Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2019

01-10-2019 | SHOULDER

No healing improvement after rotator cuff reconstruction augmented with an autologous periosteal flap

Authors: C. Holwein, B. von Bibra, P. M. Jungmann, D. C. Karampinos, K. Wörtler, M. Scheibel, A. B. Imhoff, S. Buchmann

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2019

Login to get access

Abstract

Purpose

To show descriptive clinical and magnetic resonance (MR) imaging results after an additional periosteal flap augmentation in mini-open rotator cuff reconstruction and to evaluate potential healing improvement at long-term follow-up.

Methods

Twenty-three patients with degenerative rotator cuff tears were followed after receiving a mini-open single-row repair with a subtendinous periosteal flap augmentation. Data were collected preoperatively, after 12 months and after 11 years. Clinical examination, simple shoulder test (SST), Constant–Murley Score (CS), ultrasonography examination and 3T MR imaging were performed.

Results

Out of 23 patients, 20 were available for short-term and 19 for final follow-up at a median of 11.5 years (range 10.4–13.0). Questions answered with “yes” in SST improved from baseline 5.0 (range 1.0–8.0) to short 10.5 (range 8.0–12.0) and final follow-up 12.0 (range 7.0–12.0). CS improved from 53.5 (range 25.0–66.0) to 80.8 (range 75.9–89.3) and finally to 79.8 points (range 42.3–95.4). Improvement was highly significant (p < 0.05). Severe retears were found in 9/19 patients. Ossifications along the refixed tendon were noticed in 8/19 cases. Ossifications did not correlate with clinical outcome. At final follow-up, patients with retears seemed likely to have lower strength values in CS (mean ± SD) than patients without retears (7.3 ± 4.1 vs. 12.8 ± 5.3; p < 0.05).

Conclusion

No positive effect on improving healing response in rotator cuff refixation with a periosteal flap augmentation could be found. Retear rate is comparable to that of conventional rotator cuff refixation in the published literature. Ossifications along the tendon, without negatively affecting the clinical outcome, were seen. This invasive technique cannot be advised and should not be used anymore.

