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Stern BZ, Zubizarreta N, Anthony SG, Poeran J, Gladstone JN. Association between timing of initiating supervised physical rehabilitation after rotator cuff repair and incidence of repeat repair and capsulitis: a population-based analysis. J Shoulder Elbow Surg 2024; 33:1747-1754. [PMID: 38378128 DOI: 10.1016/j.jse.2024.01.017] [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: 06/25/2023] [Revised: 12/21/2023] [Accepted: 01/01/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND There is limited consensus on the optimal time to initiate supervised physical rehabilitation after a rotator cuff repair (RCR). We examined whether timing of initiating supervised physical rehabilitation was associated with repeat RCR or development of adhesive capsulitis within 12 months postoperatively in an observational cohort of commercially insured adults. METHODS This retrospective cohort study used the IBM MarketScan Commercial Claims and Encounters Database. We included adults aged 18-64 who underwent a unilateral outpatient RCR between 2017 and 2020 and initiated supervised physical rehabilitation 1-90 days postoperatively. Multivariable logistic regression models examined the adjusted association between time of initiating supervised physical rehabilitation (1-13, 14-27, 28-41, and 42-90 days postoperatively) and each of the primary outcomes: repeat RCR and capsulitis. In a sensitivity analysis, time to rehabilitation was alternatively categorized using a data-driven approach of quartiles (1-7, 8-16, 17-30, and 31-90 days postoperatively). We report adjusted odds ratios (OR). RESULTS Among 33,841 patients (86.7% arthroscopic index RCR), the median time between index RCR and rehabilitation initiation was 16 days (interquartile range 7-30), with 39.9% initiating rehabilitation at 1-13 days. Additionally, 2.2% underwent repeat RCR within 12 months, and 12-month capsulitis was identified in 1.9% of patients. There were no significant associations between timing of initiating rehabilitation and 12-month repeat RCR (OR 0.85-0.93, P = .18-.49) or 12-month capsulitis (OR 0.83-0.94, P = .22-.63). Lack of associations between timing and outcomes was supported in sensitivity analyses. CONCLUSIONS Timing of initiating rehabilitation was not significantly associated with adverse outcomes after RCR. The finding of no increased odds of repeat RCR or capsulitis with the earliest timing may support earlier initiation of rehabilitation to accelerate return to daily activities. Findings should be replicated in another dataset of similarly-aged patients.
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Affiliation(s)
- Brocha Z Stern
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Nicole Zubizarreta
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shawn G Anthony
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James N Gladstone
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kararti C, Özyurt F, Kodak Mİ, Basat HÇ, Özsoy G, Özsoy İ, Tayfur A. Pain Neuroscience Education Following Arthroscopic Rotator Cuff Repair for Patients With Rotator Cuff Tears: A Double-Blind Randomized Controlled Clinical Trial. Am J Phys Med Rehabil 2024; 103:690-697. [PMID: 38547029 DOI: 10.1097/phm.0000000000002481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
OBJECTIVE This trial examines the efficacy of the pain neuroscience education on clinical outcomes in patients with arthroscopic rotator cuff repair. DESIGN A total of 36 participants undergoing arthroscopic rotator cuff repair were assigned to either the experimental group ( n = 18) or control group ( n = 18) in this randomized study. A 6-wk-long conventional physiotherapy program was administered for both groups. In addition, a pain neuroscience education protocol was administered for the experimental group for a whole period of 6 wks (1 session/week, 15-60 mins per session). The primary outcomes were to compare pretreatment and posttreatment scores of the experimental versus control groups on the pain and disability. Our secondary outcomes included the comparisons of scores on the catastrophizing, anxiety, depression, kinesiophobia, and quality of life. The participants were assessed both at baseline and posttreatment. RESULTS The improvement in pain catastrophizing, anxiety, depression, and kinesiophobia was greater in the experimental group ( P < 0.05). The improvement was similar in both groups in terms of the rest of outcome measures. CONCLUSIONS This study showed that the pain neuroscience education improved only psychological aspects of the chronic pain in arthroscopic rotator cuff repair. Therefore, adding pain neuroscience education to the conventional program might be useful to improve pain catastrophizing, anxiety, depression, and kinesiophobia in patients with arthroscopic rotator cuff repair.
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Affiliation(s)
- Caner Kararti
- From the Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey (CK, FÖ, MIK, AT); Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey (HCB); and Department of Physiotherapy and Rehabilitation, Selçuk University, Selçuk, Turkey (GÖ, IÖ)
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Cao DP, Yin L, Wang YF, Liu BL. Application of multidisciplinary team-based integrated traditional Chinese medicine and Western medicine in rotator cuff injury patients undergoing arthroscopic surgery. World J Clin Cases 2024; 12:3767-3775. [PMID: 38994311 PMCID: PMC11235447 DOI: 10.12998/wjcc.v12.i19.3767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/27/2024] [Accepted: 05/14/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Arthroscopic rotator cuff repair is a common surgical treatment for rotator cuff injuries (RCIs). Although this procedure has certain clinical advantages, it requires rehabilitation management interventions to ensure therapeutic efficacy. AIM To investigate the effect of integrated traditional Chinese medicine and Western medicine (TCM-WM) under the multidisciplinary team (MDT) model on the postoperative recovery of patients undergoing arthroscopic surgery for RCIs. METHODS This study enrolled 100 patients who underwent arthroscopic rotator cuff repair for RCIs at the Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine between June 2021 and May 2024. They were divided into a control group (n = 48) that received routine rehabilitation treatment and an experimental group (n = 52) that received TCM-WM under the MDT model (e.g., acupuncture, TCM traumatology and orthopedics, and rehabilitation). The results of the Constant-Murley Shoulder Score (CMS), Visual Analogue Scale (VAS), Shoulder Pain and Disability Index (SPADI), muscular strength evaluation, and shoulder range of motion (ROM) assessments were analyzed. RESULTS After treatment, the experimental group showed significantly higher CMS scores in terms of pain, functional activity, shoulder joint mobility, and muscular strength than the baseline and those of the control group. The experimental group also exhibited significantly lower VAS and SPADI scores than the baseline and those of the control group. In addition, the experimental group showed significantly enhanced muscular strength (forward flexor and external and internal rotator muscles) and shoulder ROM (forward flexion, abduction, and lateral abduction) after treatment compared with the control group. CONCLUSION TCM-WM under the MDT model improved shoulder joint function, relieved postoperative pain, promoted postoperative functional recovery, and facilitated the recovery of muscular strength and shoulder ROM in patients with RCIs who underwent arthroscopic rotator cuff repair.
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Affiliation(s)
- Di-Ping Cao
- Department of Orthopedics, The Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
| | - Lei Yin
- Department of Orthopedics, The Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
| | - Yi-Fei Wang
- Department of Orthopedics, The Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
| | - Bing-Li Liu
- Department of Orthopedics, The Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
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Corban J, Shah S, Ramappa AJ. Current Evidence Based Recommendations on Rehabilitation following Arthroscopic Shoulder Surgery: Rotator Cuff, Instability, Superior Labral Pathology, and Adhesive Capsulitis. Curr Rev Musculoskelet Med 2024; 17:247-257. [PMID: 38668940 PMCID: PMC11156828 DOI: 10.1007/s12178-024-09899-7] [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] [Accepted: 04/17/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Arthroscopy has become increasingly popular for a addressing a wide variety of shoulder pathology. However, despite increasing interest, there is still much uncertainty and variability amongst providers regarding optimal post-operative rehabilitation. This review provides an overview of the evidence underlying common rehab protocols used following arthroscopic interventions for rotator cuff disease, shoulder instability, superior labral anterior to posterior (SLAP) tears and adhesive capsulitis. RECENT FINDINGS For small and medium sized rotator cuff tears, early motion protocols do not seem to affect healing or retear rates, however there is no difference with regards to long term functional outcomes when compared to standard motion protocols. For larger tears (> 3 cm), early active motion may be associated with impaired tendon integrity. Early range of motion following arthroscopic Bankart repair has not been shown to increase rate of recurrence, however the data on return to sport requires more granularity to effectively guide care. Further research needs to be done to compare rehab protocols following SLAP repair and arthroscopic capsular release. Rehabilitation protocols following rotator cuff surgery and anterior shoulder stabilization have garnered the most research interest. However, there is still a need for larger higher-level studies examining the long-term effects of different rehab protocols. Regarding the arthroscopic management of other types of shoulder instability, SLAP tears and adhesive capsulitis, there is paucity of high-quality evidence. This knowledge gap likely underpins the variability in different rehab protocols seen in clinical practice, highlighting the need for more research.
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Affiliation(s)
| | - Sarav Shah
- New England Baptist Hospital, Boston, MA, USA
| | - Arun J Ramappa
- New England Baptist Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Mehta N, Acuna AJ, McCormick JR, Harkin WE, Swindell HW, Defroda SF, Reinold M, Nicholson GP, Garrigues GE. Publicly Available Anatomic Total Shoulder Arthroplasty Rehabilitation Protocols Show High Variability and Frequent Divergence from the 2020 ASSET Recommendations. Int J Sports Phys Ther 2024; 19:856-867. [PMID: 38966826 PMCID: PMC11221330 DOI: 10.26603/001c.118926] [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: 12/07/2023] [Accepted: 05/04/2024] [Indexed: 07/06/2024] Open
Abstract
Background In 2020, the American Society of Shoulder and Elbow Therapists (ASSET) published an evidence-based consensus statement outlining postoperative rehabilitation guidelines following anatomic total shoulder arthroplasty (TSA). Purpose The purpose of this study was to (1) quantify the variability in online anatomic TSA rehabilitation protocols, and (2) assess their congruence with the ASSET consensus guidelines. Methods This study was a cross-sectional investigation of publicly available, online rehabilitation protocols for anatomic TSA. A web-based search was conducted in April 2022 of publicly available rehabilitation protocols for TSA. Each collected protocol was independently reviewed by two authors to identify recommendations regarding immobilization, initiation, and progression of passive (PROM) and active range of motion (AROM), as well as the initiation and progression of strengthening and post-operative exercises and activities. The time to initiation of various components of rehabilitation was recorded as the time at which the activity or motion threshold was permitted by the protocol. Comparisons between ASSET start dates and mean start dates from included protocols were performed. Results Of the 191 academic institutions included, 46 (24.08%) had publicly available protocols online, and a total of 91 unique protocols were included in the final analysis. There were large variations seen among included protocols for the duration and type of immobilization post-operatively, as well as for the initiation of early stretching, PROM, AROM, resistance exercises, and return to sport. Of the 37 recommendations reported by both the ASSET and included protocols, 31 (83.78%) were found to be significantly different between groups (p\<0.05). Conclusion Considerable variability was found among online post-operative protocols for TSA with substantial deviation from the ASSET guidelines. These findings highlight the lack of standardization in rehabilitation protocols following anatomic TSA. Level of Evidence 3b.
