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Yang S, Pang L, Zhang C, Wang J, Lei Y, Li Y, Huang Y, Tang X. Lower Reoperation Rate and Superior Patient-reported Outcome Following Arthroscopic Rotator Cuff Repair with Concomitant Acromioplasty: An Updated Systematic Review of Randomized Controlled Trials. Arthroscopy 2024:S0749-8063(24)00408-0. [PMID: 38876445 DOI: 10.1016/j.arthro.2024.05.026] [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: 01/30/2024] [Revised: 05/13/2024] [Accepted: 05/18/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE This study aims to systematically assess the postoperative outcomes in patients undergoing arthroscopic rotator cuff repairs with or without concomitant acromioplasty through a rigorous systematic review of randomized controlled trial s (RCTs). METHODS This systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, aimed to identify RCTs comparing clinical outcomes of patients with full thickness rotator cuff tears undergoing arthroscopic rotator cuff repair with acromioplasty versus those without at a minimum of 12 months follow-up. Databases searched included PubMed, Web of Science, Embase, and the Cochrane Library. The risk of bias in the included studies was assessed using the revised Cochrane Risk of Bias 2 (RoB2). Meta-analysis was conducted for outcomes with at least three studies reporting, with pooled effect estimates calculated using either fixed-effect or random-effects models based on heterogeneity levels. Results were presented as the weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CIs). For outcomes with fewer than three studies reporting, a Fisher exact test was conducted, with continuity correction applied if necessary. Primary outcomes include rates of retear and reoperation, while secondary outcomes included improvement in American Shoulder and Elbow Surgeons (ASES) score, range of motion (ROM), and complication rate. RESULTS Five high-quality RCTs, with low bias risk, involving 409 patients, revealed demographics of 58.4% males, mean age 58.4 years, and acromion types: 12.2% type I, 70.7% type II, and 17.1% type III. Mean follow-up was 52.2 months. Retear (12.5% versus 16.1%, P = 0.536) and complication rates (OR, 3.11; 95% CI, 0.31-30.73; P=0.33) were comparable between the two groups. However, reoperation rate (5.3% versus 15.9%, P < 0.001) and improvement in ASES score (WMD, 3.99; 95% CI, 1.00-6.99; P=0.009) favored the acromioplasty group. Both groups showed significant improvements in ROM, but insufficient data prevented a comparison. CONCLUSIONS Compared to arthroscopic rotator cuff repair alone, arthroscopic rotator cuff repair with acromioplasty demonstrated similar rates of retear and complications, but a significantly lower reoperation rate and superior improvement in ASES score. The available data were insufficient to draw a definitive conclusion regarding ROM. This conclusion is fragile due to a limited sample size.
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Affiliation(s)
- Songyun Yang
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China; Department of Orthopedics, People's hospital of Santai County; Santai, 621100, People's Republic of China
| | - Long Pang
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China
| | - Chunsen Zhang
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China
| | - Jiapeng Wang
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China
| | - Yao Lei
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China
| | - Yinghao Li
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China
| | - Yizhou Huang
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China; Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China.
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Haft M, Pearson ZC, Ahiarakwe U, Nelson SY, Srikumaran U. Evaluating The Effect of Arthroscopic Rotator Cuff Repair with Concomitant Subacromial Decompression on 2, 4, and 6 Year Reoperation Rates. J Am Acad Orthop Surg 2024:00124635-990000000-00939. [PMID: 38657174 DOI: 10.5435/jaaos-d-23-00636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/10/2023] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION The risks and benefits of including an arthroscopic subacromial decompression (ASD) during arthroscopic rotator cuff repair (RCR) are uncertain. Some studies suggest no difference in revision surgery rates, whereas others have found higher revision surgery rates associated with concomitant ASD. In this study, we compare mid-term revision surgery rates in patients undergoing arthroscopic RCR with or without concomitant ASD. METHODS A retrospective cohort analysis was conducted using a national all-payer claims database. Current Procedural Terminology and International Classification of Disease, 10th Revision, codes were used to identify patients who underwent primary arthroscopic RCR with or without ASD in the United States. The primary study outcome was revision surgery at 2, 4, and 6 years. Univariate analysis was conducted on demographic variables (age, sex) and comorbidities in the Elixhauser Comorbidity Index using chi-square and Student t-tests. Multivariate analysis was conducted using logistic regression. RESULTS A total of 11,188 patients were identified who underwent RCR and met the inclusion criteria. Of those, 8,994 (80%) underwent concomitant ASD. Concomitant ASD was associated with lower odds of all-cause revision surgery to the ipsilateral shoulder at 2 years (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.51 to 0.73), 4 years (OR, 0.60; 95% CI, 0.51 to 0.70), and 6 years (OR, 0.59; 95% CI, 0.51 to 0.69). Concomitant ASD was also associated with lower odds of revision RCR at 2 years (OR, 0.68; 95% CI, 0.53 to 0.86), 4 years (OR, 0.63; 95% CI, 0.50 to 0.78), and 6 years (OR, 0.61; 95% CI, 0.49 to 0.76). DISCUSSION Arthroscopic RCR with concomitant ASD is associated with lower odds of all-cause revision surgery in the ipsilateral shoulder at 2, 4, and 6 years. The lower mid-term revision surgery rates suggest benefits to performing concomitant ASD with primary arthroscopic RCR. Continued research on the mid to long-term benefits of ASD is needed to determine which patient populations benefit most from this procedure. DATA AVAILABILITY The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Affiliation(s)
