Purpose
To prospectively review functional outcomes and healing rates of large and massive
rotator cuff tears repaired with a load-sharing rip-stop (LSRS) technique.
Methods
Twenty-one consecutive patients underwent arthroscopic rotator cuff repair with an
LSRS construct between January and December 2014. Seventeen patients with a minimum
of 2 years' follow-up were included. Four patients did not complete clinical evaluations
and functional outcome scores at a minimum of 2 years' follow-up and were lost to
follow-up. Ultrasound imaging was used to assess for rotator cuff healing at a minimum
of 6 months postoperatively. Range of motion, strength, and functional outcome scores
were evaluated at final follow-up.
Results
Mean active forward elevation improved from 109° preoperatively to 153° postoperatively,
and mean supraspinatus strength improved by 1 strength grade, from 3.5 preoperatively
to 4.4 postoperatively. When we compared preoperative and postoperative values, the
American Shoulder and Elbow Surgeons score improved from 40.8 to 89.5, the Single
Assessment Numeric Evaluation score improved from 32.8 to 83.1, the Simple Shoulder
Test score improved from 3.8 to 10.3, and the pain score on a visual analog scale
decreased from 4.8 to 0.8 (P < .001). Of 17 patients, 13 (82%) were satisfied with their outcomes. Ultrasound
evaluation 6 months after surgery showed complete healing in 53%, partial healing
in 29%, and no healing in 18%.
Conclusions
The LSRS construct showed satisfactory functional outcomes with reasonable healing
rates in an otherwise challenging subset of rotator cuff tears. This construct may
be an alternative for tears not amenable to double-row repair.
Level of Evidence
Level IV, therapeutic case series.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears.J Bone Joint Surg Am. 2004; 86: 219-224
- Supraspinatus rupture at the musculotendinous junction: An uncommonly recognized phenomenon.J Shoulder Elbow Surg. 2012; 21: 72-76
- A load sharing rip-stop construct for arthroscopic rotator cuff repair.Arthroscopy Tech. 2012; 1: e37-e42
- Biomechanical validation of load-sharing rip stop fixation for the repair of tissue-deficient rotator cuff tears.Am J Sports Med. 2014; 42: 457-462
- The results of massive tears of the rotator cuff.J Bone Joint Surg Am. 2000; 82: 505-515
- Results of a second attempt at surgical repair of a failed initial rotator cuff repair.J Bone Joint Surg Am. 1984; 66: 563-567
- A standardized method for the assessment of shoulder function.J Shoulder Elbow Surg. 1994; 3: 347-352
- Fatty muscle degeneration in cuff ruptures. Pre and postoperative evaluation by CT scan.Clin Orthop Relat Res. 1994; : 78-83
- An arthroscopic stitch for massive rotator cuff tears: The Mac stitch.Arthroscopy. 2004; 20: 669-671
- Mechanical strength of repairs of the rotator cuff.J Bone Joint Surg Br. 1994; 76: 371-380
- Biomechanical evaluation of a new technique for rotator cuff repair.Am J Sports Med. 2003; 31: 849-853
- Biomechanical evaluation of arthroscopic rotator cuff stitches.J Bone Joint Surg Am. 2004; 86: 1211-1216
- Biomechanical evaluation of arthroscopic rotator cuff repairs: Double-row compared with single row fixation.J Bone Joint Surg Am. 2006; 88: 403-410
- Long-term outcome of arthroscopic massive rotator cuff repair: The importance of double-row fixation.Arthroscopy. 2012; 7: 909-915
- Comparison of the clinical outcomes of single- and double-row repairs in rotator cuff tears.Am J Sports Med. 2008; 36: 1310-1316
- Arthroscopic repair of full thickness tears of supraspinatus: Does the tendon really heal?.J Bone Joint Surg Am. 2005; 87: 1229-1240
- Which method of rotator cuff repair leads to the highest rate of structural healing? A systematic review.Am J Sports Med. 2010; 38: 835-841
Article info
Publication history
Published online: June 14, 2017
Accepted:
April 3,
2017
Received:
January 16,
2017
Footnotes
See commentary on page 1659
The authors report the following potential conflict of interest or source of funding: M.P.N. receives support from Tenex Health. P.J.D. receives support from Arthrex. Arthroscopy editorial board.
Identification
Copyright
© 2017 by the Arthroscopy Association of North America
