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Desouza C, Shetty V. Effectiveness of platelet-rich plasma in partial-thickness rotator cuff tears: a systematic review. J ISAKOS 2024; 9:699-708. [PMID: 38641254 DOI: 10.1016/j.jisako.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
IMPORTANCE Partial-thickness rotator cuff tears (PTRCTs) commonly affect overhead athletes, leading to a decline in sports performance. Platelet-rich plasma (PRP) is being explored as an alternative treatment modality for individuals with PTRCTs to reduce discomfort and enhance functional recovery. We conducted a systematic review study of randomized controlled clinical trials to determine the effectiveness of PRP in treating PTRCTs. AIM To determine the effectiveness of PRP in treating PTRCTs. EVIDENCE REVIEW We conducted a comprehensive literature search for randomized controlled trials (RCTs) that compared the effectiveness of PRP with eccentric exercise and placebo injections as treatments for PTRCTs. We searched databases such as the Cochrane Library, Web of Science, PubMed, and EMBASE. The visual analog scale (VAS) score, American Shoulder and Elbow Surgeon (ASES) score, and Constant-Murley Score (CMS) was utilized as an outcome measure. Statistical analysis was performed using RevMan 5.3 software. FINDINGS Our meta-analysis included 12 studies involving 762 patients. At six weeks post-treatment, the PRP group had significantly higher VAS scores compared to the control group, indicating improvement (standard mean difference (SMD): -2.04 [95% confidence interval (CI): -4.00 to -0.08], I2 = 97%, P-value = 0.04). Patients who received PRP showed statistically significant improvements in VAS scores at 3 months and 6 months follow-up (SMD, -1.78 [95% CI: -3.03 to -0.52], I2 = 96%, P-value = 0.005) (SMD: -2.26 [95% CI: -3.77 to -0.76], I2 = 97%, P-value = 0.003). A statistically significant difference was also observed in VAS scores at the long-term 1-year follow-up (SMD: -2.27 [95% CI: -4.07 to -0.47]; I2 = 98%; P-value = 0.031). There were statistically significant differences in ASES scores and CMS scores in the short-term (SMD: 1.21 [95% CI: 0.19 to 2.24], I2 = 96%, P-value = 0.02) (SMD, 2.01 [95% CI: 0.14 to 3.88], I2 = 97%, P-value = 0.04). However, in the long-term ASES and CMS scores did not show any statistical significance (SMD: 2.06 [95% CI: -0.54 to 4.65], I2 = 99%, P-value = 0.12) (SMD: 4.36 [95% CI: -5.48 to 14.21], I2 = 99%, P-value = 0.39). CONCLUSIONS AND RELEVANCE Our findings suggest that PRP treatment is effective in reducing pain for individuals with PTRCTs, providing benefits in the short and long term. However, its impact on functional recovery appears somewhat constrained and doesn't endure over time. Additionally, significant heterogeneity exists among studies, encompassing variations in PRP composition and control group treatments. Consequently, we conclude that compelling evidence for symptom improvement in PTRCT patients following PRP treatment remains elusive. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Clevio Desouza
- SAANVI Orthopaedics, 2003, Sorrento, High Street, Hiranandani Gardens, Powai, Mumbai 400076, India; Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, 400053, India.
| | - Vijay Shetty
- SAANVI Orthopaedics, 2003, Sorrento, High Street, Hiranandani Gardens, Powai, Mumbai 400076, India; Dr L H Hiranandani Hospital, Hiranandani Gardens, Powai, Mumbai, 400076, India
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Retraction to: Clinical outcome of arthroscopic acromioplasty vs. arthroscopic rotator cuff repair for irreparable rotator cuff tears: A 3-year follow-up. Technol Health Care 2024; 32:2851. [PMID: 38393862 DOI: 10.3233/thc-231589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
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Smith KM, Clinker CE, Cutshall ZA, Lu CC, Joyce CD, Chalmers PN, Tashjian RZ. Progression of symptomatic bilateral rotator cuff disease. JSES Int 2023; 7:586-591. [PMID: 37426927 PMCID: PMC10328764 DOI: 10.1016/j.jseint.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background Prior studies have demonstrated that conservatively treated rotator cuff tears and rotator cuff tendinopathy may continue to progress. It is unclear whether that rate of progression differs between sides in patients with bilateral disease. This study evaluated the likelihood of progression of rotator cuff disease as confirmed via magnetic resonance imaging (MRI) in individuals with symptomatic bilateral pathology, treated conservatively for a minimum of 1 year. Methods We identified patients with bilateral rotator cuff disease confirmed via MRI within the Veteran's Health Administration electronic database. A retrospective chart review via the Veteran's Affairs electronic medical record was performed. Progression was determined using 2 separate MRIs with a minimum of 1 year apart. We defined progression as (1) a progression from tendinopathy to tearing, (2) an increase from partial-thickness to full-thickness tearing, or (3) an increase in tear retraction or tear width of at least 5 mm. Results Four hundred eighty MRI studies from 120 Veteran's Affair patients with bilateral, conservatively treated rotator cuff disease were evaluated. Overall, 42% (100/240) of rotator cuff disease had progressed. No significant difference was found between progression of right vs. left rotator cuff pathology, with right shoulder pathology progressing at a rate of 39% (47/120), while left shoulder disease progressed at a rate of 44% (53/120). The likelihood of disease progression was associated with less initial tendon retraction (P value = .016) and older age (P value = .025). Conclusions Rotator cuff tears are no more likely to progress on the right, as compared to the left side. Older age and less initial tendon retraction were found to be predictors of disease progression. These suggest that higher activity level may not associate with greater progression of rotator cuff disease. Future prospective studies evaluating progression rates between dominant vs. nondominant shoulders are warranted.
