High-Grade Bursal Side Rotator-Cuff Repair. A Surgical Outcome Review
High-Grade Bursal Side Rotator-Cuff Repair: A Comprehensive Review
High-Grade Bursal Side Rotator-Cuff Repair is a surgical procedure that addresses rotator cuff tears, a common cause of shoulder pain and disability. This paper provides a comprehensive review of the procedure, its outcomes, and related studies.
Rotator Cuff Tears: An Overview
Rotator cuff tears are a prevalent issue, particularly among the elderly population. They can lead to severe pain and restricted activity, significantly impacting the quality of life. The tears can be classified into partial-thickness tears (PTT) and full-thickness tears (FTT), with the former further divided into articular-sided tears (AST) and bursal-sided tears (BST).
Surgical Techniques and Outcomes
Surgical repair of rotator cuff tears has evolved from open to arthroscopic procedures, with the latter witnessing a dramatic increase in popularity due to its minimally invasive nature. The ideal repair should withstand physiological loads while allowing simultaneous healing. Arthroscopic repairs have shown predictable success, pain relief, and patient satisfaction.
Randomized Controlled Studies and Meta-Analyses
A study by Franceschi et al compared two arthroscopic modalities for AST repair. The study found significant improvements in clinical and functional outcomes and healing for both methods, indicating that they were safe, comparable, and effective.
Another study by Koh et al evaluated full-layer repair for more than 50% PTT with preservation of articular fibers. The study found that 87.9% of patients had intact repaired tendons with significant improvements in patient scores.
A meta-analysis by Lindley et al found no significant differences in patient demographics, rotator cuff pathology, rehabilitation protocols, and recurrent defects between mini-open repair and all-arthroscopic repair techniques.
Physical rehabilitation is a vital component of postoperative patient care. Gradual rehabilitation has been advocated in four phases, beginning with 4 to 6 weeks of immobilization, followed by protected passive range of motion (ROM), then a gradual progression to active ROM, and finally, an appropriate resistance exercise program.
Healing is a crucial aspect of the postoperative phase. Factors contributing to optimal repair include intact tendon-footprint motion and contact area, tendon and bone quality. However, the evidence of spontaneous rotator cuff healing, without surgical repair, has been shown to be inadequate, inferior, and limited in animal models.
With the increasing likelihood of rotator cuff tears with advancing age, it becomes essential to promptly recognize cuff tears and timely intervene by providing the most appropriate treatment. Arthroscopic repair, with its inherent advantages and promising outcomes, seems a propitious approach. The addition of a rehabilitation plan provides the requisite nourishment and environment essential for the repaired and recovering tendons. Future directions point towards the application of principles of tissue engineering to achieve enhanced repairs and functional outcomes.