- Mark Haft
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Heydar AM, Kıyak G. Effect of Arthroscopic Acromioplasty on the Isometric Abduction Strength. Cureus 2024; 16:e59426. [PMID: 38826604 PMCID: PMC11140420 DOI: 10.7759/cureus.59426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Acromioplasty is a widely performed procedure for various rotator cuff pathologies with good outcomes and high patient satisfaction. However, few studies have focused on its potential complications. Previous cadaveric studies have demonstrated that a considerable portion of the deltoid muscle is detached from its acromial origin following arthroscopic acromioplasty, but the clinical relevance of this muscle detachment has not been investigated. The goal of our research was to examine the influence of arthroscopic acromioplasty on abduction strength and to assess whether acromial anatomy plays a role in any potential effect. Methods From a preliminary sample of 87 individuals who were diagnosed with isolated impingement syndrome and underwent arthroscopic acromioplasty, 74 patients who met the inclusion criteria were ultimately included in the study. The patients were divided into two groups according to their acromion morphology: Bigliani type 2 (33 patients) and type 3 (41 patients). The isometric abduction strength of the two groups was measured by a handheld dynamometer (Isobex®; Cursor AG, Berne, Switzerland) at different abduction angles preoperatively and at the first, third, and sixth months following surgery and was statistically compared. Results Both groups showed reduced abduction strength postoperatively; however, the strength of abduction in the Bigliani type 3 group returned to near preoperative values in the third month. Although increased mean abduction strength was recorded at 30° abduction in the sixth month, this difference was not statistically significant (p=0.78). In the Bigliani type 2 group, compared with those in the sixth-month group, the preoperative abduction strength decreased from 8.32 kg to 6.0 kg (p = 0.047), 6.57 kg to 5.15 (p = 0.025), and 6.1 kg to 4.56 kg (p = 0.006) at 30, 60, and 90° abduction, respectively. Conclusions Arthroscopic acromioplasty decreased isometric abduction strength in patients with a Bigliani type 2 acromion. Patients should be counseled about this loss, which might be especially important for professional athletes and heavy manual workers.
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Affiliation(s)
- Ahmed M Heydar
- Orthopedics and Traumatology, Bahçelievler Memorial Hospital, Istanbul, TUR
| | - Görkem Kıyak
- Orthopedics and Traumatology, Academic Hospital, Istanbul, TUR
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Cerciello S, Mocini F, Proietti L, Candura D, Corona K. Critical Shoulder Angle in Patients With Cuff Tears. Sports Med Arthrosc Rev 2024; 32:38-45. [PMID: 38695502 DOI: 10.1097/jsa.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
OBJECTIVE The pathogenesis of rotator cuff tears (RCTs) is multifactorial. Critical shoulder angle (CSA), which represents the lateral extension of the acromion over the cuff, has been proposed as an extrinsic risk factor. The aim of the present systematic review and meta-analysis was to analyze the available literature regarding the correlation between RCT and CSA. METHODS A review was carried out in accordance with the "Preferred Reporting Items for Systematic reviews and Meta-Analyses" guidelines on July 17, 2023, using the following databases: PubMed, Ovid, and Cochrane Reviews. The following keywords were used: "critical shoulder angle," "rotator cuff tears," and "rotator cuff lesions." The methodological quality of the studies was assessed with the MINORS SCORE. RESULTS Twenty-eight studies were included. The average CSA among the 2110 patients with full-thickness RCT was 36.7 degrees, whereas the same value among the 2972 controls was 33.1 degrees. The average CSA in the 348 patients with partial-thickness RCT was 34.6 degrees, whereas it was 38.1 degrees in the 132 patients with massive RCT. The average MINORS score was 15.6. CONCLUSIONS CSA values were significantly higher in patients with RCT compared with the asymptomatic population. In addition, it appears that CSA values increase with the severity of rotator cuff involvement.
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Affiliation(s)
- Simone Cerciello
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Sacred Heart Catholic University, Rome
| | | | | | | | - Korona Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
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Bedi A, Bishop J, Keener J, Lansdown DA, Levy O, MacDonald P, Maffulli N, Oh JH, Sabesan VJ, Sanchez-Sotelo J, Williams RJ, Feeley BT. Rotator cuff tears. Nat Rev Dis Primers 2024; 10:8. [PMID: 38332156 DOI: 10.1038/s41572-024-00492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
Rotator cuff tears are the most common upper extremity condition seen by primary care and orthopaedic surgeons, with a spectrum ranging from tendinopathy to full-thickness tears with arthritic change. Some tears are traumatic, but most rotator cuff problems are degenerative. Not all tears are symptomatic and not all progress, and many patients in whom tears become more extensive do not experience symptom worsening. Hence, a standard algorithm for managing patients is challenging. The pathophysiology of rotator cuff tears is complex and encompasses an interplay between the tendon, bone and muscle. Rotator cuff tears begin as degenerative changes within the tendon, with matrix disorganization and inflammatory changes. Subsequently, tears progress to partial-thickness and then full-thickness tears. Muscle quality, as evidenced by the overall size of the muscle and intramuscular fatty infiltration, also influences symptoms, tear progression and the outcomes of surgery. Treatment depends primarily on symptoms, with non-operative management sufficient for most patients with rotator cuff problems. Modern arthroscopic repair techniques have improved recovery, but outcomes are still limited by a lack of understanding of how to improve tendon to bone healing in many patients.
