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Kara M, Kara Ö, Durmuş ME, Analay P, Şener FE, Çıtır BN, Korkmaz GO, Ünlü Z, Tiftik T, Gürçay E, Mülkoğlu C, Yalçınkaya B, Bağcıer F, Aksakal MF, Erdoğan K, Sertçelik A, Çakır B, Kaymak B, Özçakar L. The Relationship Among Probable SARCopenia, Osteoporosis and SuprasPinatus Tendon Tears in Postmenopausal Women: The SARCOSP Study. Calcif Tissue Int 2024; 114:340-347. [PMID: 38342790 PMCID: PMC10957602 DOI: 10.1007/s00223-024-01183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/05/2024] [Indexed: 02/13/2024]
Abstract
We aimed to investigate the relationship among probable sarcopenia, osteoporosis (OP) and supraspinatus tendon (SSP) tears in postmenopausal women. Postmenopausal women screened/followed for OP were recruited. Demographic data, comorbidities, exercise/smoking status, and handgrip strength values were recorded. Probable sarcopenia was diagnosed as handgrip strength values < 20 kg. Achilles and SSP thicknesses were measured using ultrasound. Among 1443 postmenopausal women, 268 (18.6%) subjects had SSP tears. Unilateral tears were on the dominant side in 146 (10.1%) and on the non-dominant side in 55 women (3.8%). In contrast to those without, women with SSP tears had older age, lower level of education, thinner SSP and lower grip strength (all p < 0.05). In addition, they had higher frequencies of hypertension, hyperlipidemia, DM, OP and probable sarcopenia, but lower exercise frequency (all p < 0.05). Binary logistic regression modeling revealed that age [odds ratio (OR): 1.046 (1.024-1.067 95% CI)], hypertension [OR: 1.560 (1.145-2.124 95% CI)], OP [OR: 1.371 (1.022-1.839 95% CI)] and probable sarcopenia [OR: 1.386 (1.031-1.861 95% CI)] were significant predictors for SSP tears (all p < 0.05). This study showed that age, presence of hypertension, probable sarcopenia and OP were related with SSP tears in postmenopausal women. To this end, although OP appeared to be related to SSP tears, SSP tear/thickness evaluation can be recommended for OP patients, especially those who have other risk factors such as older age, higher BMI, hypertension, and probable sarcopenia.
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Affiliation(s)
- Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Özgür Kara
- Department of Physical Medicine and Rehabilitation, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Mahmut Esad Durmuş
- Department of Physical Medicine and Rehabilitation, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Pelin Analay
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.
| | - Fatıma Edibe Şener
- Department of Physical Medicine and Rehabilitation, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Beyza Nur Çıtır
- Department of Physical Medicine and Rehabilitation, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Gizem Olgu Korkmaz
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Zeliha Ünlü
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Tülay Tiftik
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - Eda Gürçay
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - Berkay Yalçınkaya
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Fatih Bağcıer
- Department of Physical Medicine and Rehabilitation, Basaksehir Cam Sakura Hospital, Istanbul, Turkey
| | - Mahmud Fazıl Aksakal
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Kübra Erdoğan
- Department of Physical Medicine and Rehabilitation, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Ahmet Sertçelik
- Department of Public Health, Division of Epidemiology, Hacettepe University Medical School, Ankara, Turkey
| | - Banu Çakır
- Department of Public Health, Division of Epidemiology, Hacettepe University Medical School, Ankara, Turkey
| | - Bayram Kaymak
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Green CK, Scanaliato JP, Sandler AB, Patrick CM, Dunn JC, Parnes N. Outcomes of Concomitant Glenohumeral Stabilization After Arthroscopic Rotator Cuff Repair in Military Patients Younger Than 40 Years. Orthop J Sports Med 2024; 12:23259671231218970. [PMID: 38435718 PMCID: PMC10906051 DOI: 10.1177/23259671231218970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 03/05/2024] Open
Abstract
Background While concomitant rotator cuff and inferior labral tears are relatively uncommon in young civilians, military populations represent a unique opportunity to study this injury pattern. Purpose To (1) evaluate the long-term outcomes after combined arthroscopic rotator cuff and inferior labral repair in military patients <40 years and (2) compare functional outcomes with those after isolated arthroscopic rotator cuff repair. Study Design Cohort study; Level of evidence, 3. Methods Military patients who underwent arthroscopic rotator cuff repair between January 2011 and December 2016 and had a minimum of 5-year follow-up data were included in this study. The patients were categorized into those who had undergone combined arthroscopic rotator cuff and inferior labral repair (RCIL cohort) and those who had isolated arthroscopic rotator cuff repair (ARCR cohort). Pre- and postoperative outcome measures-visual analog scale for pain, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons shoulder score, Rowe Instability Score, and range of motion-were compared between the groups. Results A total of 50 shoulders (27 in the RCIL cohort and 23 in the ARCR cohort) were assessed. The RCIL and ARCR groups were similar in terms of age (mean, 33.19 years [range, 21-39 years] vs 35.39 years [range, 26-39 years], respectively) and sex (% male, 88.46% vs 82.61%, respectively). All patients were active-duty military at the time of surgery. The mean final follow-up was at 106.93 ± 16.66 months for the RCIL group and 105.70 ± 7.52 months for the ARCR group (P = .75). There were no differences in preoperative outcome scores between groups. Postoperatively, both groups experienced statistically significant improvements in all outcome scores (P < .0001 for all), and there were no significant group differences in any final postoperative outcome measures. At the final follow-up, 26 (96.30%) patients in the RCIL cohort and 20 (86.96%) in the ARCR cohort had returned to unrestricted active-duty military service (P = .3223). Conclusion The study findings indicate that concomitant glenohumeral stabilization does not prevent worse outcomes after arthroscopic rotator cuff repair in this military cohort. Combined repair produced statistically and clinically significant improvements in outcome scores at the long-term follow-up, indicating that simultaneous repair of combined lesions was an appropriate treatment option in this patient population.