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Affiliation(s)
- Karch M. Smith
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Zachary A. Cutshall
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Chao-Chin Lu
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Peter N. Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert Z. Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Mayntzhusen TW, Witten A, Gramkow J, Hansen SB, Chatterjee SA, Hølmich P, Barfod KW. Interrater and intrarater reliability of four different classification methods for evaluating acromial morphology on standardized radiographs. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
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Lucas J, van Doorn P, Hegedus E, Lewis J, van der Windt D. A systematic review of the global prevalence and incidence of shoulder pain. BMC Musculoskelet Disord 2022; 23:1073. [PMID: 36476476 PMCID: PMC9730650 DOI: 10.1186/s12891-022-05973-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 11/09/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Studies reporting on the population burden of people living with shoulder pain show wide heterogeneity in terms of case definition, study samples, and occurrence. This systematic review aims to summarize evidence pertaining to the prevalence and incidence of shoulder pain, including variability based on sex and geography. We also explored the potential influence of methodological limitations and important sources of heterogeneity (case definition and reference period) on reported estimates of shoulder pain prevalence. DATABASES AND DATA TREATMENT The study protocol was registered on Prospero under CRD42021243140. We searched EMBASE, CINAHL, Web of Science and Medline from inception to March 2021. Study selection, data extraction and risk of bias assessment was conducted by a team of three researchers. We performed a narrative synthesis of the data, using forest plots to summarize study findings, and stratified data presentation to explore the potential association of risk of bias, case definition, and reference period with estimates of prevalence and incidence of shoulder pain. RESULTS We obtained data from 61 studies reporting data from high-, middle- and low-income countries. The overall risk of bias was low, with most rated as "low-risk" and no studies rated as "high-risk". The community prevalence of shoulder pain varied widely across the countries included in our review, with a median of 16% (range 0.67 to 55.2%). Longer reference periods were typically associated with higher prevalence estimates. Primary care prevalence ranged from 1.01 to 4.84% (median 2.36%). Estimates were generally higher for women than men and were higher in high-income nations. The incidence of shoulder pain ranged from 7.7 to 62 per 1000 persons per year (median 37.8 per 1000 persons per year). Risk of bias did not clearly explain variability in study findings, but there was considerable variation in study samples, methods used, and a relative absence of data from low-income countries. CONCLUSIONS Our review demonstrates that a significant proportion of the population across the world will experience shoulder pain daily, yearly, and throughout a lifetime. Regional gaps in evidence and methodological inconsistencies must be addressed in order to establish a more definitive global burden.
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Affiliation(s)
- J Lucas
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK.
| | - P van Doorn
- Department of General Practice, Erasmus Medical Centre, Rotterdam, Netherlands
| | - E Hegedus
- Doctor of Physical Therapy Program, Tufts University School of Medicine, 101 E Washington Street, Suite 950, Phoenix, AZ, 85004, USA
| | - J Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
- Musculoskeletal Research, Clinical Therapies, University of Limerick, Limerick, Ireland
| | - D van der Windt
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
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Metcalfe A, Parsons H, Parsons N, Brown J, Fox J, Gemperlé Mannion E, Haque A, Hutchinson C, Kearney R, Khan I, Lawrence T, Mason J, Stallard N, Underwood M, Drew S. Subacromial balloon spacer for irreparable rotator cuff tears of the shoulder (START:REACTS): a group-sequential, double-blind, multicentre randomised controlled trial. Lancet 2022; 399:1954-1963. [PMID: 35461618 DOI: 10.1016/s0140-6736(22)00652-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND New surgical procedures can expose patients to harm and should be carefully evaluated before widespread use. The InSpace balloon (Stryker, USA) is an innovative surgical device used to treat people with rotator cuff tears that cannot be repaired. We aimed to determine the effectiveness of the InSpace balloon for people with irreparable rotator cuff tears. METHODS We conducted a double-blind, group-sequential, adaptive randomised controlled trial in 24 hospitals in the UK, comparing arthroscopic debridement of the subacromial space with biceps tenotomy (debridement only group) with the same procedure but including insertion of the InSpace balloon (debridement with device group). Participants had an irreparable rotator cuff tear, which had not resolved with conservative treatment, and they had symptoms warranting surgery. Eligibility was confirmed intraoperatively before randomly assigning (1:1) participants to a treatment group using a remote computer system. Participants and assessors were masked to group assignment. Masking was achieved by using identical incisions for both procedures, blinding the operation note, and a consistent rehabilitation programme was offered regardless of group allocation. The primary outcome was the Oxford Shoulder Score at 12 months. Pre-trial simulations using data from early and late timepoints informed stopping boundaries for two interim analyses. The primary analysis was on a modified intention-to-treat basis, adjusted for the planned interim analysis. The trial was registered with ISRCTN, ISRCTN17825590. FINDINGS Between June 1, 2018, and July 30, 2020, we assessed 385 people for eligibility, of which 317 were eligible. 249 (79%) people consented for inclusion in the study. 117 participants were randomly allocated to a treatment group, 61 participants to the debridement only group and 56 to the debridement with device group. A predefined stopping boundary was met at the first interim analysis and recruitment stopped with 117 participants randomised. 43% of participants were female, 57% were male. We obtained primary outcome data for 114 (97%) participants. The mean Oxford Shoulder Score at 12 months was 34·3 (SD 11·1) in the debridement only group and 30·3 (10·9) in the debridement with device group (mean difference adjusted for adaptive design -4·2 [95% CI -8·2 to -0·26];p=0·037) favouring control. There was no difference in adverse events between the two groups. INTERPRETATION In an efficient, adaptive trial design, our results favoured the debridement only group. We do not recommend the InSpace balloon for the treatment of irreparable rotator cuff tears. FUNDING Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health and Care Research partnership.
