Theodore F Schlegel1, Jeffrey S Abrams2, Brandon D Bushnell3, J Logan Brock4, Charles P Ho5. 1. Steadman Hawkins Clinic Denver, Greenwood Village, CO, USA. Electronic address: tschlegel@shcdenver.com. 2. Princeton Orthopaedic Associates, Princeton, NJ, USA. 3. Harbin Clinic Orthopaedics & Sports Medicine, Rome, GA, USA. 4. University of Pennsylvania, Philadelphia, PA, USA. 5. Steadman Philippon Research Institute, Vail, CO, USA.
Abstract
BACKGROUND: Treatment of partial-thickness cuff tears remains controversial. Although conservative therapy may treat symptoms, these defects do not spontaneously heal and conversion to a full-thickness lesion with subsequent repair may alter the tendon footprint. The ability to induce new tissue formation and limit tear progression in intermediate- and high-grade partial-thickness tears without surgical repair may represent a significant advancement in the treatment paradigm for these lesions. METHODS: We prospectively enrolled 33 patients with chronic, degenerative, intermediate-grade (n = 12) or high-grade (n = 21) partial-thickness tears (11 articular, 10 bursal, 4 intrasubstance, and 8 hybrid) of the supraspinatus tendon in a multicenter study. Following arthroscopic subacromial decompression without repair, a bioinductive implant was attached over the bursal surface of the tendon. Clinical outcomes were assessed using American Shoulder and Elbow Surgeons and Constant-Murley scores preoperatively and at 3 and 12 months postoperatively. Magnetic resonance imaging was performed to assess postoperative tendon healing and thickness at the original tear site. RESULTS: At 1-year follow-up, clinical scores improved significantly (P <.0001) and the mean tendon thickness increased by 2.0 mm (P <.0001). Magnetic resonance imaging evidence of complete healing was found in 8 patients and a considerable reduction in defect size was shown in 23, whereas 1 lesion remained stable. In 1 noncompliant patient with a high-grade articular lesion, progression to a full-thickness tear occurred while shoveling snow 1 month after surgery. No serious adverse events related to the implant were reported. CONCLUSIONS:Arthroscopic implantation of a bioinductive collagen scaffold is a safe and effective treatment for intermediate- to high-grade partial-thickness rotator cuff tears of the supraspinatus tendon.
RCT Entities:
BACKGROUND: Treatment of partial-thickness cuff tears remains controversial. Although conservative therapy may treat symptoms, these defects do not spontaneously heal and conversion to a full-thickness lesion with subsequent repair may alter the tendon footprint. The ability to induce new tissue formation and limit tear progression in intermediate- and high-grade partial-thickness tears without surgical repair may represent a significant advancement in the treatment paradigm for these lesions. METHODS: We prospectively enrolled 33 patients with chronic, degenerative, intermediate-grade (n = 12) or high-grade (n = 21) partial-thickness tears (11 articular, 10 bursal, 4 intrasubstance, and 8 hybrid) of the supraspinatus tendon in a multicenter study. Following arthroscopic subacromial decompression without repair, a bioinductive implant was attached over the bursal surface of the tendon. Clinical outcomes were assessed using American Shoulder and Elbow Surgeons and Constant-Murley scores preoperatively and at 3 and 12 months postoperatively. Magnetic resonance imaging was performed to assess postoperative tendon healing and thickness at the original tear site. RESULTS: At 1-year follow-up, clinical scores improved significantly (P <.0001) and the mean tendon thickness increased by 2.0 mm (P <.0001). Magnetic resonance imaging evidence of complete healing was found in 8 patients and a considerable reduction in defect size was shown in 23, whereas 1 lesion remained stable. In 1 noncompliant patient with a high-grade articular lesion, progression to a full-thickness tear occurred while shoveling snow 1 month after surgery. No serious adverse events related to the implant were reported. CONCLUSIONS: Arthroscopic implantation of a bioinductive collagen scaffold is a safe and effective treatment for intermediate- to high-grade partial-thickness rotator cuff tears of the supraspinatus tendon.
Authors: Jonathan A Cook; Mathew Baldwin; Cushla Cooper; Navraj S Nagra; Joanna C Crocker; Molly Glaze; Gemma Greenall; Amar Rangan; Lucksy Kottam; Jonathan L Rees; Dair Farrar-Hockley; Naomi Merritt; Sally Hopewell; David Beard; Michael Thomas; Melina Dritsaki; Andrew J Carr Journal: Health Technol Assess Date: 2021-02 Impact factor: 4.014
Authors: Daniel P Berthold; Patrick Garvin; Michael R Mancini; Colin L Uyeki; Matthew R LeVasseur; Augustus D Mazzocca; Andreas Voss Journal: Oper Orthop Traumatol Date: 2021-12-10 Impact factor: 1.154
Authors: Mathew Baldwin; N S Nagra; Gemma Greenall; Andrew J Carr; David Beard; J L Rees; Amar Rangan; Naomi Merritt; Melina Dritsaki; Sally Hopewell; Jonathan Alistair Cook Journal: BMJ Open Date: 2020-12-07 Impact factor: 2.692