Prognostic factors of retear after arthroscopic repair of massive rotator cuff tear

Tim-Yun Michael Ong, Shu-Hang Patrick Yung, Chun-Kwong Lo, Tsz-Cheung Wong, Kai-Ming Chan
2016 Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology  
<8mm by 0.39 (87.2% concordance). PLSR regression of the overall cohort identified median ST XSA and height as key predictors of graft diameter. The 95% prediction error for the overall model for a single future patient was 0.9mm. That is, predicted graft diameters of 8.92mm or above would have a 2.5% chance of being <8mm in theatre. Discussion: The ability to predict graft diameter prior to surgery may improve surgical efficiency for ligament reconstruction, particularly if a minimum graft
more » ... a minimum graft diameter threshold is to be achieved. Previous studies have correlated patient anthropometry and MRI XSA to intra-operative graft diameter, however this study is the first to present a validated predictive model. The results identify females receiving 4-STGT constructs at-risk of producing grafts <8mm, and this can be screened with MRI-based measurements of tendon geometry. More accurate predictive models that are easy to use provide surgeons with a useful clinical tool for surgical planning. With a future prospective study incorporating a range of intraoperative variables, this model can be further refined to increase its clinical applicability. Conclusion: Patient height, gender and MRI cross-sectional measurements are significant predictors of graft diameter. Whilst the actual graft diameter required for each patient is a decision for the treating surgeon, this study confirms previous correlations, and proposes a novel method of stratifying and accurately predicting the likely graft diameter for each patient. http://dx. Background: Arthroscopic reconstruction of the coraco-clavicular ligament has been described in some studies. Few published reports have considered the importance of anatomic reconstruction. The present study reports the importance of anatomic reconstruction and evaluates the position of the reconstructed ligaments and the clinical and radiographic results of arthroscopic reconstruction of coraco-clavicular ligament. Material and Methods: Arthroscopic reconstruction of the coraco-clavicular ligament using a Fiber tape and Dog Bone Button (Arthrex) was performed in 8 shoulders between June 2014 and November 2015. The mean age was 39.9 years (range, 28 to 55 years). The mean followup period was 9.1 months (range, 4 to 20 months). The injuries were as follows: Rockwood type 3 (n¼6), Rockwood type 4 (n¼1), and Rockwood type 5 (n¼1). We evaluated the position of the bone tunnel on CT images, and the extent of the tunnel widening and loss of reduction using radiography. The subjective patient outcomes were evaluated. Results: The distance from the lateral side of the clavicle to the clavicular tunnel was 28.8 ± 5.2 mm. If we divided the sagittal view of clavicle into three columns (anterior, middle, posterior), 1 shoulder was anterior, 4 shoulders were middle, and 3 shoulders were posterior. The distance from the anterior aspect of the coracoid to the coracoid tunnel was 29.2 ± 5.3 mm. Intraoperative reduction was lost in 6 patients (75%). The clavicular tunnel width was 5.5 ± 1.0 mm. The coracoid tunnel width was 5.1 ± 0.9 mm. One patient reported experiencing slight pain. The subjective patient outcomes were excellent in 6 cases and good in 2 case. Discussion: Although our clinical results were mostly satisfactory, we experienced tunnel widening and a loss of reduction. We hypothesize that the reason for this is that the position of the bone tunnel in these studies tended to differ from the anatomic attachment of the coraco-clavicular ligament; thus, we could not reconstruct the coraco-clavicular ligament in the anatomic position. Conclusion: Arthroscopic reconstruction of the coraco-clavicular ligament is recommended in patients with acromio-clavicular joint dislocation. However, in order to decrease the enlargement of the bone tunnel and the loss of reduction, it was suggested that we should reconstruct the bone tunnel in the anatomic position. http://dx.
doi:10.1016/j.asmart.2016.07.168 fatcat:2wdeusuqwzdcbd73jctkbadz5m