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Knee Surgery, Sports Traumatology, Arthroscopy

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01-08-2018 | Shoulder

Completion repair exhibits increased healing characteristics compared with in situ repair of partial thickness bursal rotator cuff tears

Authors: Arel Gereli, Baris Kocaoglu, Tekin Kerem Ulku, Sena Silay, Evren Kilinc, Serap Uslu, Ufuk Nalbantoglu

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2018

Abstract

Purpose

Little information is available regarding the healing capacity of in situ and completion repair for the treatment of partial thickness rotator cuff tears. The purpose of the study was to analyze the healing characteristics of both techniques.

Methods

Twenty-four adult Sprague–Dawley rats were operated. Partial thickness bursal side tears were created bilaterally at the supraspinatus tendons. Additional 6 rats were used as the sham group. The right shoulders were repaired in situ, and the left shoulders were repaired using the tear completion technique on the 10th day after detachment surgery. Rats were sacrificed on the 10th and 30th days after repair surgery. Type I collagen, the TNF-α concentrations, the number and diameter of fibroblasts, and neovascularization were examined at two different time points.

Results

The collagen concentration (ng/mg total protein) was significantly increased in both groups at T1 and decreased in the in situ group, whereas completion repair continued to increase at T2 (P < 0.05). The mean fibroblast diameter in the completion repair group continued to increase at both time points (P < 0.05). Neovascularization was significantly increased with tear completion compared with in situ repair (P < 0.05) at T1. No significant (n.s.) differences regarding the TNF-α concentration (pg/mg total protein) were noted for both surgical techniques at T2 (P > 0.05).

Conclusion

Despite the concerns of detaching the intact tendon, the completion repair technique exhibited increased healing characteristics compared with the in situ technique. The reason for this finding might be the refreshing effect of debridement at the chronic degenerated tendon that could improve the healing response.

Bollier M, Shea K (2012) Systematic review: what surgical technique provides the best outcome for symptomatic partial articular-sided rotator cuff tears? Iowa Orthop J 32:164–172PubMedPubMedCentral

Fenwick SA, Hazleman BL, Riley GP (2002) The vasculature and its role in the damaged and healing tendon. Arthritis Res 4:252–260CrossRefPubMedPubMedCentral

Franceschi F, Papalia R, Del Buono A, Vasta S, Costa V, Mafulli N et al (2013) Articular sided rotator cuff tears: which is the best repair? A three year prospective randomised controlled trial. Int Orthop 37:1487–1493CrossRefPubMedPubMedCentral

Finnan RP, Crosby LA (2010) Partial-thickness rotator cuff tears. J Shoulder Elbow Surg 19(4):609–616CrossRefPubMed

Galatz LM, Sandell LJ, Rothermich SY, Das R, Mastny A, Havlioglu N et al (2006) Characteristics of the rat supraspinatus tendon during tendon-to-bone healing after acute injury. J Orthop Res 24(3):541–550CrossRefPubMed

Gartner LP, Hiatt JL (2001) Color textbook of histology, 2nd edn. WB Saunders, Philadelphia, pp 111–112

Gonzalez-Lomas G, Kippe MA, Brown GD, Gardner TR, Ding A, Levine WN et al (2008) In situ transtendon repair outperforms tear completion and repair for partial articular-sided supraspinatus tendon tears. J Shoulder Elbow Surg 17(5):722–728CrossRefPubMed

Gulotta LV, Kovacevic D, Cordasco F, Rodeo SA (2011) Evaluation of tumor necrosis factor α blockade on early tendon-to-bone healing in a rat rotator cuff repair model. Arthroscopy 27(10):1351–1357CrossRefPubMed

Kamath G, Galatz LM, Keener JD, Teefey S, Middleton W, Yamaguchi K (2009) Tendon integrity and functional outcome after arthroscopic repair of high-grade partial-thickness supraspinatus tears. J Bone Joint Surg Am 91(5):1055–1062CrossRefPubMed

10.

Kelly BA, Proffen BL, Haslauer CM, Murray MM (2016) Platelets and plasma stimulate sheep rotator cuff tendon tenocytes when cultured in an extracellular matrix scaffold. J Orthop Res 34(4):623–629CrossRefPubMed

11.