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Affiliation(s)
- Andrew Metcalfe
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK.
| | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jaclyn Brown
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Aminul Haque
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Charles Hutchinson
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Rebecca Kearney
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Iftekhar Khan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tom Lawrence
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Nigel Stallard
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephen Drew
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Kang SW, Park CK, Woo SH, Kim TW, Moon MH, Yang JH, Choi MH. Factors Influencing the Size of a Non-Traumatic Full-Thickness Rotator Cuff Tear: Focusing on Socioeconomic Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106137. [PMID: 35627675 PMCID: PMC9140797 DOI: 10.3390/ijerph19106137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 02/05/2023]
Abstract
This study aimed to identify the risk factors for non-traumatic rotator cuff tears in Korean adult patients who underwent surgical treatment, focusing on socioeconomic factors. A retrospective study was conducted with 659 patients who were diagnosed with a full rotator cuff tear and underwent surgical treatment. The outcome variable was the rotator cuff tear size (mm), as indicated by preoperative magnetic resonance imaging. Socioeconomic variables included occupation, education level, insurance type, and residential area. Univariate analyses were used to evaluate the relation between tear size and independent variables, and multivariate regression was used to estimate the effects of socioeconomic factors on tear size after adjusting for other variables. Significant differences were found in mean tear size according to age, occupation, residence area, and symptom duration (p < 0.05) in multivariate regression analysis. Rural residents had a 2.12 mm larger tear size than urban residents. Compared to National Health Insurance patients, the tear size of Medicaid beneficiaries was significantly larger (6.79 mm) in urban areas. The larger the rotator cuff tear, the greater the risk of retear and poor shoulder function. Therefore, policy efforts are required to expand access to medical care for the vulnerable.
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Affiliation(s)
- Suk-Woong Kang
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, Korea; (S.-W.K.); (S.-H.W.); (T.-W.K.)
- Department of Orthopedic Surgery, Medical College, Pusan National University, Yangsan 50612, Korea
| | - Chan-Kue Park
- Department of Radiology, Pusan National University Yangsan Hospital, Medical College, Pusan National University, Yangsan 50612, Korea;
| | - Seung-Hun Woo
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, Korea; (S.-W.K.); (S.-H.W.); (T.-W.K.)
- Department of Orthopedic Surgery, Medical College, Pusan National University, Yangsan 50612, Korea
| | - Tae-Woo Kim
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, Korea; (S.-W.K.); (S.-H.W.); (T.-W.K.)
- Department of Orthopedic Surgery, Medical College, Pusan National University, Yangsan 50612, Korea
| | - Min-Hui Moon
- Office of Public Healthcare Service, Pusan National University Yangsan Hospital, Yangsan 50612, Korea;
| | - Ji-Hee Yang
- Department of Medicine, Medical College, Pusan National University, Yangsan 50612, Korea;
| | - Min-Hyeok Choi
- Office of Public Healthcare Service, Pusan National University Yangsan Hospital, Yangsan 50612, Korea;
- Department of Preventive and Occupational & Environmental Medicine, Medical College, Pusan National University, Yangsan 50612, Korea
- Correspondence: ; Tel.: +82-051-510-8030
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Sørensen L, van Tulder M, Johannsen HV, Ovesen J, Enemark U, Blæhr EE, Oestergaard LG. Costs of shoulder disorders in Denmark; a nationwide cost-off-illness study investigating 617,334 patients and matched controls. Pain 2022; 163:2162-2171. [PMID: 35135991 DOI: 10.1097/j.pain.0000000000002610] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Shoulder disorders are very common musculoskeletal conditions. Few studies have focused on the costs associated with shoulder disorders, and the economic burden has never been established in a nationwide cost-of-illness study. We aimed to evaluate the healthcare costs and costs of productivity loss (sick leave), and to evaluate if costs were higher for specific subgroups. Using national Danish registers, we identified individuals with shoulder disorders (subacromial pain, stiffness, fracture or dislocation) diagnosed between 2005 and 2017 and controls matched on age and gender without shoulder disorders. Health care usage, sick leave and related costs were estimated. During the 13-year inclusion period, 617,334 unique individuals were identified and the incidence rate was 1,215 per 100,000 person years in 2017. The expected additional societal costs were €1.21 billion annually. The mean additional total costs for the 6-years period were €11,334 (11,014; 11,654) for individuals aged ≥65 years and €25,771 (25,531; 26,012) for individuals aged <65 years. For individuals in the working age, the costs of sick leave accounted for approximately 70% of the total costs. Individuals aged ≥65 years had health care costs that were twice as high as individuals aged <65 years. Additionally, the 20% of cases accruing the highest costs accounted for 66% of the total costs. In conclusion, incidence rates of shoulder disorders were high and costs of sick leave accounted for a large proportion of total costs associated with illness in working age people. Furthermore, a minority of patients accounted for a substantial share of the total costs.
