Significant Improvement in Pain and ASES Scores After Partial - - PowerPoint PPT Presentation

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Significant Improvement in Pain and ASES Scores After Partial Thickness Rotator Cuff Repair with Augmentation Using a Xenograft Collagen Bioinductive Implant

Paul Rodenhouse, DO Shariff K. Bishai DO, MS, FAOAO Henry Ford Macomb Hospital Clinton Township, MI

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Disclosure Statement

PER: None SKB

– Zimmer/Biomet – DePuy – Rotation Medical – Arthrex – Ceterix

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Introduction

Partial thickness rotator cuff tears are common pathology that significantly affect a large spectrum of patients from sedentary individuals to athletes1 Despite their high prevalence, the diagnosis and treatment remain controversial due to literature focus on full-thickness tears2

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Introduction

Sher et al reported 20% prevalence of partial-thickness tears on MRI in 96 asymptomatic shoulders2 Based on cadaveric and imaging studies partial thickness tears range from 13 to 32% with a strong correlation to age1 Milgrom et al demonstrated linear increase in prevalence after 5th decade of life3

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Introduction

Conner et al. performed shoulder MRIs of asymptomatic elite overhead athletes showing 40% had partial or full-thickness tears1 This demonstrates no age group or population is immune

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Etiology

Intrinsic factors: hypocellularity, fascicular thinning, granulation tissue, and decreased vascularity of tissue predispose tendon to degenerative tearing 1 Extrinsic factors: subacromial impingement, glenohumeral instability, internal impingement 1 Traumatic events: singular or repetitive 1 These lead to tensile overload a tendon fiber failure

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Etiology

Increases in tendon strain due to presence of a tear lead to propagation and increases in tear size over time2-4 Often progress to full-thickness tears 4 One study of 40 patients with partial thickness cuff tears followed for a mean of 13.5 months showed 80% of lesions to have enlarged or progressed to full-thickness lesions4

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Treatments

Many treatments for partial thickness tears including:

– Arthroscopic debridement – Conversion to full thickness and repair – In-situ transtendon repairs.

All have shown some benefit in certain patients in a multitude of studies, however no technique has set itself apart from the rest

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Treatments

A novel technique, Arthroscopic augmentation with a xenograft collagen implant

Picture Courtesy of Rotation Medical

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Research

A finite-element study demonstrated by increasing thickness of the bursal side of supraspinatus by 2mm can decrease intra-tendinous strain by 47% in bursal sided tears and 40% on articular sided tears4

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Research

The implant decreases local tendon strain and provides a scaffold for new tendon tissue to grow Boker et al showed a mean increase in tendon thickness of 2.2mm at 3 months post-op which persisted for 24 months and was indistinguishable from normal cuff tissue by MRI4

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Research

 Arnoczky et al, Arthroscopy 2016

– Biopsy of collagen implants retrieved from 7 patients on second look arthroscopies

Cellular incorporation Tissue formation and maturation Implant resorption Biocompatibility to that of normal rotator cuff.

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Study

75 patients October 2014- March 2017 Single Surgeon All patients had rotator cuff tears measuring 50% or less on MRI and confirmed intra-

• peratively by surgeon

All failed conservative treatment: corticosteroid injections, oral anti-inflammatories, activity modifications, and physical therapy

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Study

Exclusion criteria included revision procedures as well as the use of suture anchors in fixation VAS and ASES were patient reported in

• ffice

VAS Results

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Pre-op Day 1 2 Weeks 6 weeks 3 months 6 months 6.03 4.61 2.94 3.05 2.70 2.08

1.75 3.5 5.25 7

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ASES Results

Pre-op 6 weeks 3 months 6 months 35.49 46.18 61.74 69.49

17.5 35 52.5 70 87.5

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Surgeons Post-op Protocols

Traditional Anchor Repair

• 6 weeks in Sling
• PT @ 4 Weeks
• PROM 4-6 Weeks
• AAROM 4-8 Weeks
• AROM 8 Weeks

Repair with Augmentation

• Start PT ASAP
• Out of sling ASAP

Conclusion

 These studies show that the xenograft collagen implant is a viable treatment option for patients with partial thickness rotator cuff tears and provides pain relief and functional improvement

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References

• 1. Matthewson, Graeme. "Advances in Orthopedics." Partial Thickness Rotator Cuff

Tears: Current Concepts 2015 (2015): n. pag. Web.

• 2. R.P. Finnan and L.A. Crosby, “Partial thickness rotator cuff tears, “ Journal of

Shoulder and Elbow Surgery, vol. 19, no.4, pp. 609-616, 2010.

• 3. C. Milgrom, M. Schaffler, S. Gilbert, and M. Van Holsbeeck “Rotator-cuff changes

in asymptomatic adults. The effect of age, hand dominance, and gender,” The Journal of Bone and Joint Surgery- British Volume, vol. 77, no. 2, pp.296-298, 1995.

• 4. D. Boker, D. Sonnabend, L. Deady, B. Cass, A. Young, C. Van Kampen, S.

Arnoczky “Evidence of healing of partial thickness rotator cuff tears following arthroscopic augmentation with a collagen implant: 2-year MRI follow-up,” Muscles, Ligaments, and Tendons Journal, 2016;6 (1): 16-25

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Thank You