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Lei Y, Zeng Y, Xia W, Xie J, Hu C, Lan Z, Ma D, Cai Y, He L, Kong D, Huang X, Yan H, Chen H, Li Z, Wang X. Risk factors for infection in patients undergoing shoulder arthroscopy: a systematic review and meta-analysis. J Hosp Infect 2024; 150:72-82. [PMID: 38782053 DOI: 10.1016/j.jhin.2024.04.025] [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: 03/13/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024]
Abstract
We conducted a meta-analysis to determine the risk of infection following shoulder arthroscopy and to identify risk factors for infection. We systematically searched the PubMed/Medline, Embase and Cochrane Library databases, as well as the reference lists of previous systematic reviews and meta-analyses; manual searches were also performed. A random-effects model was employed to estimate pooled odds ratios (ORs), based on sample size, the P-value of Egger's test and heterogeneity among studies. Of the 29,342 articles screened, 16 retrospective studies comprising 74,759 patients were included. High-quality evidence showed that patients with diabetes (OR, 1.30; 95% confidence interval (CI), 1.20-1.41) or hypertension (OR, 1.26; 95% CI, 1.10-1.44) had a higher risk of infection, while moderate quality evidence showed that patients with obesity (body mass index ≥30 kg/m2) (OR, 1.42; 95% CI, 1.28-1.57), those who were male (OR, 1.65; 95% CI, 1.12-2.44), those who had an American Society of Anesthesiologists (ASA) class ≥3 (OR, 2.02; 95% CI, 1.02-3.99) and those who had a history of smoking (OR, 2.44; 95% CI, 1.39-4.28) had a higher risk of infection. The meta-analysis revealed that there was no association between age, time of surgery, or alcohol consumption and infection. This meta-analysis identified six significant risk factors for infection following shoulder arthroscopy including diabetes, obesity, hypertension, male sex, ASA class, history of smoking. These patient-related risk factors may help identify postoperative patients at higher risk for infection following shoulder arthroscopy.
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Affiliation(s)
- Y Lei
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Y Zeng
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - W Xia
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - J Xie
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - C Hu
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Z Lan
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - D Ma
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Y Cai
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - L He
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - D Kong
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - X Huang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - H Yan
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - H Chen
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Z Li
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - X Wang
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China.
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Fei Y, Wan Y, Xu L, Huang Z, Ruan D, Wang C, He P, Zhou X, Heng BC, Niu T, Shen W, Wu Y. Novel methods to diagnose rotator cuff tear and predict post-operative Re-tear: Radiomics models. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 37:14-20. [PMID: 38766605 PMCID: PMC11098720 DOI: 10.1016/j.asmart.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/17/2024] [Indexed: 05/22/2024] Open
Abstract
Objective To validated a classifier to distinguish the status of rotator cuff tear and predict post-operative re-tear by utilizing magnetic resonance imaging (MRI) markers. Methods This retrospective study included patients with healthy rotator cuff and patients diagnosed as rotator cuff tear (RCT) by MRI. Radiomics features were identified from the pre-operative shoulder MRI and selected by using maximum relevance minimum redundancy (MRMR) methods. A radiomics model for diagnosis of RCT was constructed, based on the 3D volume of interest (VOI) of supraspinatus. Another model for the prediction of rotator re-tear after rotator cuff repair (Re-RCT) was constructed based on VOI of humerus, supraspinatus, infraspinatus and other clinical parameters. Results The model for diagnosing the status of RCT produced an area under the receiver operating characteristic curve (AUC) of 0.989 in the training cohort and 0.979 for the validation cohort. The radiomics model for predicting Re-RCT produced an AUC of 0.923 ± 0.017 for the training dataset and 0.790 ± 0.082 for the validation dataset. The nomogram combining radiomics features and clinical factors yielded an AUC of 0.961 ± 0.020 for the training dataset and 0.808 ± 0.081 for the validation dataset, which displayed the best performance among all models. Conclusion Radiomics models for the diagnosis of rotator cuff tear and prediction of post-operative Re-RCT yielded a decent prediction accuracy.
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Affiliation(s)
- Yang Fei
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, China
| | - Yidong Wan
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Institute of Translational Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lei Xu
- Department of Radiation Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zizhan Huang
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, China
| | - Dengfeng Ruan
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, China
| | - Canlong Wang
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, China
| | - Peiwen He
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaozhong Zhou
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, China
| | - Boon Chin Heng
- School of Stomatology, Peking University, Beijing, China
| | - Tianye Niu
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Institute of Translational Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Weiliang Shen
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, China
| | - Yan Wu
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang, China
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Kerhoulas Z, Ojaghi R, Hayes E, Khoury J, Pollock J. What are the common factors that lead to the failure to achieve minimal clinically important difference after shoulder surgery? A scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1749-1755. [PMID: 38480530 DOI: 10.1007/s00590-024-03867-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION The goal of this research is to identify the factors that negatively impact the achievement of the minimum clinically significant change (MCID) for the American Shoulder and Elbow Surgeons (ASES) score within the realm of various orthopedic shoulder procedures. METHODS We conducted a comprehensive review of studies published from 2002 to 2023, utilizing OvidMedline and PubMed databases. Our search criteria included terms such as "minimal clinically important difference" or "MCID" along with associated MeSH terms, in addition to "American shoulder and elbow surgeon" or "ASES." We selectively included primary investigations that assessed factors linked to the failure to achieve MCID for the ASES score subsequent to orthopedic shoulder procedures, while excluding papers addressing anatomical, surgical, or injury-related aspects. RESULTS Our analysis identified 149 full-text articles, leading to the inclusion of 12 studies for detailed analysis. The selected studies investigated outcomes following various orthopedic shoulder procedures, encompassing biceps tenodesis, total shoulder arthroplasty, and rotator cuff repair. Notably, factors, such as gender, body mass index, diabetes, smoking habits, opioid usage, depression, anxiety, workers' compensation, occupational satisfaction, and the preoperative ASES score, were all associated with the inability to attain MCID. CONCLUSION In summary, numerous factors exert a negative influence on the attainment of MCID following shoulder procedures, and these factors appear to be irrespective of the specific surgical technique employed. Patients presenting with these factors may perceive their surgical outcomes as less successful when compared to those without these factors. Identifying these factors can enable healthcare providers to provide more effective counseling to patients regarding their expected outcomes and rehabilitation course. Furthermore, these findings can aid in the development of a screening tool to better identify these risk factors and optimize them before surgery.
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Affiliation(s)
- Zoe Kerhoulas
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada
| | - Reza Ojaghi
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada.
| | - Emmitt Hayes
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada
| | - Jason Khoury
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada
| | - J Pollock
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada
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Liu YC, Huang SW, Adams CR, Lin CY, Chen YP, Kuo YJ, Chuang TY. Preoperative handgrip strength can predict early postoperative shoulder function in patients undergoing arthroscopic rotator cuff repair. J Orthop Surg Res 2024; 19:270. [PMID: 38689328 PMCID: PMC11059705 DOI: 10.1186/s13018-024-04750-8] [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: 02/29/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Rotator cuff tears (RCTs) are a common musculoskeletal disorder, and arthroscopic rotator cuff repair (ARCR) is widely performed for tendon repair. Handgrip strength correlates with rotator cuff function; however, whether preoperative grip strength can predict functional outcomes in patients undergoing ARCR remains unknown. This study aimed to investigate the correlation between preoperative grip strength and postoperative shoulder function following ARCR. METHODS A total of 52 patients with full-thickness repairable RCTs were prospectively enrolled. Baseline parameters, namely patient characteristics and intraoperative findings, were included for analysis. Postoperative shoulder functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) questionnaire and Constant-Murley scores (CMSs). Patients were followed up and evaluated at three and six months after ARCR. The effects of baseline parameters on postoperative outcomes were measured using generalized estimating equations. RESULTS At three and six months postoperatively, all clinical outcomes evaluated exhibited significant improvement from baseline following ARCR. Within 6 months postoperatively, higher preoperative grip strength was significantly correlated with higher CMSs (β = 0.470, p = 0.022), whereas increased numbers of total suture anchors were significantly correlated with decreased CMSs (β = - 4.361, p = 0.03). Higher body mass index was significantly correlated with higher postoperative QDASH scores (β = 1.561, p = 0.03) during follow-up. CONCLUSIONS Higher baseline grip strength predicts more favorable postoperative shoulder function following ARCR. A preoperative grip strength test in orthopedic clinics may serve as a predictor for postoperative shoulder functional recovery in patients undergoing ARCR.
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Affiliation(s)
- Yu-Cheng Liu
- Department of General Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shu-Wei Huang
- Department of Applied Science, National Taitung University, Taitung City, Taitung County, Taiwan
| | - Christopher R Adams
- Arthrex, Inc., Naples, FL, USA
- Orthopaedic Department, Naples Community Hospital, Naples, FL, USA
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedics, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tai-Yuan Chuang
- Department of Orthopedics, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Lai C, Li R, Tang W, Liu J, Duan XDXF, Bao D, Liu H, Fu S. Metabolic Syndrome and Tendon Disease: A Comprehensive Review. Diabetes Metab Syndr Obes 2024; 17:1597-1609. [PMID: 38616994 PMCID: PMC11015851 DOI: 10.2147/dmso.s459060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024] Open
Abstract
Metabolic syndrome (MS) is a multifaceted pathological condition characterized by the atypical accumulation of various metabolic components such as central obesity or excess weight, hyperlipidemia, low-density lipoprotein (LDL), hypertension, and insulin resistance. Recently, MS has been recognized as a notable contributor to heart and circulatory diseases. In addition, with increasing research, the impact of MS on tendon repair and disease has gradually emerged. Recent studies have investigated the relationship between tendon healing and diseases such as diabetes, dyslipidemia, obesity, and other metabolic disorders. However, diabetes mellitus (DM), hypercholesterolemia, obesity, and various metabolic disorders often coexist and together constitute MS. At present, insulin resistance is considered the major pathological mechanism underlying MS, central obesity is regarded as the predominant factor responsible for it, and dyslipidemia and other metabolic diseases are known as secondary contributors to MS. This review aims to evaluate the current literature regarding the impact of various pathological conditions in MS on tendon recovery and illness, and to present a comprehensive overview of the effects of MS on tendon recovery and diseases, along with the accompanying molecular mechanisms.
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Affiliation(s)
- Canhao Lai
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Ruichen Li
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Weili Tang
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Jinyu Liu
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Xinfang D X F Duan
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Dingsu Bao
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
- Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Huan Liu
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Shijie Fu
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
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Sandler AB, Green CK, Scanaliato JP, Fares AB, Dunn JC, Parnes N. The Influence of Obesity on Outcomes Following Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-Analysis of 118,331 Patients Internationally. JB JS Open Access 2024; 9:e23.00047. [PMID: 38638593 PMCID: PMC11023613 DOI: 10.2106/jbjs.oa.23.00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Background Given the rising prevalence of obesity, the number of patients with obesity undergoing arthroscopic rotator cuff repair (RCR) will likely increase; however, there have been mixed results in the existing literature with regard to the effect of elevated body mass index (BMI) on functional outcomes and complications. Methods The patient-reported outcome measures included the visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, range of motion, and adverse events. Results Fourteen studies (118,331 patients) were included. There were significant decreases in VAS pain scores for both patients with obesity (mean difference, -3.8 [95% confidence interval (CI), -3.9 to -3.7]; p < 0.001) and patients without obesity (mean difference, -3.2 [95% CI, -3.3 to -3.1]; p < 0.001). There were also significant increases in ASES scores for both patients with obesity (mean difference, 24.3 [95% CI, 22.5 to 26.1]; p < 0.001) and patients without obesity (mean difference, 24.3 [95% CI, 21.4 to 26.0]; p < 0.001). There were also significant increases in ASES scores for both patients with obesity (mean difference, 24.3 [95% CI, 22.5 to 26.1]; p < 0.001) and patients without obesity (mean difference, 24.3 [95% CI, 21.4 to 26.0]; p < 0.001). However, there were no significant differences in final VAS pain scores, ASES scores, or range of motion between the groups. The mean rates of complications were higher among patients with obesity (1.2% ± 1.7%) than among patients without obesity (0.59% ± 0.11%) (p < 0.0001), and the mean rates of postoperative admissions were also higher among patients with obesity (5.9%) than patients without obesity (3.7%) (p < 0.0001). Although the mean rates of reoperation were similar between groups (5.2% ± 2.8% compared with 5.2% ± 4.2%), the meta-analysis revealed lower odds of reoperation in patients without obesity (odds ratio [OR], 0.76 [95% CI, 0.71 to 0.82]). Conclusions No significant or clinically important differences in postoperative pain, ASES scores, or range of motion were found between patients with and without obesity following arthroscopic RCR. However, populations with obesity had higher rates of complications, postoperative admissions, and reoperation following arthroscopic RCR. Level of Evidence Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexis B. Sandler
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso County, Texas
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Clare K. Green
- School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | - John P. Scanaliato
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
| | - Austin B. Fares
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso County, Texas
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso County, Texas
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York
- Department of Orthopaedic Surgery, Claxton-Hepburn Medical Center, Ogdensburg, New York
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Ben H, Kholinne E, Guo J, Kim D, Je MG, Koh KH, Jeon IH. Does body mass index affect outcomes following arthroscopic superior capsular reconstruction using fascia lata autograft for massive irreparable rotator cuff tear? INTERNATIONAL ORTHOPAEDICS 2024; 48:1079-1088. [PMID: 38147071 DOI: 10.1007/s00264-023-06065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/10/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE This study aimed to evaluate the effect of increased body mass index (BMI) on patient-reported outcomes (PROs) and clinically significant outcomes (CSOs) obtained > two years postoperatively following arthroscopic superior capsular reconstruction (ASCR). METHODS A retrospective study was conducted on patients who underwent ASCR with a minimum two year follow-up. All patients were divided into normal (BMI < 25.0), overweight (BMI 25-30.0), and obese (BMI ≥ 30) according to preoperative BMI. Patients were assessed using the PROs preoperatively and at six months, one year, and two years postoperatively, including the visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Constant-Murley scores. The time required to achieve each CSO was analyzed and compared. Multivariate analyses evaluated the predictor variables and time required to achieve CSOs. RESULTS This study included 63 patients with a mean age of 64.8 ± 8.6 years, including 31 normal BMI, 25 overweight, and seven obese patients. Significant improvements in VAS and ASES scores after ASCR were observed in all three groups. Normal and overweight patients had significant improvements in the Constant score; however, no difference was observed in obese patients. No significant difference was observed in the probability distributions of CSOs between the BMI groups. Similarly, no significant differences were observed in the probability distributions of the CSOs, ASES, and Constant scores at each time point, among the BMI groups. CONCLUSION Patients in the normal and overweight groups had significant improvements in the VAS, ASES, and Constant scores after ASCR. Patients in the obese group had a significant improvement in VAS score; however, there is no difference for the ASES and Constant scores in the obese group. However, no differences were observed in all PROMs and the likelihood of achieving CSOs among the different BMI groups.