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Affiliation(s)
- Lotte Sørensen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Denmark Department of Clinical Medicine, Aarhus University, Denmark Department of Human Movement Sciences, Faculty Behavioural & Movement Sciences, Amsterdam Movement Sciences research institute, Vrije Universiteit Amsterdam, Netherlands Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark Department of Public Health, Aarhus University, Denmark DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Neeley RA, Diaz MA, Gorman RA, Frankle MA, Mighell MA. A Weaving Rip-Stop Technique Leads to a Significantly Increased Load to Failure and Reduction in Suture-Tendon Cut-Through in a Biomechanical Model of Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2021; 3:e1263-e1272. [PMID: 34712962 PMCID: PMC8527263 DOI: 10.1016/j.asmr.2021.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/24/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To present an alternative arthroscopic rip-stop technique with a single suture tape weaved through the tendon from anterior to posterior and to biomechanically test its strength against a control technique consisting of a single-row repair with simple sutures. Methods This was a controlled biomechanical study. Dissection and harvesting of the supraspinatus muscle-tendon unit were performed along the cable in 9 matched-pair cadaveric shoulders. Samples were divided into 2 groups: simple suture repair only (SSR) and simple suture repair with rip-stop (SSPR). Biomechanical testing was performed with an initial preload, followed by cyclic loading and then ramp to failure. Peak-to-peak displacement, stiffness (in newtons per millimeter), load at failure (in newtons), and failure mechanism were recorded. Data were compared using the paired-sample t test. Results The average peak-to-peak displacement for SSR samples was not significantly different from that of SSPR samples (P = .96). Similarly, elongation in the SSR and SSPR groups was not significantly different (P = .82). Stiffness was significantly different between the SSR and SSPR groups (P = .0054): SSR samples were less stiff than SSPR samples. Moreover, SSR samples failed at significantly lower forces than did SSPR samples (P = .028). A larger percentage of failures occurred due to tendon cut-through among SSR samples versus suture breakage among SSPR samples. Conclusions An alternative rip-stop technique is presented in this biomechanical model that may assist surgeons to better deal with difficult rotator cuff repairs. Weaving a suture tape as a rip-stop can increase stiffness, achieve higher failure loads when compared with simple suture repair with no rip-stop, and reduce tendon cut-through. Clinical Relevance This study provides insight into a variation of rip-stop stitch techniques that may help solve the clinical problem of failure occurring at the suture-tendon interface, specifically tendon cut-through.
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Affiliation(s)
- Ryan A Neeley
- Florida Orthopaedic Institute, Tampa, Florida, U.S.A
| | - Miguel A Diaz
- Foundation for Orthopaedic Research & Education, Tampa, Florida, U.S.A
| | - R Allen Gorman
- Foundation for Orthopaedic Research & Education, Tampa, Florida, U.S.A
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Taylor K, Baxter GD, Tumilty S. Clinical decision-making for shoulder surgery referral: An art or a science? J Eval Clin Pract 2021; 27:1159-1163. [PMID: 32941698 DOI: 10.1111/jep.13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]
Abstract
RATIONALE Decision-making in musculoskeletal health care is complex, with discrepancy among clinical providers and variation in the per cent of referrals for specialist care. To date, there is an increased focus on specialist referrals, risking overuse of expensive testing and contributing to unnecessary treatment. AIMS AND OBJECTIVES This report will considerer the difficulties of primary care musculoskeletal decision-making using shoulder injuries as an example, presenting a solution based on multi-criteria decision-making analysis with online software. The associated issues involved in clinical decision-making are complex. Contributing to the components of complexity are; the multifaceted aetiology of shoulders, the experience and knowledge of providers, and the burden of patient demands. Notwithstanding, funding considerations, resource allocation availability and other associated issues around clinical decision-making. Considering the many facets and complexities of clinical decision-making, this is an area where multi-criteria decision-making analysis (MCDM) may be appropriate. The MCDM analysis approach is increasingly being used in health care and can assist in the organizing and weighting of identified key clinical factors. MCDM could be applied to the challenges of musculoskeletal care with the potential to decrease decision-making variability. Furthermore, the significance of each key clinical factor that musculoskeletal decision-making is based on are to date unclear. CONCLUSION Therefore, this preliminary report offers a start towards clarifying key factors and an approach for implementing improved shoulder clinical care decision-making which could then be adapted and applied to other body sites.
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Affiliation(s)
- Karen Taylor
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - George D Baxter
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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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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McKenna LJ, Bonnett L, Panzich K, Lim J, Hansen SK, Graves A, Jacques A, Williams SA. The Addition of Real-time Ultrasound Visual Feedback to Manual Facilitation Increases Serratus Anterior Activation in Adults With Painful Shoulders: A Randomized Crossover Trial. Phys Ther 2021; 101:6039319. [PMID: 33336703 DOI: 10.1093/ptj/pzaa208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Serratus anterior (SA) muscle activation may be decreased with subacromial pain syndrome. The purpose of this study was to determine whether the addition of real-time ultrasound (RTUS) visual feedback increased activation of SA in adults with painful shoulders in comparison to manual facilitation alone. METHODS This assessor-blinded, 2-period, randomized cross-over trial was conducted in a university medical imaging laboratory. Adults with mild-moderate unilateral subacromial pain received both interventions in random order with at least 1-week washout between interventions. Fourteen participants were randomized to receive manual facilitation with RTUS first, and 13 were randomized to receive manual facilitation alone first. Fifteen repetitions of a supine ``serratus punch'' were facilitated by RTUS visual feedback with manual facilitation or by manual facilitation alone. Levels of SA activation via surface electromyography were normalized to a maximum voluntary isometric contraction. RESULTS A total of 25 participants completed the full trial of both interventions. Data from 25 participant periods for RTUS with manual facilitation and data from 26 participant periods for manual facilitation only were analyzed. The predicted marginal mean difference between interventions was 55.5% (95% CI = 13.9% to 97.1%) in favor of the addition of RTUS feedback. No adverse effects occurred. CONCLUSION RTUS visual feedback increases SA activation in adults with painful shoulders compared with manual facilitation alone. IMPACT Determining if RTUS can improve SA muscle activation may help clinicians improve physical therapist interventions for subacromial pain syndrome.