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Affiliation(s)
- Asheesh Bedi
- Department of Orthopedic Surgery, University of Chicago, Chicago, IL, USA
- NorthShore Health System, Chicago, IL, USA
| | - Julie Bishop
- Department of Orthopedic Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jay Keener
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Drew A Lansdown
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Peter MacDonald
- Department of Surgery, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Vani J Sabesan
- HCA Florida JFK Orthopaedic Surgery Residency Program, Atlantis Orthopedics, Atlantis, FL, USA
| | | | - Riley J Williams
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Brian T Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA.
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Hurley ET, Crook BS, Danilkowicz RM, Jazrawi LM, Mirzayan R, Dickens JF, Anakwenze O, Klifto CS. Bone Marrow Stimulation for Arthroscopic Rotator Cuff Repair: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2024:3635465231213873. [PMID: 38328818 DOI: 10.1177/03635465231213873] [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] [Indexed: 02/09/2024]
Abstract
BACKGROUND Bone marrow stimulation (BMS) has been proposed to augment healing at the time of arthroscopic rotator cuff repair (ARCR) by creating several bone marrow vents in the footprint of the rotator cuff, allowing mesenchymal stem cells, platelets, and growth factors to cover the area as a "crimson duvet." PURPOSE To perform a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes after BMS and a control for those undergoing ARCR. STUDY DESIGN Meta-analysis; Level of evidence, 1. METHODS A literature search of 3 databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RCTs comparing BMS and a control for ARCR were included. Clinical outcomes were compared, and a P value <.05 was considered to be statistically significant. RESULTS A total of 7 RCTs with 576 patients were included. Overall, 18.8% of patients treated with BMS and 21.0% of patients treated with a control had a retear (I2 = 43%; P = .61). With BMS, the mean Constant score was 88.2, and with the control, the mean Constant score was 86.7 (P = .12). Additionally, there was no significant difference in the American Shoulder and Elbow Surgeons score (94.3 vs 93.2, respectively; P = .31) or visual analog scale score (0.9 vs 0.9, respectively; P = .89). CONCLUSION The level 1 evidence in the literature did not support BMS as a modality to improve retear rates or clinical outcomes after ARCR.
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Maguire JA, Dhillon J, Scillia AJ, Kraeutler MJ. Rotator Cuff Repair With or Without Acromioplasty: A Systematic Review of Randomized Controlled Trials With Outcomes Based on Acromial Type. Am J Sports Med 2024:3635465231213009. [PMID: 38312081 DOI: 10.1177/03635465231213009] [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] [Indexed: 02/06/2024]
Abstract
BACKGROUND It is unclear whether the use of concomitant acromioplasty during rotator cuff repair (RCR) improves clinical outcomes and whether the outcomes are affected by acromial type. PURPOSE To perform a systematic review of randomized controlled trials comparing clinical outcomes of RCR with and without acromioplasty, with a subanalysis of outcomes based on acromial type. STUDY DESIGN Systematic review; Level of evidence, 2. METHODS A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify randomized controlled trials that directly compared outcomes between RCR with versus without acromioplasty. A subanalysis was performed on the studies that provided outcomes based on acromial type. The search phrase used was rotator cuff repair (acromioplasty OR subacromial decompression) randomized. Patients were evaluated based on retear rate, reoperation rate, and patient-reported outcomes (PROs). RESULTS Application of inclusion criteria yielded 5 studies (2 studies were level 1, and 3 studies were level 2) including a total of 409 patients, with 211 patients undergoing RCR alone (group A) and 198 patients undergoing RCR with acromioplasty (group B). The mean patient age was 58.5 and 58.3 years in groups A and B, respectively. The mean follow-up time was 52.9 months, and the overall percentage of male patients was 54.1%. The rotator cuff tear size was 20.7 mm and 19.8 mm for groups A and B, respectively. No significant differences were found between groups for any of the PROs at final follow-up. Overall retear rates did not significantly differ between groups based on acromial type. Between 2 studies that measured reoperation rate, a significantly higher reoperation rate was found for the nonacromioplasty group (15%) versus the acromioplasty group (4.1%) (P = .031). One of these studies found that 5 of 9 patients (56%) with a type III acromion in the nonacromioplasty group underwent reoperation compared with 0 of 4 patients with a type III acromion in the acromioplasty group. CONCLUSION There is some evidence that acromioplasty during RCR reduces the risk for later reoperation. This may be particularly true for patients with type III acromions, although further studies with larger sample sizes are needed to corroborate these data.
