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Cannada LK, Rao A, Saltzman BM. Clinical Faceoff: Management of Massive Rotator Cuff Tears in Patients Younger than 65 Years of Age. Clin Orthop Relat Res 2022; 480:672-676. [PMID: 35254327 PMCID: PMC8923571 DOI: 10.1097/corr.0000000000002154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Lisa K. Cannada
- Orthopaedic Trauma Surgeon, Novant Health Orthopedics, Charlotte, NC, USA
| | - Allison Rao
- Orthopaedic Surgeon, The Christ Hospital, Cincinnati, OH, USA
| | - Bryan M. Saltzman
- Assistant Professor, Atrium Health Musculoskeletal Institute (MSKI) Sports Medicine, Rock Hill, SC, USA
- Orthopaedic surgeon, The Sports Medicine Center, Charlotte, NC, USA
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52
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Thangarajah T, Lo IK. Optimal Management of Partial Thickness Rotator Cuff Tears: Clinical Considerations and Practical Management. Orthop Res Rev 2022; 14:59-70. [PMID: 35250316 PMCID: PMC8893150 DOI: 10.2147/orr.s348726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/17/2022] [Indexed: 11/25/2022] Open
Abstract
Partial thickness rotator cuff tears have been diagnosed with increased frequency due to heightened awareness and an improvement in diagnostic modalities. When >50% of the tendon thickness has ruptured, intra-tendinous strain of the residual tendon increases. Surgery is generally confined to patients who have failed non-operative measures and have persistent symptoms. The rationale for repairing partial thickness tears lies in their limited self-healing capacity, and propensity to enlarge over time and progress to a full thickness defect. Although tear debridement and acromioplasty can improve pain and function, tear progression can occur, in addition to worse results being noted in bursal-sided defects. Several surgical strategies have been recommended but there is a lack of evidence to advocate one form of treatment over another. The aim of this narrative review is to discuss the treatment options for partial thickness tears of the rotator cuff.
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Affiliation(s)
- Tanujan Thangarajah
- Department of Trauma and Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
- Correspondence: Tanujan Thangarajah, Department of Trauma and Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada, Email
| | - Ian K Lo
- Department of Trauma and Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
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OUP accepted manuscript. PAIN MEDICINE 2022; 23:1733-1749. [DOI: 10.1093/pm/pnac066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/14/2022]
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Abstract
With sincere appreciation to the AANA Education Foundation for their generous support, we announce our Annual Awards for the best Clinical Research, Basic Science Research, Resident/Fellow Research, and Systematic Reviews published in 2021, as well as the Most Downloaded and Most Cited papers published 5 years ago. Also, as is customary and as we require of authors, our editors update their annual disclosures of potential conflicts of interest. Finally, we annually update our masthead, thus introducing a new Associate Editor and many new members of the Editorial Board and Social Media Board.
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Van Schaik KD, Lee KS. Orthobiologics: Diagnosis and Treatment of Common Tendinopathies. Semin Musculoskelet Radiol 2021; 25:735-744. [PMID: 34937114 DOI: 10.1055/s-0041-1735475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Orthobiologics, including platelet-rich plasma, prolotherapy, and mesenchymal stem cells, are seeing increasing use in the treatment of osteoarthritis (OA), muscle injury, and tendinopathy. This article reviews the biology and applications of orthobiologics in tendons, muscles, and joints, and focuses on platelet-rich plasma (PRP). Clinical evidence-based literature related to the use of PRP in the treatment of rotator cuff injury, lateral epicondylosis, Achilles tendinopathy, plantar fasciitis, knee OA, and acute muscle injury are discussed.