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Affiliation(s)
- Leanda J McKenna
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Luke Bonnett
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Kelly Panzich
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Jacinta Lim
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Snorre K Hansen
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Anna Graves
- Department of Medical Imaging, Curtin University, Perth, Australia
| | - Angela Jacques
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Sian A Williams
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Department of Surgery and Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Effects of Hyperosmolar Dextrose Injection in Patients With Rotator Cuff Disease and Bursitis: A Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 102:245-250. [PMID: 32926850 DOI: 10.1016/j.apmr.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine whether dextrose prolotherapy offers clinical benefits in patients with shoulder pain and bursitis. DESIGN Double-blinded, randomized controlled trial. SETTING Outpatient rehabilitation department of a single medical center. PARTICIPANTS Patients (N=50) who had received a diagnosis of shoulder pain and bursitis through clinical tests and ultrasound examination. INTERVENTIONS Participants were randomly assigned to the 15% dextrose injection (D15W) group or the placebo group to receive either D15W or normal saline injection, respectively. All participants received ultrasound-guidance bursal injection every 2 weeks for a total of 3 injections. MAIN OUTCOME MEASURES The primary outcome was maximal pain level while performing activities. The secondary outcomes included resting pain level, function and disability assessment results, and ultrasonographic parameters. Participants were followed up for 3 months after completion of the injection course. RESULTS No significant differences in baseline characteristics were observed between the D15W and placebo groups. Significant time effects were observed for all outcome parameters (all P<.05); however, time × group effects were nonsignificant for all outcomes, except for tissue elasticity (P=.026). CONCLUSIONS Supporting evidence is insufficient regarding the clinical benefits of 15% dextrose bursal injection administered through 3 sessions in patients with chronic shoulder pain and bursitis. The findings indicate that these injections may increase the tissue stiffness of the supraspinatus tendon, as indicated by elastography assessment results, but further research is required to determine the nature of such changes in elastography findings.
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14
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Seven Key Themes in Physical Therapy Advice for Patients Living With Subacromial Shoulder Pain: A Scoping Review. J Orthop Sports Phys Ther 2020; 50:285-a12. [PMID: 32476583 DOI: 10.2519/jospt.2020.9152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To systematically scope the reported advice and education in physical therapy management of patients with subacromial shoulder pain, and to define key themes of the advice and education. DESIGN Scoping review. LITERATURE SEARCH We searched MEDLINE, Scopus, Web of Science, and CINAHL, with publication dates from 2007 to September 2019. STUDY SELECTION CRITERIA We included quantitative and qualitative research that reported on physical therapy interventions for subacromial shoulder pain. DATA SYNTHESIS We performed a qualitative synthesis that identified items included in patient advice and education. RESULTS Of 89 original studies included, there were 61 randomized controlled trials; 5 prospective studies; 16 nonrandomized observational intervention studies or case series; and 7 surveys, audits of physical therapy patient records, and focus groups with physical therapists. We identified 7 key themes for advice and education: exercise intensity and pain response, activity modification advice, posture advice, pain self-management advice, pathoanatomical and diagnosis information, behavioral approaches, and pain biology advice. CONCLUSION While advice focused predominantly on the local tissue pathology model, 10% of studies included information about pain neuroscience education, psychosocial factors, motor imagery, or behavior change. J Orthop Sports Phys Ther 2020;50(6):285-293. doi:10.2519/jospt.2020.9152.