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Affiliation(s)
- Clare K Green
- The George Washington University, School of Medicine and Health Services, Washington, District of Columbia, USA
| | - John P Scanaliato
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois, USA
| | - Alexis B Sandler
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, Department of Orthopaedic Surgery, El Paso, Texas, USA
| | - Cole M Patrick
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, Department of Orthopaedic Surgery, El Paso, Texas, USA
| | - John C Dunn
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, Department of Orthopaedic Surgery, El Paso, Texas, USA
| | - Nata Parnes
- Carthage Area Hospital/Claxton-Hepburn Medical Center, Department of Orthopaedic Surgery, Carthage, New York, USA
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Wang H, Cao X, Li B, Ning T, Cao Y. Clinical Approach to Inconclusive Subscapularis Tear Diagnosis: a Meta-analysis. Int J Sports Med 2024; 45:85-94. [PMID: 37820692 PMCID: PMC10834114 DOI: 10.1055/a-2158-8278] [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: 04/05/2023] [Accepted: 08/08/2023] [Indexed: 10/13/2023]
Abstract
To identify factors associated with subscapularis (SSC) tears and provide a theoretical basis for clinical diagnosis, we included studies related to subscapularis tears published before February 1, 2023. We screened for six predictors across previous studies for the meta-analysis. The predictors included age, sex, coracoid overlap (CO), coracohumeral distance (CHD), impairment of the long head of the biceps tendon (LHB), and dominant arm. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the studies. The risk ratios (RRs) and the weighted mean differences (WMDs) were used to evaluate the effect size of categorical variables and continuous variables, respectively. The Egger test was used to assess the publication bias of the studies. Ten studies were included from seven countries. A total of 2 126 patients were enrolled, of whom 1 041 had subscapularis tears and 1 085 did not. The study showed that age (WMD, 4.23 [95% CI, 2.32-6.15]; P<.00001), coracoid overlap (WMD, 1.98 [95% CI, 1.55-2.41]; P<.00001), coracohumeral distance(WMD, -1.03 [95% CI, -1.17- -0.88]; P<.00001), and an injury of the long head of the biceps tendon (RR, 4.98 [95% CI, 3.75-6.61]; P<.00001) were risk factors for subscapularis tears. These risk factors can help clinicians identify subscapularis tears early and select appropriate interventions. The level of evidence is 3.
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Affiliation(s)
- Hao Wang
- Orthopedics, Peking University First Hospital, Beijing,
China
| | - Xiangyu Cao
- Orthopedics, Peking University Third Hospital, Beijing,
China
| | - Baoqiang Li
- Orthopedics, Beijing Chaoyang Hospital, Beijing, China
| | - Taiguo Ning
- Orthopedics, Peking University First Hospital, Beijing,
China
| | - Yongping Cao
- Orthopedics, Peking University First Hospital, Beijing,
China
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Liu J, Wang W, Wang Z, Wu Q, Zhu Y, Wu W, Zhou Q. The Association between Dietary Habits and Rapid Postoperative Recovery of Rotator Cuff Repair. Nutrients 2023; 15:4587. [PMID: 37960241 PMCID: PMC10648498 DOI: 10.3390/nu15214587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Some nutritional factors have been suggested to improve postoperative outcomes in rotator cuff (RC) repair, but dietary effects on the recovery speed after the surgery remain undefined. To investigate the potential roles of dietary habits in this context, we analyzed the 12-month follow-up data of 55 patients with RC repair and found that these patients could be categorized into a rapid recovery group (n = 35) and slow recovery group (n = 20) according to their postoperative recovery patterns. Group-based logistic analysis revealed that habitual intakes of meat (OR = 1.84, 95%CI, 1.22-2.76, p = 0.003), fruits (OR = 2.33, 95%CI, 1.26-5.67, p = 0.01), and wheat-flour foods (OR = 1.62, 95%CI, 1.2-2.25, p = 0.002) were significantly associated with rapid recovery. Moreover, among all intakes of wheat-flour foods, intakes of steamed and boiled flour products were also associated with rapid recovery. Further mediation analysis showed that eosinophilic granulocytes (EOs) significantly mediated the association between rapid RC recovery and the habitual intakes of meat (mediation proportion = 17.5%, P-mediation < 0.0001), fruits (17.9%, p < 0.0001), and wheat-flour foods (11.4%, p < 0.0001). Thus, our study suggests that certain dietary habits play beneficial roles in the context of postoperative recovery for RC repair.
