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Ardebol J, Ghayyad K, Hwang S, Pak T, Menendez ME, Denard PJ. Patient-reported outcome tools and baseline scores vary by country and region for arthroscopic repair of massive rotator cuff tears: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:312-317. [PMID: 37588489 PMCID: PMC10426575 DOI: 10.1016/j.xrrt.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Different patient-reported outcome (PRO) tools are used in patients with arthroscopic rotator cuff repair (ARCR) which complicates outcome comparisons. The purpose of this systematic review was to compare PRO usage and baseline scores across world regions and countries in patients with ARCR of massive rotator cuff tears (MRCT). Methods A systematic review was performed on ARCR for MRCT. The search was conducted from September to November of 2022 using the MEDLINE database for articles published in the last 15 years. Thirty-seven articles were included after initial screening and full-text review. In each article, PRO usage, baseline scores, and country of origin were collected. PRO usage was reported in percentages and baseline scores were normalized for each region to facilitate comparisons. Normalization was performed using the PRO means from each article. These averages were converted to fractions using the worst and best possible scores. These were combined into a single numerical value, expressed as a decimal from 0 to 1, using the total sample size for each tool per region. Values closer to 0 represent worse functional outcomes. Results Thirty-two percent (n = 12) of articles were from Asia, 43.2% (n = 16) from Europe, 5.4% (n = 2) from the Middle East, and 18.9% (n = 7) from North America. The most commonly reported PRO tools were American Shoulder and Elbow Surgeons (ASES) in 19 papers, Constant-Murley Score (CMS) in 26 papers, Visual Analog Scale for pain (VAS) in 19 papers, and University of California in Los Angeles (UCLA) in 11 papers. ASES was reported in 51% of articles with 63% being from Asia (n = 12) compared to 21% from North America (n = 4). CMS was reported in 70% of studies with 58% being from Europe. Upon normalization, the preoperative score ranged from 0.30 to 0.44. Europe (0.39), and North America (0.40) showed similar scores. The lowest and highest scores were seen in the Middle East (0.3) and Asia (0.44) respectively. Conclusion There is no standardized method to report outcomes in patients undergoing ARCR for MRCT. Great variation in usage exists in PROs which complicates data comparison between world regions. With normalization, baseline scores where similar among Asia, North America, and Europe, and lowest in the Middle East.
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Affiliation(s)
- Javier Ardebol
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
| | - Kassem Ghayyad
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
| | - Simon Hwang
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
| | - Theresa Pak
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
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Vecchini E, Ricci M, Elena N, Gasperotti L, Cochetti A, Magnan B. Rotator cuff repair with single row technique provides satisfying clinical results despite consistent MRI retear rate. J Orthop Traumatol 2022; 23:23. [PMID: 35508793 PMCID: PMC9068855 DOI: 10.1186/s10195-022-00642-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of shoulder arthroscopies is steadily increasing to treat glenohumeral joint disorders, among which the rotator cuff tear is the most common. The prevalence of this condition ranges from 13% to 37% in the general population without considering the number of asymptomatic patients. The gold standard procedure for rotator cuff repair is still undefined. The purpose of this study is to evaluate a population who underwent a single row (SR) rotator cuff repair and correlate their clinical results with MRI findings. MATERIALS AND METHODS Sixty-seven consecutive rotator cuff procedures were retrospectively selected. All patients were diagnosed with a full-thickness rotator cuff tear and subsequently treated with an arthroscopic SR repair technique. Each patient was clinically assessed with the DASH questionnaire and the Constant-Murley Score to grade their satisfaction. Moreover, rotator cuff repair integrity was evaluated by MRI and graded using the Sugaya score. RESULTS Mean follow-up was 19.5 ± 5.7 months. The mean Constant score was 82.8 ± 13.0 points, with 55 patients reporting excellent results. No patient scored less than 30 points, which could be deemed as unsatisfying. Meanwhile, on the DASH questionnaire, 6.1% of our patients rated their clinical outcome as unsatisfying, whereas 75.8% rated their outcome as excellent. Postoperative MRI classified 45 patients (83.3%) as either Sugaya type I, II, or III, whereas 9 patients (16.7%) presented a Sugaya type IV consistent with a full-thickness cuff retear. Of these nine patients, five (55.6%) and three (33.3%) reported excellent results for the Constant score and DASH questionnaire, respectively. The Mann-Whitney test reported that the retear group had worse scores than the intact repaired cuff group for pain (8.3 ± 5.0 versus 13.1 ± 3.4), Constant Score (68.8 ± 18.5 versus 83.1 ± 11.6), and DASH (66.2 ± 22.1 versus 44.2 ± 14.9). Still, range of motion (ROM) differences were not significant, except for better forward flexion in the intact group (p < 0.039). CONCLUSIONS Both groups with intact repaired and retorn cuffs showed improvement in their condition, but unexpectedly, there is no significant correlation between patient satisfaction and rotator cuff integrity. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Eugenio Vecchini
- Department of Orthopedics and Trauma Surgery, University of Verona, Verona, Italy
| | - Matteo Ricci
- Department of Orthopedics and Trauma Surgery, University of Verona, Verona, Italy
| | - Nicholas Elena
- Department of Orthopedics and Trauma Surgery, University of Verona, Verona, Italy
| | - Luca Gasperotti
- Department of Orthopedics and Trauma Surgery, University of Verona, Verona, Italy
| | - Andrea Cochetti
- Department of Orthopedics, Solatrix Hospital, Rovereto, Italy
| | - Bruno Magnan
- Department of Orthopedics and Trauma Surgery, University of Verona, Verona, Italy.