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15
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Frangiamore S, Dornan GJ, Horan MP, Mannava S, Fritz EM, Hussain ZB, Moatshe G, Godin JA, Pogorzelski J, Millett PJ. Predictive Modeling to Determine Functional Outcomes After Arthroscopic Rotator Cuff Repair. Am J Sports Med 2020; 48:1559-1567. [PMID: 32406765 DOI: 10.1177/0363546520914632] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic rotator cuff repair (ARCR) is one of the most commonly performed orthopaedic surgical procedures; however, patient-reported outcomes have varied greatly in the literature. PURPOSE To identify preoperative factors that affect outcomes and to develop prognostic tools for predicting functional outcomes in future ARCR cases. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients were included who underwent ARCR for repairable full-thickness rotator cuff tears with at least 2 years of follow-up. Twelve predictors were entered as candidate predictors in each model: age, sex, workers' compensation (WC) status, previous cuff repair, tear size, tear shape, multiple-tendon involvement, tendon stump length, Goutallier classification, critical shoulder angle, length of follow-up, and baseline subjective outcomes score. Postoperative American Shoulder and Elbow Surgeons (ASES), 12-Item Short Form Health Survey Physical Component Summary (SF-12 PCS), QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand), and patient satisfaction were each modeled through proportional odds ordinal logistic regression. Model results were presented with marginal covariate effect plots and predictive nomograms. RESULTS Overall, 552 shoulders fit inclusion criteria. The mean age at surgery was 60.2 years (range, 23-81 years). Twenty-five (4.5%) shoulders underwent revision cuff repair or reverse arthroplasty at a mean 1.9 years (range, 0.1-7.9 years) postoperatively. Overall, 509 shoulders were eligible for follow-up, and minimum 2-year postoperative patient-reported outcomes were obtained for 449 (88.2%) at a mean 4.8 years (range, 2-11 years). The ASES score demonstrated significant improvement from pre- to postoperative median (interquartile range): 58 (44.9-71.6) to 98.3 (89.9-100; P < .001). Women demonstrated significantly higher 2-year reoperation rates than men (5.8% vs 1.6%; odds ratio, 2.8 [95% CI, 0.73-9.6]; P = .023). Independently significant predictors for lower postoperative ASES scores included previous ARCR (P < .001), female sex (P < .001), and a WC claim (P < .001). Significant predictors for worse QuickDASH scores included WC claim (P < .001), female sex (P < .001), previous ARCR (P = .007), and ≥7 years of follow-up time. Significant predictors for lower SF-12 PCS scores included WC claim (P < .001), female sex (P = .001), and lower baseline SF-12 PCS. Last, significant independent predictors of patient satisfaction included previous ARCR (P = .004), WC claim (P = .011), female sex (P = .041), and age (P = .041). CONCLUSION Excellent clinical outcomes and low failure rates were obtained after ARCR by using careful patient selection and modern surgical techniques for ARCR. Female sex, WC claim, and previous ARCR were significant predictors of poorer outcomes in at least 3 patient-reported outcome models. Prognostic nomograms were developed to aid in future patient selection, clinical decision making, and patient education.
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Affiliation(s)
- Salvatore Frangiamore
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
| | - Marilee P Horan
- Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
| | - Sandeep Mannava
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
| | - Erik M Fritz
- Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
| | - Zaamin B Hussain
- Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
| | - Gilbert Moatshe
- Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
| | - Jonathan A Godin
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
| | - Jonas Pogorzelski
- Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
| | - Peter J Millett
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
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Oh SB, Jeong JJ, Ji JH, Patel K, Hwang WH, Cho JH. Medialization of medial row anchor via the Nevasier portal yield enhanced footprint and outcomes in medium-to-large rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2019; 27:3989-3996. [PMID: 31375876 DOI: 10.1007/s00167-019-05641-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate clinical and radiological outcomes of medial row anchor insertion between 90° or 45° (deadman) angle in the suture-bridge rotator cuff repair of medium-to-large rotator cuff tears. METHODS This retrospective analysis included 113 consecutive patients undergoing arthroscopic suture-bridge repair for medium-to-large rotator cuff tears (mean tear size: 2.8 × 2.3 cm) between 2010 and 2013. The patients were divided into two groups: group I (53 patients) and group II (60 patients) involving 90° and 45° medial row anchors, respectively. The conventional lateral row anchors were inserted in the suture-bridge repair. The clinical outcomes at 2 years and radiological outcomes including re-tear or footprint coverage (anteroposterior length and mediolateral width) of the repaired tendon using postoperative MRI were evaluated. RESULTS Clinical outcome scores were significantly improved in both groups. However, Group I (90° anchor insertion group) showed better clinical scores without the difference of range of motion. The postoperative MRI revealed enlarged footprint coverage with 90° medial row anchor. The repaired footprint cuff size (mediolateral width) in the coronal plane MRI showed a statistically significant difference (45°: 19 mm vs. 90°: 24 mm) (p < 0.05). CONCLUSIONS Enhanced clinical outcomes and additional anatomical footprint coverage (coronal width of repaired tendon) in the suture-bridge repair are obtained with the 90° medial row anchors compared with the 45° medial row anchors. These findings would guide clinical application of 90° medial row anchor insertion for further medialization in the medium-to-large rotator cuff tears. LEVEL OF EVIDENCE Level III (retrospective comparative trial).