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Affiliation(s)
- Nabil Mehta
- Department of Orthopaedic SurgeryRush University
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Walton RA, Liuzza L, Takawira C, Leonardi C, Lopez MJ. Biocomposite Anchors Have Greater Yield Load and Energy Compared With All-Suture Anchors in an In Vitro Ovine Infraspinatus Tendon Repair Model. Arthrosc Sports Med Rehabil 2024; 6:100938. [PMID: 39006783 PMCID: PMC11240035 DOI: 10.1016/j.asmr.2024.100938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/25/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To compare tensile fatigue and strength measures of biocomposite and all-suture anchors in an ovine humerus-infraspinatus tendon model of rotator cuff repair. Methods Infraspinatus tendons on adult ovine humeri were sharply transected at the insertion. One of each pair was assigned randomly for fixation with 2 biocomposite or all-suture anchors. Constructs were tested with 200 cycles of 20 to 70 N tensile load, and gap formation was measured at the incised tendon end every 50 cycles. They were subsequently tested to failure. Outcome measures including fatigue stiffness, hysteresis, creep, and gap formation and tensile stiffness, and yield and failure displacement, load, and energy were compared between anchors. Results Biocomposite anchors had greater yield load (134.1 ± 6.5 N, P < .01) and energy (228.6 ± 85.7 J, P < .03) than all-suture anchors (104.7 ± 6.5 N, 169.8 ± 85.7 J). Fatigue properties were not different between anchors, but stiffness and gap formation increased and hysteresis and creep decreased significantly with increasing cycle number. Conclusions Although the yield displacement of both anchors was within the range of clinical failure, the tensile yield load and energy of ovine infraspinatus tendons secured to the humerus with 2 single-loaded all-suture anchors in a single row were significantly lower than those secured with 2 biocomposite anchors in the same configuration. Clinical Relevance It is important to understand the biomechanical properties for selecting anchors for rotator cuff repair. A direct comparison of fatigue testing followed by failure strength of infraspinatus tendon fixation with all-suture and biocomposite anchors could help guide anchor selection and postoperative mobility recommendations.
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Affiliation(s)
- Robert A. Walton
- Laboratory for Equine and Comparative Orthopedic Research, Veterinary Clinical Sciences Department, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, U.S.A
| | - Lindsey Liuzza
- Department of Orthopaedics, Louisiana State University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Catherine Takawira
- Laboratory for Equine and Comparative Orthopedic Research, Veterinary Clinical Sciences Department, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, U.S.A
| | - Claudia Leonardi
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, U.S.A
| | - Mandi J. Lopez
- Laboratory for Equine and Comparative Orthopedic Research, Veterinary Clinical Sciences Department, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, U.S.A
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Chen Y, Meng H, Li Y, Zong H, Yu H, Liu H, Lv S, Huai L. The effect of rehabilitation time on functional recovery after arthroscopic rotator cuff repair: a systematic review and meta-analysis. PeerJ 2024; 12:e17395. [PMID: 38784392 PMCID: PMC11114118 DOI: 10.7717/peerj.17395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Objective We compared the effects of early and delayed rehabilitation on the function of patients after rotator cuff repair by meta-analysis to find effective interventions to promote the recovery of shoulder function. Methods This meta-analysis was registered in PROSPERO (CRD42023466122). We manually searched the randomized controlled trials (RCTs) in the Cochrane Library, Pubmed, Cochrane Library, EMBASE, the China National Knowledge Infrastructure (CNKI), the China VIP Database (VIP), and the Wanfang Database to evaluate the effect of early and delayed rehabilitation after arthroscopic shoulder cuff surgery on the recovery of shoulder joint function. Review Manager 5.3 software was used to analyze the extracted data. Then, the PEDro scale was employed to appraise the methodological quality of the included research. Results This research comprised nine RCTs and 830 patients with rotator cuff injuries. According to the findings of the meta-analysis, there was no discernible difference between the early rehabilitation group and the delayed rehabilitation group at six and twelve months after the surgery in terms of the VAS score, SST score, follow-up rotator cuff healing rate, and the rotator cuff retear rate at the final follow-up. There was no difference in the ASES score between the early and delayed rehabilitation groups six months after the operation. However, although the ASES score in the early rehabilitation group differed significantly from that in the delayed rehabilitation group twelve months after the operation, according to the analysis of the minimal clinically important difference (MCID), the results have no clinical significance. Conclusions The improvement in shoulder function following arthroscopic rotator cuff surgery does not differ clinically between early and delayed rehabilitation. When implementing rehabilitation following rotator cuff repair, it is essential to consider the paradoxes surrounding shoulder range of motion and tendon anatomic healing. A program that allows for flexible progression based on the patient's ability to meet predetermined clinical goals or criteria may be a better option.
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Affiliation(s)
- Yang Chen
- Department of Rehabilitation, Taian Maternal and Child Health Hospital, Taian, Shandong, China
| | - Hui Meng
- Department of Joint and Sports Medicine, Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Yuan Li
- Department of Rehabilitation, Taian Maternal and Child Health Hospital, Taian, Shandong, China
| | - Hui Zong
- Department of Rehabilitation, Taian Maternal and Child Health Hospital, Taian, Shandong, China
| | - Hongna Yu
- Department of Rehabilitation, Taian Maternal and Child Health Hospital, Taian, Shandong, China
| | - HaiBin Liu
- School of Sports Medicine and Rehabilitation, Shandong First Medical University, Taian, Shandong, China
| | - Shi Lv
- Department of Rehabilitation, Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Liang Huai
- School of Sports Medicine and Rehabilitation, Shandong First Medical University, Taian, Shandong, China
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Wang Q, Zhou F, Xu P, Zhao L, Guo JJ. Subacromial bursa in patients with rotator cuff tear with or without adhesive capsulitis exhibits a differential transcriptome with potential molecular biomarkers. Heliyon 2024; 10:e30512. [PMID: 38737263 PMCID: PMC11087971 DOI: 10.1016/j.heliyon.2024.e30512] [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: 01/12/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
Background Although adhesive capsulitis (AC) is a common condition, the pathological mechanisms remain understudied. The purpose of our research was to evaluate variations in gene expression across the entire genome in the subacromial bursa tissue of individuals with rotator cuff tears (RCT), with or without AC, and to explore the factors that may influence the occurrence and progression of AC. Methods Transcription profiles of subacromial bursa samples from 12 RCT patients, of whom 6 had also AC, were evaluated. Data were generated using RNA-seq. DESeq2 was utilized to identify the differentially expressed genes (DEGs) in both groups. In order to conduct a more in-depth examination of the DEGs, we performed Gene Ontology (GO) functional enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. A network of interactions between proteins was built, and the central genes were determined using Cytoscape. The hub genes were confirmed through qRT-PCR and immunohistochemistry. Results 324 of the 16,251 detected genes were identified as DEGs. Analysis of GO functional enrichment showed that the DEGs were enriched in domains of biological process, molecule function and cellular component. Analysis of KEGG pathways revealed enrichment of DEGs in pathways like IL-17 signaling and ECM-receptor interaction. We verified that the association between AC and the increase in expression of the PPI network hub genes. Conclusion This study investigated the transcriptome differences of subacromial bursa in RCT patients with or without AC. Using bioinformatics technology, we identified the DEGs and screened out the hub genes. The research enhanced the data on gene expression profiles of DEGs in the subacromial bursa tissue of patients with RCT, offering fresh perspectives on the regulation of gene transcription.