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Affiliation(s)
- Jiaxin Liu
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China; (J.L.); (W.W.); (Y.Z.)
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai 200438, China; (Z.W.); (Q.W.)
- Rugao Research Institute of Longevity and Aging, Fudan University, Rugao 226500, China
| | - Wei Wang
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China; (J.L.); (W.W.); (Y.Z.)
| | - Zhifeng Wang
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai 200438, China; (Z.W.); (Q.W.)
- Rugao Research Institute of Longevity and Aging, Fudan University, Rugao 226500, China
| | - Qingyun Wu
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai 200438, China; (Z.W.); (Q.W.)
- Rugao Research Institute of Longevity and Aging, Fudan University, Rugao 226500, China
| | - Yunli Zhu
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China; (J.L.); (W.W.); (Y.Z.)
| | - Weicheng Wu
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai 200438, China; (Z.W.); (Q.W.)
- Rugao Research Institute of Longevity and Aging, Fudan University, Rugao 226500, China
| | - Qi Zhou
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China; (J.L.); (W.W.); (Y.Z.)
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Green CK, Scanaliato JP, Sandler AB, Adler A, Dunn JC, Parnes N. Simultaneous Arthroscopic Rotator Cuff Repair and Glenoid Microfracture in Active-Duty Military Patients Younger Than 50 Years: Outcomes at Midterm Follow-up. Orthop J Sports Med 2023; 11:23259671231202282. [PMID: 37859753 PMCID: PMC10583522 DOI: 10.1177/23259671231202282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 10/21/2023] Open
Abstract
Background While concomitant full-thickness rotator cuff tears and glenoid osteochondral defects are relatively uncommon in younger patients, military patients represent a unique opportunity to study this challenging injury pattern. Purpose/Hypothesis To compare the outcomes of young, active-duty military patients who underwent isolated arthroscopic rotator cuff repair (ARCR) with those who underwent ARCR plus concurrent glenoid microfracture (ARCR+Mfx). It was hypothesized that ARCR+Mfx would produce significant improvements in patient-reported outcome measures. Study Design Cohort study; Level of evidence, 3. Methods This was a retrospective analysis of consecutive active-duty military patients from a single base who underwent ARCR for full-thickness rotator cuff tears between January 2012 and December 2020. All patients were <50 years and had minimum 2-year follow-up data. Patients who underwent ARCR+Mfx were compared with those who underwent isolated ARCR based on the visual analog scale (VAS) for pain, Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) shoulder score, and range of motion. Results A total of 88 patients met the inclusion criteria for this study: 28 underwent ARCR+Mfx and 60 underwent isolated ARCR. The mean final follow-up was 74.11 ± 33.57 months for the ARCR+Mfx group and 72.87 ± 11.46 months for the ARCR group (P = .80). There were no differences in baseline patient characteristics or preoperative outcome scores between groups. Postoperatively, both groups experienced statistically significant improvements in all outcome scores (P < .0001 for all). However, the ARCR+Mfx group had significantly worse VAS pain (1.89 ± 2.22 vs 1.03 ± 1.70; P = .05), SANE (85.46 ± 12.99 vs 91.93 ± 12.26; P = .03), and ASES (86.25 ± 14.14 vs 92.85 ± 12.57; P = .03) scores. At the final follow-up, 20 (71.43%) patients in the ARCR+Mfx group and 53 (88.33%) patients in the ARCR group were able to remain on unrestricted active-duty military service (P = .05). Conclusion Concomitant ARCR+Mfx led to statistically and clinically significant improvements in patient-reported outcome measures at the midterm follow-up. However, patients who underwent ARCR+Mfx had significantly worse outcomes and were less likely to return to active-duty military service than those who underwent isolated ARCR. The study findings suggest that ARCR+Mfx may be a reasonable option for young, active patients who are not candidates for arthroplasty.
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Affiliation(s)
- Clare K. Green
- School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - John P. Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alexis B. Sandler
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Adam Adler
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA
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Gumina S, Mezzaqui L, Aimino R, Rionero M, Spagnoli A, Campagna V, Candela V. Aetiopathogenesis of Rotator Cuff Tear in Patients Younger than 50 Years: Medical Conditions Play a Relevant Role. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050998. [PMID: 37241230 DOI: 10.3390/medicina59050998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Studies on rotator cuff tears (RCT) in patients younger than 50 years have focused on the post-operative outcomes. Little is known about cuff tear etiopathogenesis, although it is a common belief that most tears are due to trauma. We have retrospectively verified the prevalence of medical conditions, whose role in tendon degeneration development have been widely demonstrated, in a group of patients younger than 50 years with postero-superior RCT. Materials and Methods: 64 patients [44M-20F; mean age (SD): 46.90 (2.80)] were enrolled. Personal data, BMI, smoking habit, diseases (diabetes, arterial hypertension, hypercholesterolaemia, thyroid diseases, and chronic obstructive pulmonary disease) were registered. The possible triggering cause and the affected side and tear dimensions were recorded, and statistical analysis was then performed. Results: 75% of patients had one or more diseases and/or a smoking habit for more than 10 years. In the remaining 25%, only four patients referred had had a traumatic event, while in the other eight patients, both medical condition and trauma were registered. The presence of two or more diseases did not affect RCT size. Conclusions: In our series, three quarters of patients with RCT had a smoking habit or medical conditions predisposing them to a tendon tear; therefore, the role of trauma in RCT onset in patients younger than 50 years is markedly resized. It is plausible that in the remaining 25%, RCT may be due to trauma or to genetic or acquired degeneration. Level of Evidence: IV.
