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No healing improvement after rotator cuff reconstruction augmented with an autologous periosteal flap

  • C. HolweinEmail author
  • B. von Bibra
  • P. M. Jungmann
  • D. C. Karampinos
  • K. Wörtler
  • M. Scheibel
  • A. B. Imhoff
  • S. Buchmann
SHOULDER
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Abstract

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.

Keywords

Rotator cuff repair Rotator cuff healing Periosteal flap Tendon augmentation 

Notes

Funding

No one of the authors has received personal financial support related to this study.

Compliance with ethical standards

Conflict of interest

Authors C. Holwein, B. von Bibra, P. M. Jungmann, D. C. Karampinos, K. Wörtler, M. Scheibel declare that they have no conflict of interest. Author A. B. Imhoff is a consultant for Arthrosurface, Arthrex, and mediBayreuth. Author S. Buchmann is a consultant for Arthrex.

Ethical approval

The study was granted approval by Ethics Commission School of Medicine Technical University of Munich with the related number 70/15s.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • C. Holwein
    • 1
    Email author
  • B. von Bibra
    • 1
  • P. M. Jungmann
    • 2
  • D. C. Karampinos
    • 3
  • K. Wörtler
    • 3
  • M. Scheibel
    • 4
  • A. B. Imhoff
    • 1
  • S. Buchmann
    • 5
  1. 1.Abteilung und Poliklinik für Sportorthopädie Klinikum rechts der Isar Technische Universität MünchenMunichGermany
  2. 2.Klinik für Neuroradiologie Universitätsspital ZürichZurichSwitzerland
  3. 3.Institut für diagnostische und interventionelle Radiologie Klinikum rechts der Isar Technische Universität MünchenMunichGermany
  4. 4.Centrum für Muskuloskeletale Chirurgie der Charité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany
  5. 5.OFZ Orthopädisches Fachzentrum WeilheimWeilheim in OberbayernGermany

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