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Affiliation(s)
- Qiuyuan Wang
- Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Feng Zhou
- Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Pingcheng Xu
- Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, PR China
- Department of Orthopedics, Suzhou Wujiang District Fourth People's Hospital, Suzhou, PR China
| | - Lingying Zhao
- Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, Suzhou, PR China
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of PR China, Suzhou, PR China
| | - Jiong Jiong Guo
- Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, PR China
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of PR China, Suzhou, PR China
- China-Europe Sports Medicine Belt-and-Road Joint Laboratory, Ministry of Education of PR China, PR China
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Rossi LA, Gorodischer TD, Camino P, Brandariz RN, Tanoira I, Piuzzi NS, Ranalletta M. Leukocyte-Poor Platelet-Rich Plasma as an Adjuvant to Arthroscopic Rotator Cuff Repair Reduces the Retear Rate But Does Not Improve Functional Outcomes: A Double-Blind Randomized Controlled Trial. Am J Sports Med 2024; 52:1403-1410. [PMID: 38587033 DOI: 10.1177/03635465241239062] [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] [Indexed: 04/09/2024]
Abstract
BACKGROUND Whether the use of PRP as an adjuvant of rotator cuff repairs leads to improved tendon healing and better functional outcomes remains unclear in clinical evidence. PURPOSE The main purpose of this study was to assess whether the use of leukocyte-poor platelet-rich plasma (LP-PRP) as an adjuvant to arthroscopic rotator cuff repair (ARCR) decreases the rate of retears compared with a control group. The secondary objective was to analyze whether LP-PRP improves patient-reported outcomes. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This was a double-blind randomized controlled trial at a single center. A consecutive series of 96 patients with rotator cuff tears <3 cm were enrolled and randomly allocated to the control group (double-row suture-bridge ARCR alone [n = 48]) and the PRP group (double-row suture-bridge repair, followed by 1 LP-PRP injection during surgery [n = 48]). The visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), and the Pittsburgh Sleep Quality Index (PSQI) were administered preoperatively and at 6- and 12-month follow-up. Magnetic resonance imaging (MRI) was performed to evaluate tendon integrity at 6-month follow-up. Both patients and assessors were blinded to the intervention received during surgery. RESULTS The mean patient age was 56.1 ± 2.98 years. Of the 96 patients, 90 had MRI performed at 6 months after surgery (94% radiological follow-up). The retear rate in the PRP group was 15.2% (7/46 [95% CI, 6%-28%]), which was lower than that in the control group of 34.1% (15/44 [95% CI, 20%-49%]) (P = .037). Therefore, the risk ratio of ruptures in patients exposed to LP-PRP was 0.44 (95% CI, 0.2-0.9; P = .037). Overall, the ASES, VAS, SANE, and PSQI scores showed a statistical improvement after surgery (P < .001). There were no significant differences in functional scores between the groups. Most of the patients exceeded the minimal clinically important difference for the ASES, SANE, and VAS without significant differences between the groups. CONCLUSION In patients with rotator cuff tears <3 cm undergoing double-row suture-bridge repair, a 5-mL dose of LP-PRP injected at the tendon-bone interface significantly reduced the retear rate. However, the use of LP-PRP in terms of postoperative pain and patient-reported outcomes failed to show clinically meaningful effects. REGISTRATION NCT04703998 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Luciano Andres Rossi
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Tomás David Gorodischer
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Camino
- Department of Hemotherapy, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Nicolás Brandariz
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Tanoira
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nicolás Santiago Piuzzi
- Department of Hemotherapy, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Maximiliano Ranalletta
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Kang JY, Kim D, Kim H, Ha IH, Lee YJ. Health Care Utilization for Common Shoulder Disorders: Analysis of the 2010-2019 National Patient Sample Data from the Health Insurance Review and Assessment Service in Korea. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:744. [PMID: 38792927 PMCID: PMC11122813 DOI: 10.3390/medicina60050744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024]
Abstract
Background and Objective: The aim of this study was to analyze trends in surgical and non-surgical service utilization for common shoulder disorders in Korea from 2010 to 2019. Methods and Materials: This retrospective, cross-sectional, descriptive study utilized National Patient Sample data from the Health Insurance and Review Assessment Service (HIRA) of Korea. These data constitute a 2% sample out of the entire Korean population and include data for a variety of parameters instrumental for health care research. Patients with at least one medical service use for rotator cuff syndrome or tear, impingement syndrome, or adhesive capsulitis between January 2010 and December 2019 were included. Trends in healthcare utilization by disorder type, patient demographics, seasonal service use, and treatment details were examined. Results: There was an upward trend in the total number of patients and costs for shoulder disorders, from 35,798 patients and USD 5,485,196 in 2010 to 42,558 and USD 11,522,543 in 2019, respectively. The number of patients aged ≥60 and hospital visits increased. March had the highest number of claims. Physical therapy was the most common non-surgical procedure, while nerve block claims more than doubled. Opioid prescription rates also tripled. Surgical treatments were dominated by shoulder rotator cuff repair and acromioplasty. Conclusions: There was a significant increase in healthcare utilization for shoulder disorders, marked by rising costs and patient numbers. The use of nerve blocks and opioids notably increased. These data are valuable for clinicians, researchers, and policymakers.
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Affiliation(s)
- Jin-Young Kang
- Jaseng Hospital of Korean Medicine, Seoul 06110, Republic of Korea;
| | - Doori Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Republic of Korea (I.-H.H.)
| | - Huijun Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Republic of Korea (I.-H.H.)
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Republic of Korea (I.-H.H.)
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Republic of Korea (I.-H.H.)
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Stern BZ, Zubizarreta N, Anthony SG, Gladstone JN, Poeran J. Variation in Utilization of Physical Therapist and Occupational Therapist Services After Rotator Cuff Repair: A Population-Based Study. Phys Ther 2024; 104:pzae015. [PMID: 38335223 DOI: 10.1093/ptj/pzae015] [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: 06/26/2023] [Revised: 10/22/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE The objective of this study was to describe the utilization of physical therapist and occupational therapist services after rotator cuff repair (RCR) and examine variation in rehabilitation characteristics by profession. METHODS This retrospective cohort study used the IBM MarketScan Commercial Claims and Encounters database. Eligible patients were 18 to 64 years old and had undergone outpatient RCR between 2017 and 2020. Physical therapist and occupational therapist services were identified using evaluation and treatment codes with profession-specific modifiers ("GP" or "GO"). Factors predicting utilization of formal rehabilitation and physical therapist versus occupational therapist services were examined; and univariable and multivariable analyses of days to initiate therapy, number of visits, and episode length by profession were completed. RESULTS Among 53,497 patients with an RCR, 81.2% initiated formal rehabilitation (93.8% physical therapist, 5.2% occupational therapist, 1.0% both services). Patients in the Northeast and West (vs the South) were less likely to receive rehabilitation (odds ratio [OR] = 0.67 to 0.70) and less likely to receive occupational therapist services (OR = 0.39). Patients living in the Midwest (versus the South) were less likely to receive rehabilitation (OR = 0.79) but more likely to receive occupational therapist services (OR = 1.51). Similarly, those living in a rural (versus urban) area were less likely to utilize rehabilitation (OR = 0.89) but more likely to receive occupational therapist services (OR = 2.21). Additionally, receiving occupational therapist instead of physical therapist services was associated with decreased therapist visits (-16.89%), days to initiate therapy (-13.43%), and episode length (-13.78%). CONCLUSION Most patients in our commercially insured cohort utilized rehabilitation services, with a small percentage receiving occupational therapist services. We identified profession-specific variation in utilization characteristics that warrants further examination to understand predictors and associated outcomes. IMPACT Variation in rehabilitation utilization after RCR, including profession-specific and regional differences, may indicate opportunities to improve standardization and quality of care.
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Affiliation(s)
- Brocha Z Stern
- Leni and Peter W. May Department of Orthopaedics and Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nicole Zubizarreta
- Leni and Peter W. May Department of Orthopaedics and Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shawn G Anthony
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James N Gladstone
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jashvant Poeran
- Leni and Peter W. May Department of Orthopaedics and Institute for Healthcare Delivery Science, Department of Population Health Science & Policy and Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Kararti C, Özüdoğru A, Basat HÇ, Özsoy İ. Favorable Clinical Outcomes After Humeral Head Depressor Muscle Coactivation Training With EMG for Patients With Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Sports Health 2024:19417381241235184. [PMID: 38499998 DOI: 10.1177/19417381241235184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The coactivation (Co-A) of shoulder muscles that contribute to humeral head depression can lead to mechanical unloading of the subacromial structures during abduction and thus can be beneficial for patients with arthroscopic rotator cuff repair (ARCR). The present study aims to examine the effectiveness of humeral head depressor muscle Co-A (DM-Co-A) training on clinical outcomes in a sample of patients with ARCR. HYPOTHESIS We hypothesized that DM-Co-A training with medioinferior vector during glenohumeral exercises can improve clinical results in the rehabilitation of ARCR. STUDY DESIGN Randomized controlled single-blind study. LEVEL OF EVIDENCE Level 1B. METHODS A total of 27 patients who underwent ARCR after a medium-sized rotator cuff tear and completed their Phase 1 training with ≥80% compliance were included. Together with 14 weeks of conservative treatment (6 weeks of Phase 2 training and 8 weeks of Phase 3 training), synchronized "DM-Co-A Training" was applied to the treatment group with an electromyography (EMG) biofeedback (EMG-BF) device. Patients in the treatment group were asked to voluntarily activate the humeral head depressor muscles guided by visual and auditory feedback of the EMG-BF device during the Phase 2 and Phase 3 conservative treatment exercises performed by the control group. Demographic characteristics of the participants were recorded. Visual analog scale and universal goniometer were used to assess pre- and posttreatment pain severity and joint range of motion, respectively. The Disabilities of Arm, Shoulder and Hand Questionnaire, Revised Oxford Shoulder Score, Modified Constant-Murley Shoulder Score, and the Western-Ontario Rotator Cuff Index were used to assess functionality. RESULTS There was a clinically meaningful improvement in pain severity, active ROM excluding internal rotation, and functionality in the treatment group compared with the control group (P < 0.05). CONCLUSION A 14-week duration DM-Co-A with EMG may be beneficial in the postoperative rehabilitation of patients after ARCR.
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Affiliation(s)
- Caner Kararti
- Kırşehir Ahi Evran University Department of Physiotherapy and Rehabilitation, Kırşehir, Turkey
| | - Anıl Özüdoğru
- Kırşehir Ahi Evran University Department of Physiotherapy and Rehabilitation, Kırşehir, Turkey
| | - Hakkı Çağdaş Basat
- Kırşehir Ahi Evran University Department of Orthopedics and Traumatology, Kırşehir, Turkey
| | - İsmail Özsoy
- Selçuk University Department of Physiotherapy and Rehabilitation, Selçuklu/Konya, Turkey
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13
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Yao L, Zhao X, Mei L, Li Y, Pang L, Zhang C, Li J, Tang X. Dyslipidemia may impact initial recovery following arthroscopic rotator cuff repair: a retrospective study. J Orthop Surg Res 2024; 19:173. [PMID: 38454405 PMCID: PMC10921706 DOI: 10.1186/s13018-024-04650-x] [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: 01/12/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The current literature shows that dyslipidemia can lead to a higher incidence of rotator cuff tears (RCTs) and an increased retear rate after repair. We aimed to evaluate the influence of preoperative dyslipidemia on postoperative pain, patient-reported outcomes (PROs), active range of motion (ROM), and structural integrity. METHODS A cohort of 111 patients who underwent arthroscopic RCT repair between January 2021 and July 2022, and whose complete preoperative serum lipid data were available within one week prior to surgery was retrospectively reviewed. Dyslipidemia was defined as the presence of an increase or decrease in at least one blood lipid profile (triglycerides, total cholesterol, low-density lipoprotein, high-density lipoprotein, or non-high-density lipoprotein). There were 43 patients in the dyslipidemia group and 68 in the ortholiposis group. Patient evaluations, including pain score, PROs, and ROMs, were conducted preoperatively; at 3 and 6 months postoperatively; and at the last follow-up. Structural integrity was assessed by magnetic resonance imaging (MRI) 6 months after surgery if possible, and Sugaya type 4 or 5 was considered a retear. Propensity score matching (PSM) was used to reduce bias. RESULTS The RCT size, surgical technique, preoperative pain status, PROs, and active ROM were comparable between patients with dyslipidemia and those with ortholiposis. Three months after surgery, patients in the dyslipidemia group had worse average PROs (Constant score: P = 0.001; ASES score: P = 0.012; UCLA score: P = 0.015), forward flexion (P = 0.012), and internal rotation (P = 0.001) than patients in the ortholiposis group did. The difference between the two groups persisted after PSM but disappeared at the sixth month after surgery. No significant differences in pain score, PROs, or active ROMs were detected between the dyslipidemia and ortholiposis groups after a mean follow-up of 24 months. Of the 72 patients who underwent MRI, 4 retears (5.6%) were found, and all were in the ortholiposis group. There was no difference in the rate of retears between the two groups (P = 0.291) or with (P = 0.495) PSM. CONCLUSIONS In conclusion, we found that perioperative dyslipidemia may impact initial recovery within the first 3 months following arthroscopic rotator cuff repair but may have no effect on pain, PROs, or active ROMs at a mean 2-year follow-up or rotator cuff integrity at 6 months postoperatively. Trail registration Retrospectively registered.
