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Rotator cuff repair augmented with endogenous fibrin clot.

ABSTRACT: Despite recent technical advances, rotator cuff repair continues to have a high retear rate. Recent research focused on biologic augmentation of rotator cuff repair with platelet-rich plasma has shown mixed results, and use of an endogenous fibrin clot from either peripheral blood or bone marrow may have advantages over the use of platelet-rich plasma. This technique describes a method to make an endogenous fibrin clot and arthroscopically apply the fibrin clot to the superior surface of the rotator cuff repair site.

SUBMITTER: Proctor CS

PROVIDER: S-EPMC3678671 | biostudies-literature | 2012 Sep

REPOSITORIES: biostudies-literature

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Rotator cuff repair augmented with endogenous fibrin clot.

Proctor Christopher S CS

Arthroscopy techniques 20120518 1

Despite recent technical advances, rotator cuff repair continues to have a high retear rate. Recent research focused on biologic augmentation of rotator cuff repair with platelet-rich plasma has shown mixed results, and use of an endogenous fibrin clot from either peripheral blood or bone marrow may have advantages over the use of platelet-rich plasma. This technique describes a method to make an endogenous fibrin clot and arthroscopically apply the fibrin clot to the superior surface of the rot ...[more]

PMID: 23766981

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Project description:Objective: To appraise studies reporting on clinical effectiveness and safety of surgical meshes used to augment rotator cuff repairs (RCRs).Design: Systematic review and meta-analysis.Data sources: MEDLINE, Embase and Cochrane databases were searched between April 2006 and April 2020.Eligibility criteria: All studies evaluating adults (?18 years) undergoing RCR were considered. There were no language restrictions.Data extraction and synthesis: Screening, data extraction and quality appraisal were conducted by two independent reviewers. Meta-analysis was conducted using a random-effects models if ?2 comparative studies reported the same outcome measure. Risk of bias assessment was undertaken for randomised (RoB2, Cochrane) and comparative studies (ROBINS-I, Cochrane).Results: We included 60 studies, consisting of 7 randomised controlled trials, 13 observational comparative studies and 40 observational case series. All comparative studies reported on shoulder-specific functional outcome scores, 18 on the radiographic occurrence of re-tear and 14 on pain score metrics. All studies contained some risk of bias.Compared with non-augmented repair, a small improvement in shoulder-specific function or pain scores was observed for synthetic patches with a mean improvement of 6.7 points on the University of California Los Angles (UCLA) shoulder score (95% CI 0.1 to 13.4) and 0.46 point reduction on the Visual Analogue Scale (95% CI -0.74 to -0.17), respectively. A reduced likelihood of radiologically observed re-tear was observed for synthetic (risk ratio (RR) 0.41, 95% CI 0.27 to 0.61) and allograft (RR 0.34, 95% CI 0.18 to 0.65) patches. A total of 49 studies reported on the occurrence of complications. Slightly higher crude complication rates were observed following patch-augmented repair (2.1%) than standard repair (1.6%).Conclusions: While several studies suggest a decreased failure rate and small improvements in shoulder function and pain following augmented RCR, a paucity of rigorous clinical evaluation, for both effectiveness and safety, prevents firm recommendations.Prospero registration number: CRD42017057908.

Project description:Purpose To compare patient-reported and surgical outcome measures in patients with and without secondary shoulder stiffness (SSS) undergoing rotator cuff repair (RCR). Methods Patients undergoing rotator cuff repair from 2014 to 2020 with complete patient-reported outcome measures (PROMs) by the short-form 12 survey (SF-12) were retrospectively reviewed to identify if operative intervention for SSS was performed alongside the RCR. Those patients with operative intervention for SSS were propensity matched to a group without prior intervention for stiffness by age, sex, laterality, body mass index, diabetes mellitus status, and the presence of a thyroid disorder. The groups were compared by rotator cuff tear (RCT) size, surgical outcomes, further surgical intervention, rotator cuff retear rate, postoperative range of motion (ROM), and SF-12 results at 1 year after surgery. Delta values were calculated for component scores of the SF-12 and ROM values by subtracting the preoperative result from the postoperative result. Results A total of 89 patients with SSS were compared to 156 patients in the control group at final analysis. The patients in the SSS group experienced a significant improvement in the delta mental health component score (MCS-12) of the SF-12 survey that was not seen in the control group (P = .005 to P = .539). Both groups experienced significant improvement by the delta physical health component score (PCS-12) of the SF-12 survey (SSS: 7.68; P < .001; control: 6.95; P < .001). The SSS group also experienced greater improvement of their forward flexion (25.8° vs 12.9°; P = .005) and external rotation (7.13° vs 1.65°; P = .031) ROM than the control group. Conclusions Operative intervention of SSS at the time of RCR has equivalent postoperative SF-12 survey outcome scores when compared to patients undergoing RCR without preoperative stiffness despite those patients having lower preoperative scores. Level of Evidence Level III retrospective comparative study.

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Rotator cuff repair augmented with endogenous fibrin clot.

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Rotator cuff repair augmented with endogenous fibrin clot.

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