J Korean Orthop Assoc.  2018 Jun;53(3):218-225. 10.4055/jkoa.2018.53.3.218.

Pain and Power Doppler Ultrasonographic Evaluation according to Bursal Preservation after Arthroscopic Rotator Cuff Repair: Comparison between Complete and Minimal Bursectomy in Early 3 Months

• Choi CH
• Kwack BH
• Lee SH

• KMID: 2429169
• DOI: http://doi.org/10.4055/jkoa.2018.53.3.218

Abstract

PURPOSE
The purpose of this study was to compare the clinical and power Doppler ultrasonographic results of arthroscopic rotator cuff repair (ARCR) between using a complete and a minimal bursectomy. Moreover, we aimed to evaluate the pain-relief and neoangiogenesis according to bursal preservation.
MATERIALS AND METHODS
Between December 2015 and August 2016, we performed a retrospective review of 78 consecutive patients who underwent ARCR due to full thickness rotator cuff tear (small-large sized tear). Thirty-six patients received ARCR using minimal bursectomy (Group A), while 42 patients received ARCR via complete bursectomy (Group B). The mean age was 57.8 years and the average symptom duration period was 20.3 months. Clinical result was assessed using a visual analogue scale (VAS) pain score due to evaluate the pain-relief and power Doppler ultrasonographic result was classified according to the modified Newman classification due to evaluate the neoangiogenesis.
RESULTS
There was no statistically significant difference in operation time, pain-relief, and neoangiogenesis in accordance with bursal preservation between the two groups. Compared to the preoperative values, pain was significantly increased two weeks postoperatively in both groups (Group A: −1.8±1.4, p=0.000; Group B: −1.4±1.7, p=0.000). Compared to the preoperative values using the power Doppler ultrasound, neoangiogenesis was significantly improved at the postoperative 6 weeks (Group A: 0.7±0.9, p=0.000; Group B: 0.9±1.1, p=0.000) and 3 months (Group A: 0.9±1.0, p=0.000; Group B: 1.0±1.1, p=0.000) in both groups.
CONCLUSION
Serial follow-up by power Doppler ultrasound before and after ARCR showed a neoangiogenesis of up to 3 months in both groups, but there was no difference in pain-relief and neoangiogenesis between the two groups.

Keyword

shoulder; rotator cuff; bursal preserving procedure; Doppler ultrasound; neoangiogenesis

MeSH Terms

Classification
Follow-Up Studies
Humans
Retrospective Studies
Rotator Cuff*
Shoulder
Tears
Ultrasonography

Figure

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  Figure 1 Representative arthroscopic images of the rotator cuff repair using a minimal bursectomy on the right shoulder (A–C) and a complete bursectomy on the left shoulder (D–F).

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  Figure 2 Power Doppler ultrasound image of the repaired rotator cuff at the peritendinous region. The vascularity was classified according to the modified Newman classification. (A) Power Doppler signal (PDS) grade 1 (arrow). (B) PDS grade 2 (arrow). (C) PDS grade 3 (arrow).

Reference

1. Hawkins RJ. The rotator cuff and biceps tendon. In : McCollister EC, editor. Surgery of the musculoskeletal system. New York: Churchill Livingstone;1990. p. 1393–1425.

2. Kim SK, Kim HN, Moon ES, Lim KY, Cho NY, Kim MS. Inflammatory cytokine expressions of the subacromial bursitis and glenohumeral joint synovitis in the patients with full thickness rotator cuff tear. Clin Should Elbow. 2011; 14:172–178.

3. Uhthoff HK, Sarkar K. Surgical repair of rotator cuff ruptures. The importance of the subacromial bursa. J Bone Joint Surg Br. 1991; 73:399–401.

4. Gelberman RH, Manske PR, Vande Berg JS, Lesker PA, Akeson WH. Flexor tendon repair in vitro: a comparative histologic study of the rabbit, chicken, dog, and monkey. J Orthop Res. 1984; 2:39–48.

5. Chillemi C, Petrozza V, Garro L, et al. Rotator cuff re-tear or non-healing: histopathological aspects and predictive factors. Knee Surg Sports Traumatol Arthrosc. 2011; 19:1588–1596.

6. Grassi W. Clinical evaluation versus ultrasonography: who is the winner? J Rheumatol. 2003; 30:908–909.

7. Stegbauer J, Rump LC, Weiner SM. Sites of inflammation in painful rheumatoid shoulder assessed by musculoskeletal ultrasound and power Doppler sonography. Rheumatol Int. 2008; 28:459–465.

8. Park TS, Yoon JP, Kim HS, Jeong WJ. Diagnostic correlation between ultrasonography and CT arthrography in rotator cuff disease. J Korean Orthop US Soc. 2013; 6:53–59.

9. Newman JS, Laing TJ, McCarthy CJ, Adler RS. Power Doppler sonography of synovitis: assessment of therapeutic response: preliminary observations. Radiology. 1996; 198:582–584.

10. Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL, Ilstrup DM, Rowland CM. Surgical repair of chronic rotator cuff tears. A prospective long-term study. J Bone Joint Surg Am. 2001; 83-A:71–77.

11. Park CM, Kim JH, Kim SJ, Choi CH. Effectiveness of multimodal pain control in early phase after arthroscopic rotator cuff repair. Clin Should Elbow. 2012; 15:1–7.

12. Ide K, Shirai Y, Ito H, Ito H. Sensory nerve supply in the human subacromial bursa. J Shoulder Elbow Surg. 1996; 5:371–382.

13. Sim SW, Moon YL, Kang JH. Differential potential of stem cells following their origin: subacromial bursa, bone marrow, umbilical cord blood. Clin Should Elbow. 2012; 15:65–72.

14. Blaine TA, Kim YS, Voloshin I, et al. The molecular pathophysiology of subacromial bursitis in rotator cuff disease. J Shoulder Elbow Surg. 2005; 14:84S–89S.

15. Boss AP, Maurer T, Seiler S, Aeschbach A, Hintermann B, Strebel S. Continuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: preliminary results. J Shoulder Elbow Surg. 2004; 13:630–634.

16. Martinoli C, Pretolesi F, Crespi G, et al. Power Doppler sonography: clinical applications. Eur J Radiol. 1998; 27:Suppl 2. S133–S140.

17. Kitchen J, Kane D. Greyscale and power Doppler ultrasonographic evaluation of normal synovial joints: correlation with pro- and anti-inflammatory cytokines and angiogenic factors. Rheumatology (Oxford). 2015; 54:458–462.

18. Fealy S, Adler RS, Drakos MC, et al. Patterns of vascular and anatomical response after rotator cuff repair. Am J Sports Med. 2006; 34:120–127.

19. Urita A, Funakoshi T, Horie T, Nishida M, Iwasaki N. Difference in vascular patterns between transosseous-equivalent and transosseous rotator cuff repair. J Shoulder Elbow Surg. 2017; 26:149–156.