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Affiliation(s)
- Lei Yao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiumei Zhao
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Lu Mei
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yinghao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Long Pang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Chunsen Zhang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jian Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
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14
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Xiao H, Wen B, Yan D, Li Q, Yang Y, Yin X, Chen D, Liu J. Hot spots and frontiers in bone-tendon interface research: a bibliometric analysis and visualization from 2000 to 2023. Front Surg 2024; 10:1326564. [PMID: 38327873 PMCID: PMC10847327 DOI: 10.3389/fsurg.2023.1326564] [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: 10/23/2023] [Accepted: 12/19/2023] [Indexed: 02/09/2024] Open
Abstract
Objective In this research, we investigated the current status, hotspots, frontiers, and trends of research in the field of bone-tendon interface (BTI) from 2000 to 2023, based on bibliometrics and visualization and analysis in CiteSpace, VOSviewer, and a bibliometric package in R software. Methods We collected and organized the papers in the Web of Science core collection (WoSCC) for the past 23 years (2000-2023), and extracted and analyzed the papers related to BTI. The extracted papers were bibliometrically analyzed using CiteSpace for overall publication trends, authors, countries/regions, journals, keywords, research hotspots, and frontiers. Results A total of 1,995 papers met the inclusion criteria. The number of papers published and the number of citations in the field of BTI have continued to grow steadily over the past 23 years. In terms of research contribution, the United States leads in terms of the number and quality of publications, number of citations, and collaborations with other countries, while the United Kingdom and the Netherlands lead in terms of the average number of citations. The University of Leeds publishes the largest number of papers, and among the institutions hosting the 100 most cited papers Hospital for Special Surgery takes the top spot. MCGONAGLE D has published the highest number of papers (73) in the last 10 years. The top three clusters include #0 "psoriatic arthritis", #1 "rotator cuff repair", and #2 "tissue engineering". The structure and function of the BTI and its key mechanisms in the healing process are the key to research, while new therapies such as mechanical stimulation, platelet-rich plasma, mesenchymal stem cells, and biological scaffolds are hot topics and trends in research. Conclusion Over the past 23 years, global research on the BTI has expanded in both breadth and depth. The focus of research has shifted from studies concentrating on the structure of the BTI and the disease itself to new therapies such as biomaterial-based alternative treatments, mechanical stimulation, platelet-rich plasma, etc.
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Affiliation(s)
- Hao Xiao
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Boyuan Wen
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Dong Yan
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Quansi Li
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Yujie Yang
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Xianye Yin
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Deyu Chen
- School of Journalism and Communication, Hunan University, Changsha, China
| | - Jiachen Liu
- XiangYa School of Medicine, Central South University, Changsha, China
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Center of System Biology and Data Information, School of Basic Medical Science, Central South University, Changsha, Hunan, China
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Umehara J, Yagi M, Ueda Y, Nojiri S, Kobayashi K, Tachibana T, Nobuhara K, Ichihashi N. Compensation strategy of shoulder synergist muscles is not stereotypical in patients with rotator cuff repair. J Orthop Res 2024; 42:21-31. [PMID: 37292048 DOI: 10.1002/jor.25641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/10/2023]
Abstract
Rotator cuff tear is a common shoulder injury that causes shoulder dysfunction and pain. Although surgical repair is the primary treatment for rotator cuff tear, it is well recognized that impaired force exertion of muscles connecting to the involved tendon and subsequent complemental change in the force exertion of synergist muscles persist even after repair. This study aimed to identify the compensation strategy of shoulder abductors by examining how synergist muscles respond to supraspinatus (SSP) muscle force deficit in patients with rotator cuff repair. Muscle shear modulus, an index of muscle force, was assessed for SSP, infraspinatus, upper trapezius, and middle deltoid muscles in repaired and contralateral control shoulders of 15 patients with unilateral tendon repair of the SSP muscle using ultrasound shear wave elastography while the patients passively or actively held their arm in shoulder abduction. In the repaired shoulder, the shear modulus of the SSP muscle declined, whereas that of other synergist muscles did not differ relative to that of the control. To find the association between the affected SSP and each of the synergist muscles, a regression analysis was used to assess the shear moduli at the population level. However, no association was observed between them. At the individual level, there was a tendency of variation among patients with regard to a specific muscle whose shear modulus complementarily increased. These results suggest that the compensation strategy for SSP muscle force deficit varies among individuals, being nonstereotypical in patients with rotator cuff injury.
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Affiliation(s)
- Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuyuki Ueda
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Faculty of Health Science, Takarazuka University of Medical and Healthcare, Takarazuka, Japan
| | - Shusuke Nojiri
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kotono Kobayashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Springer B, Dreisbach R, Schatz KD, Kubista B, Waldstein W. Online Videos Regarding Relevant Postoperative Patient Information and Postoperative Rehabilitation After Arthroscopic Rotator Cuff Repair Provide Poor Information Quality, Accuracy, and Reliability. Arthroscopy 2023; 39:2443-2453.e2. [PMID: 37355180 DOI: 10.1016/j.arthro.2023.05.031] [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: 01/04/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To evaluate the information quality, accuracy, and reliability of YouTube videos regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair. METHODS By use of The Onion Router (TOR) software and predefined search terms, 102 videos were assessed. Four scoring systems were used to evaluate included videos: (1) Journal of the American Medical Association (JAMA) benchmark criteria score; (2) Global Quality Score (GQS); (3) DISCERN score; and (4) a newly developed score, the Rotator Cuff Score (RCS). The RCS (0-30 points) was built based on the latest published evidence and guidelines from the American Academy of Orthopaedic Surgeons. Videos that scored up to 9 points were regarded as poor-quality videos. RESULTS Most of the included videos provided poor information quality, accuracy, and reliability. Videos that were uploaded by medically trained professionals showed significantly better results for all scores compared with commercial or personal-testimony videos (JAMA benchmark criteria score, P < .001; GQS, P < .001; DISCERN score, P = .001; and RCS, P = .001). Multivariate linear regression showed that the involvement of medically trained professionals was a significant predictor of better results for all scores (JAMA benchmark criteria score, β = 1.496 [P < .001]; GQS, β = 1.105 [P < .001]; DISCERN score, β = 11.234 [P < .001]; and RCS, β = 5.017 [P < .001]). Surprisingly, the like ratio was significantly higher for videos that were uploaded by non-medically trained individuals (P = .041). CONCLUSIONS The average information quality, accuracy, and reliability of YouTube videos regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair are poor. Videos from medically trained professionals provide significantly higher information quality; however, even these videos lack important information for a better understanding of arthroscopic rotator cuff repair. CLINICAL RELEVANCE Because of the lack of a peer-review process, available videos on YouTube regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair are of low quality, accuracy, and reliability. However, patients increasingly visit YouTube to gather medical knowledge. Physicians should enlighten patients about these findings and should be able to provide alternative sources of high-quality information.
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Affiliation(s)
- Bernhard Springer
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Robin Dreisbach
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Klaus-Dieter Schatz
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Bernd Kubista
- Department of Orthopaedics, Sanatorium Hera, Vienna, Austria
| | - Wenzel Waldstein
- Clinic for Orthopaedics Paulinenhilfe, Diakonie-Klinikum Stuttgart, Stuttgart, Germany.
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Carnevale A, Mannocchi I, Schena E, Carli M, Sassi MSH, Marino M, Longo UG. Performance Evaluation of an Immersive Virtual Reality Application for Rehabilitation after Arthroscopic Rotator Cuff Repair. Bioengineering (Basel) 2023; 10:1305. [PMID: 38002429 PMCID: PMC10668954 DOI: 10.3390/bioengineering10111305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Few studies have evaluated the effectiveness of shoulder rehabilitation in virtual environments. The objective of this study was to investigate the performance of a custom virtual reality application (VR app) with a stereophotogrammetric system considered the gold standard. A custom VR app was designed considering the recommended rehabilitation exercises following arthroscopic rotator cuff repair. Following the setting of the play space, the user's arm length, and height, five healthy volunteers performed four levels of rehabilitative exercises. Results for the first and second rounds of flexion and abduction displayed low total mean absolute error values and low numbers of unmet conditions. In internal and external rotation, the number of times conditions were not met was slightly higher; this was attributed to a lack of isolated shoulder movement. Data is promising, and volunteers were able to reach goal conditions more often than not. Despite positive results, more literature comparing VR applications with gold-standard clinical parameters is necessary. Nevertheless, results contribute to a body of literature that continues to encourage the application of VR to shoulder rehabilitation programs.