Level of evidence

IV.
Literature
1.
Agout C, Berhouet J, Bouju Y, Godeneche A, Collin P, Kempf JF et al (2018) Clinical and anatomic results of rotator cuff repair at 10 years depend on tear type. Knee Surg Sports Traumatol Arthrosc 26:2490–2497CrossRefPubMed
2.
Allen MR, Hock JM, Burr DB (2004) Periosteum: biology, regulation, and response to osteoporosis therapies. Bone 35:1003–1012CrossRefPubMed
3.
Apostolakos J, Durant TJ, Dwyer CR, Russell RP, Weinreb JH, Alaee F et al (2014) The enthesis: a review of the tendon-to-bone insertion. Muscles Ligaments Tendons J 4:333–342CrossRefPubMedPubMedCentral
4.
Badhe SP, Lawrence TM, Smith FD, Lunn PG (2008) An assessment of porcine dermal xenograft as an augmentation graft in the treatment of extensive rotator cuff tears. J Shoulder Elbow Surg 17:35S–39SCrossRefPubMed
5.
Barnes LA, Kim HM, Caldwell JM, Buza J, Ahmad CS, Bigliani LU et al (2017) Satisfaction, function and repair integrity after arthroscopic versus mini-open rotator cuff repair. Bone Jt J 99-B:245–249CrossRef
6.
Bartl C, Kouloumentas P, Holzapfel K, Eichhorn S, Wortler K, Imhoff A et al (2012) Long-term outcome and structural integrity following open repair of massive rotator cuff tears. Int J Shoulder Surg 6:1–8CrossRefPubMedPubMedCentral
7.
Bateman JE (1963) The diagnosis and treatment of ruptures of the rotator cuff. Surg Clin North Am 43:1523–1530CrossRefPubMed
8.
Beitzel K, Solovyova O, Cote MP, Apostolakos J, Russell RP, McCarthy MB et al (2013) The future role of mesenchymal stem cells in the management of shoulder disorders. Arthroscopy 29:1702–1711CrossRefPubMed
9.
Bell S, Lim YJ, Coghlan J (2013) Long-term longitudinal follow-up of mini-open rotator cuff repair. J Bone Jt Surg Am 95:151–157CrossRef
10.
Bonnevialle N, Bayle X, Faruch M, Wargny M, Gomez-Brouchet A, Mansat P (2015) Does microvascularization of the footprint play a role in rotator cuff healing of the shoulder? J Shoulder Elbow Surg 24:1257–1262CrossRefPubMed
11.
Brunner UH (2002) Klinische Untersuchung der Schulter. In: Habermeyer P (ed) Schulterchirurgie, vol 1. Urban and Fischer, Auflage, pp 45–69
12.
Buchmann S, Sandmann GH, Walz L, Reichel T, Beitzel K, Wexel G et al (2015) Growth factor release by vesicular phospholipid gels: in-vitro results and application for rotator cuff repair in a rat model. BMC Musculoskelet Disord 16:82CrossRefPubMedPubMedCentral
13.
Cai YZ, Zhang C, Jin RL, Shen T, Gu PC, Lin XJ et al (2018) Arthroscopic rotator cuff repair with graft augmentation of 3-dimensional biological collagen for moderate to large tears: a randomized controlled study. Am J Sports Med 46:1424–1431CrossRefPubMed
14.
Chang CH, Chen CH, Su CY, Liu HT, Yu CM (2009) Rotator cuff repair with periosteum for enhancing tendon-bone healing: a biomechanical and histological study in rabbits. Knee Surg Sports Traumatol Arthrosc 17:1447–1453CrossRefPubMed
15.
16.
Chen CH, Chang CH, Su CI, Wang KC, Liu HT, Yu CM et al (2010) Arthroscopic single-bundle anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft: clinical outcome at 2 to 7 years. Arthroscopy 26:907–917CrossRefPubMed
17.
Chen CH, Chang CH, Wang KC, Su CI, Liu HT, Yu CM et al (2011) Enhancement of rotator cuff tendon-bone healing with injectable periosteum progenitor cells-BMP-2 hydrogel in vivo. Knee Surg Sports Traumatol Arthrosc 19:1597–1607CrossRefPubMed
18.
Chen CH, Chen WJ, Shih CH, Yang CY, Liu SJ, Lin PY (2003) Enveloping the tendon graft with periosteum to enhance tendon-bone healing in a bone tunnel: a biomechanical and histologic study in rabbits. Arthroscopy 19:290–296CrossRefPubMed
19.
Ciampi P, Scotti C, Nonis A, Vitali M, Di Serio C, Peretti GM et al (2014) The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears: a 3-year follow-up study. Am J Sports Med 42:1169–1175CrossRefPubMed
20.
Collin P, Colmar M, Thomazeau H, Mansat P, Boileau P, Valenti P et al (2018) Clinical and MRI outcomes 10 years after repair of massive posterosuperior rotator cuff tears. J Bone Jt Surg Am 100:1854–1863CrossRef
21.
Colnot C, Zhang X, Knothe Tate ML (2012) Current insights on the regenerative potential of the periosteum: molecular, cellular, and endogenous engineering approaches. J Orthop Res 30:1869–1878CrossRefPubMedPubMedCentral
22.
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
23.
Degen RM, Carbone A, Carballo C, Zong J, Chen T, Lebaschi A et al (2016) The effect of purified human bone marrow-derived mesenchymal stem cells on rotator cuff tendon healing in an athymic rat. Arthroscopy 32:2435–2443CrossRefPubMed
