Comparison of Passive Stiffness Changes in the Supraspinatus Muscle After Double-Row and Knotless Transosseous-Equivalent Rotator Cuff Repair Techniques

A Cadaveric Study

Taku Hatta, Hugo Giambini, Alexander W. Hooke, Chunfeng D Zhao, John W. Sperling, Scott P. Steinmann, Nobuyuki Yamamoto, Eiji Itoi, Kai Nan An

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: To investigate the alteration of passive stiffness in the supraspinatus muscle after double-row (DR) and knotless transosseous-equivalent (KL-TOE) repair techniques, using shear wave elastography (SWE) in cadavers with rotator cuff tears. We also aimed to compare altered muscular stiffness after these repairs to that obtained from shoulders with intact rotator cuff tendon. Methods: Twelve fresh-frozen cadaveric shoulders with rotator cuff tear (tear size: small [6], medium-large [6]) were used. Passive stiffness of 4 anatomic regions in the supraspinatus muscle was measured based on an established SWE method. Each specimen underwent DR and KL-TOE footprint repairs at 30° glenohumeral abduction. SWE values, obtained at 0°, 10°, 20°, 30°, 60°, and 90° abduction, were assessed in 3 different conditions: preoperative (torn) and postoperative conditions with the 2 techniques. The increased ratio of SWE values after repair was compared among the 4 regions to assess stiffness distribution. In addition, SWE values were obtained on 12 shoulders with intact rotator cuff tendons as control. Results: In shoulders with medium-large-sized tears, supraspinatus muscles showed an increased passive stiffness after rotator cuff repairs, and this was significantly observed at adducted positions. KL-TOE repair showed uniform stiffness changes among the 4 regions of the supraspinatus muscle (mean, 189% to 218% increase after repair), whereas DR repair caused a significantly heterogeneous stiffness distribution within the muscle (mean, 187% to 319% after repair, P = .002). Although a repair-induced increase in muscle stiffness was observed also in small-sized tears, there were no significant differences in repaired stiffness changes between DR and KL-TOE (mean, 127% to 138% and 127% to 130% after repairs, respectively). Shoulders with intact rotator cuff tendon showed uniform SWE values among the 4 regions of the supraspinatus muscle (mean, 38.2 to 43.0 kPa). Conclusions: Passive stiffness of the supraspinatus muscle increases after rotator cuff repairs for medium-large-sized tears. KL-TOE technique for the medium-large-sized tear provided a more uniform stiffness distribution across the repaired supraspinatus muscles compared with the DR technique. Clinical Relevance: Based on this insight, investigating rotator cuff muscle stiffness changes, further studies using SWE may determine the optimal repair technique for various sizes of rotator cuff tears.

Original languageEnglish (US)
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
DOIs
StateAccepted/In press - Oct 29 2015

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Rotator Cuff
Elasticity Imaging Techniques
Muscles
Tears
Tendons
Bursitis
Cadaver

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Comparison of Passive Stiffness Changes in the Supraspinatus Muscle After Double-Row and Knotless Transosseous-Equivalent Rotator Cuff Repair Techniques : A Cadaveric Study. / Hatta, Taku; Giambini, Hugo; Hooke, Alexander W.; Zhao, Chunfeng D; Sperling, John W.; Steinmann, Scott P.; Yamamoto, Nobuyuki; Itoi, Eiji; An, Kai Nan.

In: Arthroscopy - Journal of Arthroscopic and Related Surgery, 29.10.2015.