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Affiliation(s)
- Hui Ben
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Korea
| | - Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Jia Guo
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Korea
| | - Dohun Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Korea
| | - Min Geol Je
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Korea
| | - In Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Korea.
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Ma X, Shen J, Wan J. Impact of obesity on outcomes of rotator cuff repair: A systematic review and meta-analysis. PLoS One 2024; 19:e0299125. [PMID: 38478532 PMCID: PMC10936781 DOI: 10.1371/journal.pone.0299125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/05/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND To synthesize the existing evidence on the association between obesity and rotator cuff repair outcomes such as pain, shoulder function, range of motion, and complications. METHODS We searched PubMed, EMBASE, and Scopus databases for relevant observational studies (cohort and case-control) and randomized controlled trials (RCTs). The target population in the included studies comprised adults who had undergone rotator cuff repair procedures. The outcomes of interest were functional outcomes (such as range of motion), pain scores, patient-reported outcome measures, and complication rates (such as re-repair and readmission rates). We applied random-effects models and calculated pooled effect sizes reported as standardized mean differences (SMDs) or relative risks (RRs) with 95% confidence intervals. RESULTS We analysed data from 11 studies. In most, the follow-up periods ranged from 12 to 60 months. Obese individuals experienced greater pain (SMD 0.30; 95% CI, 0.10, 0.50) and lower shoulder function (SMD -0.33; 95% CI, -0.54, -0.12) than other individuals in the long-term post-operative follow-up. Obese individuals also had higher risks of complications (RR 1.48; 95% CI, 1.11, 1.98) and readmission (RR 1.35; 95% CI, 1.27, 1.43), but a similar likelihood of re-repair (RR, 1.27; 95% CI, 0.82, 1.95) than non-obese/normal BMI individuals. While the forward flexion and external rotation functions were comparable, obese individuals displayed less internal rotation function than other individuals (SMD -0.59; 95% CI, -0.87, -0.30). CONCLUSION Obesity was associated with unfavourable outcomes after rotator cuff surgery, including increased pain, reduced shoulder function, high risks of complications, and readmission. These findings emphasize the importance of addressing obesity-related factors to improve post-operative outcomes.
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Affiliation(s)
- Xiaojun Ma
- Department of Sports Medicine, Ningxia Hui Autonomous Region People’s Hospital, Yinchuan City, Ningxia Hui Autonomous Region, China
| | - Jia Shen
- Department of Intensive Care Unit, General Hospital of Ningxia Medical University, Yinchuan City, Ningxia Hui Autonomous Region, China
| | - Jun Wan
- Department of Sports Medicine, Ningxia Hui Autonomous Region People’s Hospital, Yinchuan City, Ningxia Hui Autonomous Region, China
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Moran FG, Hurley ET, Storme JG, Karavan MP, Downey SA, Klifto CS, Delaney RA, Mullett H. Studies on Bankart Repair for Anterior Shoulder Instability Show Poor Reporting of Data and Reflect Low Level of Evidence: A Systematic Review. Arthroscopy 2024; 40:963-969.e5. [PMID: 37474082 DOI: 10.1016/j.arthro.2023.07.010] [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] [Received: 12/14/2022] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE To assess the quality and level of evidence of studies reporting on Bankart repair for anterior shoulder instability. METHODS A search was performed using the PubMed/Medline database for all studies that reported clinical outcomes on Bankart repair for anterior shoulder instability. The search term "Bankart repair" with all results were analyzed via strict inclusion and exclusion criteria. Two independent investigators scored each included study based on the 10 criteria of the Modified Coleman Methodology Score (CMS) out of 100 and gave each study a score out of 25 based on the Anterior Shoulder Instability (ASI) Methodology criteria. RESULTS Two hundred sixty-six studies were included in the analysis and encompassed a total of 19,156 patients and 19,317 surgical procedures for Bankart repair for shoulder instability. Overall, 81.6% of studies were Level III or IV evidence. The mean CMS score for the studies was 55.3 out of 100, and the mean ASI Methodology score for the studies was 12.1 out of 25. Weaknesses in the studies were identified in sample size, description of preoperative investigations and diagnoses, reporting of mean glenoid bone loss, nonsubjective clinical outcome reporting, and description of associated pathologies. CONCLUSIONS A large proportion of studies reporting the clinical outcomes of Bankart repair for anterior shoulder instability are of low methodological quality and have a low level of evidence. CLINICAL RELEVANCE This study emphasizes need for greater reporting of many variables such as body mass index, mean glenoid bone loss, and patient-reported outcomes and provides a framework for future studies reporting.
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Affiliation(s)
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A..
| | | | - Mark P Karavan
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | | | - Christopher S Klifto
- Sports Surgery Clinic, Dublin, Ireland; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
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Yang Z, Chen W, Liang J, Liu T, Zhang B, Wang X, Yang X, Fang S, Daoji C, Yin X, Jiang J, Yun X. Association of obesity with high retears and complication rates, and low functional scores after rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elbow Surg 2023; 32:2400-2411. [PMID: 37419440 DOI: 10.1016/j.jse.2023.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/07/2023] [Accepted: 05/21/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Obesity influences the outcomes of orthopedic surgeries such as total knee arthroplasty and spinal surgery. However, the effect of obesity on the outcomes of rotator cuff repair is unknown. This systematic review and meta-analysis aimed to examine the effect of obesity on rotator cuff repair outcomes. METHODS PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched to identify relevant studies published from their inception till July 2022. Two reviewers independently screened titles and abstracts using the specified criteria. Articles were included if they indicated the effect of obesity on rotator cuff repair and the related outcomes after surgery. Review Manager 5.4.1 software was used to perform statistical analysis. RESULTS Thirteen articles involving 85,497 patients were included. Obese patients had higher retear rates than nonobese patients (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.23-5.41, P = .01), lower American Shoulder and Elbow Surgeons scores (mean difference [MD]: -3.59, 95% CI: -5.45 to [-1.74]; P = .0001), higher visual analog scale for pain (mean difference: 0.73, 95% CI: 0.29-1.17; P = .001), higher reoperation rates (OR 1.31, 95% CI 1.21-1.42, P < .00001), and higher rates of complications (OR 1.57, 95% CI 1.31-1.87, P = .000). Obesity did not affect the duration of surgery (MD: 6.03, 95% CI: -7.63 to 19.69; P = .39) or external rotation of the shoulder (MD: -1.79, 95% CI: -5.30 to 1.72; P = .32). CONCLUSION Obesity is a significant risk factor for retear and reoperation after rotator cuff repair. Furthermore, obesity increases the risk of postoperative complications and leads to lower postoperative American Shoulder and Elbow Surgeons scores and higher shoulder visual analog scale for pain.
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Affiliation(s)
- Zhitao Yang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Wei Chen
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Junwen Liang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Tao Liu
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Borong Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xihao Wang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xudong Yang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Sen Fang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Cairang Daoji
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xiaoli Yin
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Jin Jiang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
| | - Xiangdong Yun
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
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11
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Parnes N, Scanaliato JP, Dunn JC, Fink WA, Sandler A, Fares AB. Obesity negatively affects outcomes following arthroscopic rotator cuff repair at four-year follow-up. Shoulder Elbow 2023; 15:46-52. [PMID: 37974610 PMCID: PMC10649479 DOI: 10.1177/17585732221095846] [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: 02/28/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 11/19/2023]
Abstract
Introduction The purpose is to evaluate the influence of obesity (BMI 30 to 39.9 kg/m2) on surgical outcomes following arthroscopic rotator cuff repair surgery. Materials and Methods A retrospective review was performed examining the outcomes of arthroscopic rotator cuff repair in both a normal weight (BMI 18.5 to 24.9 kg/m2) and an obese (BMI 30 to 39.9 kg/m2) patient population, specifically looking at functional outcomes and range of motion. Secondary variables analyzed were surgical time, complications, and medical comorbidities. Results 52 normal weight patients (mean BMI 23.7 ± 2.1) and 59 obese patients (mean BMI 34.0 ± 2.4) were included. Both groups demonstrated statistically significant improvements in VAS, SANE and ASES scores (P < 0.0001), however there were significantly better outcomes in the normal weight group in VAS (0.56 ± 0.96 vs 1.42 ± 2.22; P = 0.0108), ASES (96.1 ± 5.8 vs 90.6 ± 15.6; P = 0.0192), and internal rotation (9.2 ± 3.0 vs 10.9 ± 2.3; P = 0.0010). Additionally, the obese cohort had more complications, longer surgical times, and a greater comorbid background. Conclusions Obesity is associated with significantly more comorbid conditions, surgical complications, longer surgical time, and worse patient reported outcomes than normal weight patients undergoing arthroscopic rotator cuff repair.
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Affiliation(s)
- Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital. Carthage, NY, USA
| | - John P Scanaliato
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas, USA
| | - John C Dunn
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas, USA
| | - Walter A Fink
- Department of Orthopaedic Surgery, Carson Tahoe Health, Carson City, Nevada, USA
| | - Alexis Sandler
- Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC, USA
| | - Austin B Fares
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas, USA
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12
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Şahin K, Albayrak MO, Şentürk F, Ersin M, Erşen A. Gender and degree of tendon healing are independent predictive factors for clinical outcome in successfully healed rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2023; 31:4585-4593. [PMID: 37453965 DOI: 10.1007/s00167-023-07508-7] [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: 03/30/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Arthroscopic rotator cuff repair (aRCR) is a commonly performed procedure and has been reported to be a successful treatment. Successful healing has traditionally been considered to be associated with good outcome; however, knowledge on predictive factors affecting final outcome other than tendon healing is limited. This study aims to investigate predictive factors influencing clinical outcome following aRCR in patients with successfully healed tears. METHODS This retrospective case-control study was conducted in a single center with 135 patients who had successfully healed tendons based on Sugaya classification (grades I-III) on postoperative magnetic resonance imaging (MRI) scans following aRCR. Clinical outcome measures included Constant-Murley score (CMS), range of motion (ROM), pain score. Various preoperative, intraoperative factors and degree of postoperative tendon healing were assessed to identify independent predictive factors for final clinical outcome. RESULTS Mean age of patients was 55.9 ± 9.0 years and mean follow-up duration was 46.8 ± 14.9 months. There were 50 (37%) male and 85 (63.0%) female patients. At final follow-up, mean CMS was 85.7 ± 12.0. Considering mean postoperative CMS and the minimal clinically important difference (MCID) of 10 points for CMS, a cutoff level of 75 points for CMS was set (85-10 = 75) and study population was divided into two study groups (group I, poor outcome, CMS ≤ ;75, and group II, good outcome, CMS > 75). There were 24 (17.8%) patients in group I and 111 (82.2%) patients in group II. Univariate analysis revealed that gender, body mass index (BMI) and degree of tendon healing (Sugaya classification) differed significantly between two groups (p < 0.05). Multivariate logistic regression analysis which was conducted with these variables showed that female gender (odds ratio 3.65) and Sugaya grade III (odds ratio 8.19) were independent predictive factors which were significantly associated with poor outcome (p < 0.05). CONCLUSIONS This study showed that despite achieving a successful healing, considerable amount of patients (17.8%) have ended up with poor outcome. Female gender and degree of tendon healing were identified as independent predictive factors for poor outcome. These data would help surgeons during decision-making, risk assessment and patient counseling. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Koray Şahin
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey.
| | - Muhammed Oğuzhan Albayrak
- Department of Orthopedics and Traumatology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Fatih Şentürk
- Department of Orthopedics and Traumatology, Hendek State Hospital, Sakarya, Turkey
| | - Mehmet Ersin
- Department of Orthopedics and Traumatology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey
| | - Ali Erşen
- Department of Orthopedics and Traumatology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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13
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Fares AB, Scanaliato JP, Green CK, Dunn JC, Gordon M, Parnes N. The Effect of the Overweight Condition on Arthroscopic Rotator Cuff Repair Outcomes. Orthopedics 2023; 46:242-249. [PMID: 36719410 DOI: 10.3928/01477447-20230125-07] [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] [Indexed: 02/01/2023]
Abstract
This study sought to investigate the influence of a preexisting overweight condition (body mass index [BMI], 25-29.9 kg/m2) on functional outcomes after arthroscopic rotator cuff repair surgery. A retrospective review was performed examining the outcomes of arthroscopic rotator cuff repair in a normal-weight (BMI, 18.5-24.9 kg/m2) and an overweight (BMI, 25-29.9 kg/m2) population. Functional outcomes were assessed to include the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation score, and the visual analog scale (VAS) pain score, as well as range of motion in forward flexion, external rotation, and internal rotation. A total of 52 normal-weight patients (mean BMI, 23.7±2.1 kg/m2) and 57 overweight patients (mean BMI, 28.4±1.4 kg/m2) were included. Both groups demonstrated statistically and clinically significant improvements in VAS score, Single Assessment Numeric Evaluation score, and ASES score at final follow-up (P<.0001), with no difference in range of motion (P>.05). Overall, when comparing outcomes between the groups, there were significantly better outcomes in the normal-weight group's VAS scores (mean, 0.56±0.96 vs 1.3±1.7; P=.0064), ASES scores (mean, 96.1±5.8 vs 92.4±9.7; P=.0187), and internal rotation (mean thoracic vertebrae, 9.2±3.0 vs 10.4±2.6; P=.0289). However, these differences did not reach clinical significance regarding the threshold of patients meeting standard minimal clinically important difference, substantial clinical benefit, and patient-acceptable symptomatic state for rotator cuff repairs. Over-weight patients have improved outcomes after arthroscopic rotator cuff repair surgery with noninferior clinical results when compared with normal-weight patients. More data regarding outcomes of overweight patients will help physicians make better-informed decisions when considering rotator cuff repair. [Orthopedics. 2023;46(4):242-249.].