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Affiliation(s)
- Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00100 Rome, Italy
- Icot Latina, 00100 Latina, Italy
| | | | | | | | - Alessandra Spagnoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00100 Rome, Italy
| | - Vincenzo Campagna
- Orthopaedics and Traumatology Unit, Celio Military Hospital, 00100 Rome, Italy
| | - Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00100 Rome, Italy
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Scanaliato JP, Eckhoff MD, Dunn JC, Czajkowski H, Fink WA, Parnes N. Long-term Results of Arthroscopic Repair of Full-Thickness Traumatic Rotator Cuff Tears in Active Duty Military Patients Under the Age of 40 Years. Am J Sports Med 2022; 50:2753-2760. [PMID: 35862618 DOI: 10.1177/03635465221107371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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 is an effective procedure through which to decrease pain and increase strength, with favorable long-term outcomes demonstrated in older patient populations with full-thickness rotator cuff tears. The long-term outcomes after this procedure in younger, higher-demand patients, however, is not as clearly defined. PURPOSE To report on the long-term outcomes after arthroscopic rotator cuff repair of traumatic full-thickness rotator cuff tears in active duty military patients under the age of 40 years at the time of surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS Preoperative, midterm, and final evaluations were collected, including scores on the visual analog scale for pain, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons shoulder form. A total of 42 patients were screened for inclusion: 3 underwent additional surgical procedures on the operative shoulder and 2 were lost to follow-up, leaving 37 patients with mean follow-up of 104.51 months available for analysis. A subgroup analysis was performed comparing outcomes between patients with Southern California Orthopaedic Institute grade 1 or 2 tears and those with grade 3 or 4 tears. RESULTS At final follow-up, pain per the visual analog scale decreased to 1.16 from 8.03 (P < .0001); the Single Assessment Numeric Evaluation score increased to 87.32 from 48.24 (P < .0001); and the American Shoulder and Elbow Surgeons score increased to 88.68 from 41.00 (P < .0001). There was no statistically significant difference in outcome scores or range of motion between midterm and final follow-up. Improvement in outcome scores and range of motion at final follow-up did not vary between patients with small and large tears. Of 42 patients, 37 (88.1%) were able to return to full unrestricted active duty and sporting activity, while 5 (11.9%) were medically separated from the military. CONCLUSION Active duty military patients under the age of 40 years with traumatic full-thickness rotator cuff tears had statistically and clinically significant increases in outcome scores and decreases in pain after arthroscopic rotator cuff repair at long-term follow-up.
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Affiliation(s)
| | | | - John C Dunn
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | - Walter A Fink
- Carson Tahoe Health Administration, Carson City, Nevada, USA
| | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA.,Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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Effect of Physical Therapy and Rehabilitation Timing on Rotator Cuff Repair Revisions and Capsulitis. J Am Acad Orthop Surg 2022; 30:e444-e452. [PMID: 35772092 DOI: 10.5435/jaaos-d-21-00899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/03/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION One variable that could potentially affect failure of a rotator cuff repair (RCR) is the timing of beginning physical therapy (PT) after the procedure. Although many studies have demonstrated decreased stiffness with beginning PT early, studies have also demonstrated that early PT increases repair failure. The goal of this study was to identify revision surgery and capsulitis rates after RCRs from an available database and determine whether an association was present with the timing of PT post-RCR. METHODS Medicare patients within the PearlDiver database who underwent RCR were stratified based on the timing of their first PT session postoperatively, and revision surgery and capsulitis rates were determined among the groups for both open and arthroscopic RCR. Demographics and comorbidities of the cohort were also used to formulate a multivariate analysis for revision surgery rate. RESULTS The cohort consisted of 64,842 patients who underwent RCR and started PT within 13 weeks of surgery. Starting PT within 1 week postoperatively resulted in a significantly higher revision surgery rate compared with starting PT in weeks 2 to 5, 6 to 9, or 10 to 13 (6.9% vs. 3.6% among all other groups, P = <0.001). The multivariate analysis for revision surgery further demonstrated that starting PT within 1 week postoperatively was associated with a significantly higher rate of revision surgery compared with beginning PT after 1 week (OR = 2.086, P < 0.001). No association was found between timing of beginning PT and capsulitis rates. CONCLUSION In the Medicare patient cohort, beginning PT within 1 week postoperatively was associated with a significantly higher revision surgery rate; however, no associated benefit was noted in capsulitis rates for beginning PT early. This calls into question the use of an early passive range of motion protocol for older patient cohort; however, further studies should be completed to conclusively determine the most efficacious time to begin rehabilitation post-RCR. LEVEL OF EVIDENCE Level III.