24.
Dyrna F, Buchmann S, Beitzel K, Imhoff AB (2016) Rotatorenmanschettenheilung Obere Extremität 11:3–9
25.
El-Azab H, Buchmann S, Beitzel K, Waldt S, Imhoff AB (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 18:1730–1737CrossRefPubMed
26.
Ellman H (1987) Arthroscopic subacromial decompression: analysis of one- to three-year results. Arthroscopy 3:173–181CrossRefPubMed
27.
Ficklscherer A, Serr M, Loitsch T, Niethammer TR, Lahner M, Pietschmann MF et al (2017) The influence of different footprint preparation techniques on tissue regeneration in rotator cuff repair in an animal model. Arch Med Sci 13:481–488CrossRefPubMed
28.
Flury M, Rickenbacher D, Jung C, Schneider MM, Endell D, Audige L (2018) Porcine dermis patch augmentation of supraspinatus tendon repairs: a pilot study assessing tendon integrity and shoulder function 2 years after arthroscopic repair in patients aged 60 years or older. Arthroscopy 34:24–37CrossRefPubMed
29.
Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8:599–605CrossRefPubMed
30.
Gerber C, Schneeberger AG, Beck M, Schlegel U (1994) Mechanical strength of repairs of the rotator cuff. J Bone Jt Surg Br 76:371–380CrossRef
31.
Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1995) Fatty infiltration of disrupted rotator cuff muscles. Rev Rhum Engl Ed 62:415–422PubMed
32.
Gwinner C, Gerhardt C, Haneveld H, Scheibel M (2016) Two-staged application of PRP in arthroscopic rotator cuff repair: a matched-pair analysis. Arch Orthop Trauma Surg 136:1165–1171CrossRefPubMed
33.
Harris MT, Butler DL, Boivin GP, Florer JB, Schantz EJ, Wenstrup RJ (2004) Mesenchymal stem cells used for rabbit tendon repair can form ectopic bone and express alkaline phosphatase activity in constructs. J Orthop Res 22:998–1003CrossRefPubMed
34.
Hernigou P, Flouzat Lachaniette CH, Delambre J, Zilber S, Duffiet P, Chevallier N et al (2014) Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study. Int Orthop 38:1811–1818CrossRefPubMed
35.
Iannotti JP, Deutsch A, Green A, Rudicel S, Christensen J, Marraffino S et al (2013) Time to failure after rotator cuff repair: a prospective imaging study. J Bone Jt Surg Am 95:965–971CrossRef
36.
Jensen PT, Lambertsen KL, Frich LH (2018) Assembly, maturation, and degradation of the supraspinatus enthesis. J Shoulder Elbow Surg 27:739–750CrossRefPubMed
37.
Kuntz LA, Rossetti L, Kunold E, Schmitt A, von Eisenhart-Rothe R, Bausch AR et al (2018) Biomarkers for tissue engineering of the tendon-bone interface. PLoS One 13:e0189668CrossRefPubMedPubMedCentral
38.
Kwon J, Kim SH, Lee YH, Kim TI, Oh JH (2018) The rotator cuff healing index: a new scoring system to predict rotator cuff healing after surgical repair. Am J Sports Med 47:173–180CrossRefPubMed
39.
Kyung HS, Kim SY, Oh CW, Kim SJ (2003) Tendon-to-bone tunnel healing in a rabbit model: the effect of periosteum augmentation at the tendon-to-bone interface. Knee Surg Sports Traumatol Arthrosc 11:9–15CrossRefPubMed
40.
41.
Li H, Jiang J, Wu Y, Chen S (2012) Potential mechanisms of a periosteum patch as an effective and favourable approach to enhance tendon-bone healing in the human body. Int Orthop 36:665–669CrossRefPubMed
42.
Lippit SBHD, Matsen FA (1993) A practical tool for evaluating function: the simple shoulder test. In: Matsen FA, Fu FH, Hawkins RJ (eds) The shoulder: a balance of mobility and stability. American Academy of Orthopaedic Surgeons, Rosemont, pp 545–559
43.
Liu Q, Yu Y, Reisdorf RL, Qi J, Lu CK, Berglund LJ et al (2018) Engineered tendon-fibrocartilage-bone composite and bone marrow-derived mesenchymal stem cell sheet augmentation promotes rotator cuff healing in a non-weight-bearing canine model. Biomaterials 192:189–198CrossRefPubMed
44.
McMahon PJ, Prasad A, Francis KA (2014) What is the prevalence of senior-athlete rotator cuff injuries and are they associated with pain and dysfunction? Clin Orthop Relat Res 472:2427–2432CrossRefPubMedPubMedCentral
45.
Minagawa H, Yamamoto N, Abe H, Fukuda M, Seki N, Kikuchi K et al (2013) Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: from mass-screening in one village. J Orthop 10:8–12CrossRefPubMedPubMedCentral
46.
Murthi AM, Lankachandra M (2019) Technologies to augment rotator cuff repair. Orthop Clin North Am 50:103–108CrossRefPubMed
47.