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Affiliation(s)
- Katherine D Van Schaik
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kenneth S Lee
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Sheean AJ. Commentary Author Reply to "Regarding 'Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial'". Arthroscopy 2021; 37:1376. [PMID: 33896492 DOI: 10.1016/j.arthro.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Andrew J Sheean
- San Antonio Military Medical Center, San Antonio, Texas, U.S.A
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Flatow EL. Regarding "Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial". Arthroscopy 2021; 37:1375-1376. [PMID: 33745937 DOI: 10.1016/j.arthro.2021.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/12/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Evan L Flatow
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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58
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Kwong CA, Woodmass JM, Gusnowski EM, Bois AJ, Leblanc J, More KD, Lo IKY. Author Reply to "Regarding 'Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial'". Arthroscopy 2021; 37:1376-1377. [PMID: 33745940 DOI: 10.1016/j.arthro.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Cory A Kwong
- Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jarret M Woodmass
- Pan Am Clinic, Department of Orthopedics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eva M Gusnowski
- Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Aaron J Bois
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Justin Leblanc
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Kristie D More
- University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada
| | - Ian K Y Lo
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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Xiang XN, Deng J, Liu Y, Yu X, Cheng B, He HC. Conservative treatment of partial-thickness rotator cuff tears and tendinopathy with platelet-rich plasma: A systematic review and meta-analysis. Clin Rehabil 2021; 35:1661-1673. [PMID: 33896214 DOI: 10.1177/02692155211011944] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the effect of platelet-rich plasma as a conservative therapy in individuals with partial-thickness rotator cuff tears or tendinopathy on pain, and function. DATA SOURCES Embase, MEDLINE, CENTRAL, Web of Science, CINAHL, PEDro, and the grey literature (to 31 March 2021). METHODS Randomized controlled trials in English that reported short-term (6 ± 1 months), or long-term (⩾1 year) outcomes (shoulder pain or function) were conducted. Two independent reviewers screened the literature, completed the assessment of the Cochrane's risk of bias and extracted the data. Mean difference or standardized mean difference was used for continuous data. Heterogeneity was identified with I2 test. RESULTS A total of 11 studies were eligible, and nine studies (n = 629) were included in this meta-analysis, that showed statistically significant short-term effects of platelet-rich plasma on pain relief (MD = -1.56; 95% CI -2.82 to -0.30), Constant-Murley score (MD = 16.48; 95% CI 12.57 to 20.40), and Shoulder Pain and Disability Index (MD = -18.78; 95% CI -36.55 to -1.02). Nonetheless, no long-term effect was observed on pain and function, except Constant-Murley score (MD = 24.30; 95% CI 23.27 to 25.33). The results of minimal important difference reached the minimal clinically important difference, except American Shoulder and Elbow Surgeons. For subgroup analysis, differences of pain relief were statistically significant in platelet-rich plasma-treated groups with double centrifugation, single injection, and post-injection rehabilitation. CONCLUSION Our results suggested platelet-rich plasma had positive effects on pain relief and functional improvement for partial-thickness rotator cuff tears and rotator cuff tendinopathy, although the effects may not last for a long time.
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Affiliation(s)
- Xiao-Na Xiang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China.,School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, P. R. China.,Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, P. R. China
| | - Jie Deng
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Yan Liu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Xi Yu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China.,School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, P. R. China
| | - Biao Cheng
- Department of Burn & Plastic Surgery, General Hospital of Southern Theatre Command, PLA, Guangzhou, P. R. China
| | - Hong-Chen He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China.,School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, P. R. China.,Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, P. R. China
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Sheean AJ. Editorial Commentary: Platelet-Rich Plasma Has Advantages Over Corticosteroid for Nonoperative Treatment of Rotator Cuff Pathology: Another Step in the Right Direction. Arthroscopy 2021; 37:518-520. [PMID: 33546790 DOI: 10.1016/j.arthro.2020.12.194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 02/02/2023]
Abstract
Lack of high-quality evidence has limited the widespread acceptance of platelet-rich plasma, bone marrow aspirate, and other therapeutics, collectively referred to as "orthobiologics," for partial-thickness rotator cuff tears and associated tendinopathies. The existing literature is limited, among other things, by underpowered studies and imprecise descriptions of the administration and/or formulation of the platelet-rich plasma being investigated. However, recent research favors platelet-rich plasma over corticosteroid injections in the nonoperative treatment of rotator cuff pathology. In light of evidence showing a deleterious effect of corticosteroids on subsequent surgical interventions, surgeons should continue to be wary of subacromial corticosteroid injections if alternatives such as platelet-rich plasma exist. A corticosteroid injection may have been the "go-to" nonoperative intervention in the past, but platelet-rich plasma may be a more effective arrow in our quiver. Of course, the conspicuous cost differential between these 2 different injections remains a very real consideration. However, this should be weighed against the increased risk (and cost) of a revision repair in the event that a surgical repair is performed subsequent to a corticosteroid injection.
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