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Affiliation(s)
- James A Maguire
- St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Jaydeep Dhillon
- Rocky Vista University College of Osteopathic Medicine, Greenwood Village, Colorado, USA
| | | | - Matthew J Kraeutler
- University of Colorado Anschutz Medical Campus, Department of Orthopedics, Aurora, Colorado, USA
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Ernstbrunner L, Werthel JD, Götschi T, Hooke AW, Zhao C. Anterolateral Acromioplasty Reduces Gliding Resistance Between the Supraspinatus Tendon and the Coracoacromial Arch in a Cadaveric Model. Arthrosc Sports Med Rehabil 2024; 6:100845. [PMID: 38226343 PMCID: PMC10788404 DOI: 10.1016/j.asmr.2023.100845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/07/2023] [Indexed: 01/17/2024] Open
Abstract
Purpose To investigate the gliding resistance dynamics between the supraspinatus (SSP) tendon and the coracoacromial arch, both before and after subacromial decompression (anterolateral acromioplasty) and acromion resection (acromionectomy). Methods Using 4 fresh-frozen cadaveric shoulders, acromion shapes were classified (2 type I and 2 type III according to Bigliani). Subacromial bursa and coracoacromial ligament maintenance replicated physiologic sliding conditions. Gliding resistance was measured during glenohumeral abduction (0° to 60°) in internal rotation (IR) and external rotation (ER). Peak gliding resistance between the SSP tendon and the coracoacromial arch was determined and compared between intact, anterolateral acromioplasty, and acromionectomy. Results Peak SSP gliding resistance during abduction in an intact shoulder was significantly higher in IR than in ER (4.1 vs 2.1 N, P < .001). The mean peak SSP gliding resistance during 0° to 60° glenohumeral abduction in IR in the intact condition was significantly higher compared with the subacromial decompression condition (4.1 vs 2.8 N, P = .021) and with the acromionectomy condition (4.1 vs 0.9 N, P < .001). During 0° to 60° glenohumeral abduction in ER, mean peak SSP gliding resistance in the intact condition was not significantly different compared with the subacromial decompression condition (2.1 vs 2.0 N, P = .999). The 2 specimens with a hooked (i.e. type III) acromion showed significantly higher mean peak SSP gliding resistance during glenohumeral abduction in IR and ER when compared with the 2 specimens with a flat (i.e. type I) acromion (IR: 5.8 vs 3.0 N, P = .006; ER: 2.8 vs 1.4 N, P = .001). Conclusions In this cadaveric study, peak gliding resistance between the SSP tendon and the coracoacromial arch during combined abduction and IR was significantly reduced after anterolateral acromioplasty and was significantly higher in specimens with a hooked acromion. Clinical Relevance The clinical benefit of subacromial decompression remains unclear. This study suggests that anterolateral acromioplasty might reduce supraspinatus gliding resistance in those with a hooked acromion and in the typical "impingement" position.
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Affiliation(s)
- Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
- Orthopedic Biomechanics Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jean-David Werthel
- Orthopedic Biomechanics Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Tobias Götschi
- Laboratory for Orthopaedic Biomechanics, ETH Zurich, University of Zurich, Zurich, Switzerland
| | - Alex W. Hooke
- Orthopedic Biomechanics Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Chunfeng Zhao
- Orthopedic Biomechanics Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
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Werthel JD, Fleurette J, Besnard M, Favard L, Boileau P, Bonnevialle N, Nové-Josserand L. Long-term results of revision rotator cuff repair for failed cuff repair: a minimum 10-year follow-up study. J Shoulder Elbow Surg 2024; 33:300-305. [PMID: 37468031 DOI: 10.1016/j.jse.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 07/21/2023]
Abstract
HYPOTHESIS Rotator cuff repair remains associated with high retear rates, which range from 13% to 79%. The objective of this study was to evaluate the long-term clinical and structural results after revision rotator cuff repair at a minimum 10-year follow-up. METHODS We retrospectively studied the records of all patients who underwent revision rotator cuff repair in 3 different institutions between July 2001 and December 2007 with a minimum 10-year follow-up. A total of 54 patients (61% males, mean age 52 ± 6 years old) met the inclusion criteria. Outcome measures included pain (visual analog scale [VAS]), range of motion (ROM), Subjective Shoulder Value (SSV), and the Constant score. Superior migration, osteoarthritis, and acromiohumeral interval (AHI) were assessed on standard radiographs. Fatty infiltration and structural integrity of the repaired tendon were evaluated on magnetic resonance imaging or computed tomographic arthrogram. RESULTS At a mean 14.1 years (10.4-20.5), range of motion did not progress significantly in elevation and internal rotation between pre- and postoperation (158° [range, 100°-180°] to 164° [range, 60°-180°], P = .33, and L3 [range, sacrum-T12] to T12 [range, buttocks-T7], P = .34, respectively) and decreased in active external rotation from 45° (range, 10°-80°) to 39° (range, 10°-80°) (P = .02). However, VAS, SSV, and Constant score were all significantly improved at last follow-up (P < .001). AHI decreased significantly (P = .002) from 10 mm (7-14 mm) to 8 mm (0-12 mm). Two percent of the supraspinatus/infraspinatus tendons were Sugaya 1, 24% were Sugaya 2, 35% were Sugaya 3, 12% were Sugaya 4, and 27% were Sugaya 5. Goutallier score progressed for all muscles, but this did not reach significance and mean Goutallier remained <2 for all 4 muscles at last follow-up. Hamada score progressed from 0% >grade 2 preoperatively to 6% >grade 2 at last follow-up. CONCLUSION Revision rotator cuff repair provides significant pain relief and improvement in functional scores at long-term follow-up. The mild progression of fatty infiltration, AHI, and Hamada score suggests that despite high retear rates (39% of stage 4 and 5 in the Sugaya classification), revision repair could possibly have a protective role on the evolution toward cuff tear arthropathy.