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Potty AG, Potty ASR, Maffulli N, Blumenschein LA, Ganta D, Mistovich RJ, Fuentes M, Denard PJ, Sethi PM, Shah AA, Gupta A. Approaching Artificial Intelligence in Orthopaedics: Predictive Analytics and Machine Learning to Prognosticate Arthroscopic Rotator Cuff Surgical Outcomes. J Clin Med 2023; 12:2369. [PMID: 36983368 PMCID: PMC10056706 DOI: 10.3390/jcm12062369] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Machine learning (ML) has not yet been used to identify factors predictive for post-operative functional outcomes following arthroscopic rotator cuff repair (ARCR). We propose a novel algorithm to predict ARCR outcomes using machine learning. This is a retrospective cohort study from a prospectively collected database. Data were collected from the Surgical Outcome System Global Registry (Arthrex, Naples, FL, USA). Pre-operative and 3-month, 6-month, and 12-month post-operative American Shoulder and Elbow Surgeons (ASES) scores were collected and used to develop a ML model. Pre-operative factors including demography, comorbidities, cuff tear, tissue quality, and fixation implants were fed to the ML model. The algorithm then produced an expected post-operative ASES score for each patient. The ML-produced scores were compared to actual scores using standard test-train machine learning principles. Overall, 631 patients who underwent shoulder arthroscopy from January 2011 to March 2020 met inclusion criteria for final analysis. A substantial number of the test dataset predictions using the XGBoost algorithm were within the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds: 67% of the 12-month post-operative predictions were within MCID, while 84% were within SCB. Pre-operative ASES score, pre-operative pain score, body mass index (BMI), age, and tendon quality were the most important features in predicting patient recovery as identified using Shapley additive explanations (SHAP). In conclusion, the proposed novel machine learning algorithm can use pre-operative factors to predict post-operative ASES scores accurately. This can further supplement pre-operative counselling, planning, and resource allocation. Level of Evidence: III.
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Affiliation(s)
- Anish G. Potty
- South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
- The Institute of Musculoskeletal Excellence (TIME Orthopaedics), Laredo, TX 78041, USA
- School of Osteopathic Medicine, The University of the Incarnate Word, San Antonio, TX 78209, USA
| | - Ajish S. R. Potty
- South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, 84084 Fisciano, Italy
- San Giovanni di Dio e Ruggi D’Aragona Hospital “Clinica Ortopedica” Department, Hospital of Salerno, 84124 Salerno, Italy
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent ST5 5BG, UK
| | - Lucas A. Blumenschein
- Department of Orthopaedics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Deepak Ganta
- School of Engineering, Texas A&M International University, Laredo, TX 78041, USA
| | - R. Justin Mistovich
- Department of Orthopaedics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Mario Fuentes
- School of Engineering, Texas A&M International University, Laredo, TX 78041, USA
| | | | - Paul M. Sethi
- Orthopaedic & Neurosurgery Specialists, Greenwich, CT 06905, USA
| | | | - Ashim Gupta
- South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
- Future Biologics, Lawrenceville, GA 30043, USA
- BioIntegrate, Lawrenceville, GA 30043, USA
- Regenerative Orthopaedics, Noida 201301, Uttar Pradesh, India
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15
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Stitz DJ, Guo AA, Lam PH, Murrell GAC. Determinants of Operative Time in Arthroscopic Rotator Cuff Repair. J Clin Med 2023; 12:jcm12051886. [PMID: 36902675 PMCID: PMC10003271 DOI: 10.3390/jcm12051886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
Arthroscopic rotator cuff repairs have been reported to take between 72 and 113 min to complete. This team has adopted its practice to reduce rotator cuff repair times. We aimed to determine (1) what factors reduced operative time, and (2) whether arthroscopic rotator cuff repairs could be performed in under 5 min. Consecutive rotator cuff repairs were filmed with the intent of capturing a <5-min repair. A retrospective analysis of prospectively collected data of 2232 patients who underwent primary arthroscopic rotator cuff repair by a single surgeon was performed using Spearman's correlations and multiple linear regression. Cohen's f2 values were calculated to quantify effect size. Video footage of a 4-min arthroscopic repair was captured on the 4th case. Backwards stepwise multivariate linear regression found that an undersurface repair technique (f2 = 0.08, p < 0.001), fewer surgical anchors (f2 = 0.06, p < 0.001), more recent case number (f2 = 0.01, p < 0.001), smaller tear size (f2 = 0.01, p < 0.001), increased assistant case number (f2 = 0.01, p < 0.001), female sex (f2 = 0.004, p < 0.001), higher repair quality ranking (f2 = 0.006, p < 0.001) and private hospital (f2 = 0.005, p < 0.001) were independently associated with a faster operative time. Use of the undersurface repair technique, reduced anchor number, smaller tear size, increased surgeon and assistant surgeon case number, performing repairs in a private hospital and female sex independently lowered operative time. A <5-min repair was captured.
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Affiliation(s)
- Daniel J. Stitz
- Orthopaedic Research Institute, St. George Hospital Campus, Kogarah, NSW 2217, Australia
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Allen A. Guo
- Orthopaedic Research Institute, St. George Hospital Campus, Kogarah, NSW 2217, Australia
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Patrick H. Lam
- Orthopaedic Research Institute, St. George Hospital Campus, Kogarah, NSW 2217, Australia
| | - George A. C. Murrell
- Orthopaedic Research Institute, St. George Hospital Campus, Kogarah, NSW 2217, Australia
- Correspondence: ; Tel.: +61-(02)-9113-2827
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16
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Migliorini F, Baroncini A, Eschweiler J, Knobe M, Tingart M, Maffulli N. Return to sport after arthroscopic surgery for femoroacetabular impingement. Surgeon 2023; 21:21-30. [PMID: 34953722 DOI: 10.1016/j.surge.2021.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 11/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is common among the active and young population. The present study analysed the rate of return to sport, related influencing factors, and the sport activity level according to the Hip Outcome Score - Sport-Specific Subscale (HOS-SSS). METHODS The literature search was performed in December 2020. All clinical trials investigating HOS-SSS and/or return to sport after arthroscopic treatment for FAI were considered for inclusion. The outcomes of interest were to analyse the rate of return to sport and the sport activity level according to the HOS-SSS in patients who underwent arthroscopic osteoplasty for FAI. RESULTS Data from 41 studies (4063 procedures) were retrieved. A total of 88.75% (581 of 655) of patients returned to sports within a mean of 37.4 ± 16.5 months. The HOS-SSS score improved from 45.0 ± 10.6 to 73.1 ± 9.5 (P < 0.0001) at last follow-up. The following baseline characteristics evidenced positive association with post-operative activity level: lighter weight (P = 0.01), younger age (P = 0.001), Tönnis angle grade I (P = 0.009), greater HHS (P = 0.01), NAHS (P < 0.0001) and HOS-ADL (P = 0.01). CONCLUSION Arthroscopic treatment for FAI resulted in excellent results in terms of return to sport. Moreover, lighter weight and younger age, greater HHS, NAHS, HOS-ADL at baseline were positively associated with post-operative sport activity level. LEVEL OF EVIDENCE IV, systematic review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Alice Baroncini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Matthias Knobe
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Markus Tingart
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, (SA), Italy; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England, United Kingdom; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, United Kingdom.
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17
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Diabetes Mellitus and Obesity as Prognostic Factors in Arthroscopic Repair of Chronic Rotator Cuff Tears. J Clin Med 2023; 12:jcm12020627. [PMID: 36675554 PMCID: PMC9866981 DOI: 10.3390/jcm12020627] [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] [Received: 11/30/2022] [Revised: 01/01/2023] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
Metabolic diseases such as obesity and diabetes mellitus seem to have an influence on reoperation and long-term functional outcomes after arthroscopic repair of chronic rotator cuff tears. High prevalence of these pathologies can be found in the Canary Islands. A retrospective cohort study was carried out, in which 80 patients undergoing shoulder arthroscopic surgery for the repair of chronic rotator cuff tears were included, with a minimum follow up of 5 years, to study the occurrence of complications, reoperation, and functional outcomes. Functionality after surgery improved in 75% of patients with diabetes and remained the same or worsened in 25% (OR = 1.444). In the group of non-diabetic patients, 83.9% had improved function after surgery while it remained the same or worsened in 16.1% (OR = 0.830). Functionality after surgery improved in 76.6% of obese patients and remained the same or worsened in 23.4% (OR = 1.324). In the non-obese group, 87.9% had improved function after surgery, while it remained the same or worsened in 12.1% (OR = 0.598). Despite not obtaining statistically significant differences, the analysis of the results obtained suggests that obesity and diabetes could act by decreasing the subjective improvement in functionality after surgery, and, in the case of obesity, also increase the risk of reoperation.
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18
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Alben MG, Gordon D, Gambhir N, Kim MT, Romeo PV, Rokito AS, Zuckerman JD, Virk MS. Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) of upper extremity PROMIS scores following arthroscopic rotator cuff repairs. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-022-07279-7. [PMID: 36622420 DOI: 10.1007/s00167-022-07279-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/07/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE To calculate and determine what factors are associated with achieving the Minimal Clinically Important Difference (MCID) and the Substantial Clinical Benefit (SCB) of Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Testing v2.0 (UE), Pain Interference (P-Interference), and Pain Intensity (P-Intensity) in patients undergoing arthroscopic rotator cuff repair (aRCR). METHODS The change in PROMIS scores representing the optimal cutoff for a ROC curve with an area under the curve analysis was used to calculate the anchor-based MCID and SCB. To assess the responsiveness of each PROM, effect sizes and standardized response means (SRM) were calculated. To identify factors associated with attaining the MCID and SCB, univariate and multivariate logistic regression analyses were performed. RESULTS A total of 323 patients with an average age of 59.9 ± 9.5 were enrolled in this study, of which, 187/323 [57.9%] were male and 136/323 [42.1%] were female. The anchor-based MCID for PROMIS UE, P-Interference, and P-Intensity was: 9.0, 7.5, and 11.2, respectively. The respective SCB was 10.9, 9.3, and 12.7. Effect size and SRM were: PROMIS UE (1.4, 1.3), P-Interference (1.8, 1.5), and P-Intensity (2.3, 2.0). Lower preoperative P-Intensity scores (p = 0.02), dominant arm involvement (p = 0.03), and concomitant biceps tenodesis (p = 0.03) were associated with patients achieving the SCB for PROMIS UE. CONCLUSION A large responsiveness for each of the PROMIS instruments due to the majority of patients reporting great improvement after aRCR and a small standard deviation across all outcome measures was shown in our study. Lower preoperative P-Intensity scores and concomitant biceps tenodesis were associated with higher odds of achieving the SCB for PROMIS UE. The knowledge of MCID and SCB values for PROMIS instruments will allow the surgeon to determine whether the improvements in the PROMIS scores after aRCR are clinically meaningful. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Dan Gordon
- Department of Orthopedic Surgery, Baylor University Medical Center Dallas, Dallas, TX, USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Matthew T Kim
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Paul V Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Andrew S Rokito
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Joseph D Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA.
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19
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Reddy RP, Charles S, Solomon DA, Sabzevari S, Hughes JD, Lesniak BP, Lin A. Arthritis Severity and Medical Comorbidities Are Prognostic of Worse Outcomes Following Arthroscopic Rotator Cuff Repair in Patients With Concomitant Glenohumeral Osteoarthritis. Arthrosc Sports Med Rehabil 2022; 4:e1969-e1977. [PMID: 36579053 PMCID: PMC9791835 DOI: 10.1016/j.asmr.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/18/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose To assess demographic factors, comorbidities, radiographic variables, and injury patterns as potential prognostic indicators of poor functional and patient-reported outcomes following arthroscopic rotator cuff repair in patients with concomitant glenohumeral osteoarthritis. Methods A retrospective review of consecutive patients with glenohumeral osteoarthritis who underwent arthroscopic supraspinatus repairs between 2013 and 2018 with a minimum of 1-year follow up was performed. Demographic variables included age, tobacco use, alcohol use, diabetes, sex, hypercholesterolemia, and body mass index while injury patterns included partial- versus full-thickness tear, bicep tendon involvement, and osteoarthritis severity. Multivariate linear regression was used to identify independent predictors of visual analog pain scale (VAS), subjective shoulder value (SSV), and American Shoulder and Elbow Surgeons (ASES) score as well as active range of motion (ROM) in forward flexion (FF) and external rotation (ER). Binary logistic regression was used to identify predictors of repair failure as well as postoperative strength in FF and ER. Results In total, 91 patients (mean age 61.48 ± 9.4 years) were identified with an average follow up of 26.3 ± 5.7 months. Repair failures occurred in 9.9% (9/91 patients) of the total cohort. Postoperative outcomes were significantly improved with regards to visual analog pain scale, subjective shoulder value, ASES score, ROM in FF, FF strength, and external rotation strength compared with preoperative baseline. Obesity (P = .023) and diabetes (P = .010) were significant independent predictors of greater pain scores postoperatively. Obesity (P = .029) and tobacco use (P = .007) were significant predictors of lower ASES scores postoperatively. Finally, moderate-to-severe osteoarthritis was a significant risk factor for poor ROM and strength in FF postoperatively compared to mild osteoarthritis (P = .029). No variables were predictive of repair failure. Conclusions Tobacco use, obesity, and diabetes are associated with worse pain and patient-reported outcomes following arthroscopic rotator cuff repair in the context of glenohumeral OA. In addition, moderate-to-severe OA is associated with worse strength and forward flexion compared to those with mild OA. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
| | | | | | | | | | | | - Albert Lin
- Address correspondence to Albert Lin, M.D., UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA 15203.