Kim YS, Lee HJ, Bae SH, Jin H, Song HS (2015) Outcome comparison between in situ repair versus tear completion repair for partial thickness rotator cuff tears. Arthroscopy 31(11):2191–2198CrossRefPubMed

12.

Kim KC, Shin HD, Cha SM, Park JY (2014) Repair integrity and functional outcome after arthroscopic conversion to a full-thickness rotator cuff tear: articular- versus bursal side partial tears. Am J Sports Med 42:451–456CrossRefPubMed

13.

Lundgreen K, Lian OB, Engebretsen L, Scott A (2013) Lower muscle regenerative potential in full-thickness supraspinatus tears compared to partial thickness tears. Acta Orthop 84(6):565–570CrossRefPubMedPubMedCentral

14.

Mall NA, Tanaka MJ, Choi LS, Paletta GA Jr (2014) Factors affecting rotator cuff healing. J Bone Joint Surg Am 96(9):778–788CrossRefPubMed

15.

Matava MJ, Purcell DB, Rudzki JR. Partial-thickness rotator cuff tears (2005). Am J Sports Med. 33(9):1405–1417

16.

Matthewson G, Beach CJ, Nelson AA, Woodmas JM, Ono Y, Boorman RS et al (2015). Partial thickness rotator cuff tears: current concepts. Adv Orthop 2015:458786CrossRefPubMedPubMedCentral

17.

Mazzocca AD, Rincon LM, O’Connor RW, Obopilwe E, Andersen M, Geaney L et al (2008) Intra-articular partialthickness rotator cuff tears:analysis of injured and repaired strain behavior. Am J Sports Med 36(1):110–116CrossRefPubMed

18.

Miettinen M, McCue PA, Sarlomo-Rikala M, Biernat W, Czapiewski P, Kopczynski J et al (2015) Sox10—a marker for not only schwannian and melanocytic neoplasms but also myoepithelial cell tumors of soft tissue: a systematic analysis of 5134 tumors. Am J Surg Pathol 39(6):826–835CrossRefPubMedPubMedCentral

19.

Millington-Ward S, Allers C, Tuohy G, Conget P, Allen D, McMahon HP et al (2002) Validation in mesenchymal progenitor cells of a mutation-independent ex vivo approach to gene therapy for osteogenesis imperfecta. Hum Mol Genet 11(19):2201–2206CrossRefPubMed

20.

Otoshi K, Kikuchi S, Ohi G, Numazaki H, Sekiguchi M, Konno S (2011) The process of tendon regeneration in an achilles tendon resection rat model as a model for hamstring regeneration after harvesting for anterior cruciate ligament reconstruction. Arthroscopy 27(2):218–227CrossRefPubMed

21.

Peters KS, Lam PH, Murrell GA (2010) Repair of partial-thickness rotator cuff tears: a biomechanical analysis of footprint contact pressure and strength in an ovine model. Arthroscopy 26(7):877–884CrossRefPubMed

22.

Sharma P, Maffulli N (2005) Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am 87:187–202PubMed

23.

Shin SJ (2012) A comparison of 2 repair techniques for partialthickness articular-sided rotator cuff tears. Arthroscopy 28:25–33CrossRefPubMed

24.

Soslowsky LJ, Carpenter JE, DeBano CM, Banerji I, Moalli MR (1996) Development and use of an animal model for investigations on rotator cuff disease. J Shoulder Elbow Surg 5(5):383–392CrossRefPubMed

25.

Sun L, Zhang Q, Ge H, Sun Y, Cheng B (2015) Which is the best repair of articular-sided rotator cuff tears: a meta-analysis. J Orthop Surg Res 10:84CrossRefPubMedPubMedCentral

26.

Yamakado K (2012). Histopathology of residual tendon in high-grade articular-sided partial-thickness rotator cuff tears (PASTA lesions). Arthroscopy 28(4):474–480CrossRefPubMed

Title: Completion repair exhibits increased healing characteristics compared with in situ repair of partial thickness bursal rotator cuff tears
Authors: Arel Gereli
Baris Kocaoglu
Tekin Kerem Ulku
Sena Silay
Evren Kilinc
Serap Uslu
Ufuk Nalbantoglu
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-018-4870-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Completion repair exhibits increased healing characteristics compared with in situ repair of partial thickness bursal rotator cuff tears

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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