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Affiliation(s)
- Arianna Carnevale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Roma, Italy; (A.C.); (M.M.)
| | - Ilaria Mannocchi
- Department of Industrial, Electronic and Mechanical Engineering, University of Roma Tre, Via Vito Volterra, 62, 00146 Roma, Italy; (I.M.); (M.C.); (M.S.H.S.)
| | - Emiliano Schena
- Unit of Measurement and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy;
| | - Marco Carli
- Department of Industrial, Electronic and Mechanical Engineering, University of Roma Tre, Via Vito Volterra, 62, 00146 Roma, Italy; (I.M.); (M.C.); (M.S.H.S.)
| | - Mohamed Saifeddine Hadj Sassi
- Department of Industrial, Electronic and Mechanical Engineering, University of Roma Tre, Via Vito Volterra, 62, 00146 Roma, Italy; (I.M.); (M.C.); (M.S.H.S.)
| | - Martina Marino
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Roma, Italy; (A.C.); (M.M.)
| | - Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Roma, Italy; (A.C.); (M.M.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy
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Longo UG, Carnevale A, Andreoli F, Mannocchi I, Bravi M, Sassi MSH, Santacaterina F, Carli M, Schena E, Papalia R. Immersive virtual reality for shoulder rehabilitation: evaluation of a physical therapy program executed with oculus quest 2. BMC Musculoskelet Disord 2023; 24:859. [PMID: 37919702 PMCID: PMC10621204 DOI: 10.1186/s12891-023-06861-5] [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: 05/29/2023] [Accepted: 09/07/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Virtual Reality (VR) systems have been increasingly used across several medical fields. A crucial preliminary step for developing optimized VR-based applications for rehabilitation purposes is identifying potential interventions to meet the requirements necessary to satisfy end-users' needs. This study aims to assess the acceptability, usability, and appropriateness of a VR physical therapy program executed with Oculus Quest 2 by expert physiotherapists of shoulder musculoskeletal rehabilitation. METHODS Eleven physiotherapists were enrolled to test a VR program for shoulder musculoskeletal rehabilitation. At the end of each session, physiotherapists completed three questionnaires about the acceptability, usability, and appropriateness of the VR system and application, investigating aspects such as wearability, safety, stability, ease of control, comfort, size, utility, playability, and use mode. RESULTS The acceptability questionnaire revealed that all the physiotherapists found the VR system easy to wear and control, very confident, and safe. The usability questionnaire showed that most physiotherapists (73%) found the VR application entertaining, although only 45% said the system could be used independently by patients without the support of a therapist. Many physiotherapists found the use of the VR application appropriate for patients with rotator cuff tears treated conservatively (63.6%) or surgically (54.5%), for patients with shoulder osteoarthritis treated conservatively (72.7%), for patients with shoulder osteoarthritis after surgical treatment (63.6%). 91% of physiotherapists think it would be best for patients to use the VR system under the supervision of a therapist and not independently in a home setting. CONCLUSIONS The use of VR in orthopaedic rehabilitation is encouraging, although further efforts are needed to increase the independent use of patients without the supervision of a physiotherapist. Moreover, future studies should strive to ensure the clinical effectiveness of VR rehabilitation in reaching therapeutic goal settings.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, Roma, 200, 00128, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit? Campus Bio-Medico di Roma, Via Álvaro del Portillo, Roma, 21, 00128, Italy.
| | - Arianna Carnevale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, Roma, 200, 00128, Italy
| | - Flavia Andreoli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, Roma, 200, 00128, Italy
| | - Ilaria Mannocchi
- Department of Industrial, Electronic and Mechanical Engineering, University of Roma Tre, Via Vito Volterra, Roma, 62, 00146, Italy
| | - Marco Bravi
- Research Unit of Physical and Rehabilitation Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, Roma, 200, 00128, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Roma, 00135, Italy
| | - Mohamed Saifeddine Hadj Sassi
- Department of Industrial, Electronic and Mechanical Engineering, University of Roma Tre, Via Vito Volterra, Roma, 62, 00146, Italy
| | - Fabio Santacaterina
- Research Unit of Physical and Rehabilitation Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, Roma, 200, 00128, Italy
| | - Marco Carli
- Department of Industrial, Electronic and Mechanical Engineering, University of Roma Tre, Via Vito Volterra, Roma, 62, 00146, Italy
| | - Emiliano Schena
- Laboratory of Measurement and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, Roma, 21, 00128, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, Roma, 200, 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit? Campus Bio-Medico di Roma, Via Álvaro del Portillo, Roma, 21, 00128, Italy
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19
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Fliegel BE, Hall A, Patel A, Lee D, Cohen SB, Freedman K, Tjoumakaris F. Patient Preferences in Short-Interval Staged Bilateral Rotator Cuff Repair. Orthopedics 2023; 46:e347-e352. [PMID: 37126836 DOI: 10.3928/01477447-20230426-04] [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: 05/03/2023]
Abstract
The decision to seek and undergo treatment for bilateral rotator cuff tears is often complex. The purpose of this study was to investigate patient preferences for undergoing short-interval staged bilateral rotator cuff repair; timing of surgeries; and order of surgeries. A retrospective analysis was performed for patients who underwent bilateral arthroscopic rotator cuff repairs within 12 months at a single institution. Postoperative patient-reported outcomes, satisfaction, and decision-making factors were collected via REDCap surveys. Ninety patients were included (63 men and 27 women; mean age, 58.1 years). The mean time between surgeries was 7.33 months. Forty-two percent of patients had left rotator cuff repair first. Patients reported a mean satisfaction score of 91.6 of 100 with the order of the surgeries and 87.3 of 100 with the timing of the surgeries. Mean postoperative American Shoulder and Elbow Surgeons standardized assessment scores were 94.6 and 93.7 (left vs right shoulder first, respectively) for left shoulders and 94.2 and 93.9 (left vs right shoulder first, respectively) for right shoulders. Mean postoperative Single Assessment Numeric Evaluation scores were 86.5 and 83.9 (left vs right shoulder first, respectively) for left shoulders and 87.3 and 86.0 (left vs right shoulder first, respectively) for right shoulders. Decision-making factors noted as highly important included night pain, function, surgeon recommendation, and daily pain. Most patients who undergo short-interval staged bilateral rotator cuff repair are satisfied with the order and timing of their surgery. Decision-making factors such as night pain and functional limitation play a key role in the timing and order of bilateral rotator cuff repairs. [Orthopedics. 2023;46(6):e347-e352.].
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Sabesan V, Dawoud M, Al-Mansoori A, Stephens BJ, Lavin AC, Lozano JM, Fomunung CK. Factors influencing physical therapy utilization after shoulder surgery: a retrospective review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:511-518. [PMID: 37928991 PMCID: PMC10625012 DOI: 10.1016/j.xrrt.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Postoperative physical therapy (PT) is a cornerstone to achieve optimal patient outcomes. Access to postoperative PT can be limited by insurance type, coverage, and cost. With copayments (CP) for PT as high as $75 per visit, PT can be costprohibitive for patients. The purpose of this study was to evaluate factors affecting PT utilization among patients that underwent shoulder surgery. Methods A retrospective analysis was performed of 80 shoulder surgery patients with postoperative PT sessions attended at a single institution from 2017 to 2019. Patients were divided based on insurance type: private insurance (PI), and Medicare with or without supplemental insurance (MI), and CP or no copayment. Demographics, CP, total, and postoperative number of PT sessions utilized was collected and analyzed. Results The cohort had 53 females and an average age of 62. There was no significant difference between PI and MI at baseline other than surgery performed (P = .03), older MI group (69 years vs. 56 years: P < .01), and more females in PI group (76% vs. 55%; P = .05). There was no significant difference in the number of PT sessions between groups. The PI group was more likely to have a CP (P < .01). The CP group more often had PI and significantly more total PT visits (P = .05), while the no copayment group more often had Medicare (P < .01). CP was not independently associated with a change in the number of PT visits or total PT visits. Conclusions The utilization of PT after shoulder surgery was found to not be influenced by insurance type or CP as determined by the number of PT sessions attended. Further investigations are necessary to better understand the relationship between CP and different insurance types and develop effective strategies to increase access to PT for postoperative shoulder patients.
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Affiliation(s)
- Vani Sabesan
- HCA Florida JFK Hospital, Palm Beach Shoulder Service – Atlantis Orthopaedics, Palm Beach, FL, USA
- Cleveland Clinic Florida, Levitetz Department of Orthopedic Surgery, Weston, FL, USA
| | - Mirelle Dawoud
- Cleveland Clinic Florida, Levitetz Department of Orthopedic Surgery, Weston, FL, USA
| | - Ahmed Al-Mansoori
- Cleveland Clinic Florida, Levitetz Department of Orthopedic Surgery, Weston, FL, USA
| | - B. Joshua Stephens
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, FL, USA
| | - Alessia C. Lavin
- HCA Florida JFK Hospital, Palm Beach Shoulder Service – Atlantis Orthopaedics, Palm Beach, FL, USA
| | - Juan Manuel Lozano
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Clyde K. Fomunung
- HCA Florida JFK Hospital, Palm Beach Shoulder Service – Atlantis Orthopaedics, Palm Beach, FL, USA
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Demirci S, Kara D, Yıldız Tİ, Eraslan L, Uysal Ö, Sevinç C, Ulusoy B, Gazeloğlu AO, Turgut E, Huri G, Turhan E, Düzgün İ. Effects of Different Frequencies of Physical Therapy Visits on Shoulder Function After Arthroscopic Rotator Cuff Repair. Phys Ther 2023; 103:pzad066. [PMID: 37341580 DOI: 10.1093/ptj/pzad066] [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: 12/10/2021] [Revised: 01/15/2023] [Accepted: 02/24/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE There is no consensus about the optimal frequency of patient visits during the rehabilitation program after arthroscopic rotator cuff repair (ARCR). This study aimed to investigate the short- and long-term effects of high-frequency (HF) and low-frequency (LF) visits of the patients in the first 12 weeks of rehabilitation after ARCR. METHODS This was a quasi-randomized study with 2 parallel groups. Forty-seven patients with ARCR were included in 2 different patient visit frequency protocols (HF = 23, LF = 24) in 12 weeks of postoperative rehabilitation. Patients in the HF group visited the clinic twice a week, whereas patients in the LF group visited once every 2 weeks for the first 6 weeks and once a week for the following 6 weeks. Both groups performed the same exercise protocol. Outcome measurements were pain and range of motion measured at baseline; at the 3rd, 5th, 8th, 12th, and 24th weeks; and at 1-year follow-up. Shoulder function was assessed at the 12th and 24th weeks and at 1-year follow-up with an American Shoulder and Elbow Surgeons score. RESULTS There was a significant group × time interaction in pain intensity during the activity between the groups. The activity pain intensity was higher in the LF group (4.2 points) at 8 weeks post surgery than in the HF group (2.7 points) (mean difference: 1.5 points, P < .05), whereas it was similar in both groups at other time periods. The interaction term was not significant between the groups for pain intensity during rest and night through the 1-year follow-up. No group × time interactions were observed in shoulder range of motion and American Shoulder and Elbow Surgeons score over the postoperative period. CONCLUSION Both rehabilitation programs at different visit frequencies after ARCR showed similar clinical results in the long term. A supervised, controlled rehabilitation program with LF visits in the first 12 weeks after surgery can be sufficient to achieve optimal clinical results and reduce rehabilitation-related costs after ARCR. IMPACT This study highlights that LF treatment protocols under the supervision of the therapist can be adopted after the arthroscopic rotator cuff repair to achieve successful results while decreasing the treatment costs. Physical therapists should plan the treatment sessions efficiently for the compliance of the patients to the exercise treatment. LAY SUMMARY If you are a patient with arthroscopic rotator cuff repair, a supervised, controlled rehabilitation program with low-frequency visits in the first 12 weeks after surgery could help you achieve the best outcome and help lower the costs of rehabilitation. A total of 3 visits in the first 6 weeks might be sufficient (once every 2 weeks). More frequent visits (1-2 visits a week) should happen 6 to 12 weeks after the surgery.
