Volume 26, Issue 3 , Pages 293-294, March 2010
Rotator Cuff Repair: Obviously
Article Outline
In this issue, we include a diverse collection of articles considering current challenges, complications, and controversies surrounding that confluence of tendons connecting or otherwise conjoining the 4 muscles comprising the shoulder rotator cuff. With apologies for our continuing alliterative clarion, the collection culminates in a classification that we believe will become a Current Concepts classic guiding successful cuff closure. We'll conclude our exercise in consonant cuteness by concurring that, while our literature constantly confounds with conflicting conclusions, clever consideration can clarify the obvious.
To begin, Norris et al. from Union Memorial Hospital in Baltimore, Maryland, compare suture size and material in vitro to examine bone cutout in transosseous tendon repairs.1 Their conclusions are well founded on the experimental data presented, but obviously readers must reach their own conclusions about the clinical relevance of this investigation.
Systematic review methods represent a valuable tool to answer clinical questions, especially when the literature is controversial or discrepant. As such, we are enthusiastic about the study, “Does the literature confirm superior clinical results in radiographically healed rotator cuffs after rotator cuff repair?” by Slabaugh et al. of the Rush Division of Sports Medicine in Chicago, in collaboration with former Rush Sports Medicine Fellow and current Arthroscopy Associate Editor, Matt Provencher of San Diego.2 These authors demonstrate the challenges in synthesizing the arthroscopic and related literature, because the 13 studies included use diverse methods to diagnose recurrent rotator cuff tear after rotator cuff repair; in addition, the studies used diverse measures of clinical outcome. Those familiar with the primary literature will not be surprised to learn that some studies, using some outcome measures, found improved results in patients who had an intact rotator cuff—some, but not all. Further, it is not a surprise that, similarly, a primary investigation in the current issue, “Arthroscopic repair of full-thickness rotator cuff tears: Is there tendon healing in patients aged 65 years or older?” by Charousset et al. of the Institut Ostéo Articulaire Paris Courcelles in Paris, simply adds to the controversy.3 In our estimation, it is intuitive if not obvious that the ultimate goal must be an improved understanding of rotator cuff anatomy, biology, and pathology so as to achieve surgical repairs that result in healed, rather than nonhealed, rotator cuff repairs.
Certainly, nonhealing of rotator cuff repair is to be expected in cases of anchor pullout. Benson et al. of the University of Western Ontario, retrospectively review “The incidence of early metallic suture anchor pullout after arthroscopic rotator cuff repair” and test the hypothesis that the incidence is “not insignificant and
…higher in larger sized tears.”4 Interested readers should scrutinize the study results, and also take note of the excellent discussion in which the authors thoroughly consider the evidence-based issues associated with rotator cuff anchor failure. Next, readers may consider what we find to be an original report of 4 cases of “Medial-row failure after arthroscopic double-row rotator cuff repair” by Yamakado et al. of Fukui, Japan.5 As above, it seems obvious that research must continue with a focus on improved understanding of rotator cuff anatomy, biology, and pathology to develop techniques that result in successful surgical repair.
With this in mind, we conclude our editorial by noting with great pleasure and excitement, “The geometric classification of rotator cuff tears: A system linking tear pattern to treatment and prognosis,” by Davidson and Burkhart of Phoenix, Arizona, and San Antonio, Texas.6 We could not agree more with the authors: “A valuable classification system allows for communication among surgeons and/or other investigators and offers information on treatment and prognosis. It provides a means for comparison of epidemiologic data and treatment outcomes.” Without a doubt, the Burkhart classification is such a system. Dr. Stephen S. Burkhart needs no further introduction to the readers of Arthroscopy, nor does this outstanding Current Concepts review article. It is rare that authors achieve so much with so few words; the review is concise, and right to the point. The tables are of immense educational value, the figures are of immense clarity, and the video at www.arthroscopyjournal.org is not to be missed.
Having considered in the paragraphs above the challenges, complications, and controversies surrounding bone cutout in transosseous tendon repairs, nonhealing of rotator cuff repair, rotator cuff anchor pullout, and medial row failure after arthroscopic double-row rotator cuff repair, rotator cuff surgeons would do well to heed the lessons that Davidson and Burkhart so generously share. In sum, we are truly proud to publish the Burkhart classification in the Arthroscopy journal: obviously.
References
- . Effect of suture size and type on bone cutout in transosseous tendon repairs. Arthroscopy. 2010;26:324–327
- Does the literature confirm superior clinical results in radiographically healed rotator cuffs after rotator cuff repair?. Arthroscopy. 2010;26:393–403
- . Arthroscopic repair of full-thickness rotator cuff tears: Is there tendon healing in patients aged 65 years or older. Arthroscopy. 2010;26:302–309
- . The incidence of early metallic suture anchor pullout after arthroscopic rotator cuff repair. Arthroscopy. 2010;26:310–315
- . Medial-row failure after arthroscopic double-row rotator cuff repair. Arthroscopy. 2010;26:430–435
- . The geometric classification of rotator cuff tears: A system linking tear pattern to treatment and prognosis. Arthroscopy. 2010;26:417–424
PII: S0749-8063(10)00035-6
doi:10.1016/j.arthro.2010.01.001
© 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Volume 26, Issue 3 , Pages 293-294, March 2010