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Affiliation(s)
- Jean-David Werthel
- Orthopedic Department, Hôpital Ambroise Paré, Boulogne-Billancourt, France.
| | - Justine Fleurette
- Orthopedic Department, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Marion Besnard
- Orthopedic Department, Centre Hospitalier Intercommunal Amboise- Château-Renault, Amboise, France
| | - Luc Favard
- Orthopedic Department, CHRU Tours-Trousseau, Chambray-lès-Tours, France
| | - Pascal Boileau
- Institut de Chirurgie Réparatrice, Groupe Kantys, Nice, France
| | | | - Laurent Nové-Josserand
- Ramsay Générale de Santé, Jean Mermoz Private Hospital, Centre Orthopédique Santy, Lyon, France
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Testa EJ, Katz L, Zhang H, Chang K, Kutschke MJ, Dworkin M, Owens BD. Rotator Cuff Tears to Shoulder Instability: The Relationship Between Acromial Morphology and Shoulder Pathology. JBJS Rev 2024; 12:01874474-202401000-00004. [PMID: 38181125 DOI: 10.2106/jbjs.rvw.23.00188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
» The acromion is a well-studied region of the scapula that has demonstrated substantial relationships to various shoulder pathologies.» Abnormal acromial morphology is associated with rotator cuff pathology, and our understanding of this risk factor inspired acromioplasty as an adjunctive treatment for rotator cuff tears.» The acromion is linked closely to shoulder kinematics and biomechanics, as it serves as the origin for the deltoid muscle.» In degenerative shoulder disease, eccentric glenohumeral osteoarthritis has been associated with a higher, flatter acromial roof.» Increasing literature is emerging connecting morphology of the acromion with shoulder instability.
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Affiliation(s)
- Edward J Testa
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Luca Katz
- Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Helen Zhang
- Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Kenny Chang
- Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Michael J Kutschke
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Myles Dworkin
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
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Brandariz R, Charbonnier C, Culebras Almeida A, Lädermann A, Cunningham G. The role of bone morphology of the greater tuberosity and lateral acromion on subacromial space during scaption: a three-dimensional dynamic simulation analysis. BMC Musculoskelet Disord 2023; 24:888. [PMID: 37968608 PMCID: PMC10647087 DOI: 10.1186/s12891-023-06957-y] [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: 05/20/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The bone morphology of the greater tuberosity and lateral acromion plays a central role in subacromial impingement syndrome. The critical shoulder angle (CSA) and greater tuberosity angle (GTA) are two-dimensional measurement parameters that have been validated to evaluate it radiologically. These markers are, however, static and don't consider the dynamic effect of glenohumeral motion. OBJECTIVES This study aimed to better understand the biomechanics in subacromial impingement with a dynamic simulation based on a validated 3D biomechanical model coupling joint kinematics and 3D reconstructed computed tomography. STUDY DESIGN & METHODS Sixty-one patients were included in this study: a case group of 44 patients with degenerative rotator cuff tears involving only the supraspinatus, and a control group of 17 without a rotator cuff tear. Patients with previous surgeries, traumatic cuff tears, and cuff tear arthropathy were excluded. CSA, GTA, and impingement-free range of motion (IF-ROM) of the glenohumeral joint in scaption were calculated. Correlation tests were used to determine the relationship between ROM and CSA, GTA, and combined CSA and GTA values. RESULTS CSA and GTA were significantly higher in the rotator cuff tear group (p = 0.001 and < 0.001), while IF-ROM was significantly higher in the control group (p = 0.001). There was no overall correlation between CSA and GTA (R = 0.02, p = 0.8). Individual correlation between both angles with IF-ROM was negatively weak for CSA (R = -0.4, p < 0.001) and negatively moderate for GTA and IF-ROM (R = -0.5, p < 0.001). However, combining both angles resulted in a negatively high correlation with IF-ROM (R = -0.7, p < 0.001). CONCLUSION Subacromial space narrowing during scaption is highly correlated to the cumulative values of GTA and CSA. These findings suggest that the combined bony morphology of the lateral acromion and greater tuberosity plays an important role in subacromial impingement. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Caecilia Charbonnier
- Medical Research Department, Artanim Foundation, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alejandro Culebras Almeida
- Shoulder and Elbow Center La Colline, Geneva, Switzerland
- Department of Orthopaedics and Traumatology, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
| | - Alexandre Lädermann
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Gregory Cunningham
- Shoulder and Elbow Center La Colline, Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
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12
