Specifically, what is “excessive” rotator cuff repair tension—particularly when it could adversely affect microvascular blood flow within the rotator cuff itself? A new study has answers.
Repair Tension vs Microvascular Blood Flow: Where’s the Line?
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#rotatorcuffrepairSecondary#microvascularbloodflow#repairtension
The study, “Excessively High Repair Tension Decreases Microvascular Blood Flow Within the Rotator Cuff,” was published online on October 20, 2022, in The American Journal of Sports Medicine.
“Repair tension and microvascular blood flow within the rotator cuff has a critical impact on tendon healing after rotator cuff repair. However, the relationship between repair tension and microvascular blood flow within the rotator cuff remains unclear,” the researchers wrote.
The research group designed a study which measured simultaneously the repair tension and microvascular blood flow within the rotator cuff for 30 patients with full-thickness rotator cuff tears. The team used two tools to objectively measure and quantify repair tension vs microvascular blood flow: a digital tension meter and a contact-type laser Doppler flowmeter for the blood flow.
The team measured each patient’s microvascular blood flow at 4 levels of tension (0, 10, 20, and 30 N) and at 5 points on the rotator cuff.
Overall, the data showed, there was no difference in microvascular blood flow (mL/min/100 g) within the rotator cuff between 0 N (mean, 3.51; 95% CI, 3.0-4.0) and 10 N (mean, 3.74; 95% CI, 3.2-4.3) of tension (p = .716).
However, there were differences in microvascular blood flow within the rotator cuff between 0 and 20 N of tension (mean, 2.84; 95% CI, 2.3-3.4) (p = .002) and between 0 and 30 N of tension (mean, 2.45; 95% CI, 1.9-3.0) (p < .001).
What is the optimal repair tension? Certainly, it would appear from the data, under 20 N or 30 N. But, of course, read the study yourself and, if you want to contact the research team, here’s who they are.
Study authors included Satoshi Miyake, M.D., Ph.D., Teruaki Izaki, M.D., Ph.D., Yasuhara Arashiro, M.D., Ph.D., Shunsuke Kobayashi, M.D., Yozo Shibata, M.D., Ph.D., Terufumi Shibata, M.D., Ph.D., and Takuaki Yamamoto, M.D., Ph.D., all of Fukuoka University Faculty of Medicine in Fukuoka, Japan. Yozo Shibata, M.D., Ph.D., Terufumi Shibata, M.D., Ph.D., of Fukuoka University Chikushi, Fukuoka, Japan.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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