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Affiliation(s)
- Seung-Bae Oh
- Department of Orthopaedic Surgery, Daejeon St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Jung Jeong
- Department of Orthopaedic Surgery, Daejeon St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hun Ji
- Department of Orthopaedic Surgery, Daejeon St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Kaushal Patel
- Department of Orthopaedic Surgery, Daejeon St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Ha Hwang
- Department of Orthopaedic Surgery, Daejeon St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Hyung Cho
- Department of Orthopaedic Surgery, Daejeon St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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17
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Woodmass JM, Wagner ER, Chang MJ, Welp KM, Elhassan BT, Higgins LD, Warner JJP. Arthroscopic Treatment of Massive Posterosuperior Rotator Cuff Tears: A Critical Analysis Review. JBJS Rev 2019; 6:e3. [PMID: 30204644 DOI: 10.2106/jbjs.rvw.17.00199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jarret M Woodmass
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric R Wagner
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Michelle J Chang
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathryn M Welp
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Jon J P Warner
- Department of Orthopaedic Surgery, Shoulder Service, Boston Shoulder Institute, Massachusetts General Hospital, Boston, Massachusetts
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18
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Gowd AK, Cvetanovich GL, Liu JN, Nwachukwu BU, Cabarcas BC, Cole BJ, Forsythe B, Romeo AA, Verma NN. Preoperative Mental Health Scores and Achieving Patient Acceptable Symptom State Are Predictive of Return to Work After Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2019; 7:2325967119878415. [PMID: 31696133 PMCID: PMC6820363 DOI: 10.1177/2325967119878415] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background: The incidence of rotator cuff repairs has risen dramatically over the past 10 years, most notably in the working-class population. Return to work (RTW) is a valuable outcome measure to set patient expectations before surgery. Purpose: To establish the rate of RTW after rotator cuff repair with respect to stratified levels of occupational demand (sedentary, light, moderate, and heavy) and to identify clinical factors significantly associated with postoperative RTW. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who received rotator cuff repair between 2014 and 2017 were queried from a prospectively maintained institutional registry. Work status was evaluated from clinical and physical therapy notes, and RTW was stratified based on duty level. The minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) values were calculated for American Shoulder and Elbow Surgeons (ASES) score and subjective Constant score through use of an anchor-based approach. Patient demographic factors, preoperative ASES scores, Constant scores, and health-related quality of life scores, as well as change in postoperative scores exceeding the thresholds for MCID, SCB, and PASS, were analyzed to determine significant associations with RTW without restriction. Results: In total, 89 patients with documented pre- and postoperative work status underwent surgery. Rates of RTW for sedentary, light, moderate, and heavy duties were 100%, 84.0%, 77.4%, and 63.3%, respectively, within return at less than 7 postoperative months on average. RTW was associated with achieving PASS (P = .004) but not achieving MCID and SCB (P = .429 and .452, respectively). Injury to a patient’s dominant side had reduced odds (0.057; 95% CI, 0.004-0.763; P = .030) for RTW at full duty. Tear characteristics and type of insurance were not associated with RTW. Preoperative Veterans RAND Mental Component Score (>53.3; area under the curve, 70.4%) was predictive of returning to work. Conclusion: A vast majority of patients undergoing rotator cuff repair can expect to return to work within 8 months of surgery. Preoperative mental health scores can predict future return to work, which supports the concept that mental health status plays an important role in the outcomes after rotator cuff repair surgery.
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Affiliation(s)
- Anirudh K Gowd
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | | | - Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, California, USA
| | | | | | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
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19
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Rodríguez-Piñero Durán M, Vidal Vargas V, Castro Agudo M. [Ultrasound findings in chronic subacromal pain syndrome]. Rehabilitacion (Madr) 2019; 53:240-246. [PMID: 31813421 DOI: 10.1016/j.rh.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/19/2019] [Accepted: 06/19/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Subacromial pain syndrome is a clinical picture characterised by pain located around the acromion triggered or exacerbated by shoulder movements. Ultrasound is a suitable imaging technique to evaluate the soft tissues occupying the subacromial space. The aim of this study was to describe the ultrasound findings in patients diagnosed with chronic subacromial pain syndrome by age, sex, and time since onset. MATERIAL AND METHODS We conducted a retrospective study of patients diagnosed with chronic SDS who underwent shoulder ultrasound. The variables studied were age, sex, affected side, time since onset, sonographic findings and ultrasound diagnosis. A descriptive study of the variables and statistical inference was performed with the chi-square test. RESULTS A total of 253 clinical histories of patients who underwent shoulder ultrasound were reviewed. Of these, 100 were selected who met the pre-established criteria. Involvement was bilateral in 5 of them and consequently the total number of ultrasound scans reviewed was 105. Differences were found between ultrasound finding by age, but not by sex or time since onset. CONCLUSIONS The findings of this study indicate that there is good clinical-radiological correlation between subacromial pain syndrome and ultrasound findings. The structure most frequently involved in the origin of the pain was the supraspinatus tendon. Differences were found by age but not by sex or the time since onset.
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Affiliation(s)
- M Rodríguez-Piñero Durán
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Virgen Macarena, Unidad de Gestión Clínica de Rehabilitación provincial de Sevilla, Sevilla, España
| | - V Vidal Vargas
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Virgen Macarena, Unidad de Gestión Clínica de Rehabilitación provincial de Sevilla, Sevilla, España.
| | - M Castro Agudo
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Virgen Macarena, Unidad de Gestión Clínica de Rehabilitación provincial de Sevilla, Sevilla, España
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20
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Feichtinger X, Monforte X, Keibl C, Hercher D, Schanda J, Teuschl AH, Muschitz C, Redl H, Fialka C, Mittermayr R. Substantial Biomechanical Improvement by Extracorporeal Shockwave Therapy After Surgical Repair of Rodent Chronic Rotator Cuff Tears. Am J Sports Med 2019; 47:2158-2166. [PMID: 31206305 DOI: 10.1177/0363546519854760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Characteristics of chronic rotator cuff tears include continuous loss of tendon structure as well as tendon elasticity, followed by a high failure rate after surgical reconstruction. Several studies have already shown the beneficial effect of extracorporeal shockwave therapy (ESWT) on tissue regeneration in tendon pathologies. HYPOTHESIS ESWT improves biomechanical tendon properties as well as functional shoulder outcomes in chronic rotator cuff reconstruction in rodents. STUDY DESIGN Controlled laboratory study. METHODS After tendon detachment and 3 weeks of degeneration, a subsequent transosseous reattachment of the supraspinatus tendon was performed in 48 adult male Sprague-Dawley rats (n = 16 per group). Rodents were randomly assigned to 3 study groups: no ESWT/control group, intraoperative ESWT (IntraESWT), and intra- and postoperative ESWT (IntraPostESWT). Shoulder joint function, as determined by gait analysis, was assessed repeatedly during the observation period. Eight weeks after tendon reconstruction, the rats were euthanized, and biomechanical and gene expression analyses were performed. RESULTS Macroscopically, all repairs were intact at the time of euthanasia, with no ruptures detectable. Biomechanical analyses showed significantly improved load-to-failure testing results in both ESWT groups in comparison with the control group (control, 0.629; IntraESWT, 1.102; IntraPostESWT, 0.924; IntraESWT vs control, P≤ .001; IntraPostESWT vs control, P≤ .05). Furthermore, functional gait analyses showed a significant enhancement in intensity measurements for the IntraPostESWT group in comparison with the control group (P≤ .05). Gene expression analysis revealed no significant differences among the 3 groups. CONCLUSION Clearly improved biomechanical results were shown in the single-application and repetitive ESWT groups. Furthermore, functional evaluation showed significantly improved intensity measurements for the repetitive ESWT group. CLINICAL RELEVANCE This study underpins a new additional treatment possibility to prevent healing failure. Improved biomechanical stability and functionality may enable faster remobilization as well as an accelerated return to work and sports activities. Furthermore, as shockwave therapy is a noninvasive, easy-to-perform, cost-effective treatment tool with no undesired side effects, this study is of high clinical relevance in orthopaedic surgery. Based on these study results, a clinical study has already been initiated to clinically confirm the improved functionality by ESWT.