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20
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Fares AB, Scanaliato JP, Gavalas A, Dunn JC, Czajkowski H, Parnes N. Severe Obesity Is Not Associated With Worse Functional Outcomes Following Arthroscopic Rotator Cuff Repair. Arthroscopy 2022; 38:2602-2608. [PMID: 35278599 DOI: 10.1016/j.arthro.2022.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to investigate the outcomes of arthroscopic rotator cuff repair in a severely obese population (body mass index [BMI] > 0 kg/m2) compared to a healthy weight population (BMI 18.5-24.9 kg/m2). METHODS This study is a retrospective review of prospectively collected data examining the outcomes of arthroscopic rotator cuff repair in both severely obese patients and healthy weight patients. Primary outcome measures analyzed include the American Shoulder and Elbow Surgeons (ASES) Score, the Single Assessment Numeric Evaluation (SANE), pain Visual Analog Scale (VAS), range of motion, and complications. RESULTS A total of 89 patients met inclusion/exclusion criteria: 52 healthy weight patients (BMI 18.5-24.9 kg/m2) and 37 severely obese patients (BMI >40 kg/m2). Patient-reported pain and functional outcomes had significantly improved after surgery in both groups with regard to the visual analog score (VAS) scores, Single Assessment Numeric Evaluation (SANE) scores, and American Shoulder and Elbow Surgeons Shoulder (ASES) scores (P < .0001). When directly comparing the outcomes in the healthy weight group to the severely obese group, the latter had significantly inferior outcomes in VAS scores (P = .0048), SANE scores (P = .0118), ASES scores (P = .0031), and postoperative internal rotation (P =.0132). At large, these outcomes did not have clinically significant differences. The severely obese group also had higher total numbers of comorbid conditions and longer operative times (P =.0041). CONCLUSIONS Severely obese patients and their associated comorbid conditions pose unique challenges in rotator cuff tear management, but they still achieve overall excellent outcomes after repair and noninferior clinical differences when compared to healthy weight patients. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Austin B Fares
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas.
| | - John P Scanaliato
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas
| | - Anthony Gavalas
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas
| | - John C Dunn
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas
| | - Hunter Czajkowski
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York; Department of Orthopaedic Surgery, Claxton-Hepburn Medical Center, Ogdensburg, New York
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21
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Gambhir N, Shankar D, Alben M, Kwon Y, Rokito A, Virk MS. The Effects Of Obesity On 1 Year Functional Outcomes Following Arthroscopic Rotator Cuff Tear Repair. JSES Int 2022; 6:631-637. [PMID: 35813139 PMCID: PMC9264002 DOI: 10.1016/j.jseint.2022.04.004] [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] [Indexed: 11/19/2022] Open
Abstract
Background The purpose of our study was to examine the impact that an increased body mass index (BMI) has on arthroscopic rotator cuff repair (aRCR) outcomes. Methods We identified a sample of 313 patients who underwent aRCR at our institution from 2017 to 2020. Patients were classified into cohorts by BMI: normal BMI (<25), overweight (25-30), and obese (≥30). Patient-Reported Outcomes Measurement Information System (PROMIS) scores (Pain Interference, Pain Intensity, and Upper Extremity) and Clinical Global Impressions scale rating of pain and functional improvement after surgery were obtained at 1 year postoperatively. The significance of the BMI category as a predictor for outcomes was evaluated using multiple linear and multivariable logistic regressions. Receiver operating characteristic curve analysis with Youden’s J-statistic was used to determine optimal BMI cutoff for predicting likelihood of achieving minimum clinically important difference (MCID) and substantial clinical benefit (SCB) on the Clinical Global Impressions scales. Results Obesity was a significant predictor of reduced preoperative-to-postoperative improvement in the PROMIS Upper Extremity score (P = .04). However, BMI was not predictive of other preoperative-to-postoperative differences in outcome scores or the size and number of cuff tendons torn (P > .05). Optimal BMI cutoffs were determined for pain MCID (40.8), pain SCB (26.8), function MCID (27.4), and function SCB (26.8), but all cutoffs had low correct classification rates (≤13%). Discussion and Conclusion Obesity was not found to be an independent risk factor for increased rotator cuff tear size or tendon involvement but was nonetheless associated with worse upper extremity function and pain after aRCR.
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Affiliation(s)
| | | | | | | | | | - Mandeep S. Virk
- Corresponding author: Mandeep S. Virk, MD, Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery at NYU Grossman School of Medicine, 333 East 38th St, New York, NY 10016, USA.
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22
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DeClercq MG, Fiorentino AM, Lengel HA, Ruzbarsky JJ, Robinson SK, Oberlohr VT, Whitney KE, Millett PJ, Huard J. Systematic Review of Platelet-Rich Plasma for Rotator Cuff Repair: Are We Adhering to the Minimum Information for Studies Evaluating Biologics in Orthopaedics? Orthop J Sports Med 2021; 9:23259671211041971. [PMID: 34901286 PMCID: PMC8655472 DOI: 10.1177/23259671211041971] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/19/2021] [Indexed: 01/08/2023] Open
Abstract
Background The therapeutic efficacy of orthobiologic therapies for rotator cuff repair is difficult to evaluate owing to reporting inconsistences. In response, the Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines were developed to ensure standard reporting on orthobiologic therapies. Purpose To systematically review clinical studies evaluating platelet-rich plasma (PRP) for full-thickness rotator cuff repair and adherence to MIBO guidelines. Study Design Scoping review; Level of evidence, 4. Methods A search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, EMBASE, and the Cochrane Library databases. Inclusion criteria were clinical studies reporting on rotator cuff tears (≥1 cm) surgically repaired with PRP. Patient demographics, biologic intervention, and adherence to the MIBO guidelines were systematically reviewed. Results A total of 19 studies (1005 patients) were included in this review. Across all studies, 58.5% of the MIBO checklist items for PRP were reported. Out of 47 checklist items, 19 were reported in over 85% of studies, whereas 22 were reported in less than half of studies. Details of whole-blood processing and characteristics, as well as PRP processing and characteristics, were reported inconsistently, and no study provided adequate information to enable the precise replication of preparation protocols for PRP. Conclusion This systematic review highlights the current reporting deficiencies within the scientific literature of important variables for evaluating PRP for full-thickness rotator cuff repair. There was widespread variability among published studies that evaluate PRP for this application and, more specifically, studies were limited by inconsistent universal reporting of whole-blood and PRP processing and postprocessing characteristics. To improve our understanding of biologic efficacy and to promote repeatability, stricter adherence to the MIBO guidelines is necessary. We propose that the checklist limitations be addressed and that modification of the MIBO guidelines be considered to improve the reporting of individual components within certain categories.
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Affiliation(s)
- Madeleine G DeClercq
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Alyson M Fiorentino
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Sara K Robinson
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Verena T Oberlohr
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Kaitlyn E Whitney
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Johnny Huard
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
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23
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Bolam SM, Park YE, Konar S, Callon KE, Workman J, Monk AP, Coleman B, Cornish J, Vickers MH, Munro JT, Musson DS. Obesity Impairs Enthesis Healing After Rotator Cuff Repair in a Rat Model. Am J Sports Med 2021; 49:3959-3969. [PMID: 34694156 DOI: 10.1177/03635465211049219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Being overweight or obese is associated with poor outcomes and an increased risk of failure after rotator cuff (RC) surgery. However, the effect of obesity on enthesis healing has not been well characterized. HYPOTHESES Diet-induced obesity (DIO) would result in inferior enthesis healing in a rat model of RC repair, and a dietary intervention in the perioperative period would improve enthesis healing. STUDY DESIGN Controlled laboratory study. METHODS Male Sprague-Dawley rats were divided into 3 weight-matched groups (n = 26 per group): control diet (CD), high-fat diet (HFD), or HFD until surgery and then CD thereafter (HF-CD). After 12 weeks, the left supraspinatus tendon was detached, followed by immediate repair. Animals were sacrificed, and RCs were harvested at 2 and 12 weeks after surgery for biomechanical and histological evaluations. Metabolic end points were assessed using dual-energy X-ray absorptiometry and plasma analyses. RESULTS DIO was established in the HFD and HF-CD groups before surgery and subsequently reversed in the HF-CD group after surgery. At 12 weeks after surgery, the body fat percentage (P = .0021) and plasma leptin concentration (P = .0025) were higher in the HFD group compared with the CD group. Histologically, the appearance of the repaired entheses was poorer in both the HFD and HF-CD groups compared with the CD group at 12 weeks after surgery, with semiquantitative scores of 6.20 (P = .0078), 4.98 (P = .0003), and 8.68 of 15, respectively. The repaired entheses in the HF-CD group had a significantly lower load to failure (P = .0278) at 12 weeks after surgery compared with the CD group, while the load to failure in the HFD group was low but not significantly different (P = .0960). There were no differences in the biomechanical and histological results between the groups at 2 weeks after surgery. Body mass at the time of surgery, plasma leptin concentration, and body fat percentage were negatively correlated with histology scores and plasma leptin concentration was correlated with load to failure at 12 weeks after surgery. CONCLUSION DIO impaired enthesis healing in this rat RC repair model, with inferior biomechanical and histological outcomes. Restoring a normal weight with dietary changes after surgery did not improve healing outcomes. CLINICAL RELEVANCE Obesity is a potentially modifiable factor that impairs RC healing and increases the risk of failure after surgery. Exploring interventions that improve the metabolic state of obese patients and counseling patients appropriately about their modest expectations after repair should be considered.
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Affiliation(s)
- Scott M Bolam
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Young-Eun Park
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Subhajit Konar
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Karen E Callon
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Josh Workman
- Department of Chemical and Materials Engineering, University of Auckland, Auckland, New Zealand
| | - A Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Brendan Coleman
- Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Jillian Cornish
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Mark H Vickers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jacob T Munro
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - David S Musson
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand.,Department of Nutrition and Dietetics, University of Auckland, Auckland, New Zealand
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24
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Zhao J, Luo M, Pan J, Liang G, Feng W, Zeng L, Yang W, Liu J. Risk factors affecting rotator cuff retear after arthroscopic repair: a meta-analysis and systematic review. J Shoulder Elbow Surg 2021; 30:2660-2670. [PMID: 34089878 DOI: 10.1016/j.jse.2021.05.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Retear after arthroscopic rotator cuff repair (ARCR) consistently challenges medical staff and patients, and the incidence of retear after surgery is 10%-94%. The purpose of this study was to identify the risk factors that cause retear after ARCR and provide theoretical guidance for clinical intervention to reduce the occurrence of postoperative rotator cuff retear. METHODS The protocol for this meta-analysis was registered with PROSPERO (CRD42021225088). PubMed, Web of Science, and Embase were searched for observational studies on risk factors for rotator cuff retear after arthroscopic repair. Meta-analytical methods were used to determine the odds ratio or weighted mean difference of potential risk factors related to postoperative rotator cuff retear. Stata 15.1 was used to quantitatively evaluate the publication bias of the statistical results. RESULTS Fourteen studies from 6 countries with a total of 5693 patients were included. The meta-analysis revealed that the risk factors for retear after rotator cuff repair were age, body mass index, diabetes, subscapularis and infraspinatus fatty infiltration, symptom duration, bone mineral density, tear length, tear width, tear size area, amount of retraction, critical shoulder angle, acromiohumeral interval, distance from the musculotendinous junction to the glenoid, operative duration, biceps procedure, and postoperative University of California Los Angeles shoulder score. CONCLUSION These findings can help clinical medical staff identify patients who are prone to retear early after arthroscopic repair and develop targeted prevention and treatment strategies for modifiable risk factors, which are of great significance for reducing the occurrence of rotator cuff retear after ARCR.
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Affiliation(s)
- Jinlong Zhao
- The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 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
| | - 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
| | - 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
| | - Wenxuan Feng
- 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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25
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Bolam SM, Satokar VV, Konar S, Coleman B, Monk AP, Cornish J, Munro JT, Vickers MH, Albert BB, Musson DS. A Maternal High Fat Diet Leads to Sex-Specific Programming of Mechanical Properties in Supraspinatus Tendons of Adult Rat Offspring. Front Nutr 2021; 8:729427. [PMID: 34589513 PMCID: PMC8473632 DOI: 10.3389/fnut.2021.729427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/16/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Over half of women of reproductive age are now overweight or obese. The impact of maternal high-fat diet (HFD) is emerging as an important factor in the development and health of musculoskeletal tissues in offspring, however there is a paucity of evidence examining its effects on tendon. Alterations in the early life environment during critical periods of tendon growth therefore have the potential to influence tendon health that cross the lifespan. We hypothesised that a maternal HFD would alter biomechanical, morphological and gene expression profiles of adult offspring rotator cuff tendon. Materials and Methods: Female Sprague-Dawley rats were randomly assigned to either: control diet (CD; 10% kcal or 43 mg/g from fat) or HFD (45% kcal or 235 mg/g from fat) 14 days prior to mating and throughout pregnancy and lactation. Eight female and male offspring from each maternal diet group were weaned onto a standard chow diet and then culled at postnatal day 100 for tissue collection. Supraspinatus tendons were used for mechanical testing and histological assessment (cellularity, fibre organisation, nuclei shape) and tail tendons were collected for gene expression analysis. Results: A maternal HFD increased the elasticity (Young's Modulus) in the supraspinatus tendon of male offspring. Female offspring tendon biomechanical properties were not affected by maternal HFD. Gene expression of SCX and COL1A1 were reduced in male and female offspring of maternal HFD, respectively. Despite this, tendon histological organisation were similar between maternal diet groups in both sexes. Conclusion: An obesogenic diet during pregnancy increased tendon elasticity in male, but not female, offspring. This is the first study to demonstrate that maternal diet can modulate the biomechanical properties of offspring tendon. A maternal HFD may be an important factor in regulating adult offspring tendon homeostasis that may predispose offspring to developing tendinopathies and adverse tendon outcomes in later life.