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Zhao J, Luo M, Liang G, Pan J, Han Y, Zeng L, Yang W, Liu J. What Factors Are Associated with Symptomatic Rotator Cuff Tears: A Meta-analysis. Clin Orthop Relat Res 2022; 480:96-105. [PMID: 34424222 PMCID: PMC8673964 DOI: 10.1097/corr.0000000000001949] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/02/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff tears are common. A previous systematic review reported on factors associated with rotator cuff tears; however, it included relatively few studies and few variables, and in addition, it had considerable heterogeneity. To identify the factors associated with symptomatic rotator cuff tears and to help guide clinicians to potentially modifiable factors, we felt a broader and more inclusive meta-analysis would be useful. QUESTIONS/PURPOSES In this systematic review and meta-analysis, we asked what (1) demographic, (2) disease, and (3) imaging factors are associated with symptomatic rotator cuff tears? METHODS PubMed, Embase, and Web of Science were searched, and the search period were from the inception of each database through February 2021. The keywords included "risk factor," "rotator cuff injury," "rotator cuff tears," and "rotator cuff tendinitis." All comparative studies on symptomatic rotator cuff tears were included. We considered that the diagnosis of rotator cuff tear could be made by any imaging tool (MRI or ultrasound). We considered either partial- or full-thickness tears to be a rotator cuff tear. No language restrictions were applied. Twenty-six articles from 14 countries involving 9809 individuals, consisting of 3164 patients and 6645 controls, were included. The Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality (AHRQ) scale were used to evaluate the risk of bias of the included studies, and the highest scores were 9 and 11, respectively. The Newcastle-Ottawa Scale was used for retrospective comparative studies, and the AHRQ was used to evaluate prospective comparative studies. The eight retrospective comparative studies we included were scored from 4 to 9. The quality score of the 18 prospective comparative studies ranged from 6 to 9. Publication bias was explored using the Egger test. Heterogeneity was estimated using the I2 value. If there was no heterogeneity (I2 ≤ 50%), a fixed-effects model was used to determine the overall effect size; if there was heterogeneity (I2 > 50%), a random-effects model was used to merge the effect values. A meta-analysis was performed with RevMan 5.3, and the risk ratio (RR) and weighted mean difference of related factors were calculated. RESULTS Our meta-analysis identified the following demographic factors associated with an increased risk of rotator cuff tears: older age (mean difference 3.1 [95% CI 1.4 to 4.8]; p < 0.001), greater BMI (mean difference 0.77 [95% CI 0.37 to 1.17]; p < 0.001), smoking (RR 1.32 [95% CI 1.17 to 1.49]; p < 0.001), dominant arm (RR 1.15 [95% CI 1.06 to 1.24]; p < 0.001), greater height (mean difference 0.9 [95% CI 0.4 to 1.4]; p < 0.001), and heavier weight (mean difference 2.24 [95% CI 0.82 to 3.66]; p = 0.002). Regarding disease factors, we found that traumatic events (RR 1.91 [95% CI 1.40 to 2.54]; p < 0.001) and hypertension (RR 1.50 [95% CI 1.32 to 1.70]; p < 0.001) were associated with symptomatic rotator cuff tears. Regarding imaging factors, we found that the following three factors were associated with symptomatic rotator cuff tears: greater acromion index (mean difference 0.11 [95% CI 0.06 to 0.16]; p < 0.001), greater critical shoulder angle (mean difference 1.9 [95% CI 1.5 to 2.3]; p < 0.001), and smaller glenoid version angle (mean difference -1.3 [95% CI -1.9 to -0.8]; p < 0.001). We found no association between the patient's sex or the presence or absence of thyroid disease and the likelihood of a rotator cuff tear being present. CONCLUSION This study identified several factors associated with symptomatic rotator cuff tears, including blood glucose, blood pressure, weight, and smoking. Clinicians may seek to modify these factors, possibly in patients with symptomatic rotator cuff tears, but also in symptomatic patients who have not yet been diagnosed with rotator cuff tears because there would be no harm or risk associated with modifying any of the factors we identified. Future research should further study whether addressing these factors can delay the progression and size of rotator cuff tears.Level of Evidence Level III, prognostic study.
