of bursal layer-only repair when full-thickness repair would put the articular layer under tension, compared with all-layers repair when full-thickness repair is feasible.
HYPOTHESIS: Better outcomes will be seen in the bursal layer-only repair, as the articular layer would be under tension when repaired onto its footprint during the all-layers repair.
STUDY DESIGN: Cohort study; Level of evidence 3.
METHODS: This study included 112 patients who underwent arthroscopic rotator cuff repair for posteriorly delaminated tears of either all layers (group A) or the bursal layer alone (group B). If the articular layer was able to be reduced onto its footprint, the patient was assigned to group A; if such reduction was not possible or was only marginally possible under significant tension, the patient was assigned to group B. Pain scored on a visual analog scale (VAS) was assessed, as were subjective shoulder value (SSV), University of California, Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) score, and shoulder active range of motion (ROM). Postoperative magnetic resonance arthrography (MRA) or computed tomographic arthrography (CTA) was undertaken 6 months postoperatively for structural integrity assessment.
RESULTS: After 2 years, the VAS pain score (group A, from 6.5 to 1.2; group B, from 6.4 to 1.2), SSV (group A, from 38.3 to 89.4; group B, from 38.0 to 90.1), ASES score (group A, from 36.4 to 90.4; group B, from 38.0 to 90.8), UCLA shoulder score (group A, from 15.3 to 30.7; group B, from 15.0 to 31.3), and ROM improved significantly in both groups compared with preoperative values (P < .001). However, none of these values differed significantly between groups. On follow-up MRA or CTA images, there was no significant difference in the retear rate between group A (28%; 16/57) and group B (24%; 11/45).
CONCLUSION: The all-layers repair did not produce better clinical outcomes or structural integrity than the bursal layer-only repair. The study findings indicate that if repair of the articular layer is possible only under significant tension or is not reparable, rather than all-layers repair by force, bursal-layer repair without incorporating the articular layer may produce comparable clinical outcomes and structural integrity in the delaminated rotator cuff tear.
Full Text
http://ajs.sagepub.com/content/44/2/468
DOI
10.1177/0363546515615573
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sung Jae(김성재)
Lee, Hyun Hee(이현희)
Chun, Yong Min(천용민) ORCID logo https://orcid.org/0000-0002-8147-6136
Choi, Yun Rak(최윤락)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146447
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