Factors correlated with the optimal tension for arthroscopic rotator cuff repair using Grasper Tensioning Attachment

Autor: Ryuta Oishi, Tomohiro Uno, Nariyuki Mura, Michiaki Takagi, Issei Yuki
Rok vydání: 2021
Předmět:
Zdroj: Journal of shoulder and elbow surgery. 31(5)
ISSN: 1532-6500
Popis: Background Little is known about the optimal tension in arthroscopic rotator cuff repair (ARCR). This study aimed to identify preoperative, intraoperative, and postoperative factors that correlate with the tension in ARCR and to determine the optimal intraoperative tension using grasper tensioning attachment (GTA), a tension meter attached to the common arthroscopic surgical grasper. Methods Sixty-three patients with a mean age of 65.3 years (range, 45–83 years) at surgery who underwent ARCR were included. The mean follow-up period was 24.1 months (range, 24–28 months). We investigated their demographic data, Japanese Orthopaedic Association score, DeOrio and Cofield classification, and Goutallier stage on the supraspinatus and infraspinatus muscles. We also evaluated the cuff integrity based on the Sugaya classification on magnetic resonance imaging. The free edge of the torn retracted tendon was grasped, and then the passive tension to the footprint was measured with GTA with the arm at the side. The anteroposterior (AP) and mediolateral (ML) diameters were also measured. Results The preoperative Goutallier stages on the supraspinatus muscle were as follows: stage 0, 7 cases; stage 1, 34; stage 2, 20; and stage 3, 2. The mean intraoperative rotator repair tension was 10.0 ± 2.5 N (range, 7.5–17 N). The mean AP diameter of the rotator cuff tear was 22 ± 10 mm (range, 8–50 mm) and the mean ML diameter was 24 ± 10 mm (range, 10–50 mm). Age, DeOrio and Cofield classification, Goutallier stage, and the AP and ML diameters correlated with the rotator repair tension. The rotator repair tension in Sugaya classification type Ⅲ or Ⅳ (n = 12, 11.4 ± 2.4 N) was significantly larger than that in type Ⅰ or Ⅱ (n = 51, 9.7 ± 2.4 N, p = 0.03). A tension ≥10 N as a cutoff value from the receiver operating characteristic curve was a risk factor of poor cuff integrity (95% confidence interval: 0.53–0.88). Conclusions Rotator repair tension ≥10 N was a risk factor of poor cuff integrity. Thus, care should be taken when performing intraoperative procedures and administering postoperative regimens.
Databáze: OpenAIRE
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