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Affiliation(s)
- Jinlong Zhao
- The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guagnzhou, China
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
| | - Minghui Luo
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Guihong Liang
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Jianke Pan
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Yanhong Han
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Lingfeng Zeng
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Weiyi Yang
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Jun Liu
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
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Zhao J, Luo M, Liang G, Wu M, Pan J, Zeng LF, Yang W, Liu J. Risk Factors for Supraspinatus Tears: A Meta-analysis of Observational Studies. Orthop J Sports Med 2021; 9:23259671211042826. [PMID: 34660827 PMCID: PMC8516389 DOI: 10.1177/23259671211042826] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/08/2021] [Indexed: 12/19/2022] Open
Abstract
Background: The pathogenesis of rotator cuff tears remains unclear, and there is a lack of high-quality evidence-based research on the risk factors for supraspinatus tears. Purpose: To explore 10 potential risk factors for supraspinatus muscle tears. Study Design: Systematic review; Level of evidence, 3. Methods: This review was conducted according to the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) guidelines. PubMed, Embase, and Web of Science were searched for cohort, case-control and cross-sectional studies published before January 2021 on supraspinatus tears. The following potential risk factors were analyzed: age, body mass index, male sex, female sex, arm dominance, diabetes mellitus, smoking, hypertension, thyroid disease, and the critical shoulder angle (CSA). Risk ratios (RRs) or weighted mean differences (WMDs) of related risk were calculated. The Egger test was used to evaluate publication bias. Results: A total of 9 articles from 8 countries were included; among the 3240 patients, 687 were included in the supraspinatus tear group, and 2553 were included in the nonsupraspinatus tear group. The meta-analysis showed that older age (WMD, 3.36 [95% confidence interval (CI), 0.53-6.20]; P = .02), male sex (RR, 0.87 [95% CI, 0.78-0.97]; P = .01), smoking (RR, 2.21 [95% CI, 1.56-3.14]; P < .00001), diabetes (RR, 1.67 [95% CI, 1.03-2.70]; P = .04), hypertension (RR, 1.51 [95% CI, 1.16-1.97]; P = .002), and the CSA (WMD, 2.25 [95% CI, 1.39-3.12]; P < .00001) were risk factors for supraspinatus tears. Conclusion: Older age, male sex, smoking, diabetes, hypertension, and a higher CSA were found to be risk factors for supraspinatus tears in this meta-analysis review. Identifying risk factors for supraspinatus tears early can help clinicians identify these high-risk patients and choose appropriate treatments.
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Affiliation(s)
- Jinlong Zhao
- The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.,Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, People's Republic of China
| | - Minghui Luo
- Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, People's Republic of China.,The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China
| | - Guihong Liang
- Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, People's Republic of China.,The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China
| | - Ming Wu
- The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.,Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, People's Republic of China
| | - Jianke Pan
- Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, People's Republic of China.,The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China
| | - Ling-Feng Zeng
- Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, People's Republic of China.,The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China
| | - Weiyi Yang
- Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, People's Republic of China.,The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China
| | - Jun Liu
- Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, People's Republic of China.,The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China.,Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, People's Republic of China
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11
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Patients who have undergone rotator cuff repair experience around 75% functional recovery at 6 months after surgery. Knee Surg Sports Traumatol Arthrosc 2021; 29:2220-2227. [PMID: 32347347 DOI: 10.1007/s00167-020-06019-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The purposes of this study were to (1) evaluate changes in recovery patterns [i.e., clinical outcomes, range of motion (ROM)] in the first 12 months following surgery, (2) identify potential prognostic factors of early clinical outcomes after rotator cuff repair (RCR). METHODS The study cohort included 344 consecutive patients treated with RCR. Data were collected prospectively and included pre- and perioperative variables. Univariate and multivariate linear regression analyses for various parameters including demographics, pre- and perioperative variables were used to predict shoulder function at 12-month follow-up, as measured by clinical outcomes and ROM. RESULTS Significant improvement in all clinical scores and ROM were noted during serial follow-ups after RCR (all p < 0.001). Multivariate analysis revealed that female sex, older age, more anchors, diabetes mellitus, and preoperative stiffness were independently associated with worse shoulder function 3 months after RCR. Including the 3 months factors, heavy labor, use of the suture-bridge technique, and large tears were also independently associated with worse outcomes 6 months after surgery. Heavy labor, suture-bridge technique, diabetes mellitus, and preoperative stiffness were associated with significantly worse functional outcomes at 12 months after surgery (all p < 0.05). CONCLUSION Functional recovery based on clinical outcomes (i.e., UCLA, ASES scores) showed approximately 60% of ultimate recovery at 3 months and approximately 75% recovery at 6 months after RCR. Female sex, diabetes mellitus, preoperative stiffness, a larger number of anchors, suture bridge technique, heavy labor, old age and, larger tears were prognostic factors of poor clinical results or ROM in the short-term follow-up intervals. Knowledge of these prognostic factors may lead to improved insight for physicians to predict the pattern of the recovery and patient expectations accordingly. LEVEL OF EVIDENCE III, A cohort study.
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12
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Wessel LE, Eliasberg CD, Bowen E, Sutton KM. Shoulder and elbow pathology in the female athlete: sex-specific considerations. J Shoulder Elbow Surg 2021; 30:977-985. [PMID: 33220412 DOI: 10.1016/j.jse.2020.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/08/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Abstract
Unique biologic and biomechanical aspects of the female body make women more prone to certain orthopedic injuries. Sex differences are well understood with regard to certain orthopedic pathologies such as anterior cruciate ligament injury, hallux valgus, carpal tunnel, and carpometacarpal joint arthritis; however, sex differences are less commonly discussed with regard to shoulder and elbow pathology. The purpose of this review is to elucidate sex differences specific to sports-related shoulder and elbow injuries in the female athlete population.