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Affiliation(s)
- Scott M. Bolam
- Bone and Joint Laboratory, University of Auckland, Auckland, New Zealand
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Vidit V. Satokar
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Subhajit Konar
- Bone and Joint Laboratory, University of Auckland, Auckland, New Zealand
| | - Brendan Coleman
- Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Andrew Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Jillian Cornish
- Bone and Joint Laboratory, University of Auckland, Auckland, New Zealand
| | - Jacob T. Munro
- Bone and Joint Laboratory, University of Auckland, Auckland, New Zealand
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Mark H. Vickers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - David S. Musson
- Bone and Joint Laboratory, University of Auckland, Auckland, New Zealand
- Department of Nutrition, University of Auckland, Auckland, New Zealand
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26
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Morikawa D, Hawthorne BC, McCarthy MBR, Bellas N, Johnson JD, Trudeau MT, Murphy KV, Mancini MR, LeVasseur MR, Cote MP, Mazzocca AD. Analysis of Patient Factors Affecting In Vitro Characteristics of Subacromial Bursal Connective Tissue Progenitor Cells during Rotator Cuff Repair. J Clin Med 2021; 10:jcm10174006. [PMID: 34501453 PMCID: PMC8432549 DOI: 10.3390/jcm10174006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 02/04/2023] Open
Abstract
Unsatisfactory failure rates following rotator cuff (RC) repair have led orthopaedic surgeons to explore biological augmentation of the healing enthesis. The subacromial bursa (SB) contains abundant connective tissue progenitor cells (CTPs) that may aid in this process. The purpose of the study was to investigate the influence of patient demographics and tear characteristics on the number of colony-forming units (CFUs) and nucleated cell count (NCC) of SB-derived CTPs. In this study, we harvested SB tissue over the supraspinatus tendon and muscle in 19 patients during arthroscopic RC repair. NCC of each sample was analyzed on the day of the procedure. After 14 days, CFUs were evaluated under a microscope. Spearman’s rank correlation coefficient was then used to determine the relationship between CFUs or NCC and patient demographics or tear characteristics. The study found no significant correlation between patient demographics and the number of CFUs or NCC of CTPs derived from the SB (p > 0.05). The study did significantly observe that increased tear size was negatively correlated with the number of CFUs (p < 0.05). These results indicated that increased tear size, but not patient demographics, may influence the viability of CTPs and should be considered when augmenting RCrepairs with SB.
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Affiliation(s)
- Daichi Morikawa
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu 279-0021, Japan
- Correspondence: (D.M.); (A.D.M.)
| | - Benjamin C. Hawthorne
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Mary Beth R. McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Nicholas Bellas
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Jeremiah D. Johnson
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Maxwell T. Trudeau
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Kyle V. Murphy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Michael R. Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Matthew R. LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Mark P. Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
- Correspondence: (D.M.); (A.D.M.)
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Silva CMM, Mourão NM, da Rocha LN, Landim JIVD, Rocha HAL, Lacerda MAA, Rocha FAC, Leite JAD. Surgical outcome following rotator cuff tear repair in a low-income population. Impact of obesity and smoking. BMC Musculoskelet Disord 2021; 22:714. [PMID: 34419023 PMCID: PMC8380319 DOI: 10.1186/s12891-021-04599-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022] Open
Abstract
Background Comorbidities and socioeconomic issues impact outcome of rotator cuff tear (RCT) repair. There are no data on RCT repair outcome from developing regions. We determined the impact of obesity and smoking following RCT repair in a low-income population. Methods This is a retrospective case series. Forty-seven shoulders of 42 patients subjected to open or arthroscopic repair of a RCT with a minimum of 2 years follow-up were cross-sectionally evaluated. Patients were seen in the Orthopaedic Service of the Hospital Geral de Fortaleza-CE, Brazil between March and September 2018. RCT were classified as partial or full-thickness lesions. Fatty infiltration (Goutallier) and tendon retraction (Patte) were recorded as well as obesity (BMI > 30), literacy [>/≤ 8 school years (SY)] and smoking status 6 months prior to surgery (present/absent). Outcomes included pain (visual analogue scale; VAS, 0–10 cm), range of motion [active forward flexion and external rotation (ER)], UCLA and ASES scoring. Results Patients were 59.9 ± 7.4 years-old, 35(74.4%) female with 19 (17.1–30.2 IQR) median of months from diagnosis to surgery and 25 median months of follow-up (26.9–34.0 IQR); over 90% declared < 900.00 US$ monthly family income and two-thirds had ≤8 SY. Forty patients (85.1%) had full-thickness tears, 7 (14.9%) had Goutallier ≥3 and over 80% had < Patte III stage. Outcomes were similar regardless of fatty infiltration or tendon retraction staging. There were 17 (36.1%) smokers and 13 (27.6%) obese patients. Outcome was similar when comparing obese vs non-obese patients. Smokers had more pain (P = 0.043) and less ER (P = 0.029) with a trend towards worse UCLA and ASES scores as compared to non-smokers though differences did not achieve minimal clinically important difference (MCID) proposed for surgical RCT treatment. After adjusting for obesity, VAS and ER values in smokers were no longer significant (P = 0.2474 and 0.4872, respectively). Conclusions Our data document outcomes following RCT repair in a low-income population. Smoking status but not obesity impacted RCT repair outcome though not reaching MCID for surgical treatment.
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Affiliation(s)
- Christine M M Silva
- Postgraduating Program in Surgery, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, Brazil.,Orthopaedic Service - Shoulder and Elbow Group - Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Natália M Mourão
- Orthopaedic Service - Shoulder and Elbow Group - Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Leila N da Rocha
- Department of Internal Medicine, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, Brazil
| | - Joaquim I V D Landim
- Department of Internal Medicine, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, Brazil
| | - Hermano A L Rocha
- Department of Maternal and Child Health, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil.,Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Marco A A Lacerda
- Orthopaedic Service - Shoulder and Elbow Group - Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Francisco A C Rocha
- Department of Internal Medicine, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, Brazil. .,Instituto de Biomedicina - Laboratório de Investigação em Osteoartropatias, Rua Cel. Nunes de Melo, 1315 - 1°. Andar, Rodolfo Teófilo -, Fortaleza, CE, 60430-270, Brazil.
| | - José A D Leite
- Department of Surgery, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, Brazil
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Hopewell S, Keene DJ, Heine P, Marian IR, Dritsaki M, Cureton L, Dutton SJ, Dakin H, Carr A, Hamilton W, Hansen Z, Jaggi A, Littlewood C, Barker K, Gray A, Lamb SE. Progressive exercise compared with best-practice advice, with or without corticosteroid injection, for rotator cuff disorders: the GRASP factorial RCT. Health Technol Assess 2021; 25:1-158. [PMID: 34382931 PMCID: PMC9421560 DOI: 10.3310/hta25480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Rotator cuff-related shoulder pain is very common, but there is uncertainty regarding which modes of exercise delivery are optimal and the long-term benefits of corticosteroid injections. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of progressive exercise compared with best-practice physiotherapy advice, with or without corticosteroid injection, in adults with a rotator cuff disorder. DESIGN This was a pragmatic multicentre superiority randomised controlled trial (with a 2 × 2 factorial design). SETTING Twenty NHS primary care-based musculoskeletal and related physiotherapy services. PARTICIPANTS Adults aged ≥ 18 years with a new episode of rotator cuff-related shoulder pain in the previous 6 months. INTERVENTIONS A total of 708 participants were randomised (March 2017-May 2019) by a centralised computer-generated 1 : 1 : 1 : 1 allocation ratio to one of four interventions: (1) progressive exercise (n = 174) (six or fewer physiotherapy sessions), (2) best-practice advice (n = 174) (one physiotherapy session), (3) corticosteroid injection then progressive exercise (n = 182) (six or fewer physiotherapy sessions) or (4) corticosteroid injection then best-practice advice (n = 178) (one physiotherapy session). MAIN OUTCOME MEASURES The primary outcome was Shoulder Pain and Disability Index (SPADI) score over 12 months. Secondary outcomes included SPADI subdomains, the EuroQol 5 Dimensions, five-level version, sleep disturbance, fear avoidance, pain self-efficacy, return to activity, Global Impression of Treatment and health resource use. Outcomes were collected by postal questionnaires at 8 weeks and at 6 and 12 months. A within-trial economic evaluation was also conducted. The primary analysis was intention to treat. RESULTS Participants had a mean age of 55.5 (standard deviation 13.1) years and 49.3% were female. The mean baseline SPADI score was 54.1 (standard deviation 18.5). Follow-up rates were 91% at 8 weeks and 87% at 6 and 12 months. There was an overall improvement in SPADI score from baseline in each group over time. Over 12 months, there was no evidence of a difference in the SPADI scores between the progressive exercise intervention and the best-practice advice intervention in shoulder pain and function (adjusted mean difference between groups over 12 months -0.66, 99% confidence interval -4.52 to 3.20). There was also no difference in SPADI scores between the progressive exercise intervention and best-practice advice intervention when analysed at the 8-week and 6- and 12-month time points. Injection resulted in improvement in shoulder pain and function at 8 weeks compared with no injection (adjusted mean difference -5.64, 99% confidence interval -9.93 to -1.35), but not when analysed over 12 months (adjusted mean difference -1.11, 99% confidence interval -4.47 to 2.26), or at 6 and 12 months. There were no serious adverse events. In the base-case analysis, adding injection to best-practice advice gained 0.021 quality-adjusted life-years (p = 0.184) and increased the cost by £10 per participant (p = 0.747). Progressive exercise alone was £52 (p = 0.247) more expensive per participant than best-practice advice, and gained 0.019 QALYs (p = 0.220). At a ceiling ratio of £20,000 per quality-adjusted life-year, injection plus best-practice advice had a 54.93% probability of being the most cost-effective treatment. LIMITATIONS Participants and physiotherapists were not blinded to group allocation. Twelve-month follow-up may be insufficient for identifying all safety concerns. CONCLUSIONS Progressive exercise was not superior to a best-practice advice session with a physiotherapist. Subacromial corticosteroid injection improved shoulder pain and function, but provided only modest short-term benefit. Best-practice advice in combination with corticosteroid injection was expected to be most cost-effective, although there was substantial uncertainty. FUTURE WORK Longer-term follow-up, including any serious adverse effects of corticosteroid injection. TRIAL REGISTRATION Current Controlled Trials ISRCTN16539266 and EudraCT 2016-002991-28. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 48. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sally Hopewell
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David J Keene
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Peter Heine
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ioana R Marian
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Melina Dritsaki
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lucy Cureton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Susan J Dutton
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Helen Dakin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Willie Hamilton
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Zara Hansen
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Anju Jaggi
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | | | - Karen Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alastair Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Is obesity a risk factor in percutaneous hallux valgus surgery? Foot Ankle Surg 2021; 27:577-580. [PMID: 32800432 DOI: 10.1016/j.fas.2020.07.013] [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: 04/16/2020] [Revised: 06/14/2020] [Accepted: 07/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Obesity and its relationship with higher rate of complications in orthopedic surgeries have been reported. There is no evidence of the relation between obesity and percutaneous foot surgery. Our objective was to evaluate obesity as a risk factor for complications and reoperations in percutaneous surgery of the hallux valgus. METHODS A total 532 feet were retrospectively reviewed in which a percutaneous hallux valgus correction was performed. Complications and surgical reoperations were recorded. Patients were divided into 2 groups: BMI less and greater than 30kg/m2. RESULTS There were no differences in the rate of complications or reoperations. The total complication rate was 8%. Obesity as an isolated risk factor, presented aOR=1.14 (95%CI 0.54-2.4, p=.714). The overall rate of reoperations was 9%. Obesity presented an aOR=0.64 (95%CI 0.27-1.49, p=.31). CONCLUSION Obesity has not been associated with a higher rate of complications and reoperations in percutaneous hallux valgus surgery. It is a safe procedure and BMI should not influence in the prognosis. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Level of obesity is directly associated with complications following arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2021; 30:1581-1587. [PMID: 33536124 DOI: 10.1016/j.jse.2020.09.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the association between increasing levels of obesity and postoperative complications within 30 days of arthroscopic rotator cuff repair (ARCR). METHODS We queried the American College of Surgeons National Surgical Quality Improvement Program database for all patients who underwent ARCR from 2015 to 2017. Patients were stratified into 3 cohorts according to their body mass index (BMI). Patients with a BMI < 30 kg/m2 were placed in the non-obese cohort, patients with a BMI between 30 and 40 kg/m2 were placed in the obese cohort, and patients with a BMI > 40 kg/m2 were placed in the morbidly obese cohort. Postoperative complications within 30 days of the procedure were collected. Multivariate logistic regression was used to investigate the relationship between increasing levels of obesity and postoperative complications. RESULTS There were 18,521 patients included in this study. Of these patients, 9548 (51.6%) were non-obese, 7438 (40.2%) were obese, and 1535 (8.3%) were morbidly obese. A comparison among non-obese, obese, and morbidly obese patients showed increasing rates of medical complications (0.5% vs. 1.0% vs. 1.4%), pulmonary complications (0.1% vs. 0.3% vs. 0.5%), renal complications (0.0% vs. 0.1% vs. 0.2%), readmission (0.9% vs. 1.2% vs. 1.6%), nonhome discharge (0.4% vs. 0.5% vs. 1.2%), and overall complications (0.8% vs. 1.3% vs. 1.8%). In comparison to non-obesity, both obesity and morbid obesity were identified by multivariate analysis as significant predictors of medical complications (odds ratio [ORs] of 1.72 and 2.16, respectively), pulmonary complications (ORs of 2.66 and 4.06, respectively), and overall complications (ORs of 1.52 and 1.77, respectively). CONCLUSION This study used a large national database to identify increasing levels of obesity as a risk factor for medical complications, pulmonary complications, and overall complications within 30 days of ARCR.
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Meshram P, Liu B, Kim SW, Heo K, Oh JH. Revision Rotator Cuff Repair Versus Primary Repair for Large to Massive Tears Involving the Posterosuperior Cuff: Comparison of Clinical and Radiological Outcomes. Orthop J Sports Med 2021; 9:2325967121998791. [PMID: 33959668 PMCID: PMC8060764 DOI: 10.1177/2325967121998791] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background: The retear rate after revision rotator cuff repair (rRCR) ranges from 50% to
90%. Patients who undergo primary RCR (pRCR) for large to massive rotator
cuff tear (mRCT) also have unpredictable outcomes. Purpose: To compare the clinical outcomes after rRCR for a posterosuperior rotator
cuff tear of any size with those after pRCR for mRCT and to identify the
risk factors for poor outcomes and retear after rRCR. Study Design: Cohort study; Level of evidence, 3. Methods: Among patients with posterosuperior cuff tear treated between 2010 and 2017,
the clinical outcomes of 46 patients who underwent rRCR were compared with
106 patients who underwent pRCR for mRCT. Between-group differences in
patient-reported outcomes (visual analog scale [VAS] for pain, VAS for
satisfaction and American Shoulder and Elbow Surgeons [ASES] and Constant
scores) at final follow-up were evaluated and compared with previously
published minimal clinically important difference (MCID) values.