Research output: Contribution to journalArticle

@article{8e8508edcecc4409a8e930f0b256c002,
title = "Comparison of Passive Stiffness Changes in the Supraspinatus Muscle After Double-Row and Knotless Transosseous-Equivalent Rotator Cuff Repair Techniques: A Cadaveric Study",
abstract = "Purpose: To investigate the alteration of passive stiffness in the supraspinatus muscle after double-row (DR) and knotless transosseous-equivalent (KL-TOE) repair techniques, using shear wave elastography (SWE) in cadavers with rotator cuff tears. We also aimed to compare altered muscular stiffness after these repairs to that obtained from shoulders with intact rotator cuff tendon. Methods: Twelve fresh-frozen cadaveric shoulders with rotator cuff tear (tear size: small [6], medium-large [6]) were used. Passive stiffness of 4 anatomic regions in the supraspinatus muscle was measured based on an established SWE method. Each specimen underwent DR and KL-TOE footprint repairs at 30° glenohumeral abduction. SWE values, obtained at 0°, 10°, 20°, 30°, 60°, and 90° abduction, were assessed in 3 different conditions: preoperative (torn) and postoperative conditions with the 2 techniques. The increased ratio of SWE values after repair was compared among the 4 regions to assess stiffness distribution. In addition, SWE values were obtained on 12 shoulders with intact rotator cuff tendons as control. Results: In shoulders with medium-large-sized tears, supraspinatus muscles showed an increased passive stiffness after rotator cuff repairs, and this was significantly observed at adducted positions. KL-TOE repair showed uniform stiffness changes among the 4 regions of the supraspinatus muscle (mean, 189{\%} to 218{\%} increase after repair), whereas DR repair caused a significantly heterogeneous stiffness distribution within the muscle (mean, 187{\%} to 319{\%} after repair, P = .002). Although a repair-induced increase in muscle stiffness was observed also in small-sized tears, there were no significant differences in repaired stiffness changes between DR and KL-TOE (mean, 127{\%} to 138{\%} and 127{\%} to 130{\%} after repairs, respectively). Shoulders with intact rotator cuff tendon showed uniform SWE values among the 4 regions of the supraspinatus muscle (mean, 38.2 to 43.0 kPa). Conclusions: Passive stiffness of the supraspinatus muscle increases after rotator cuff repairs for medium-large-sized tears. KL-TOE technique for the medium-large-sized tear provided a more uniform stiffness distribution across the repaired supraspinatus muscles compared with the DR technique. Clinical Relevance: Based on this insight, investigating rotator cuff muscle stiffness changes, further studies using SWE may determine the optimal repair technique for various sizes of rotator cuff tears.",
author = "Taku Hatta and Hugo Giambini and Hooke, {Alexander W.} and Zhao, {Chunfeng D} and Sperling, {John W.} and Steinmann, {Scott P.} and Nobuyuki Yamamoto and Eiji Itoi and An, {Kai Nan}",
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language = "English (US)",
journal = "Arthroscopy - Journal of Arthroscopic and Related Surgery",
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T1 - Comparison of Passive Stiffness Changes in the Supraspinatus Muscle After Double-Row and Knotless Transosseous-Equivalent Rotator Cuff Repair Techniques

T2 - A Cadaveric Study

AU - Hatta, Taku

AU - Giambini, Hugo

AU - Hooke, Alexander W.

AU - Zhao, Chunfeng D

AU - Sperling, John W.

AU - Steinmann, Scott P.