Papadopoulos P, Karataglis D, Boutsiadis A, Fotiadou A, Christoforidis J, Christodoulou A (2011) Functional outcome and structural integrity following mini-open repair of large and massive rotator cuff tears: a 3–5 year follow-up study. J Shoulder Elbow Surg 20:131–137CrossRefPubMed
48.
Park JS, Park HJ, Kim SH, Oh JH (2015) Prognostic factors affecting rotator cuff healing after arthroscopic repair in small to medium-sized tears. Am J Sports Med 43:2386–2392CrossRefPubMed
49.
Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res 254:81–86
50.
Pauly S, Gerhardt C, Scheibel M (2015) Sehnenheilung nach Rotatorenmanschettenrekonstruktion. Obere Extremität 10:17–23CrossRef
51.
Pauzenberger L, Heuberer PR, Dyrna F, Obopilwe E, Kriegleder B, Anderl W et al (2018) Double-layer rotator cuff repair: anatomic reconstruction of the superior capsule and rotator cuff improves biomechanical properties in repairs of delaminated rotator cuff tears. Am J Sports Med 46:3165–3173CrossRefPubMed
52.
Proctor CS (2014) Long-term successful arthroscopic repair of large and massive rotator cuff tears with a functional and degradable reinforcement device. J Shoulder Elbow Surg 23:1508–1513CrossRefPubMed
53.
Ritsila V, Alhopuro S, Rintala A (1972) Bone formation with free periosteum. An experimental study. Scand J Plast Reconstr Surg 6:51–56CrossRefPubMed
54.
55.
Rui YF, Lui PP, Lee YW, Chan KM (2012) Higher BMP receptor expression and BMP-2-induced osteogenic differentiation in tendon-derived stem cells compared with bone-marrow-derived mesenchymal stem cells. Int Orthop 36:1099–1107CrossRefPubMed
56.
Saraswat MK, Styles-Tripp F, Beaupre LA, Luciak-Corea C, Otto D, Lalani A et al (2015) Functional outcomes and health-related quality of life after surgical repair of full-thickness rotator cuff tears using a mini-open technique: a concise 10-year follow-up of a previous report. Am J Sports Med 43:2794–2799CrossRefPubMed
57.
Scheibel M, Brown A, Woertler K, Imhoff AB (2007) Preliminary results after rotator cuff reconstruction augmented with an autologous periosteal flap. Knee Surg Sports Traumatol Arthrosc 15:305–314CrossRefPubMed
58.
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. Arthroscopy 21:1307–1316CrossRefPubMed
59.
Thangarajah T, Pendegrass CJ, Shahbazi S, Lambert S, Alexander S, Blunn GW (2015) Augmentation of rotator cuff repair with soft tissue scaffolds. Orthop J Sports Med 3:2325967115587495CrossRefPubMedPubMedCentral
60.
Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F (1996) Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 67:264–268CrossRefPubMed
61.
Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H et al (2010) Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg 19:116–120CrossRefPubMed
62.
Yoon JP, Lee CH, Jung JW, Lee HJ, Lee YS, Kim JY et al (2018) Sustained delivery of transforming growth factor beta1 by use of absorbable alginate scaffold enhances rotator cuff healing in a rabbit model. Am J Sports Med 46:1441–1450CrossRefPubMed
63.
Youn I, Jones DG, Andrews PJ, Cook MP, Suh JK (2004) Periosteal augmentation of a tendon graft improves tendon healing in the bone tunnel. Clin Orthop Relat Res 419:223–231CrossRef
64.
Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C (2008) The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Jt Surg Am 90:2423–2431CrossRef
Metadata
Title
No healing improvement after rotator cuff reconstruction augmented with an autologous periosteal flap
Authors
C. Holwein
B. von Bibra
P. M. Jungmann
D. C. Karampinos
K. Wörtler
M. Scheibel
A. B. Imhoff
S. Buchmann
Publication date
01-10-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05384-8

Other articles of this Issue 10/2019

Knee Surgery, Sports Traumatology, Arthroscopy 10/2019 Go to the issue

ELBOW

Encouraging mid-term outcomes for arthroscopic autologous osteochondral transplant (OAT) in capitellum osteochondritis dissecans (OCD)

KNEE

No dynamic extrusion of the medial meniscus in ultrasound examination in patients with confirmed root tear lesion

Hip

Professional soccer is associated with radiographic cam and pincer hip morphology

KNEE

Anterolateral ligament injury has a synergic impact on the anterolateral rotatory laxity in acute anterior cruciate ligament-injured knees

ELBOW

Dual reconstruction of lateral collateral ligament is safe and effective in treating posterolateral rotatory instability of the elbow

KNEE

What are the prevalence and risk factors for repeat ipsilateral knee arthroscopy?