Radiological outcomes were evaluated using magnetic resonance imaging or
ultrasonography at a minimum 1-year follow-up. Multivariate linear
regression analysis was performed to identify the risk factors for poor ASES
score, and multivariate logistic regression analysis was used to assess the
risk factors for retear after rRCR. Results: The mean follow-up was 26.4 months (range, 24-81 months). Although final VAS
for pain, VAS for satisfaction, and ASES scores in the rRCR group were
significantly worse than those in the pRCR group, the Constant score was
similar between the groups. These differences in outcomes did not exceed the
MCID threshold. The retear rate in the rRCR group was 50% compared with 39%
for the pRCR group (P = .194). In the rRCR group, risk
factors for worse ASES score were retear (P = .043;
r = –11.3), lower body mass index (P =
.032; r = 1.9), and lower preoperative VAS for pain
(P = .038; r = 2.3), and risk factors
for retear were preoperative high-grade fatty degeneration (Goutallier
grades 3 and 4) of the supraspinatus muscle (P = .026; odds
ratio, 5.2) and serum hyperlipidemia (P = .035; odds ratio,
11.8). Conclusion: Both study groups had similar clinical and radiological outcomes. Patients
with symptomatic failed rotator cuff repairs having high-grade fatty
degeneration of the supraspinatus muscle and/or serum hyperlipidemia had a
greater likelihood of retear after rRCR.
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Affiliation(s)
- Prashant Meshram
- Shoulder Division, Department of Orthopedics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bei Liu
- Department of Orthopaedic Surgery, Seoul National University College
of Medicine, Seoul National University Bundang
Hospital, Seongnam-si, Republic of Korea
| | - Sang Woo Kim
- Department of Orthopaedic Surgery, Seoul National University College
of Medicine, Seoul National University Bundang
Hospital, Seongnam-si, Republic of Korea
| | - Kang Heo
- Department of Orthopaedic Surgery, Seoul National University College
of Medicine, Seoul National University Bundang
Hospital, Seongnam-si, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College
of Medicine, Seoul National University Bundang
Hospital, Seongnam-si, Republic of Korea
- Joo Han Oh, MD, PhD, Department of Orthopaedic Surgery, Seoul
National University College of Medicine, Seoul National University Bundang
Hospital, Seongnam-si, Republic of Korea (
)
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Moorthy V, Chen JY, Lee M, Ang BFH, Lie DTT. The UCLA Shoulder Score Is a Better Predictor of Treatment Success Than the Constant and Oxford Shoulder Scores After Arthroscopic Rotator Cuff Repair: A 2-Year Follow-Up Study. Arthrosc Sports Med Rehabil 2021; 3:e485-e490. [PMID: 34027459 PMCID: PMC8129435 DOI: 10.1016/j.asmr.2020.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of this study was to determine the correlation between functional outcome scores and treatment success after arthroscopic rotator cuff repair. Methods We conducted a retrospective cohort study of patients who underwent unilateral rotator cuff repair at a tertiary hospital between 2010 and 2015. University of California at Los Angeles Shoulder Score (UCLASS), Constant Shoulder Score (CSS), and Oxford Shoulder Score (OSS) were measured before and at 6, 12, and 24 months after surgery. Patients were divided into 2 groups at each follow-up: (1) those with successful treatment and (2) those with unsuccessful treatment. Treatment success was defined as simultaneous fulfilment of 3 criteria: clinically significant improvement in pain, expectations for surgery met, and patient satisfied with surgery. Results A total of 214 subjects met the inclusion criteria. UCLASS was a consistent significant predictor of treatment success at 6 months (odds ratio [OR] 1.192, P = .005, 95% confidence interval [CI] 1.054-1.348), 12 months (OR 1.274, P < .001, 95% CI 1.153-1.406), and 24 months (OR 1.266, P < .001, 95% CI 1.162-1.380). Lower preoperative CSS was significant in predicting treatment success at 6 months (OR 0.952, P = .001, 95% CI 0.926-0.979), while larger tear size was significant in predicting treatment success at 24 months (OR 1.773, P = .043, 95% CI 1.019-3.083). Conclusion UCLASS is a better tool for predicting treatment success than CSS and OSS in patients undergoing arthroscopic rotator cuff repair, up to a minimum of 24 months’ follow-up. A holistic assessment of shoulder function, taking into account both subjective and objective evaluation of function, as well as patient-reported satisfaction, is important in determining treatment success after arthroscopic rotator cuff repair. Level of Evidence III, retrospective comparative study.
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Affiliation(s)
- Vikaesh Moorthy
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | | | - Merrill Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Sun Y, Lin J, Luo Z, Chen J. Preoperative Lymphocyte to Monocyte Ratio Can Be a Prognostic Factor in Arthroscopic Repair of Small to Large Rotator Cuff Tears. Am J Sports Med 2020; 48:3042-3050. [PMID: 32931300 DOI: 10.1177/0363546520953427] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Complete arthroscopic repair can treat small to large rotator cuff tears (RCTs) with good outcomes; however, the repair might be compromised by inflammation. PURPOSE To investigate the prognostic value of preoperative lymphocyte to monocyte ratio (LMR), a marker of systemic inflammation before surgery, in arthroscopic rotator cuff repair. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Between January 2014 and January 2016, primary small to large RCTs without stiffness, significant muscle fatty infiltration, or atrophy were completely repaired in 110 consecutive patients and followed. Preoperative LMR was obtained from blood routinely examined 1 day before surgery. Descriptive data and pre- and intraoperative variables were collected. Correlation analysis and multivariable linear regression analysis were used to determine the relationship between preoperative LMR and recovery including American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, Fudan University Shoulder Score (FUSS), visual analog scale (VAS) score for pain, and range of motion (ROM). Poor recovery was defined as ASES score <80, shoulder stiffness as external rotation ≤20°, and pain as VAS score >3. The predictive value of preoperative LMR was determined by receiver operating characteristic (ROC) curve. RESULTS A total of 99 patients (101 shoulders) were followed for 2.88 ± 0.43 years. Overall, mean ASES, Constant-Murley, FUSS, and VAS scores were significantly improved at the final follow-up; however, 27 cases had either ASES <80, shoulder stiffness, pain, or a combination of these. Correlation analysis and multivariable linear analysis showed that preoperative LMR was the only factor independently associated with functional recovery, pain, and ROM. Patients with poor recovery had lower preoperative LMR than those with good recovery. Based on the ROC curve, the cutoff value of preoperative LMR was 4.760. Patients with preoperative LMR <4.760 had significantly inferior clinical outcomes compared with their counterparts. The corresponding specificity was 0.542, and sensitivity was 0.779. CONCLUSION Arthroscopic repair for small to large RCTs yielded good outcomes; however, some patients still had inferior functional scores, shoulder stiffness, or pain, which correlated with the level of preoperative systemic inflammation. As a marker of systemic inflammation, preoperative LMR could be prognostic for rotator cuff repair.
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Affiliation(s)
- Yaying Sun
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Jinrong Lin
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Zhiwen Luo
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
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O'Donnell EA, Fu MC, White AE, Taylor SA, Dines JS, Dines DM, Warren RF, Gulotta LV. The Effect of Patient Characteristics and Comorbidities on the Rate of Revision Rotator Cuff Repair. Arthroscopy 2020; 36:2380-2388. [PMID: 32654928 DOI: 10.1016/j.arthro.2020.05.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the national rates of failed primary rotator cuff repair (RCR) requiring revision repair, using numerous patient characteristics previously defined in orthopaedic literature, including smoking history, diabetes mellitus (DM), hyperlipidemia (HLD), vitamin D deficiency, and osteoporosis to determine which factors independently affect the success of primary RCR. METHODS A combined public and private national insurance database was searched from 2007 to 2016 for all patients who underwent RCR. Current Procedural Terminology codes were used to identify RCRs. Laterality modifiers for the primary surgery were used to identify subsequent revision RCRs. All patients who did not have a linked laterality modifier for the RCR Current Procedural Terminology code were excluded from the study. Basic demographics were recorded. International Classification of Diseases Ninth Revision codes were used to identify patient characteristics including Charlson Comorbidity Index, smoking status, DM, obesity, HLD, vitamin D deficiency, and osteoporosis. Patient age categorized as <60, 60-69, 70-74, or 75+ years old. Dichotomous data were analyzed with χ2 testing. Multivariable logistic regression was used to characterize independent associations with revision RCR. RESULTS Included in the study were 41,467 patients (41,844 shoulders, 52.7% male patients) who underwent primary arthroscopic RCR. Of all arthroscopic RCRs, 3072 patients (3463 shoulders, 53.5% male patients) underwent revision RCR (8.38%). In both primary and revision RCR, patients age 60 to 69 years were most prevalent, accounting for 38.4% and 37.6% of the cohorts, respectively. The average time from primary RCR to revision was 414.9 days (median 214.0 days). Increasing age and male sex (odds ratio [OR] 1.10, P = .019, 95% confidence interval [CI] 1.02-1.19) were significantly predictive of revision RCR. Of the remaining patient characteristics, smoking most strongly predicted revision RCR (OR 1.36, P < .001, CI 1.23-1.49). Obesity (OR 1.32, P < .001, CI 1.21-1.43), hyperlipidemia (OR 1.09, P = .032, CI 1.01-1.18), and vitamin D deficiency (OR 1.18, P < .001, CI 1.08-1.28) also increased risk of revision RCR significantly. DM was found to be protective against revision surgery (OR 0.84, P < .001, CI 0.76-0.92). Overall comorbidity burden as measured by the Charlson Comorbidity Index was not predictive of revision RCR. CONCLUSIONS Smoking, obesity, vitamin D deficiency, and HLD are shown to be independent risk factors for failure of primary RCR requiring revision RCR. However, despite the suggestions of previous studies, DM, osteoporosis, and overall comorbidity burden did not demonstrate independent associations in this study. LEVEL OF EVIDENCE IV, Case Series.
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Affiliation(s)
- Evan A O'Donnell
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A
| | - Michael C Fu
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A
| | - Alex E White
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Samuel A Taylor
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A
| | - Joshua S Dines
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A
| | - David M Dines
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A
| | - Russell F Warren
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A
| | - Lawrence V Gulotta
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A
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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: 30] [Impact Index Per Article: 7.5] [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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Tramer JS, Khalil LS, Fidai MS, Meldau J, Sheena GJ, Muh SJ, Moutzouros V, Makhni EC. Mental health and tobacco use are correlated with PROMIS upper extremity and pain interference scores in patients with shoulder pathology. Musculoskelet Surg 2020; 106:69-74. [PMID: 32661838 DOI: 10.1007/s12306-020-00674-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether patient demographics have predictive influence on patient-reported outcomes measurement information system (PROMIS) domains of pain interference (PROMIS-PI), depression (PROMIS-D), and upper extremity (PROMIS-UE) for patients with shoulder pathology treated nonoperatively. METHODS Patients with partial rotator cuff tears, impingement, scapular dyskinesia, osteoarthritis, muscle strains, biceps tendonitis, instability, and acromioclavicular arthritis were retrospectively identified. Patients who underwent surgery were excluded. Demographic characteristics were documented, and PROMIS scores before and after nonoperative intervention were analyzed for correlations between each domain. RESULTS A total of 638 questionnaires (PROMIS-UE, PROMIS-PI, and PROMIS-D) were analyzed. PROMIS-UE had a strong negative correlation with PROMIS-PI (R = - 0.73, P < .001). PROMIS-PI and PROMIS-D demonstrated a positive correlation of moderate strength (R = 0.54, P < .001). Patients who never used tobacco, compared to current or former users, had significantly higher PROMIS-UE scores (34.5 vs. 30.6 and 31.9; P < .001), lower PROMIS-PI (59.7 vs. 63.1 and 60.9; P < .001), and lower PROMIS-D scores (47.3 vs. 52.1 and 49.3; P < .001). Patients with body mass index < 24.8 had significantly higher PROMIS-UE scores than those with > 24.8 (P < .05). CONCLUSION There is an inverse relationship between upper extremity physical function and pain and depression, as measured by PROMIS scores. Smoking and increased BMI are significant contributors to worse outcomes in patients with shoulder pathology, even in nonoperative populations. Counseling patients regarding prognosis and functional outcomes is important in managing their expectations in this patient population.
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Affiliation(s)
- J S Tramer
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - L S Khalil
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - M S Fidai
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - J Meldau
- Michigan State University College of Human Medicine, 965 Fee Rd A110, East Lansing, MI, 48824, USA
| | - G J Sheena
- College of Medicine - Central Michigan University, 1280 East Campus Drive, Mount Pleasant, MI, 48859, USA
| | - S J Muh
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - V Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - E C Makhni
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
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Allen WE, Lin JJ, Barfield WB, Friedman RJ, Eichinger JK. Shoulder motion decreases as body mass increases in patients with asymptomatic shoulders. JSES Int 2020; 4:438-442. [PMID: 32939465 PMCID: PMC7479022 DOI: 10.1016/j.jseint.2020.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Higher complication rates are reported after shoulder arthroplasty in obese patients. Understanding the effect of body mass index (BMI) on range of motion (ROM) in asymptomatic shoulders may be useful in evaluating clinical outcomes for patients of varying BMIs presenting with shoulder pathology. The purpose of this study is to investigate patient characteristics, in particular BMI, that may affect ROM outcomes after shoulder arthroplasty. Methods Individuals aged 18 years or older (mean 57.21 ± 16.27 years) were recruited with asymptomatic shoulder presentation and without history of shoulder injury. A total of 224 shoulders were grouped into 4 BMI categories, and ROM was measured with a goniometer. Analysis was performed between patient demographics and ROM. Results Analyzed continuously, BMI negatively correlated with ROM for internal rotation (IR; r = −0.511, P < .01), forward elevation (FE; r = −0.418, P < .01), and external rotation (ER; r = −0.328, P < .01). ROM analyzed by BMI category revealed a dose effect of BMI vs ROM. Obese patients demonstrated a significant decrease in IR whereas morbidly obese patients had significant decreases for all ranges: IR (r = −0.469, P < .01), FE (r = −0.452, P < .01), and ER (r = –0.33, P < .01). Normal- and overweight patients revealed no significant correlations with ROM. Conclusion As BMI is negatively correlated with ROM of the asymptomatic shoulder, patients with higher BMIs may be predisposed to diminished outcomes postoperatively. These baseline correlations will allow surgeons to make postoperative expectations and anticipate poorer outcomes of shoulder ROM in obese patients.
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Affiliation(s)
| | | | | | | | - Josef K. Eichinger
- Corresponding author: Josef K. Eichinger, MD, 96 Jonathan Lucas St, CSB 708, Charleston, SC 29425, USA.