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Affiliation(s)
- Serdar Demirci
- Balıkesir University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Balıkesir, Turkey
| | - Dilara Kara
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation in Sports, Ankara, Turkey
| | - Taha İbrahim Yıldız
- Afyonkarahisar University of Health Sciences, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Afyonkarahisar, Turkey
| | - Leyla Eraslan
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation in Sports, Ankara, Turkey
| | - Özgün Uysal
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation in Sports, Ankara, Turkey
| | - Ceyda Sevinç
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation in Sports, Ankara, Turkey
| | - Burak Ulusoy
- Cankiri Karatekin University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Çankırı, Turkey
| | - Ali Okan Gazeloğlu
- Hacettepe University, Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Elif Turgut
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation in Sports, Ankara, Turkey
| | - Gazi Huri
- Hacettepe University, Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Egemen Turhan
- Hacettepe University, Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - İrem Düzgün
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation in Sports, Ankara, Turkey
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Gadangi PV, Lambert BS, Goble H, Harris JD, McCulloch PC. Validated Wearable Device Shows Acute Postoperative Changes in Sleep Patterns Consistent With Patient-Reported Outcomes and Progressive Decreases in Device Compliance After Shoulder Surgery. Arthrosc Sports Med Rehabil 2023; 5:100783. [PMID: 37636255 PMCID: PMC10450855 DOI: 10.1016/j.asmr.2023.100783] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/02/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose To assess the utility of a validated wearable device (VWD) in examining preoperative and postoperative sleep patterns and how these data compare to patient-reported outcomes (PROs) after rotator cuff repair (RCR) or total shoulder arthroplasty (TSA). Methods Male and female adult patients undergoing either RCR or TSA were followed up from 34 days preoperatively to 6 weeks postoperatively. Sleep metrics were collected using a VWD in an unsupervised setting. PROs were assessed using the following validated outcome measures: Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function questionnaire; American Shoulder and Elbow Surgeons self-evaluation questionnaire; visual analog scale assessing pain; and Disabilities of the Arm, Shoulder and Hand questionnaire. Data were analyzed preoperatively and at 2-week intervals postoperatively with χ2 analysis to evaluate device compliance. Sleep metrics and PROs were evaluated at each interval relative to preoperative values within each surgery type with an analysis of variance repeated on time point. The relation between sleep metrics and PROs was assessed with correlation analysis. Results A total of 57 patients were included, 37 in the RCR group and 20 in the TSA group. The rate of device compliance in the RCR group decreased from 84% at surgery to 46% by 6 weeks postoperatively (P < .001). Similarly, the rate of device compliance in the TSA group decreased from 81% to 52% (P < .001). Deep sleep decreased in RCR patients at 2 to 4 weeks (decrease by 10.99 ± 3.96 minutes, P = .021) and 4 to 6 weeks postoperatively (decrease by 13.37 ± 4.08 minutes, P = .008). TSA patients showed decreased deep sleep at 0 to 2 weeks postoperatively (decrease by 12.91 ± 5.62 minutes, P = .045) and increased rapid eye movement sleep at 2 to 4 weeks postoperatively (increase by 26.91 ± 10.70 minutes, P = .031). Rapid eye movement sleep in the RCR group and total sleep in the TSA group were positively correlated with more favorable PROs (P < .05). Conclusions VWDs allow for monitoring components of sleep that offer insight into potential targets for improving postoperative fatigue, pain, and overall recovery after shoulder surgery. However, population demographic factors and ease of device use are barriers to optimized patient compliance during data collection. Level of Evidence Level IV, diagnostic case series.
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Affiliation(s)
- Pranav V. Gadangi
- Texas A&M Health Science Center, College Station, Texas, U.S.A
- Texas A&M College of Engineering, College Station, Texas, U.S.A
| | - Bradley S. Lambert
- Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Haley Goble
- Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Joshua D. Harris
- Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Patrick C. McCulloch
- Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
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Pichené-Houard A, Sirveaux F, Clerc-Urmès I, Paris N, Michel B, Jacquot A, Martinet N, Claudon L, Paysant J, Wild P. Predictive factors of return-to-work trajectory after work-related rotator cuff syndrome: A prospective study of 96 workers. Am J Ind Med 2023; 66:759-774. [PMID: 37460254 DOI: 10.1002/ajim.23511] [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: 02/09/2023] [Revised: 05/10/2023] [Accepted: 06/07/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Sustained return to work after surgery for work-related rotator cuff syndrome (WRRCS) remains quite difficult. The main purpose of the present study was to identify predictive factors of a return-to-work (RTW) trajectory. METHODS A total of 96 workers with WRRCS were identified by 4 surgeons. They were followed prospectively before and after the surgery, until 1 year after RTW, or for 20 months after surgery when they did not. Participants completed a series of standardized questionnaires related to working conditions, health, and beliefs, and performed functional tests at the inclusion time. During the follow-up period, they were regularly asked about their working conditions (present or not at work), activity (normal or lightened physical duties) and schedules (full- or part-time job). Statistical analysis was based on single- and multiple-factor models of prediction of the workers' trajectory. RESULTS Three trajectories of RTW were distinguished, considering RTW and absenteeism that occurred during the follow-up: stable, unstable, and non-RTW. The median age of the sample was 49.5 [45.0-54.0], with 67.7% of workers employed in highly physically demanding jobs. In the multiple factor model, three factors were highly predictive of the trajectory: perceived health before surgery, having had a repaired ruptured-rotator-cuff tendinopathy, and the level of physical demand of the job. CONCLUSION Three easy-to-collect predictive factors of RTW trajectory have been identified. They may be useful for healthcare professionals and care givers to identify vulnerable workers' risk of occupational dropout after arthroscopic surgery for rotator cuff tendinopathy.
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Affiliation(s)
- Anne Pichené-Houard
- Département Homme au Travail, Institut National de Recherche et de Sécurité (INRS), Vandoeuvre-lès-Nancy Cedex, France
| | - François Sirveaux
- Pôle lorrain de chirurgie de l'appareil locomoteur, Centre Chirurgical Emile Gallé, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Isabelle Clerc-Urmès
- Département Homme au Travail, Institut National de Recherche et de Sécurité (INRS), Vandoeuvre-lès-Nancy Cedex, France
| | | | - Blaise Michel
- Clinique Louis Pasteur, service de chirurgie orthopédique, Essey-lès- Nancy, France
| | - Adrien Jacquot
- Clinique Louis Pasteur, service de chirurgie orthopédique, Essey-lès- Nancy, France
| | - Noël Martinet
- Institut Régional de Médecine Physique et de Réadaptation de Nancy, Centre Louis Pierquin, UGECAM du Nord-Est, Nancy, France
| | - Laurent Claudon
- Département Homme au Travail, Institut National de Recherche et de Sécurité (INRS), Vandoeuvre-lès-Nancy Cedex, France
| | - Jean Paysant
- Institut Régional de Médecine Physique et de Réadaptation de Nancy, Centre Louis Pierquin, UGECAM du Nord-Est, Nancy, France
| | - Pascal Wild
- Département Homme au Travail, Institut National de Recherche et de Sécurité (INRS), Vandoeuvre-lès-Nancy Cedex, France
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Zheng W, Weng R, Wu X, Liu Z, Liao Z, Chen S, Zheng S, Yi Z, Huang X, Wei H. Clinical efficacy and tendon integrity of patients with subscapularis tear by the technique of arthroscopic single external row repair. Front Med (Lausanne) 2023; 10:1167158. [PMID: 37564049 PMCID: PMC10411732 DOI: 10.3389/fmed.2023.1167158] [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: 02/16/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
Background With the development of arthroscopic technology and equipment, arthroscopy can effectively repair the tear of the subscapular muscle. However, it is difficult to expose the subscapular muscle and operate it under a microscope. In this study, the SwiveLock® C external row anchor under arthroscopy was applied to repair the tear of the subscapular muscle in a single row, which is relatively easy to operate with reliable suture and fixation, and its efficacy was evaluated. Purpose This study aimed to assess the clinical efficacy and the tendon integrity of patients who had subscapularis tears by adopting the single-row repair technique with a SwiveLock® C external row anchor. Methods Patients who had the subscapular muscle tear either with or without retraction were included, and their follow-up time was at least 1 year. The degree of tendon injury was examined by magnetic resonance imaging (MRI) and confirmed by arthroscopy. The tendon was repaired in an arthroscopic manner by utilizing the single-row technique at the medial margin of the lesser tuberosity. One double-loaded suture SwiveLock® C anchor was applied to achieve a strong fixation between the footprint and tendon. The range of motion, pain visual simulation score, American Shoulder and Elbow Surgeons (ASES) score, and Constant score of shoulder joint were evaluated for each patient before the operation, 3 months after the operation, and at least 1 year after the operation. Results In total, 110 patients, including 31 males and 79 females, with an average age of 68.28 ± 8.73 years were included. Arthroscopic repair of the subscapular tendon with SwiveLock® C external anchor can effectively improve the range of motion of the shoulder joint. At the last follow-up, the forward flexion of the shoulder joint increased from 88.97 ± 26.33° to 138.38 ± 26.48° (P < 0.05), the abduction range increased from 88.86 ± 25.27° to 137.78 ± 25.64° (P < 0.05), the external rotation range increased from 46.37 ± 14.48° to 66.49 ± 14.15° (P < 0.05), and the internal rotation range increased from 40.03 ± 9.01° to 57.55 ± 7.43° (P < 0.05). The clinical effect is obvious. The constant shoulder joint score increased from 40.14 ± 15.07 to 81.75 ± 11.00 (P < 0.05), the ASES score increased from 37.88 ± 13.24 to 82.01 ± 9.65 (P < 0.05), and the visual analog scale score decreased from 5.05 ± 2.11 to 1.01 ± 0.85 (P < 0.05). In the 6th month after the operation, two cases (1.81%) were confirmed to have re-tears via MRI. Conclusion In this study, we repaired the subscapularis muscle with a single-row technique fixed by SwiveLock® C anchor and FiberWire® sutures and evaluated its efficacy. The results showed that the clinical effect of single-row arthroscopic repair was satisfactory and that reliable tendon healing could be achieved.
