Background Platelet-rich plasma (PRP) has the potential to improve tendon-bone healing. The evidence is still controversial as to whether PRP application after repair of medium-sized to large cuff ...tears leads to superior structural and clinical outcome, especially after single-row repair. Methods In a randomized study, 102 patients (PRP group, 52 patients; control group, 50 patients) with medium-sized and large degenerative posterosuperior tears were included for arthroscopic repair with a minimum follow-up of 2 years. Patients were evaluated with clinical scores (visual analog scale score, Constant-Murley score, University of California–Los Angeles score, and American Shoulder and Elbow Surgeons score) and ultrasound to assess retear and vascularity pattern of the cuff. Results Visual analog scale scores were significantly lower in the PRP group than in controls at 1 month, 3 months, and 6 months but not later. Constant-Murley scores were significantly better in the PRP group compared with controls at 12 and 24 months, whereas University of California–Los Angeles scores were significantly higher in the PRP group at 6 and 12 months ( P < .05). The American Shoulder and Elbow Surgeons score in both groups was comparable at all the times. At 24 months, retear in the PRP group (n = 2; 3.8%) was significantly lower than in the control group (n = 10; 20%; P = .01). The retear difference was significant only for large tears (PRP:control group, 1:6; P = .03). Doppler ultrasound examination showed significant vascularity in the PRP group repair site at 3 months postoperatively ( P < .05) and in peribursal tissue until 12 months. Conclusion Application of moderately concentrated PRP improves clinical and structural outcome in large cuff tears. PRP also enhances vascularity around the repair site in the early phase.
Background Current evidence suggests that distinct scapular morphologies may predispose patients to a rotator cuff tear. The objective of this longitudinal study was to evaluate the relationship ...between symptomatic degenerative cuff tears and different radiographic acromial characteristics, including acromion shape, indices (acromial index AI, critical shoulder angle CSA), and acromial spur. Methods We divided 166 patients into 3 groups matched for age and sex: group 1, degenerative full-thickness tear; group 2, partial thickness bursal tear; and group 3, normal cuff. Patients were evaluated with standard radiographs and ultrasonography. Results The presence of an acromial spur was strongly associated with a full-thickness cuff tear (odds ratio, 3.5; P = .001). AI and CSA revealed a statistically significant difference between means of group 1 ( P = .006) and group 3 ( P < .001). There was no statistically significant difference in means of AI between groups 1 and 2 ( P = .695) and between groups 2 and 3, with respect to AI ( P = .071) and CSA ( P = .125). Receiver operating characteristic curve revealed a higher area for CSA (0.70) than for AI (0.61). Stepwise logistic regression rejected AI as a cuff tear predictor but confirmed CSA and a spur to be stronger predictors of a full-thickness cuff tear. There was no association between the Bigliani acromial type and rotator cuff tear ( P = .06). Conclusions The presence of an acromion spur is strongly associated with full-thickness cuff tear. Higher AI and CSA are associated with a full-thickness tear but not with partial tears. The type of acromion is not related to cuff tear.
As per some cadaveric studies, blood flow in posterosuperior rotator cuff tendons improves in the abducted shoulder position compared with the neutral position. In a clinical post–rotator cuff repair ...scenario, the impact of abduction on altered blood flow in and around the posterosuperior rotator cuff tendons is unknown in terms of clinical outcomes and structural healing.
This study included 42 eligible patients aged between 40 and 70 years with clinically diagnosed and radiologically confirmed rotator cuff tears undergoing arthroscopic rotator cuff repair. Patients were randomly allocated to undergo application of either an abduction brace (group 1) or an arm pouch (group 2). On postoperative day 1, power Doppler scanning was performed on the index shoulder in adduction and 30° of abduction in each patient; the allocated treatment (abduction brace or arm pouch) was then applied. Power Doppler scanning was repeated at 6 weeks in the immobilization position assigned to the patient (abduction or adduction). The vascular flow in 6 regions was noted as per the criteria of Fealy et al. A visual analog scale score was assessed preoperatively and at 1, 3, 6, 12, and 56 weeks postoperatively. Clinical assessment was performed with the Constant-Murley score at 1 year, and structural healing of the cuff was assessed using ultrasonography at 3 and 12 months.
On the first postoperative day, blood flow was significantly higher in all 6 areas of the shoulder in group 1 than in group 2. The mean total vascular score was significantly higher in group 1 than in group 2 on postoperative day 1 (P = .0001) and remained so at 6 weeks (P = .0001). However, significantly higher vascular flow was noted only in the peribursal region at 6 weeks in group 1 (P = .04). No significant difference in the visual analog scale score was noted between the 2 groups at any given point of follow-up. Furthermore, no clinical and structural healing differences were noted between the 2 groups at final follow-up.
Higher blood flow in and around the posterosuperior rotator cuff owing to an abducted shoulder position with an abduction brace in the first 6 weeks postoperatively fails to offer any advantage in terms of lower pain levels, better clinical scores, or superior cuff healing.
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