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Özcan S, Yurten H. The Effect of Acromioplasty Performed During Rotator Cuff Repairs on Clinical Outcomes in Patients With Type 3 Acromion: A Retrospective Study. Cureus 2023; 15:e48867. [PMID: 38106787 PMCID: PMC10724503 DOI: 10.7759/cureus.48867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVE Rotator cuff (RC) tears often necessitate surgery, with acromioplasty being frequently performed alongside RC repair. However, the impact of acromioplasty on clinical outcomes remains a subject of discussion. The current study aimed to investigate the effect of acromioplasty during RC repair on clinical outcomes in patients with type 3 acromion. MATERIALS AND METHODS Eighty-five patients, who underwent RC repair between January 2016 and December 2020, were categorized into two groups: Group 1, comprising 40 patients without acromioplasty, and Group 2, including 45 patients who received acromioplasty. Subacromial distance (SAD) and clinical scores were assessed pre- and post-operatively. RESULTS Group 1, comprising 40 patients without acromioplasty, had an average age of 59.45±10.43 years. Among them, 27 (67.5%) were female. The mean symptom duration was 10.4±4.3 months, and the mean follow-up period was 16.2±1.9 months. Group 2, which underwent acromioplasty, included 45 patients with an average age of 56.49±8.97 years, with 30 (66.7%) of them being female. The mean symptom duration was 9.5±3.6 months, and the mean follow-up time was 15.78±2.17 months in this group. Group 2 showed a relatively greater improvement in SAD compared to Group 1. The evaluation of clinical outcomes did not reveal any significant differences between the groups. CONCLUSION Concomitant acromioplasty does not have a significant effect on clinical outcomes in patients undergoing arthroscopic RC repair.
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Affiliation(s)
- Seçkin Özcan
- Orthopedics and Traumatology, Yalova Education and Research Hospital, Yalova, TUR
| | - Hakan Yurten
- Orthopedics and Traumatology, Ministry of Health Elaziğ Fethi̇ Seki̇n City Hospital, Elazığ, TUR
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13
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Wang Y, Chen J, Li D, Xiang X. Biplanar Acromioplasty: An Arthroscopic Spur Removal Technique Based on Original Bony Landmarks. Arthrosc Tech 2023; 12:e1369-e1374. [PMID: 37654894 PMCID: PMC10466226 DOI: 10.1016/j.eats.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/12/2023] [Indexed: 09/02/2023] Open
Abstract
In this study, we introduce an arthroscopic acromioplasty technique based on original bony landmarks, namely biplanar acromioplasty. This technique focuses on smoothing both the coronal and transverse plane of acromion, corresponding to the anterior and inferior acromial surface, and restores the acromion to its original shape. We believe this technique is effective, time-saving, and reproducible.
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Affiliation(s)
- Yuanyuan Wang
- Fourth Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Jianfa Chen
- Fourth Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Ding Li
- Fourth Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Xiaobing Xiang
- Fourth Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
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14
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Gould HP. CORR Insights®: High Acromial Slope and Low Acromiohumeral Distance Increase the Risk of Retear of the Supraspinatus Tendon After Repair. Clin Orthop Relat Res 2023; 481:1171-1173. [PMID: 36812065 PMCID: PMC10194537 DOI: 10.1097/corr.0000000000002600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/27/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Heath P Gould
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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15
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Woodmass JM, Al Khatib L, McRae S, Lapner P, Mascarenhas R, Neogi D, MacDonald PB. Arthroscopic Rotator Cuff Repair with and without Acromioplasty in the Treatment of Full-Thickness Rotator Cuff Tears: Long-Term Outcomes of a Multicenter, Randomized Controlled Trial. J Bone Joint Surg Am 2022; 104:2101-2107. [PMID: 36476738 DOI: 10.2106/jbjs.22.00135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to reevaluate patients from a previous randomized controlled trial at a long-term follow-up to determine the long-term efficacy of subacromial decompression in patients with full-thickness rotator cuff tears. METHODS This is a secondary study based on a previous, multicenter, randomized controlled trial with patients allocated to arthroscopic rotator cuff repair with or without acromioplasty. The original study was conducted between 2003 and 2011, and the secondary study was conducted between 2015 and 2021. Patients were invited by a blinded assessor to return to complete the Western Ontario Rotator Cuff (WORC) index and a questionnaire about reoperation and to undergo a clinical assessment. If participants were unable to return, they were asked to complete the questionnaires by mail. A chart review on all participants in the original study was conducted. RESULTS Eighty-six patients were randomized in the original trial, with 31 of 45 from the group without acromioplasty and 25 of 41 from the acromioplasty group returning for long-term follow-up. The mean duration (and standard deviation) of follow-up was 11.2 ± 2.4 years for the group without acromioplasty and 11.5 ± 2.6 