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Affiliation(s)
- Weipeng Zheng
- The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
| | - Rui Weng
- The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
| | - Xiaohang Wu
- Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Zhijun Liu
- The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
| | - Zhihao Liao
- The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
| | - Sheng Chen
- The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
| | - Suming Zheng
- The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
| | - Zhiyong Yi
- The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
| | - Xudong Huang
- The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
| | - Hewei Wei
- The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
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Liu C, Jiang S, Xu W, Chen X, He R, Deng K, Su H, Yin X, Su S, Liang T, Zhu L, Hou G, Zhang Y, Shi Y, Lv W, Liu L, Guo Z, Xu Y, Xu T, Wang K. Poly-l-lactide-co-ε-caprolactone (PLCL) and poly-l-lactic acid (PLLA)/gelatin electrospun subacromial spacer improves extracellular matrix (ECM) deposition for the potential treatment of irreparable rotator cuff tears. Int J Biol Macromol 2023:125522. [PMID: 37353124 DOI: 10.1016/j.ijbiomac.2023.125522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 06/25/2023]
Abstract
Biodegradable subacromial spacer implantation has become practicable for the treatment of irreparable rotator cuff tears (IRCT). However, the relative high degradation rate and inferior tissue regeneration properties of current subacromial spacer may lead to failure regards to long-term survival. It is reported that satisfactory clinical results lie in the surrounding extracellular matrix (ECM) deposition after implantation. This study aims to develop a biological subacromial spacer that would enhance tissue regeneration properties and results in better ECM deposition. Physicochemical properties were characterized on both poly-l-lactide-co-ε-caprolactone (PLCL) dip-coating spacer (monolayer spacer, MS) and PLCL dip-coating + Poly-l-Lactic Acid (PLLA)/Gelatin electrospun spacer (Bilayer Spacer, BS). Cytocompatibility, angiogenesis, and collagen inducibility were evaluated with tendon fibroblasts and endothelial cells. Ultrasonography and histomorphology were used to analyze biodegradability and surrounding ECM deposition after the implantation in vivo. BS was successfully fabricated with the dip-coating and electrospinning technique, based on the human humeral head data. In vitro studies demonstrated that BS showed a greater cytocompatibility, and increased secretion of ECM proteins comparing to MS. In vivo studies indicated that BS promoted ECM deposition and angiogenesis in the surrounding tissue. Our research highlights that BS exhibits better ECM deposition and reveals a potential candidate for the treatment of IRCT in future.
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Affiliation(s)
- Chang Liu
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China; Department of Orthopaedic Surgery, The Lingnan Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Shihai Jiang
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig 04103, Germany
| | - Wenbin Xu
- Department of Orthopaedic Surgery, The Lingnan Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Xi Chen
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Ronghan He
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Kunxue Deng
- Medprin Regenerative Medical Technologies Co., Ltd, Guangzhou 510630, China
| | - Hengxian Su
- Zhujiang Hospital of Southern Medical University, Guangzhou 510282, China
| | - XiaoPeng Yin
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Shouwen Su
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Tangzhao Liang
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Lei Zhu
- Department of Plastic and Aesthetic Surgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou 510630, China
| | - Gang Hou
- Department of Orthopaedic Surgery, The Lingnan Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yuanyuan Zhang
- Obstetrics and Gynaecology, Maternal and Child Health Care Hospital of Jiaozuo, Jiaozuo 454000, China
| | - Yi Shi
- Department of Orthopedics, First Affiliated Hospital of Anhui Medical University, 230022, China
| | - Wenhao Lv
- Department of Joint Surgery, Jiaozuo Coal Industry (Group) Co. Ltd. Central Hospital, Jiaozuo 454000, China
| | - Libiao Liu
- Medprin Regenerative Medical Technologies Co., Ltd, Guangzhou 510630, China
| | - Zeyue Guo
- Medprin Regenerative Medical Technologies Co., Ltd, Guangzhou 510630, China
| | - Yichun Xu
- Department of Orthopaedic Surgery, The Lingnan Hospital of Sun Yat-sen University, Guangzhou 510630, China.
| | - Tao Xu
- Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China; Center for Bio-intelligent Manufacturing and Living Matter Bioprinting, Research Institute of Tsinghua University in Shenzhen, Tsinghua University, Shenzhen 518057, China; East China Institute of Digital Medical Engineering, Shangrao 334000, China.
| | - Kun Wang
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
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Shao H, Zhang S, Chen J, Wen A, Wu Z, Huang M, Yao W, Lin Z, Liu C, Jin Z, Li Y. Radial extracorporeal shockwave therapy reduces pain and promotes proximal tendon healing after rotator cuff repair: Randomized clinical trial. Ann Phys Rehabil Med 2023; 66:101730. [PMID: 37027927 DOI: 10.1016/j.rehab.2023.101730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 04/08/2023]
Abstract
BACKGROUND Extracorporeal shockwave therapy (ESWT) is widely used to treat soft tissue disorders, but evidence for its application after rotator cuff (RC) repair is lacking. OBJECTIVES To investigate the effect of ESWT on short-term functional and structural outcomes after RC repair. METHODS Thirty-eight individuals were randomly assigned to the ESWT group (n = 19) or control group (n = 19) 3 months after RC repair. Both groups underwent 5 weeks of advanced rehabilitation and participants in the ESWT group additionally received 2000 pulses of shockwave therapy every week for 5 weeks. The primary outcome was pain measured on a visual analog scale (VAS). Secondary outcomes were range of motion (ROM), Constant score, University of California Los Angeles score (UCLA), American Shoulder and Elbow Surgeons form (ASES), and Fudan University shoulder score (FUSS). Changes in signal/noise quotient (SNQ), muscle atrophy and fatty infiltration were analyzed from MRI. All participants underwent clinical and MRI examinations 3 months (baseline) and 6 months (follow-up) post repair. RESULTS A total of 32 participants completed all assessments. Pain and function improved in both groups. At 6 months post repair, pain intensity was lower and ASES scores higher in the ESWT than in the control group (all p-values < 0.01). SNQ near the suture anchor site decreased significantly from baseline to follow-up in the ESWT group (p = 0.008) and was significantly lower than that in the control group (p = 0.036). Muscle atrophy and the fatty infiltration index did not differ between groups. CONCLUSION ESWT and exercise more effectively reduced early shoulder pain than rehabilitation alone and accelerated proximal supraspinatus tendon healing at the suture anchor site after RC repair. However, ESWT may not be more effective than advanced rehabilitation in terms of functional outcomes at the short-term follow-up.
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Affiliation(s)
- Hong Shao
- Department of Sports Medicine, Huashan Hospital, Fudan University, No12 Wulumuqi Zhong Road, Shanghai 200040, China; Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shurong Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, No12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, No12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Aizhen Wen
- Department of Sports Medicine, Huashan Hospital, Fudan University, No12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Ziying Wu
- Department of Sports Medicine, Huashan Hospital, Fudan University, No12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Mingru Huang
- Department of Sports Medicine, Huashan Hospital, Fudan University, No12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Wei Yao
- Department of Sports Medicine, Huashan Hospital, Fudan University, No12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Zifan Lin
- Department of Sports Medicine, Huashan Hospital, Fudan University, No12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Chang Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, No12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Zhengbiao Jin
- Department of Sports Medicine, Huashan Hospital, Fudan University, No12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Yunxia Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, No12 Wulumuqi Zhong Road, Shanghai 200040, China.
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Lee D, Destine H, Gibbs BS, Lencer AJ, Paul RW, Palm J, Tjoumakaris FP. Disruptions in Standard Care in Patients After Arthroscopic Rotator Cuff Repair During the COVID-19 Pandemic. Orthop J Sports Med 2023; 11:23259671231157380. [PMID: 37123993 PMCID: PMC10134137 DOI: 10.1177/23259671231157380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/13/2022] [Indexed: 05/02/2023] Open
Abstract
Background The coronavirus disease-2019 (COVID-19) pandemic led to disruptions in care for orthopaedic patients who underwent surgery just before the outbreak, rendering some unable to participate in standard postoperative care. Many of these patients underwent clinical follow-up and physical therapy via telehealth. Purpose To evaluate the methods of postoperative care in patients who underwent arthroscopic rotator cuff repair (RCR) and had follow-ups during the height of the pandemic versus those who received prior standard of care. We aimed to compare the 1-year outcomes between these cohorts. Study Design Cohort study; Level of evidence, 3. Methods A retrospective chart review was used to identify patients who underwent primary RCR in February and March 2020 (COVID cohort) and the same period in 2019 (control cohort) at a single institution. Excluded were patients who underwent revision RCR, used workers' compensation, or were incarcerated or deceased. The included patients reported the postoperative care received, their satisfaction with care, physical therapy appointment type (in person, home based, telehealth, or self-guided), satisfaction with physical therapy, and minimum 1-year postoperative American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Penn Shoulder Score (PSS) outcomes. Results Overall, 428 patients were included for final analysis--199 in the COVID cohort and 229 controls. Follow-up data were collected for 160 patients in the COVID group (80.4%) and 169 control patients (73.8%). In the COVID group, 110 patients (68.8%) had ≥1 clinical visit conducted via telehealth, compared with zero in the control group. There were no differences between the COVID and control groups in the ASES (84.2 ± 16.5 vs 86.5 ± 17; P = .27 ), SANE (83.9 ± 15.4 vs 84.8 ± 17.5; P = .66), PSS (84.8 ± 15.3 vs 87.1 ± 15.1; P = .22), or patient satisfaction with the care received (81.7 ± 22.6 vs 86.3 ± 23.5; P = .09). Satisfaction with physical therapy was significantly higher in the control group (88.3 ± 18.9 vs 81.9 ± 22.5; P = .01). Conclusion Despite disruptions in care, RCR patients had comparable 1-year outcomes during the pandemic versus before the pandemic. Telehealth clinical follow-up appointments did not adversely affect patient-reported outcome measures and may be appropriate for RCR patients beyond the pandemic.