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Haleem A, Gohal C, Leroux T, Henry P, Alolabi B, Khan M. Primary arthroscopic repair of massive rotator cuff tears results in significant improvements with low rate of re-tear. Knee Surg Sports Traumatol Arthrosc 2021; 29:2134-2142. [PMID: 32748233 DOI: 10.1007/s00167-020-06190-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/27/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE To conduct a systematic review of outcomes following primary arthroscopic repair of chronic massive rotator cuff tears (RCTs) and to assess clinical outcomes and rates of repair failure. The authors' preferred treatment algorithm is also provided. METHODS Medline, Embase and PubMed were searched identifying articles pertaining to primary arthroscopic repair of chronic massive RCTs without the use of augmentation. Primary outcomes were patient-reported outcomes and the secondary outcome was the rate of repair failure. Outcome data were pooled and presented as well as assessment of study methodological quality. Data from studies reporting similar outcome measures were pooled when possible, and mean differences alongside confidence intervals and p values were reported, where appropriate. RESULTS Twenty-six studies (1405 participants) were included, with mean age of 62 years (range 52-69). The mean duration of symptoms pre-operatively was 31 months (range 6-40), and the mean follow-up time was 39 months (range 12-111). Complete repair was performed in 78% of patients and partial repair was performed in 22%. Both complete and partial repairs resulted in significant improvements with respect to pain, range of motion and functional outcome scores. The rate of repair failure for the total cohort was 36% at a mean follow-up of 31 months, and for the complete and partial repair subgroups the failure rate was 35% and 40%, respectively. CONCLUSIONS Arthroscopic repairs of chronic, massive RCTs, whether complete or partial, are associated with significant improvements in pain, function and objective outcome scores. The rate of repair failure is lower than previously reported, however, still high at 36%. The present paper finds that arthroscopic repair is still a viable treatment option for massive RCTs. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ahmed Haleem
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Chetan Gohal
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Timothy Leroux
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Patrick Henry
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Bashar Alolabi
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Moin Khan
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada.
- St. Joseph's Healthcare Hamilton, 50 Charlton Ave E., Mary Grace Wing, Room G807, Hamilton, ON, L8N 4A6, Canada.
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Besnard M, Freychet B, Clechet J, Hannink G, Saffarini M, Carrillon Y, Godenèche A. Partial and complete repairs of massive rotator cuff tears maintain similar long-term improvements in clinical scores. Knee Surg Sports Traumatol Arthrosc 2021; 29:181-191. [PMID: 32108260 DOI: 10.1007/s00167-020-05907-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 02/13/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE The authors have previously published early outcomes of arthroscopic repairs of 86 massive rotator cuff tears (mRCTs) and aimed to determine whether their clinical scores are maintained or deteriorate after 5 more years. METHODS Of the initial series of 86 shoulders, 2 had deceased, 16 lost to follow-up and 4 reoperated, leaving 64 for assessment. The repairs were complete in 44 and partial in 20, and 17 shoulders had pseudoparalysis. Preoperative assessment included absolute Constant score, shoulder strength, tear pattern, tendon retraction, and fatty infiltration. Patients were evaluated at 8.1 ± 0.6 years (range 7.1-9.3) using absolute and age-/sex-adjusted Constant score, subjective shoulder value (SSV), and simple shoulder test (SST). RESULTS Absolute Constant score was 80.0 ± 11.7 at first follow-up (at 2-5 years) but diminished to 76.7 ± 10.2 at second follow-up (at 7-10 years) (p < 0.001). Adjusted Constant score was 99.7 ± 15.9 at first follow-up and remained 98.8 ± 15.9 at second follow-up (ns). Comparing other outcomes revealed a decrease in strength over time (p < 0.001) but no change in pain, SSV or SST. Partially-repaired shoulders had lower strength at both follow-ups (p < 0.05). Pseudoparalytic shoulders had lower absolute and adjusted Constant score at second follow-up (p < 0.05), but their net improvements in absolute Constant score were higher (p = 0.014). CONCLUSIONS Both partial and complete arthroscopic repairs grant satisfactory long-term outcomes for patients with mRCTs, regardless of their tear pattern, fatty infiltration and presence of pseudoparalysis. Absolute Constant score decreased over time for both repair types, but adjusted Constant score remained stable, suggesting that decline is due to aging rather than tissue degeneration. The clinical relevance of this study is that arthroscopic repair should be considered for mRCTs, even if not completely repairable, rather than more invasive and/or risky treatments, such as reverse shoulder arthroplasty. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marion Besnard
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Benjamin Freychet
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Julien Clechet
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Gerjon Hannink
- Department of Operating Rooms and MITeC Technology Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Yannick Carrillon
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Arnaud Godenèche
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
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What is wrong in comparison of single- and double-row repairs in rotator cuff tears? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1589-1590. [PMID: 31175449 DOI: 10.1007/s00590-019-02462-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
When the meta-analysis studies comparing single-row (SR) and double-row (DR) repair methods in the literature are examined, the SR method is unsuccessful in re-tears especially in large and massive tears. In this study, I was able to determine that, except for Barber's work, double-loaded anchors were used for the SR repair. Particularly, low tension of the repaired muscle-tendon unit is important in terms of repairable massive retracted cuff tears. For this reason, medially placed triple-loaded anchors were developed. Again, the SR ripstop method using suture tape, in terms of re-tears and success rates, is similar to the double-row suture bridge method. Based on current systemic review and meta-analysis studies, it is not appropriate to adapt SR and DR rotator cuff repair results to today's conditions.
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