years for the acromioplasty group. There was no significant difference in WORC scores between the groups with and without acromioplasty at the time of the long-term follow-up (p = 0.30). Seven (16%) of the 45 patients in the group without acromioplasty underwent reoperation. One (2%) of the initial 41 patients allocated to acromioplasty underwent reoperation. All patients who underwent a reoperation had a Type-2 or 3 acromion. CONCLUSIONS Patients who underwent rotator cuff repair with or without acromioplasty experienced improvement of outcomes from their preoperative level at a long-term follow-up (mean, 11 years), and there were no differences in patient-reported outcomes, specifically WORC scores, between these groups. However, a significantly higher reoperation rate was observed in patients who had rotator cuff repair without acromioplasty, specifically in those with a Type-2 or 3 acromion. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jarret M Woodmass
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic, Winnipeg, Manitoba, Canada
| | | | - Sheila McRae
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic Foundation, Winnipeg, Manitoba, Canada
| | - Peter Lapner
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Peter B MacDonald
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic, Winnipeg, Manitoba, Canada
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Khazzam M. Settling the Controversy of Acromioplasty During Rotator Cuff Repair: Commentary on an article by Jarrett M. Woodmass, MD, FRCSC, et al.: "Arthroscopic Rotator Cuff Repair with and without Acromioplasty in the Treatment of Full-Thickness Rotator Cuff Tears. Long-Term Outcomes of a Multicenter, Randomized Controlled Trial". J Bone Joint Surg Am 2022; 104:2130. [PMID: 36476741 DOI: 10.2106/jbjs.22.01019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Michael Khazzam
- Department of Orthopaedic Surgery; Shoulder Service, University of Texas Southwestern Medical Center, Dallas, Texas
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17
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Waterman BR. Editorial Commentary: Classic Arthroscopic Anterolateral Acromioplasty Does Not Translate to Clinically Meaningful Differences in Lateral Acromial Overcoverage. Arthroscopy 2022; 38:2969-2971. [PMID: 36344056 DOI: 10.1016/j.arthro.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022]
Abstract
Despite its time-honored tradition, the classic Neer acromioplasty has come under increased scrutiny in the recent literature, particularly when performed in the absence of rotator cuff repair. The American Medical Association Current Procedural Terminology Committee has transitioned the acromioplasty procedure, and definition of the related Current Procedural Terminology code 29827, to a procedure that is "added-on" to shoulder arthroscopy. Several authors have sought to investigate the true value of arthroscopic subacromial decompression for extrinsic sources of impingement. Common indications for acromioplasty include bursal-sided tears, prominent type III hooked acromial morphology, calcified coracoacromial ligament, and severe rotator cuff tendinopathy. However, the classic arthroscopic acromioplasty may not meaningfully address lateral outlet impingement and acromial overcoverage, as measured by an elevated critical shoulder angle or acromial index, thereby leading to persistent abduction impingement and mechanical abrasion. In these cases, lateral acromial resection of up 5 to 10 mm may be preferentially considered to decrease the pathologic critical shoulder angle (>35°) and reduce the risk of primary or secondary rotator cuff tendon failure.
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18
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He S, Xu H, Liu S. Effect of Arthroscopic Acromioplasty Combined with Rotator Cuff Repair in the Treatment of Aged Patients with Full-Thickness Rotator Cuff Tear and Rotator Cuff Injury. Emerg Med Int 2022; 2022:4475087. [PMID: 35966500 PMCID: PMC9365591 DOI: 10.1155/2022/4475087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Full-thickness rotator cuff tear and rotator cuff injury are frequently occurring diseases and widely exist in the social population. Surgical repair is the most effective treatment for rotator cuff tears and injuries. With the continuous development of arthroscopy, more and more surgeons choose arthroscopic acromioplasty plus rotator cuff repair for the treatment of rotator cuff injury. However, previously published systematic reviews or meta-analyses still cast doubt on the efficacy of such concomitant procedures for postoperative patient function and pain recovery. In this study, we analyzed the effects of parameters such as shoulder function and acromion morphology on aged patients with full-thickness rotator cuff tear combined with rotator cuff injury treated with arthroscopic acromion plasty and rotator cuff repair. The results showed that arthroscopic acromion plasty and rotator cuff repair helped to promote the joint function recovery of the aged patients with full-thickness rotator cuff tear combined with rotator cuff injury and alleviate the pain of the patients. Compared with simple rotator cuff repair, this technique can increase the postoperative AT and reduce the ACEA and to some extent reduce the risk of postoperative rotator cuff reinjury, which is worthy of promotion.
