Journal article
No healing improvement after rotator cuff reconstruction augmented with an autologous periosteal flap.
- Holwein C Abteilung und Poliklinik für Sportorthopädie Klinikum rechts der Isar Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany. christianholwein@gmx.de.
- von Bibra B Abteilung und Poliklinik für Sportorthopädie Klinikum rechts der Isar Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
- Jungmann PM Klinik für Neuroradiologie Universitätsspital Zürich, Frauenklinikstraße 10, 8091, Zurich, Switzerland.
- Karampinos DC Institut für diagnostische und interventionelle Radiologie Klinikum rechts der Isar Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
- Wörtler K Institut für diagnostische und interventionelle Radiologie Klinikum rechts der Isar Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
- Scheibel M Centrum für Muskuloskeletale Chirurgie der Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
- Imhoff AB Abteilung und Poliklinik für Sportorthopädie Klinikum rechts der Isar Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
- Buchmann S OFZ Orthopädisches Fachzentrum Weilheim, Johann-Baur-Str. 5, Weilheim in Oberbayern, 82362, Germany.
- 2019-04-17
Published in:
- Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - 2019
Periosteal flap
Rotator cuff healing
Rotator cuff repair
Tendon augmentation
Adult
Aged
Arthroscopy
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Rotator Cuff
Rotator Cuff Injuries
Surgical Flaps
Suture Techniques
Treatment Outcome
Ultrasonography
Wound Healing
English
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.
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.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1007/s00167-019-05384-8
- PMID 30989274
- Persistent URL
- https://sonar.ch/global/documents/47557
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