AU - Yamamoto, Nobuyuki

AU - Itoi, Eiji

AU - An, Kai Nan

PY - 2015/10/29

Y1 - 2015/10/29

N2 - Purpose: To investigate the alteration of passive stiffness in the supraspinatus muscle after double-row (DR) and knotless transosseous-equivalent (KL-TOE) repair techniques, using shear wave elastography (SWE) in cadavers with rotator cuff tears. We also aimed to compare altered muscular stiffness after these repairs to that obtained from shoulders with intact rotator cuff tendon. Methods: Twelve fresh-frozen cadaveric shoulders with rotator cuff tear (tear size: small [6], medium-large [6]) were used. Passive stiffness of 4 anatomic regions in the supraspinatus muscle was measured based on an established SWE method. Each specimen underwent DR and KL-TOE footprint repairs at 30° glenohumeral abduction. SWE values, obtained at 0°, 10°, 20°, 30°, 60°, and 90° abduction, were assessed in 3 different conditions: preoperative (torn) and postoperative conditions with the 2 techniques. The increased ratio of SWE values after repair was compared among the 4 regions to assess stiffness distribution. In addition, SWE values were obtained on 12 shoulders with intact rotator cuff tendons as control. Results: In shoulders with medium-large-sized tears, supraspinatus muscles showed an increased passive stiffness after rotator cuff repairs, and this was significantly observed at adducted positions. KL-TOE repair showed uniform stiffness changes among the 4 regions of the supraspinatus muscle (mean, 189% to 218% increase after repair), whereas DR repair caused a significantly heterogeneous stiffness distribution within the muscle (mean, 187% to 319% after repair, P = .002). Although a repair-induced increase in muscle stiffness was observed also in small-sized tears, there were no significant differences in repaired stiffness changes between DR and KL-TOE (mean, 127% to 138% and 127% to 130% after repairs, respectively). Shoulders with intact rotator cuff tendon showed uniform SWE values among the 4 regions of the supraspinatus muscle (mean, 38.2 to 43.0 kPa). Conclusions: Passive stiffness of the supraspinatus muscle increases after rotator cuff repairs for medium-large-sized tears. KL-TOE technique for the medium-large-sized tear provided a more uniform stiffness distribution across the repaired supraspinatus muscles compared with the DR technique. Clinical Relevance: Based on this insight, investigating rotator cuff muscle stiffness changes, further studies using SWE may determine the optimal repair technique for various sizes of rotator cuff tears.

AB - Purpose: To investigate the alteration of passive stiffness in the supraspinatus muscle after double-row (DR) and knotless transosseous-equivalent (KL-TOE) repair techniques, using shear wave elastography (SWE) in cadavers with rotator cuff tears. We also aimed to compare altered muscular stiffness after these repairs to that obtained from shoulders with intact rotator cuff tendon. Methods: Twelve fresh-frozen cadaveric shoulders with rotator cuff tear (tear size: small [6], medium-large [6]) were used. Passive stiffness of 4 anatomic regions in the supraspinatus muscle was measured based on an established SWE method. Each specimen underwent DR and KL-TOE footprint repairs at 30° glenohumeral abduction. SWE values, obtained at 0°, 10°, 20°, 30°, 60°, and 90° abduction, were assessed in 3 different conditions: preoperative (torn) and postoperative conditions with the 2 techniques. The increased ratio of SWE values after repair was compared among the 4 regions to assess stiffness distribution. In addition, SWE values were obtained on 12 shoulders with intact rotator cuff tendons as control. Results: In shoulders with medium-large-sized tears, supraspinatus muscles showed an increased passive stiffness after rotator cuff repairs, and this was significantly observed at adducted positions. KL-TOE repair showed uniform stiffness changes among the 4 regions of the supraspinatus muscle (mean, 189% to 218% increase after repair), whereas DR repair caused a significantly heterogeneous stiffness distribution within the muscle (mean, 187% to 319% after repair, P = .002). Although a repair-induced increase in muscle stiffness was observed also in small-sized tears, there were no significant differences in repaired stiffness changes between DR and KL-TOE (mean, 127% to 138% and 127% to 130% after repairs, respectively). Shoulders with intact rotator cuff tendon showed uniform SWE values among the 4 regions of the supraspinatus muscle (mean, 38.2 to 43.0 kPa). Conclusions: Passive stiffness of the supraspinatus muscle increases after rotator cuff repairs for medium-large-sized tears. KL-TOE technique for the medium-large-sized tear provided a more uniform stiffness distribution across the repaired supraspinatus muscles compared with the DR technique. Clinical Relevance: Based on this insight, investigating rotator cuff muscle stiffness changes, further studies using SWE may determine the optimal repair technique for various sizes of rotator cuff tears.

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DO - 10.1016/j.arthro.2016.02.024

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