Abstract
Introduction
Rotator cuff tears are common and good-to-excellent clinical outcome is reported after subsequent repair. However, the retear rate of rotator cuff repairs has been shown to be as high as 20%. The reasons for retear seem to be multifactorial, mainly comprised by mechanical and biological aspects. Regarding mechanical causes, the role of the tendon tension and malreduction is so far unknown. First, we hypothesized that the tendon tension depends on the technique of tendon reposition and that malreduction of the tendon results in an increased tendon tension. Second, we aimed to demonstrate the inter- and intraobserver reliability of a novel custom-made digital tensiometer clamp.
Materials and methods
A tendon defect of posterosuperior rotator cuff (reverse L-shaped) was simulated in seven cadaveric human shoulder specimens. By use of a custom-made tensiometer clamp, the supraspinatus tendon was reduced by pulling it in (1) an anterolateral direction (anatomical reduction) and (2) in a straight lateral direction (malreduction) until the footprint was completely covered. The reduction procedure was consecutively repeated to evaluate the inter- and intraobserver reliability.
Results
The mean traction forces for anatomical reduction and malreduction were 16.02 N (SD 8.06) and 19.52 N (SD 9.95), respectively. The difference between the two groups was statistically significant (p = 0.028). The interobserver reliability showed a correlation of r = 0.757 [95% confidence interval (CI) 0.092–0.955]. The intraobserver reliability of the three surgeons was observed to be between r = 0.905 and 0.986.
Conclusions
The malreduction of the rotator cuff has a significant influence on the tendon tension and may therefore affect the healing rate of the tendon after the repair, so that a tension-balanced repair could improve the clinical results. Furthermore, the application of a novel custom-made tensiometer clamp showed good interobserver and excellent intraobserver reliabilities.
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References
McCarron JA, Derwin KA, Bey MJ et al (2013) Failure with continuity in rotator cuff repair “healing”. Am J Sports Med 41:134–141. doi:10.1177/0363546512459477
Kasten P, Keil C, Grieser T et al (2011) Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon. Int Orthop 35:1663–1670. doi:10.1007/s00264-011-1262-2
Duquin TR, Buyea C, Bisson LJ (2010) Which method of rotator cuff repair leads to the highest rate of structural healing? A systematic review. Am J Sports Med 38:835–841. doi:10.1177/0363546509359679
Morse K, Davis AD, Afra R et al (2008) Arthroscopic versus mini-open rotator cuff repair: a comprehensive review and meta-analysis. Am J Sports Med 36:1824–1828. doi:10.1177/0363546508322903
Huang R, Wang S, Wang Y et al (2016) systematic review of all-arthroscopic versus mini-open repair of rotator cuff tears: a meta-analysis. Sci Rep. doi:10.1038/srep22857
Galatz LM, Ball CM, Teefey SA et al (2004) The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Jt Surg Am 86:219–224
Lorbach O, Tompkins M (2012) Rotator cuff: biology and current arthroscopic techniques. Knee Surg Sports Traumatol Arthrosc 20:1003–1011. doi:10.1007/s00167-012-1901-1
Marrero LG, Nelman KR, Nottage WM (2011) Long-term follow-up of arthroscopic rotator cuff repair. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 27:885–888. doi:10.1016/j.arthro.2011.02.019
Bennett WF (2003) Arthroscopic repair of massive rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 19:380–390. doi:10.1053/jars.2003.50131
Wolf EM, Pennington WT, Agrawal V (2004) Arthroscopic rotator cuff repair: 4- to 10-year results. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 20:5–12. doi:10.1016/j.arthro.2003.11.001
Haviv B, Dolev E, Haber M et al (2010) Arthroscopic rotator cuff repair: clinical outcome of 607 patients. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 18:1707–1711. doi:10.1007/s00167-010-1091-7
Harryman DT, Mack LA, Wang KY et al (1991) Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Jt Surg Am 73:982–989
Sugaya H, Maeda K, Matsuki K, Moriishi J (2005) Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthrosc J Arthrosc Relat Surg 21:1307–1316. doi:10.1016/j.arthro.2005.08.011
Ide J, Karasugi T, Okamoto N et al (2015) Functional and structural comparisons of the arthroscopic knotless double-row suture bridge and single-row repair for anterosuperior rotator cuff tears. J Shoulder Elbow Surg 24:1544–1554. doi:10.1016/j.jse.2015.03.015