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Lee SM, Seo YG, Park WH, Yoo JC. Preoperative Rotator Muscle Strength Ratio Predicts Shoulder Function in Patients After Rotator Cuff Repair. Orthop J Sports Med 2020; 8:2325967119899346. [PMID: 32095486 PMCID: PMC7008562 DOI: 10.1177/2325967119899346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/18/2019] [Indexed: 01/19/2023] Open
Abstract
Background Shoulder function after rotator cuff repair is associated with patient satisfaction after surgery. Several studies have demonstrated that the muscle strength ratio (external rotators/internal rotators) is an important factor to evaluate shoulder function, but little is known about the relationship between the preoperative muscle strength ratio and postoperative shoulder function. Purpose To evaluate the effect of the preoperative muscle strength ratio of the shoulder rotators on function after rotator cuff repair. Study Design Cohort study; Level of evidence, 3. Methods The study participants were patients with small- to medium-sized rotator cuff tears diagnosed by magnetic resonance imaging; 77 patients were included in the analysis. Preoperative muscle strength was assessed through use of isokinetic equipment. Patients were classified into 2 groups (normal and abnormal) according to a normal strength ratio range of 55% to 75%, with "abnormal" meaning a deviation of more than 15% from the normal range. The American Shoulder and Elbow Surgeons (ASES) score and the Constant score were used to evaluate shoulder function preoperatively and postoperatively at 6 months, 1 year, and 2 years. Results There were 30 patients in the normal group and 47 in the abnormal group, with a preoperative muscle strength ratio of 63.5% ± 5.5% and 42.6% ± 6.1%, respectively. The ASES score was 88.6 ± 9.1 in the normal group and 77.5 ± 13.6 in the abnormal group at 2 years postoperatively, and the Constant score was 82.7 ± 8.4 in the normal group and 69.5 ± 13.4 in the abnormal group at 2 years postoperatively. A significant difference was found in postoperative shoulder function between the normal and abnormal groups. Conclusion This study demonstrated that the preoperative muscle strength ratio was associated with postoperative shoulder function. The preoperative muscle strength ratio should be considered an important predictor of shoulder function after rotator cuff repair.
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Affiliation(s)
- Sang Min Lee
- Division of Sports Medicine Center, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Yong Gon Seo
- Division of Sports Medicine Center, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Won Hah Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
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Reducing Lateral Femoral Cutaneous Nerve Palsy in Obese Patients in the Beach Chair Position: Effect of a Standardized Positioning and Padding Protocol. J Am Acad Orthop Surg 2019; 27:437-443. [PMID: 30325879 DOI: 10.5435/jaaos-d-17-00624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION To report on the effectiveness of a standardized patient positioning and padding protocol in reducing lateral femoral cutaneous nerve (LFCN) palsy in obese patients who have undergone shoulder surgery in the beach chair position. METHODS We retrospectively reviewed the medical records of 400 consecutive patients with a body mass index (BMI) of ≥30 kg/m who underwent either open or arthroscopic shoulder surgery in the beach chair position by a single surgeon. Before June 2013, all patients were placed in standard beach chair positioning with no extra padding. After June 2013, patients had foam padding placed over their thighs underneath a wide safety strap and underneath the abdominal pannus. Flexion at the waist was minimized, and reverse Trendelenburg was used to position the shoulder appropriately. Patient demographic and surgical data, including age, sex, weight, BMI, presence of diabetes, procedure duration, American Society of Anesthesiologists (ASA) grade, and anesthesia type (general, regional, regional/general) were recorded. Symptoms of LFCN palsy were specifically elicited postoperatively in a prospective fashion and identified clinically by focal pain, numbness, and/or tingling over the anterolateral thigh. RESULTS The median age was 58.0 years, and the study consisted of 142 male (36%) and 258 female (64%) subjects. Five cases (3.6%) of LFCN palsy occurred with conventional beach chair positioning, and a single case (0.4%) occurred with the standardized positioning and padding technique (P = 0.02). Median age, sex, presence of diabetes, median BMI, surgery type, and surgical time were not significantly different between the patients who did and did not develop LFCN palsy. All cases resolved completely within 6 months. DISCUSSION The occurrence of LFCN palsy following shoulder surgery in the beach chair position remains uncommon, even among obese patients. Use of a standardized positioning and padding protocol for obese patients in the beach chair position reduced the prevalence of LFCN palsy. LEVEL OF EVIDENCE Level III (prognostic).
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Matson AP, Kim C, Bajpai S, Green CL, Hash TW, Garrigues GE. The effect of obesity on fatty infiltration of the rotator cuff musculature in patients without rotator cuff tears. Shoulder Elbow 2019; 11:30-38. [PMID: 31019560 PMCID: PMC6463385 DOI: 10.1177/1758573217736008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/17/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND The modified Goutallier classification system describes the fatty infiltration of rotator cuff musculature (RCM) seen on magnetic resonance imaging (MRI) to assist with surgical decision-making for patients with rotator cuff tears (RCT). We describe the relationship between body mass index (BMI) and fatty infiltration in patients without RCT. METHODS Twenty-five patients from each of four different BMI ranges (< 25 kg/m2; 25 kg/m2 to 30 kg/m2; 30 kg/m2 to 35 kg/m2; > 35 kg/m2) were randomly selected from 1088 consecutive shoulder MRI scans (T1 parasagittal series). Four physician-readers evaluated MRI scans and assigned modified Goutallier grades (0 to 4) in each of the four rotator cuff muscles, as well as two adjacent muscles. RESULTS Grade distributions varied significantly based on BMI category for infraspinatus (p = 0.001), teres minor (p < 0.001), subscapularis (p = 0.025), teres major (p < 0.001) and deltoid (p < 0.001). Higher grades were evident with a diagnosis of diabetes mellitus in three of six muscles (p < 0.05), hyperlipidaemia in one muscle (p = 0.021) and greater patient age in three muscles (p < 0.05). CONCLUSIONS Obese and severely obese patients without RCT have more fatty infiltration seen on MRI. Patient factors (older age and diagnosis of diabetes mellitus) can be predictive of fatty infiltration in RCM. Fatty infiltration of RCM is not solely attributable to the presence of a RCT.
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Affiliation(s)
- Andrew P. Matson
- Department of Orthopaedic Surgery, Duke University Medical Center, USA,Andrew P. Matson, Box 3000, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
| | - Christopher Kim
- Department of Orthopaedic Surgery, Duke University Medical Center, USA
| | - Swara Bajpai
- School of Medicine, Duke University Medical Center, USA
| | - Cynthia L. Green
- Department of Biostatistics and Bioinformtics, Duke University Medical Center, USA
| | - Thomas W. Hash
- Department of Radiology, Duke University Medical Center, USA
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Cvetanovich GL, Gowd AK, Liu JN, Nwachukwu BU, Cabarcas BC, Cole BJ, Forsythe B, Romeo AA, Verma NN. Establishing clinically significant outcome after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2019; 28:939-948. [PMID: 30685283 DOI: 10.1016/j.jse.2018.10.013] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/26/2018] [Accepted: 10/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Outcomes reporting in rotator cuff repair (RCR) literature has been variable. The minimal clinical important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) bridge the gap between statistical significance and clinical relevance. METHODS The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numeric Evaluation (SANE), and Constant-Murley (Constant) scores were collected preoperatively and 1 year postoperatively for patients undergoing RCR between 2014 and 2017. An anchor-based approach was used to calculate the MCID, SCB change, and PASS for the ASES questionnaire. RESULTS The study included 288 patients who underwent RCR. The MCID, SCB, and PASS were, respectively, 11.1, 17.5, and 86.7 for ASES, 4.6, 5.5, and 23.3 for the Constant score, and 16.9, 29.8, and 82.5 for the SANE score. Factors associated with reduced odds of achieving MCID were current smoking for ASES (odds ratio, 0.056) and single-row repair for the Constant score (odds ratio, 0.310). Workers' compensation patients had reduced odds of achieving ASES SCB (odds ratio, 0.267) and were associated with reduced odds of achieving PASS by ASES (odds ratio, 0.244), SANE (OR, 0.452), and Constant (odds ratio, 0.313). Lower preoperative scores were associated with achieving MCID and SCB and higher preoperative Constant scores associated with PASS (P < .001). CONCLUSION This study establishes MCID, SCB, and PASS for ASES, Constant, and SANE scores in patients undergoing RCR. Factors associated with failing to achieve clinically significant values included current smoking, single-row repairs, high body mass index, and workers' compensation status.
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Affiliation(s)
| | - Anirudh K Gowd
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brandon C Cabarcas
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Anthony A Romeo
- Department of Orthopedic Surgery, The Rothman Institute, New York, NY, USA
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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Patient-related Risk Factors for Postoperative Stiffness Requiring Surgical Intervention After Arthroscopic Rotator Cuff Repair. J Am Acad Orthop Surg 2019; 27:e319-e323. [PMID: 30278008 DOI: 10.5435/jaaos-d-16-00929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Risk factors for stiffness after arthroscopic rotator cuff repair (RCR) have been limited to studies with small patient numbers. The objective is to determine patient-related risk factors for stiffness after RCR. METHODS The PearlDiver database was queried from 2007 to 2015 for patients undergoing isolated arthroscopic RCR. A multivariate binomial logistic regression analysis assessed for risk factors requiring a postoperative manipulation under anesthesia (MUA) or lysis of adhesions (LOA) within 9 months after RCR. RESULTS Two hundred thirty-two of 19,229 patients (1.2%) underwent a LOA and/or MUA within 9 months after arthroscopic RCR. Significant risk factors identified were age less than 50 years (odds ratio [OR], 1.9; P < 0.0001), female gender (OR, 2.0; P < 0.0001), diabetes mellitus (DM) type I (OR, 2.7; P < 0.0001), hypothyroidism (OR, 1.3; P = 0.020), and systemic lupus erythematosus (OR, 2.1; P = 0.004). However, tobacco use was associated with a 0.5 risk of developing stiffness (P < 0.0001). DISCUSSION Systemic lupus erythematosus, hypothyroidism, and DMI (but not DMII) in addition to young age and female gender were risk factors for LOA/MUA after arthroscopic RCR.
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Editorial Commentary: Medicine Is About Shared Decision Making and Discussion of Risk-Benefit Ratios-Body Mass Index Cutoffs Are Unjust. Arthroscopy 2019; 35:747-748. [PMID: 30827427 DOI: 10.1016/j.arthro.2018.11.029] [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: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 02/02/2023]
Abstract
As physicians, we have the responsibility of evaluating patient problems and making decisions about their plan of care. In today's world, the paternalistic approach to patient care has been appropriately replaced by shared decision making. Therefore, patients who are undergoing evaluation for elective shoulder arthroscopy procedures should be counseled about the risks and benefits of surgery relative to their clinical presentation both physiologically and orthopaedically. No one medical factor in isolation should be used to decide on the appropriateness of surgery, including an absolute body mass index cutoff. Among the main drivers of these cutoff algorithms are alternative payment models and episodes of care, which are here to stay. Although some aspects of these models are beneficial, we cannot let some of these simplistic algorithms replace our decision-making skills as physicians.
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Rubenstein WJ, Lansdown DA, Feeley BT, Ma CB, Zhang AL. The Impact of Body Mass Index on Complications After Shoulder Arthroscopy: Should Surgery Eligibility Be Determined by Body Mass Index Cutoffs? Arthroscopy 2019; 35:741-746. [PMID: 30704887 DOI: 10.1016/j.arthro.2018.10.136] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/28/2018] [Accepted: 10/28/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of this study is to analyze postoperative complications after shoulder arthroscopy stratified by body mass index (BMI) and to quantify the trade-off in postsurgical complications and access to care that occurs with BMI eligibility cutoffs. METHODS Patients who underwent shoulder arthroscopy in the National Surgical Quality Improvement Program database from 2015 to 2016 were identified. Patients were categorized on the basis of their BMI. χ2 tests were used to identify differences in complication rates between different BMI categories. Logistic regression was used to calculate the odds ratio of having a major complication by BMI category. The positive predictive value (PPV) was calculated at different BMI cutoffs. RESULTS There were 26,509 shoulder arthroscopy cases identified in the National Surgical Quality Improvement Program database with 383 major complications, for an overall rate of 1.4%. Patients with a BMI >40 had a higher overall complication rate (2.3% vs 1.4%, P = .001), as well as higher rates of readmission (P = .012), pneumonia (P = .030), progressive renal insufficiency (P = .006), and cardiac arrest (P = .008). BMI >40 was associated with an increased risk of major complications (odds ratio, 1.84; confidence interval, 1.29-2.61). A BMI cutoff of 40 would avoid 12% of major complications while excluding 8% of complication-free surgeries. At a BMI cutoff of 40, the PPV was 2.3% where 43 surgeries would be denied for every complication avoided. CONCLUSION Patients with a BMI >40 have a statistically significant but only slightly increased risk of 30-day complications after shoulder arthroscopy. Instituting a BMI eligibility cutoff at 40 has a low PPV and would prevent 43 complication-free surgeries from proceeding for every complication prevented. Patients should be counseled individually about their risk factors, but denial of shoulder arthroscopy on the basis of BMI alone may not be an appropriate strategy for risk reduction. LEVEL OF EVIDENCE Level III, comparative prognostic trial.