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Affiliation(s)
- Lauren E Wessel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Claire D Eliasberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Edward Bowen
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Karen M Sutton
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
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13
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Abstract
Purpose Arthroscopic rotator cuff repair (ARCR) for relatively small rotator cuff tears (RCTs) has shown promising results; however, such surgery for larger tears often results in failure and poor clinical outcomes. One cause of failure is over-tension at the repair site that will be covered with the tendon stump. Reports on the clinical outcomes using ARCR with tension ≤ 30 N are lacking. This study aimed to evaluate ARCR outcomes and failure rates using less tension (30 N) and to assess the prognostic factors for failure. Methods Our study group comprised of 118 patients who underwent ARCR for full-thickness RCTs with full tendon stump coverage of the footprint with a tension of ≤ 30 N, measured using a tension meter; no additional procedures, such as margin convergence or footprint medialisation, were performed. The failure rate was calculated, and the prognostic factor for failure was assessed using multivariate regression analyses. Results There were seven cases of failure in the study group. Postoperatively, flexion and internal rotation ranges of motion, acromiohumeral interval, muscle strength, and clinical results improved significantly. Using multivariate regression analyses, intraoperative concomitant subscapularis tendon lesion and pre-operative infraspinatus tendon retraction, assessed using radial-sequence magnetic resonance imaging, were significantly correlated with post-ARCR failure using less tension (p = 0.030 and p = 0.031, respectively). Conclusion ARCR is likely to succeed for RCTs that can be extracted using tension ≤ 30 N. However, cases with more severe subscapularis tendon lesions and those with high infraspinatus tendon retraction may show surgical failure. Level of evidence LEVEL IV Retrospective case series
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14
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Wang C, Yang P, Zhang H, Liu W, Zhang Y, Yu T, Zhao X, Qi C. [Effect of unilateral rotator cuff repair on the contralateral shoulder in patients with bilateral rotator cuff tears]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1399-1404. [PMID: 33191697 DOI: 10.7507/1002-1892.202006045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effect of unilateral rotator cuff repair on the contralateral shoulder in patients with bilateral rotator cuff tears. Methods A clinical data of 46 patients with bilateral rotator cuff tears met the criteria between May 2016 and May 2019 was retrospectively analyzed. Of 46 patients, 23 patients underwent bilateral conservative treatment (conservation group), 23 patients underwent unilateral arthroscopic rotator cuff repair, and conservative treatment on the contralateral side (operation group). There was no significant difference in gender, age, disease duration, degree of rotator cuff tear, and comorbidities between 2 groups ( P>0.05). Before operation and at 6 and 12 months after operation, the degree of the rotator cuff tear was measured by MRI, and the shoulder function was evaluated by the visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) (forward flexion, external rotation, external rotation at 90° of abduction, and internal rotation). The evaluation results of the non-surgical side of shoulders in the operation group were compared with one side of shoulders in the conservation group. Results All incisions healed by first intention without any complication after operation. All patients were followed up 12 months. MRI reexamination showed that the degree of rotator cuff tear of the contralateral shoulder in the operation group increased significantly after operation ( P<0.05). There was no significant difference between the operation group and the conservation group before operation ( P>0.05), but the rotator cuff tear of the contralateral shoulder in the operation group was more serious than that of the conservation group at 6 and 12 months after operation ( P<0.05). At 6 and 12 months after operation, the VAS score, UCLA score, and ASES score significantly improved when compared with the preoperative scores in 2 groups ( P<0.05). There was no significant difference in the VAS score, UCLA score, and ASES score between 2 groups before operation ( P>0.05). The function scores in the conservation group were better than those in the operation group at 6 and 12 months after operation ( P<0.05). There were significant differences in the ROM of shoulder between pre- and post-operation in 2 groups ( P<0.05). And there was no significant difference between 2 groups at pre- and post-operation ( P>0.05). Conclusion For patients with bilateral rotator cuff tears, the unilateral rotator cuff repair can aggravate the rotator cuff tear of contralateral shoulder.
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Affiliation(s)
- Chen Wang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Pu Yang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Hui Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Weijie Liu
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Yi Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Tengbo Yu
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Xia Zhao
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Chao Qi
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
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Haveri S, Patil KS, Uppin RB, Patil S, Putti BB. A Cross-Sectional Study on Novel-Risk Factors Associated with Supraspinatus Tendon Tear. Indian J Orthop 2020; 55:457-463. [PMID: 33927825 PMCID: PMC8046856 DOI: 10.1007/s43465-020-00222-3] [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] [Received: 02/16/2020] [Accepted: 08/02/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Several patient-related factors have been identified which are responsible for the development of rotator cuff tears. The purpose of the study was to assess various parameters which can be risk factors for the development of supraspinatus tendon tear. METHODS A total of 100 patients with symptomatic rotator cuff tear, aged > 18 years, of either gender, presenting to the outpatient department were included in this cross-sectional study. Magnetic resonance imaging was done and based on its results; patients were identified for the type of tear. Demographic, clinical, and biochemical factors affecting the tears were assessed using logistic regression analysis. RESULTS Factors such as age, gender, pain radiation, night pain, and analgesic intake had significant association with supraspinatus tendon tears. CONCLUSION "Pain radiation" and "Analgesic intake" were two new parameters found associated with the supraspinatus tendon tears. New parameters that have been assessed as risk factors will help in better understanding of supraspinatus tendon tears.