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Affiliation(s)
- Shihui He
- Department of Orthopaedics, Zhoushan Hospital, Zhoushan, Zhejiang Province 316000, China
| | - Hao Xu
- Department of Orthopaedics, Zhoushan Hospital, Zhoushan, Zhejiang Province 316000, China
| | - Shuhua Liu
- Department of Orthopaedics, Zhoushan Hospital, Zhoushan, Zhejiang Province 316000, China
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Willenbring TJ, DeVos MJ, Warth RJ, Gregory JM. Trends in Acromioplasty Utilization During Arthroscopic Rotator Cuff Repair: An Epidemiological Study of 139,586 Patients. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e22.00075. [PMID: 35472042 PMCID: PMC10566984 DOI: 10.5435/jaaosglobal-d-22-00075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Acromioplasty remains very common during rotator cuff repair (RCR) despite limited evidence of clinical efficacy. This study observed the incidence of acromioplasty from 2010 to 2018 in Texas using a publicly available database. METHODS A total of 139,586 records were analyzed from the Texas Healthcare Information Collection database ranging from 2010 to 2018. These cases were divided into those with and without acromioplasty (N = 107,427 and N = 32,159, respectively). Acromioplasty use was standardized as the number of acromioplasties per RCR (acromioplasty rate). Two subgroup analyses were conducted: surgical institution type and payor status. RESULTS In 2010, acromioplasty occurred in 84% of all RCR cases with nearly continuous decline to 74% by 2018 (P < 0.001). All subgroups followed this pattern except teaching hospitals which displayed insignificant change from 2010 to 2018 (P = 0.99). The odds of receiving acromioplasty in patients with neither Medicare nor Medicaid was higher than those with Medicare or Medicaid coverage (odds ratio = 1.36, P < 0.001). DISCUSSION Overall acromioplasty rates decreased modestly, but markedly, beginning in 2012. Despite this small decrease in acromioplasty rate, it remains a commonly performed procedure in conjunction with RCR. Both the academic status of the surgical facility and the payor status of the patient affect the acromioplasty rate.
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Affiliation(s)
- Taylor J. Willenbring
- From the Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - Marijke J. DeVos
- From the Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - Ryan J. Warth
- From the Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - James M. Gregory
- From the Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX
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20
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[Analysis of influencing factors of early pain after arthroscopic rotator cuff repair]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:284-290. [PMID: 35293168 PMCID: PMC8923925 DOI: 10.7507/1002-1892.202111020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the influencing factors that affect early pain after arthroscopic rotator cuff repair. METHODS A clinical data of 592 patients who met the selection criteria and underwent arthroscopic rotator cuff repair between June 2018 and October 2020 were retrospectively analyzed. There were 239 males and 353 females, with an average age of 58.1 years (range, 32-81 years). Before operation and at 3 days, 6 weeks, and 3 months after operation, the pain degree of patients was evaluated by visual analogue scale (VAS) score; and the patients were divided into no pain or mild pain group and moderate to severe pain group according to the postoperative VAS score. Preoperative and intraoperative related factors were included for univariate analysis, including age, gender, body mass index, preoperative VAS score, history of frozen shoulder, history of hypertension, history of diabetes, history of smoking, affected tendons (supraspinatus, infraspinatus, or subscapularis tendon injury), supraspinatus muscle atrophy, fatty infiltration, operation time, degree of rotator cuff tear, number of anchors, and whether to perform acromioplasty. The influencing factors of postoperative pain were screened; further logistic regression was used to conduct multivariate analysis to screen for risk factors. RESULTS Moderate to severe pain occurred in 440 patients (74.3%) at 3 days after operation, 382 patients (66.2%) at 6 weeks, and 141 patients (23.8%) at 3 months. Multivariate analysis showed that the women, partial-thickness rotator cuff tear, and acromioplasty were risk factors for pain at 3 days after operation ( P<0.05); the women, combined with fatty infiltration, partial-thickness rotator cuff tear, and acromioplasty were the risk factors at 6 weeks ( P<0.05); and the women, combined with fatty infiltration, and partial-thickness rotator cuff tear were risk factors at 3 months ( P<0.05). CONCLUSION Among patients undergoing arthroscopic rotator cuff repair, women, those with smaller rotator cuff tears, combined with fatty infiltration, and acromioplasty have more severe pain within 3 months after operation, and attention should be paid to postoperative analgesia in these patients management, providing an individualized approach to rehabilitation, and closer follow-up.
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Milano G, Saccomanno MF. Editorial Commentary: Acromioplasty Does Not Improve Clinical Outcome of Arthroscopic Rotator Cuff Repair: The Game Is Over! Arthroscopy 2021; 37:3079-3080. [PMID: 34602149 DOI: 10.1016/j.arthro.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 02/02/2023]
Abstract
Acromioplasty is a well-known, simple, and reproducible surgical technique that is used in isolation or in combination with other arthroscopic procedures. The clinical value of acromioplasty combined with arthroscopic rotator cuff repair has been largely investigated. Main theoretical benefits lie in the opportunity to improve the visualization, decrease abrasive wear with prominent acromial morphology, and release natural growth factors. On the other hand, acromioplasty and release of the coracoacromial ligament may weaken the insertion of the deltoid muscle, induce scar formation in the subacromial space, theoretically limiting shoulder mobility, and increase risk of anterior-superior humeral escape, especially in patients with large to massive rotator cuff tears. Clinical studies report conflicting results. My results show no differences in clinical outcomes in rotator cuff repairs with or without subacromial decompression, regardless of the acromial morphology. At the same time, I do believe that confirmatory studies are always necessary, especially if the aim is to disprove the usefulness of a common practice.
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KAYA YE, AYANOĞLU T. Short-Term Results of Patients Undergoing Arthroscopic Subacromial Decompression and Acromioplasty. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2021. [DOI: 10.33631/duzcesbed.879275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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