Long-term outcome after structural failure of rotator cuff repairs

BACKGROUND: In a previous study, twenty consecutive patients with a rerupture of the rotator cuff, as documented with magnetic resonance imaging, were found to have significantly less pain and better function and strength, compared with the preoperative state, at 3.2 years postoperatively. It was the purpose of this study to determine the clinical and structural outcomes of these reruptures in the same twenty patients after a longer period of follow-up. METHODS: At a mean of 7.6 years postoperatively, the twenty patients were reexamined clinically and with standard radiographs and magnetic resonance imaging with use of the same clinical, radiographic, and magnetic resonance imaging criteria as were utilized in the review at 3.2 years. The mean age at the time of final follow-up was sixty-six years. RESULTS: Nineteen of the twenty patients continued to be either very satisfied or satisfied with the outcome. The relative Constant score averaged 88% and was not significantly different from the score at 3.2 years, which averaged 83%. The mean scores for pain, function, and strength also had not changed significantly. Overall, the twenty reruptures had not increased in size, and eight of them had healed structurally at the time of the 7.6-year follow-up. Seven of these eight reruptures had been of the supraspinatus tendon only, and seven had been smaller than 400 mm(2) at 3.2 years. Twelve reruptures persisted, and five were larger than the preoperative tear. Fatty infiltration of the infraspinatus muscle progressed significantly (p = 0.015) and the acromiohumeral distance decreased significantly (p = 0.006) between the two follow-up periods. Neither fatty infiltration of the supraspinatus and subscapularis muscles nor glenohumeral osteoarthritis progressed significantly. CONCLUSIONS: At an average of 7.6 years, the clinical outcomes after structural failure of rotator cuff repairs remained significantly improved over the preoperative state in terms of pain, function, strength, and patient satisfaction. Overall, the reruptures that had been present at 3.2 years did not increase in size. We also found that reruptures of the supraspinatus that had been smaller than 400 mm(2) had the potential to heal.

Correlation of atrophy and fatty infiltration on strength and integrity of rotator cuff repairs: a study in thirteen patients

In 13 patients, the development of supraspinatus muscle atrophy and fatty infiltration after rotator cuff tendon repair was quantified prospectively via magnetic resonance imaging. Intraoperative electrical nerve stimulation at repair showed that the maximal supraspinatus tension (up to 200 N) strongly correlated with the anatomic cross-sectional muscle area and with muscle fatty infiltration (ranging from 12 N/cm(2) in Goutallier stage 3 to 42 N/cm(2) in Goutallier stage 0). Within 1 year after successful tendon repair (n = 8), fatty infiltration did not recover, and atrophy improved partially at best; however, if the repair failed (n = 5), atrophy and fatty infiltration progressed significantly. The ability of the rotator cuff muscles to develop tension not only correlates with their atrophy but also closely correlates with their degree of fatty infiltration. With current repair techniques, atrophy and fatty infiltration appear to be irreversible, despite successful tendon repair. Unexpectedly, not only weak but also very strong muscles are at risk for repair failure.

Magnetic resonance imaging for diagnosis and assessment of cartilage defect repairs

Clinical magnetic resonance imaging (MRI) is the method of choice for the non-invasive evaluation of articular cartilage defects and the follow-up of cartilage repair procedures. The use of cartilage-sensitive sequences and a high spatial-resolution technique enables the evaluation of cartilage morphology even in the early stages of disease, as well as assessment of cartilage repair. Sequences that offer high contrast between articular cartilage and adjacent structures, such as the fat-suppressed, 3-dimensional, spoiled gradient-echo sequence and the fast spin-echo sequence, are accurate and reliable for evaluating intrachondral lesions and surface defects of articular cartilage. These sequences can also be performed together in reasonable examination times. In addition to morphology, new MRI techniques provide insight into the biochemical composition of articular cartilage and cartilage repair tissue. These techniques enable the diagnosis of early cartilage degeneration and help to monitor the effect and outcome of various surgical and non-surgical cartilage repair therapies.

Estimate of expense of repairs of Massachusetts by [John] Walton and [Josiah] Moore, 13 January 1806

Includes estimate from Walton & Moore for adding another storey to Massachusetts Hall, replacing the roof, replacing glass, and painting the interior.

Vote of thanks and $100 for repairs of Massachusetts Hall, 15 December 1812

In this letter signed by President John Kirkland, the Corporation voted to honor Loammi Baldwin for his supervision of the repairs to Massachusetts Hall. Repairs included new doors, doorframes, and windows. These updates were likely delayed repairs of damage sustained during the American Revolution when American soldiers were quartered in Massachusetts Hall.

Estimates for repairs to Wigglesworth House, undated

Includes estimates for building stairs on the outside of Wigglesworth House, making shutters, constructing a porch over the well, and making general repairs on the inside of the house.

[Repairs and occasional expenses calculations, 1801]

Slip of paper with calculations for unidentified "repairs" and "occasional expenses" between 1796 and 1801.

Repairs of Houses in Cambridge from June 1797 to 1799, [1799 June 1]

Fragment of one leaf with handwritten accounting figures for the costs of repairs on Cambridge houses to June 1, 1799. The total sum on the document is included as a note at the bottom of the Treasurer's account.

Ship maintenance: foreign commercial shipyard repairs to U.S. government ships.

Mode of access: Internet.

Practical shipbuilding; a treatise on the structural design and building of modern steel vessels; the work of construction, from the making of the raw material to the equipped vessel, including subsquent up-keep and repairs.

I. Text.--II. Diagrams and illustrations.

Organizational, direct support, and general support maintenance repairs parts and special tools list (including depot maintenance repair parts and special tools) : disperser, riot control agent, portable, M3, FSN 1040-711-8296.

"27 April 1972."