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Affiliation(s)
- Sameer Haveri
- Department of Orthopedics, JNMC, Belagavi, 590010 India
| | | | | | - Santosh Patil
- Department of Radiology, JNMC, Belagavi, 590010 India
| | - B. B. Putti
- Department of Orthopedics, KLE-USM, Belagavi, 590010 India
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Jensen AR, Taylor AJ, Sanchez-Sotelo J. Factors Influencing the Reparability and Healing Rates of Rotator Cuff Tears. Curr Rev Musculoskelet Med 2020; 13:572-583. [PMID: 32681307 DOI: 10.1007/s12178-020-09660-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF THE REVIEW To discuss tear- and patient-related factors that influence the healing potential of rotator cuff tears and to clarify the terminology surrounding this topic. RECENT FINDINGS Over the last few years, further insight has been gained regarding rotator cuff tear features that are associated with poor healing rates after rotator cuff repair. Some of these features have been incorporated in prediction models developed to accurately predict rotator cuff healing rates utilizing preoperative risk factors weighted by importance. Rotator cuff tears may be considered functionally irreparable based on their size, chronicity, absence of adequate tendon length, atrophy, and fatty infiltration. Furthermore, advanced age, use of tobacco products, diabetes, and other patient-related factors may impair tendon healing. Careful analysis and discussion of all these factors with patients is essential to determine if surgical repair of a rotator cuff tear should be recommended, or if it is best to proceed with one of the several salvage procedures reviewed in this topical collection, including augmentation of the repair, superior capsular reconstruction, tendon transfers, and other.
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Affiliation(s)
- Andrew R Jensen
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, 90403, USA
| | - Adam J Taylor
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA
| | - Joaquin Sanchez-Sotelo
- Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA.
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Wang L, Kang Y, Chen S, Mo X, Jiang J, Yan X, Zhu T, Zhao J. Macroporous 3D Scaffold with Self-Fitting Capability for Effectively Repairing Massive Rotator Cuff Tear. ACS Biomater Sci Eng 2020; 7:904-915. [PMID: 33715366 DOI: 10.1021/acsbiomaterials.0c00193] [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] [Indexed: 02/06/2023]
Abstract
The postoperative retear rate of direct repair of massive rotator cuff tear has risen up to 40% because of the dissatisfied tendon-to-bone healing and poor regenerative potential of remnant rotator cuff tissue. A biological scaffold that connects the remnant rotator cuff tissue and bone might be a promising substitute. In the present study, we have developed a macroporous three-dimensional scaffold poly(ester-urethane)urea (PEUU), with self-fitting capability employing thermally induced phase separation (TIPS) technique. The scaffold provides oriented connected macropores for cells migration, and promoted tendon-to-bone healing on the basis of surgical repair. The scaffolds were characterized by scanning electron microscopy, stress-strain test and cell biocompatibility study. In vitro studies exhibited that PEUU scaffold with suitable elastic mechanical properties can better support proliferation and migration of rabbit bone mesenchymal stem cells (RBMSCs). After three months postreconstruction of massive rotator cuff tear in a rabbit model using PEUU scaffold, there was complete regeneration of rotator cuff with physical tendon-to-bone interface and continuous tendon tissue, as observed from histological analysis. Further, biomechanical testing demonstrated that rotator cuff induced by PEUU scaffold had no significant difference as compared to normal rotator cuff. This macroporous, mechanically matched scaffold is potentially suitable for the application in massive rotator cuff repair. In conclusion, this study demonstrates the high efficiency of the macroporous 3D scaffold with self-fitting capability in facilitating rotator cuff regeneration.
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Affiliation(s)
- Liren Wang
- Department of Sports Medicine, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233, PR China
| | - Yuhao Kang
- Department of Sports Medicine, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233, PR China
| | - Sihao Chen
- Multidisciplinary Center for Advanced Materials, Advanced Research Institute, Shanghai University of Engineering Science, No. 333 Longteng Road, Shanghai 201620, PR China
| | - Xiumei Mo
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, No. 2999 North Renmin Road, Shanghai 201620, PR China
| | - Jia Jiang
- Department of Sports Medicine, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233, PR China
| | - Xiaoyu Yan
- Department of Sports Medicine, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233, PR China
| | - Tonghe Zhu
- Department of Sports Medicine, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233, PR China
| | - Jinzhong Zhao
- Department of Sports Medicine, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233, PR China
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Athiviraham A, Landy DC. Editorial Commentary: "Rotator-Metrics": Understanding Risk Factors for Rotator Cuff Repair Failure May Lead to Better Outcomes. Arthroscopy 2018; 34:2980-2982. [PMID: 30392682 DOI: 10.1016/j.arthro.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/03/2018] [Accepted: 08/03/2018] [Indexed: 02/02/2023]
Abstract
Retear following rotator cuff repair is a significant risk and is associated with worse patient-reported outcomes. Tear size, fatty infiltration, age, and chronicity have all been reported as independent risk factors. Understanding risk factors for rotator cuff repair failure may allow surgeons to optimize outcomes by addressing certain tears, such as tears involving the anterior rotator cuff cable and subscapularis, more acutely and incorporating patch augmentation in tears that are at high risk for failure.
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