El-Azab H, Buchmann S, Beitzel K et al (2010) Clinical and structural evaluation of arthroscopic double-row suture-bridge rotator cuff repair: early results of a novel technique. Knee Surg Sports Traumatol Arthrosc 18:1730–1737. doi:10.1007/s00167-010-1257-3
Gulotta LV, Nho SJ, Dodson CC et al (2011) Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part I—functional outcomes and radiographic healing rates. J Shoulder Elbow Surg 20:934–940. doi:10.1016/j.jse.2011.03.029
Boileau P, Brassart N, Watkinson DJ et al (2005) Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Jt Surg Am 87:1229–1240. doi:10.2106/JBJS.D.02035
Neyton L, Godenèche A, Nové-Josserand L et al (2013) Arthroscopic suture-bridge repair for small to medium size supraspinatus tear: healing rate and retear pattern. Arthrosc J Arthrosc Relat Surg 29:10–17. doi:10.1016/j.arthro.2012.06.020
Chung SW, Oh JH, Gong HS et al (2011) Factors affecting rotator cuff healing after arthroscopic repair: osteoporosis as one of the independent risk factors. Am J Sports Med 39:2099–2107. doi:10.1177/0363546511415659
Goutallier D, Postel J-M, Gleyze P et al (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg Am Shoulder Elbow Surg Al 12:550–554. doi:10.1016/S1058274603002118
Abtahi AM, Granger EK, Tashjian RZ (2015) Factors affecting healing after arthroscopic rotator cuff repair. World J Orthop 6:211–220. doi:10.5312/wjo.v6.i2.211
George MS, Khazzam M (2012) Current concepts review: revision rotator cuff repair. J Shoulder Elbow Surg Am Shoulder Elbow Surg Al 21:431–440. doi:10.1016/j.jse.2011.11.029
Wu XL, Briggs L, Murrell GAC (2012) Intraoperative determinants of rotator cuff repair integrity: an analysis of 500 consecutive repairs. Am J Sports Med 40:2771–2776. doi:10.1177/0363546512462677
Sugaya H, Maeda K, Matsuki K, Moriishi J (2007) Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. J Bone Jt Surg Am 89:953–960. doi:10.2106/JBJS.F.00512
Anderson K, Boothby M, Aschenbrener D, van Holsbeeck M (2006) Outcome and structural integrity after arthroscopic rotator cuff repair using 2 rows of fixation minimum 2-year follow-up. Am J Sports Med 34:1899–1905. doi:10.1177/0363546506290187
Warner JJP, Deng X-H, Warren RF, Torzilli PA (1992) Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint. Am J Sports Med 20:675–685. doi:10.1177/036354659202000608
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Kim DH, Jang YH, Choi YE et al (2016) Evaluation of repair tension in arthroscopic rotator cuff repair: does it really matter to the integrity of the rotator cuff? Am J Sports Med. doi:10.1177/0363546516651831
Dierckman BD, Wang DW, Bahk MS et al (2016) In vivo measurement of rotator cuff tear tension: medial versus lateral footprint position. Am J Orthop Belle Mead NJ 45:E83–E90
Mannava S, Plate JF, Whitlock PW et al (2011) Evaluation of in vivo rotator cuff muscle function after acute and chronic detachment of the supraspinatus tendon: an experimental study in an animal model. J Bone Jt Surg Am 93:1702–1711. doi:10.2106/JBJS.J.00184
Domb BG, Glousman RE, Brooks A et al (2008) High-tension double-row footprint repair compared with reduced-tension single-row repair for massive rotator cuff tears. J Bone Jt Surg Am 90(Suppl 4):35–39. doi:10.2106/JBJS.H.00650
Hersche O, Gerber C (1998) Passive tension in the supraspinatus musculotendinous unit after long-standing rupture of its tendon: a preliminary report. J Shoulder Elbow Surg Am Shoulder Elbow Surg Al 7:393–396
Davidson PA, Rivenburgh DW (2000) Rotator cuff repair tension as a determinant of functional outcome. J Shoulder Elbow Surg 9:502–506. doi:10.1067/mse.2000.109385
Baring TKA, Cashman PPM, Reilly P et al (2011) Rotator cuff repair failure in vivo: a radiostereometric measurement study. J Shoulder Elbow Surg Am Shoulder Elbow Surg Al 20:1194–1199. doi:10.1016/j.jse.2011.04.010
Cho NS, Lee BG, Rhee YG (2011) Arthroscopic rotator cuff repair using a suture bridge technique: is the repair integrity actually maintained? Am J Sports Med 39:2108–2116. doi:10.1177/0363546510397171
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Pastor MF, Kraemer M, Schwarze M, Hurschler C, Smith T, and Wellmann M declare that they have no conflict of interest.
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Pastor, MF., Kraemer, M., Schwarze, M. et al. The effect of rotator cuff malreduction on tendon tension: an evaluation of a custom-made digital tensiometer clamp. Arch Orthop Trauma Surg 138, 219–225 (2018). https://doi.org/10.1007/s00402-017-2823-7
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DOI: https://doi.org/10.1007/s00402-017-2823-7