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Affiliation(s)
- Xaver Feichtinger
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,AUVA Trauma Center Vienna-Meidling, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department of Orthopaedic Surgery II, Herz-Jesu Krankenhaus, Vienna, Austria
| | - Xavier Monforte
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department of Life Science Engineering, University of Applied Sciences Technikum Wien, Vienna, Austria
| | - Claudia Keibl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - David Hercher
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Jakob Schanda
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,AUVA Trauma Center Vienna-Meidling, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andreas H Teuschl
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department of Life Science Engineering, University of Applied Sciences Technikum Wien, Vienna, Austria
| | | | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Vienna-Meidling, Vienna, Austria.,Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Rainer Mittermayr
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,AUVA Trauma Center Vienna-Meidling, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
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21
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The increasing incidence of surgically treated quadriceps tendon ruptures. Knee Surg Sports Traumatol Arthrosc 2019; 27:3644-3649. [PMID: 30919003 PMCID: PMC6800863 DOI: 10.1007/s00167-019-05453-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/27/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Due to increased life expectancy and a more active life style of the older people, we hypothesised that the incidence of quadriceps tendon rupture (QTR) is higher than previously reported. The objective of this nationwide population-based study was to investigate the annual incidence of QTR in patients who underwent operative treatment in Finland between 1997 and 2014. METHODS The Finnish National Hospital Discharge Register was searched for all adult patients who had undergone surgical treatment for QTR during the study period. Population-based annual incidence and incidence trends for surgically treated QTR were calculated. RESULTS During the study period, 1343 QTR surgeries were performed. Of these, 90% were performed on male patients. The incidence of QTR increased by 411% from 0.55 to 2.82 per 100,000 person-years from 1997 to 2014. The average yearly increase in the number of surgeries was 9.0%. In male patients, the incidence of QTR increased by 490% and in female patients by 121%. The mean age of the male patients increased during the study period from 50 to 59 years. CONCLUSIONS Based on the data from the Finnish National Hospital Discharge Register, the annual incidence of QTR increased by over 400% during the 18-year study period. The average age of the patients also increased. Because QTR is only very rarely treated without surgery, the results of our study can be considered to be a reliable estimate of the increase in the incidence of this condition. There is an urgent need to establish the risk factors associated with QTR and to also establish the optimal surgical technique. LEVEL OF EVIDENCE IV.
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Abstract
The aim of this study was to analyze the occurrence of rotator cuff impingement due to reduction of subacromial space height during complex shoulder motion to determine safety of sexual activities. The hypothesis was that such activities could be deleterious if not performed with precaution. To use a patient-specific 3D measurement technique coupling medical imaging and optical motion capture to evaluate the safety of various sexual positions according to subacromial compression. Descriptive laboratory study. A volunteer couple underwent Magnetic Resonance Imaging (MRI) and motion capture of their shoulders. Five common active and passive sexual positions were evaluated. Significant differences in subacromial space height were observed between the different performed actions. All active sexual positions requiring important pressure on the hands or elbows (e.g., scorpio) or weight lifting (e.g., superman) caused subacromial impingement. No subacromial impingement was however observed during passive sexual activities (e.g., basset hound). This study indicates that some sexual positions could potentially place the rotator cuff at risk. Such high-tech investigation shows promise in the areas of cause, intervention and education. The present findings may assist health professionals in providing them with preventive measures and is highly relevant for decision-making regarding health promoting initiatives.
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23
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Andia I, Martin JI, Maffulli N. Advances with platelet rich plasma therapies for tendon regeneration. Expert Opin Biol Ther 2018; 18:389-398. [DOI: 10.1080/14712598.2018.1424626] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Isabel Andia
- Regenerative Medicine Laboratory, BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Jose Ignacio Martin
- Regenerative Medicine Laboratory, BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
- Interventional Imaging. Department of Radiology, Cruces University Hospital, Barakaldo, Spain
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Dentristry, Salerno, Italy
- Barts and the London School of Medicine and Dentistry Centre for Sports and Exercise Medicine, Queen Mary University of London, London, England
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