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Affiliation(s)
- William J Rubenstein
- Department of Orthopedics, University of California at San Francisco, San Francisco, California, U.S.A..
| | - Drew A Lansdown
- Department of Orthopedics, University of California at San Francisco, San Francisco, California, U.S.A
| | - Brian T Feeley
- Department of Orthopedics, University of California at San Francisco, San Francisco, California, U.S.A
| | - C Benjamin Ma
- Department of Orthopedics, University of California at San Francisco, San Francisco, California, U.S.A
| | - Alan L Zhang
- Department of Orthopedics, University of California at San Francisco, San Francisco, California, U.S.A
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Cooper JD, Lorenzana DJ, Heckmann N, McKnight B, Mostofi A, Gamradt SC, Rick Hatch GF. The Effect of Obesity on Operative Times and 30-Day Readmissions After Anterior Cruciate Ligament Reconstruction. Arthroscopy 2019; 35:121-129. [PMID: 30611339 DOI: 10.1016/j.arthro.2018.07.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To understand the effect of obesity on operative times and 30-day readmission rates after arthroscopic anterior cruciate ligament reconstruction (ACLR). METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology billing codes to identify all patients aged 18 years and older who underwent ACLR between 2007 and 2014. The Student t test was used for continuous variables, and the χ-square or Fisher exact test was used for categorical variables. Multivariate analysis was conducted to identify factors associated with 30-day readmission. RESULTS We identified 9,000 patients who underwent ACLR. In the readmission analysis, the total readmission rate was 0.70%. After multivariate analysis, a body mass index (BMI) of 40 or greater was associated with a significantly increased risk of 30-day readmission (odds ratio, 3.06; 95% confidence interval, 1.09-8.57). An operative time of less than 80 minutes was associated with a decreased risk of readmission (odds ratio, 0.40, 95% confidence interval, 0.18-0.92). In the operative-time analysis, the mean operative time was 100.7 minutes. Older age was predictive of decreasing operative time, with the operative time being 32.75 minutes shorter in patients aged 65 years or older than in those younger than 25 years. After multivariate analysis, class II obesity (BMI of 35-39.9) predicted an increase of 7.11 minutes and class III obesity (BMI ≥ 40) predicted an increase of 8.70 minutes compared with normal weight (BMI of 18.5-24.9). CONCLUSIONS Obesity is associated with longer operative times and increased 30-day readmissions after ACLR, with patients with a BMI of 40 or greater having over 3 times the risk of readmission compared with patients with a normal weight. Male sex, black race, and younger age are all also associated with increased operative times. LEVEL OF EVIDENCE Level III, observational, retrospective cohort study.
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Affiliation(s)
- Joseph D Cooper
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A..
| | - Daniel J Lorenzana
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Nathanael Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Braden McKnight
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Amir Mostofi
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A.; Huntington Memorial Hospital, Pasadena, California, U.S.A
| | - Seth C Gamradt
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - George F Rick Hatch
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
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Abstract
BACKGROUND Psychologic factors are associated with pain and disability in patients with chronic shoulder pain. Recent research regarding the association of affective psychologic factors (emotions) with patients' pain and disability outcome after surgery disagrees; and the relationship between cognitive psychologic factors (thoughts and beliefs) and outcome after surgery is unknown. QUESTIONS/PURPOSES (1) Are there identifiable clusters (based on psychologic functioning measures) in patients undergoing shoulder surgery? (2) Is poorer psychologic functioning associated with worse outcome (American Shoulder and Elbow Surgeons [ASES] score) after shoulder surgery? METHODS This prospective cohort study investigated patients undergoing shoulder surgery for rotator cuff-related shoulder pain or rotator cuff tear by one of six surgeons between January 2014 and July 2015. Inclusion criteria were patients undergoing surgery for rotator cuff repair with or without subacromial decompression and arthroscopic subacromial decompression only. Of 153 patients who were recruited and consented to participate in the study, 16 withdrew before data collection, leaving 137 who underwent surgery and were included in analyses. Of these, 124 (46 of 124 [37%] female; median age, 54 years [range, 21-79 years]) had a complete set of four psychologic measures before surgery: Depression, Anxiety and Stress Scale; Pain Catastrophizing Scale; Pain Self-Efficacy Questionnaire; and Tampa Scale for Kinesiophobia. The existence of clusters of people with different profiles of affective and cognitive factors was investigated using latent class analysis, which grouped people according to their pattern of scores on the four psychologic measures. Resultant clusters were profiled on potential confounding variables. The ASES score was measured before surgery and 3 and 12 months after surgery. Linear mixed models assessed the association between psychologic cluster membership before surgery and trajectories of ASES score over time adjusting for potential confounding variables. RESULTS Two clusters were identified: one cluster (84 of 124 [68%]) had lower scores indicating better psychologic functioning and a second cluster (40 of 124 [32%]) had higher scores indicating poorer psychologic functioning. Accounting for all variables, the cluster with poorer psychologic functioning was found to be independently associated with worse ASES score at all time points (regression coefficient for ASES: before surgery -9 [95% confidence interval {CI}, -16 to -2], p = 0.011); 3 months after surgery -15 [95% CI, -23 to -8], p < 0.001); and 12 months after surgery -9 [95% CI, -17 to -1], p = 0.023). However, both clusters showed improvement in ASES score from before to 12 months after surgery, and there was no difference in the amount of improvement between clusters (regression coefficient for ASES: cluster with poorer psychologic function 31 [95% CI, 26-36], p < 0.001); cluster with better psychologic function 31 [95% CI, 23-39], p < 0.001). CONCLUSIONS Patients who scored poorly on a range of psychologic measures before shoulder surgery displayed worse ASES scores at 3 and 12 months after surgery. Screening of psychologic factors before surgery is recommended to identify patients with poor psychologic function. Such patients may warrant additional behavioral or psychologic management before proceeding to surgery. However, further research is needed to determine the optimal management for patients with poorer psychologic function to improve pain and disability levels before and after surgery. LEVEL OF EVIDENCE Level II, therapeutic study.
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Fischer C, Gross S, Zeifang F, Schmidmaier G, Weber MA, Kunz P. Contrast-Enhanced Ultrasound Determines Supraspinatus Muscle Atrophy After Cuff Repair and Correlates to Functional Shoulder Outcome. Am J Sports Med 2018; 46:2735-2742. [PMID: 30080421 DOI: 10.1177/0363546518787266] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Muscle degeneration as a consequence of rotator cuff tears is mainly assessed by magnetic resonance imaging. Contrast-enhanced ultrasound (CEUS) is a new functional imaging method to assess microvascular perfusion as a fundamental parameter of muscle tissue vitality. In this cross-sectional study, the authors evaluated supraspinatus muscle perfusion after cuff repair and analyzed its association with functional shoulder outcome and the grade of echogenicity in B-mode ultrasound indicating fatty infiltration. HYPOTHESIS The authors expected reduced microperfusion of the operated versus the contralateral supraspinatus muscle and a correlation of the muscular microperfusion with functional shoulder outcome. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients who received unilateral repair of the supraspinatus tendon between 2009 and 2014 were invited for a single follow-up examination. Functional scores were assessed, including the Constant-Murley score and American Shoulder and Elbow Surgeons score. CEUS examination was performed bilaterally in an oblique sagittal plane of the supraspinatus fossa. Perfusion was quantified by the parameters wash-in perfusion index (WiPI) and peak enhancement via VueBox quantification software. The results of the Constant-Murley score, American Shoulder and Elbow Surgeons score, and perfusion parameters were referenced to the contralateral shoulder. Echogenicity of the supraspinatus muscle was classified with a 3-point scale as compared with the trapezius muscle. RESULTS Sixty-seven patients were available, with a mean follow-up of 38.0 ± 18.5 months. Functional assessment showed impaired shoulder function on the operated shoulder as compared with the contralateral side (relative Constant Score [CS], 80% ± 19%). CEUS revealed diminished perfusion on the operated shoulder (WiPI, 55.1% ± 40.2%, P < .001). A strong correlation could be demonstrated between the perfusion deficit and functional impairment (relative WiPI and CS: rs = .644, P < .001). Higher grade of echogenicity in B-mode ultrasound was associated with reduced perfusion. CONCLUSION CEUS could visualize impaired supraspinatus muscle perfusion after rotator cuff repair as compared with the contralateral, healthy shoulder. With its ability to quantify microvascular perfusion as a surrogate parameter for muscle vitality and function, CEUS may serve as a quantitative method to evaluate rotator cuff muscles.
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Affiliation(s)
- Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Sascha Gross
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Zeifang
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
| | - Pierre Kunz
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany.,Shoulder and Elbow Surgery, Catholic Hospital Mainz, Mainz, Germany
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The impact of body mass index on metatarsalgia surgical outcomes. INTERNATIONAL ORTHOPAEDICS 2018; 43:1443-1447. [PMID: 30076443 DOI: 10.1007/s00264-018-4067-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Several studies have suggested that an increased body mass index (BMI) is a negative factor for forefoot plantar pain but its influence in the surgical correction of metatarsalgia is unknown. The purpose of the present study is to evaluate the influence of the BMI on the surgical outcomes of metatarsalgia. It has been hypothesized that the higher the BMI, the worse the functional outcomes after metatarsalgia surgical treatment at one year follow-up. MATERIAL AND METHODS A prospective cohort study that included all patients operated on for third rocker metatarsalgia was conducted. Weil's osteotomy was performed on all the patients operated on. The patients' pre-operative height, weight, and BMI were recorded. The patients were subsequently divided into three groups based on their BMI. There was group 1 or the normal group (18.5 > BMI ≤ 25 kg/m2), group 2 or the overweight group (25 > BMI ≤ 30 kg/m2), and group 3 or the obese group (BMI > 30 kg/m2). Pre-operative, post-operative, and differential AOFAS were used to evaluate and compare the groups. The post-operative VAS was also measured to assess pain. The correlation between the BMI and those variables was also analyzed. RESULTS After the exclusion criteria were applied, 107 patients were finally assessed. There were 22 patients (20.6%) in group 1, 52 patients (48.6%) in group 2, and 33 patients (30.8%) in group 3. No correlation was observed between the BMI and AOFAS (p > 0.05). Neither were any differences found when the three groups were compared (p > 0.05). Moreover, no correlation between the BMI and the VAS score was observed (p = 0.690). CONCLUSION Obesity does not negatively influence functional outcomes after surgery for metatarsalgia in short to medium term. Regardless of their BMI, patients with propulsive metatarsalgia improve in functionality after surgical treatment.
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Perets I, Rybalko D, Chaharbakhshi EO, Mu BH, Chen AW, Domb BG. Minimum Five-Year Outcomes of Hip Arthroscopy for the Treatment of Femoroacetabular Impingement and Labral Tears in Patients with Obesity: A Match-Controlled Study. J Bone Joint Surg Am 2018; 100:965-973. [PMID: 29870448 DOI: 10.2106/jbjs.17.00892] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Obesity is a negative prognostic factor for various surgical procedures. The purpose of this study was to compare patients with obesity who underwent hip arthroscopy for femoroacetabular impingement and labral tears with a match-controlled group of normal-weight patients. METHODS Data were prospectively collected and retrospectively reviewed for patients who underwent arthroscopy between February 2008 and December 2011. Inclusion criteria were treatment for femoroacetabular impingement and labral tears and completed preoperative patient-reported outcomes and visual analog scale (VAS) for pain. Exclusion criteria were previous ipsilateral hip conditions or preoperative Tönnis grade of ≥2. Patients with obesity (body mass index [BMI] of ≥30 kg/m) were matched and were compared with normal-weight patients (BMI of 18.5 to 24.99 kg/m) using a 1:1 ratio by age at the time of the surgical procedure within 5 years, sex, acetabular Outerbridge grade (0 or 1 compared with 2, 3, or 4), and capsular treatment. RESULTS Of the 96 obesity cases with follow-up, 74 were pair-matched to control cases. The mean BMI was 34.3 kg/m for the obesity group and 22.7 kg/m for the control group (p < 0.0001). The mean follow-up time was 71.6 months for the obesity group and 71.3 months for the control group (p = 0.41). All mean preoperative patient-reported outcomes and VAS scores for patients without conversion to total hip arthroplasty were significantly worse in the obesity group: modified Harris hip score (p = 0.0001), Non-Arthritic Hip Score (p = 0.0001), Hip Outcome Score Sports-Specific Scale (HOS-SSS) (p = 0.015), and VAS (p = 0.01). No significant differences were observed with regard to demographic characteristics, intraoperative findings, procedures, follow-up scores, magnitudes of improvement, or secondary arthroscopy rates (p > 0.05). Both groups demonstrated significant improvements in mean outcome scores at ≥5 years (p < 0.0001). In both groups, no significant differences were detected in mean outcome scores between 2 years and ≥5 years (p > 0.05). The conversion rate to total hip arthroplasty was 29.7% for the obesity group and 14.9% for the control group (relative risk, 2.0 [95% confidence interval, 1.1 to 3.8]; p = 0.04). CONCLUSIONS Hip arthroscopy for the treatment of femoroacetabular impingement and labral tears in patients with obesity yielded significant improvements at ≥5 years; these results were similar to a matched group of normal-weight patients. However, patients with obesity demonstrated a twofold increased risk of conversion to total hip arthroplasty. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Itay Perets
- American Hip Institute, Westmont, Illinois.,Department of Orthopaedics, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | | | - Edwin O Chaharbakhshi
- American Hip Institute, Westmont, Illinois.,Loyola University College of Medicine, Maywood, Illinois
| | - Brian H Mu
- American Hip Institute, Westmont, Illinois
| | | | - Benjamin G Domb
- American Hip Institute, Westmont, Illinois.,Hinsdale Orthopaedics, Hinsdale, Illinois
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Factors affecting rotator cuff integrity after arthroscopic repair for medium-sized or larger cuff tears: a retrospective cohort study. J Shoulder Elbow Surg 2018; 27:1012-1020. [PMID: 29290609 DOI: 10.1016/j.jse.2017.11.016] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/01/2017] [Accepted: 11/06/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND We wished to identify the preoperative prognostic factors associated with structural integrity after repair of medium-sized and larger rotator cuff tears and to determine the cutoff values using receiver operating characteristic curve analysis. METHODS The study included 180 patients with medium-sized and larger rotator cuff tears. Each had a minimum 2-year postoperative follow-up by magnetic resonance imaging. We assessed several patient-related and disease-related preoperative factors using univariate and multivariate logistic regression analysis. To determine the cutoff value for the significant variables, receiver operating characteristic curve analysis was performed. RESULTS Retears occurred in 28 of the 180 patients (15.6%). Univariate analysis found that retear was significantly affected by the type of work and pattern of tear. The rate of retear was significantly increased in diabetes and with increasing tear size, extent of retraction, delamination, and fatty infiltration. Furthermore, reduced remnant tendon length, distance from the musculotendinous junction to the face of the glenoid, occupation ratio, and acromiohumeral interval were also significant risk factors. In the multivariate analysis, body mass index, diabetes, dyslipidemia, extent of retraction, delamination, distance from musculotendinous junction to face of glenoid, occupation ratio, fatty infiltration of infraspinatus, and acromiohumeral interval remained significant risk factors. The extent of retraction (22.2 mm) and the occupation ratio (53.5%) showed highly accurate cutoff values for predicting retear. CONCLUSION Multiple factors influenced the healing process after rotator cuff repair. The best predictors were the extent of retraction and occupation ratio, which could help assist in determining the prognosis after rotator cuff repairs.
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