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Affiliation(s)
- Donghoon Lee
- Rothman Orthopaedic Institute, Philadelphia Pennsylvania, USA
| | - Henson Destine
- Rothman Orthopaedic Institute, Philadelphia Pennsylvania, USA
| | - Brian S. Gibbs
- Rothman Orthopaedic Institute, Philadelphia Pennsylvania, USA
| | - Adam J. Lencer
- Rothman Orthopaedic Institute, Philadelphia Pennsylvania, USA
| | - Ryan W. Paul
- Rothman Orthopaedic Institute, Philadelphia Pennsylvania, USA
| | - Justin Palm
- Rothman Orthopaedic Institute, Philadelphia Pennsylvania, USA
| | - Fotios P. Tjoumakaris
- Rothman Orthopaedic Institute, Philadelphia Pennsylvania, USA
- Fotios P. Tjoumakaris, MD, Rothman Orthopaedics at Thomas Jefferson University, 2500 English Creek Avenue, Building 1300, Egg Harbor Township, NJ 08234, USA ()
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Baumann A, Indermuhle T, Curtis D, Perez J, Leland JM. Factors Affecting Postoperative Rehabilitation Therapy Utilization After Arthroscopic Rotator Cuff Repair: An Epidemiological Analysis. Cureus 2023; 15:e36740. [PMID: 37123773 PMCID: PMC10132080 DOI: 10.7759/cureus.36740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
Background and objective Rotator cuff tear (RCT) is an orthopedic shoulder pathology commonly managed via arthroscopic rotator cuff repair (ARCR) after the failure of conservative treatment options. Physical therapy (PT) after ARCR is an important component of patient recovery. Postoperative complications, such as postoperative shoulder stiffness (POSS), are frequent among these patients and place a significant burden on patients and clinicians. The purpose of this study is to analyze temporal PT utilization among patients after ARCR and its potential to improve patient outcomes and examine possible factors affecting postoperative complication rates. Methods An epidemiological study was performed by using a large de-identified national health research network (TriNetX) within the United States to search for patients with a diagnosis of partial or complete RCT and subsequent ARCR. Data were collected on patient demographics, number of postoperative PT visits, and PT visits distribution in the early postoperative period. Statistical analysis was performed to analyze factors that impacted the utilization of postoperative PT after ARCR. Results A total of 21,540 patients underwent ARCR with 11,312 receiving ARCR for partial RCT and 10,228 for complete RCT. Of all ARCR patients, 6,923 (32.1%) received postoperative PT within one year of ARCR. Patients with partial RCT had a greater number of PT visits (mean ±SD: 3.85 ± 8.33; min-max: 0-110; t = 15.2) compared to patients with complete RCT (2.90 ± 7.97; min-max: 0-125) after ARCR (p<0.001). Patients with ARCR for partial RCT also had more visits within the first 12 weeks after ARCR as compared to patients with ARCR for complete RCT (p<0.001). Female patients had more visits than male patients after ARCR, regardless of the RCT extent (p<0.001). Conclusion Partial RCT and female sex are associated with increased postoperative PT usage after ARCR. Postoperative PT utilization has high variability after ARCR, regardless of the RCT extent. More research is needed to further explore the impact of PT utilization on postoperative complications after ARCR.
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Parel I, Candoli V, Filippi MV, Padolino A, Merolla G, Sanniti S, Galassi R, Paladini P, Cutti AG. Shoulder Rehabilitation Exercises With Kinematic Biofeedback After Arthroscopic Rotator Cuff Repair: Protocol for a New Integrated Rehabilitation Program. JMIR Res Protoc 2023; 12:e35757. [PMID: 36947146 PMCID: PMC10131889 DOI: 10.2196/35757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/28/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The recovery of scapular and humeral physiological kinematic parameters, as well as the sensorimotor control of movement, plays a primary role in the rehabilitation process after arthroscopic rotator cuff repair. A highly customized rehabilitation approach is required to achieve this aim. Biofeedback can be a useful tool, but there is poor evidence of its application in the rehabilitation after arthroscopic rotator cuff tear repair. OBJECTIVE The aim of this paper is to outline an innovative exercise-based rehabilitation program exploiting visual biofeedback for the recovery of patients arthroscopically treated for rotator cuff repair. METHODS For establishment of the innovative program, a multidisciplinary team involving experts in shoulder surgery, rehabilitation medicine, physical therapy, and biomedical and clinical engineering was formed. Starting from a conventional rehabilitation program, the team selected a set of exercises to be integrated with a biofeedback tool, named the INAIL (National Institute for Insurance against Accidents at Work) Shoulder and Elbow Outpatient program (ISEO program). ISEO is a motion analysis system based on inertial wearable sensors positioned over the thorax, scapula, humerus, and forearm. ISEO can return a visual biofeedback of humerus and scapula angles over time or of the scapula-humeral coordination, with possible overlap of patient-specific or asymptomatic reference values. A set of 12 progressive exercises was defined, divided into four groups based on humerus and scapula movements. Each group comprises 2-4 of the 12 exercises with an increasing level of complexity. Exercises can require the use of a ball, stick, rubber band, and/or towel. For each exercise, we present the starting position of the patient, the modality of execution, and the target position, together with notes about the critical factors to observe. The type of visual biofeedback to adopt is specified, such as the coordination between angles or the variation of a single angle over time. To guide the therapist in customizing the patient's rehabilitation program, a list of operative guidelines is provided. RESULTS We describe various applications of the ISEO exercise program in terms of frequency and intensity. CONCLUSIONS An innovative rehabilitation program to restore scapular and humeral kinematics after rotator cuff repair based on kinematic biofeedback is presented. Biofeedback is expected to increase patient awareness and self-correction under therapist supervision. Randomized controlled trials are needed to investigate the potential effect of the exercise-based biofeedback in comparison with conventional rehabilitation programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/35757.
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Affiliation(s)
- Ilaria Parel
- Laboratory of Biomechanics, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
- Department of Clinical Engineering, Azienda Unità Sanitaria Locale della Romagna, Cesena, Italy
| | - Valeria Candoli
- Department of Rehabilitation Medicine, Azienda Unità Sanitaria Locale della Romagna, Riccione, Italy
| | - Maria Vittoria Filippi
- Department of Rehabilitation Medicine, Azienda Unità Sanitaria Locale della Romagna, Riccione, Italy
| | - Antonio Padolino
- Laboratory of Biomechanics, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
- Shoulder and Elbow Surgical Unit, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
| | - Giovanni Merolla
- Laboratory of Biomechanics, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
- Shoulder and Elbow Surgical Unit, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
| | - Stefano Sanniti
- Department of Clinical Engineering, Azienda Unità Sanitaria Locale della Romagna, Cesena, Italy
| | - Riccardo Galassi
- Department of Rehabilitation Medicine, Azienda Unità Sanitaria Locale della Romagna, Riccione, Italy
| | - Paolo Paladini
- Laboratory of Biomechanics, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
- Shoulder and Elbow Surgical Unit, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
| | - Andrea Giovanni Cutti
- Laboratory of Motion Analysis, National Institute for Insurance against Accidents at Work Prosthetic Center, Vigorso di Budrio, Italy
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Swansen T, Wright MA, Murthi AM. Postoperative Rehabilitation Following Rotator Cuff Repair. Phys Med Rehabil Clin N Am 2023; 34:357-364. [PMID: 37003657 DOI: 10.1016/j.pmr.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Postoperative rehabilitation following rotator cuff repair is essential for a positive patient outcome. Each patient should have a program tailored to their individual tear and repair characteristics. Their plan should be advanced according to their progress, with therapist and surgeon communication. The rehabilitation progresses through 4 stages. This begins with a period of immobilization, passive range of motion, and protecting the repair and ends with functional and sport-specific exercises. Rehabilitation advances in progress-based steps during 24 weeks. The rehabilitation process aims to balance healing of the tendon repair and the risk of postoperative stiffness.
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Affiliation(s)
- Taylor Swansen
- Department of Orthopaedics, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD 21218, USA
| | - Melissa A Wright
- Department of Orthopaedics, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD 21218, USA
| | - Anand M Murthi
- Department of Orthopaedics, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD 21218, USA.
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Li T, Li Y, Zhang L, Pang L, Tang X, Zhu J. Venous thromboembolism after arthroscopic shoulder surgery: a systematic review. J Orthop Surg Res 2023; 18:103. [PMID: 36788620 PMCID: PMC9927062 DOI: 10.1186/s13018-023-03592-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To summarize the incidence, risk factors, diagnosis methods, prophylaxis methods, and treatment of venous thromboembolism (VTE) following arthroscopic shoulder surgery. METHODS Literature on VTE after arthroscopic shoulder surgeries was summarized, and all primary full-text articles reporting at least 1 case of deep vein thrombosis (DVT) or pulmonary embolism (PE) after arthroscopic shoulder surgeries were included. Articles were critically appraised and systematically analyzed to determine the incidence, risk factors, diagnosis, prophylaxis, and management of VTE following arthroscopic shoulder surgeries. RESULTS This study included 42 articles in which the incidence of VTE ranges from 0 to 5.71% and the overall incidence was 0.26%. Most VTE events took place between the operation day and the 14th day after the operation (35/51). Possible risk factors included advanced age (> 70 years), obesity (BMI ≥ 30 kg/m2), diabetes mellitus, thrombophilia, history of VTE, prolonged operation time, hormone use, and immobilization after surgery. The most common prophylaxis method was mechanical prophylaxis (13/15). No statistical difference was detected when chemoprophylaxis was applied. The management included heparinization followed by oral warfarin, warfarin alone and rivaroxaban, a direct oral anticoagulant. CONCLUSION Based on the included studies, the incidence rate of VTE after arthroscopic shoulder surgeries is relatively low. The risk factors for VTE are still unclear. CT/CTA and ultrasound were the mainstream diagnosis methods for PE and DVT, respectively. Current evidence shows that chemical prophylaxis did not deliver significant benefits, since none of the existing studies reported statistically different results. High-quality studies focusing on the prophylaxis and management of VTE population undergoing arthroscopic shoulder surgeries should be done in the future.
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Affiliation(s)
- Tao Li
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Yinghao Li
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Linmin Zhang
- grid.13291.380000 0001 0807 1581West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Long Pang
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Nursing, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, Sichuan Province, People's Republic of China.
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Rabin A, Maman E, Dolkart O, Kazum E, Kozol Z, Uhl TL, Chechik O. Regaining motion among patients with shoulder pathology - are all exercises equal? Shoulder Elbow 2023; 15:105-112. [PMID: 36895611 PMCID: PMC9990106 DOI: 10.1177/17585732211067161] [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: 05/02/2021] [Revised: 09/06/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022]
Abstract
Background Little information exists to guide the choice of exercise for regaining shoulder range of motion (ROM). The purpose of this study was to compare the maximal ROM reached, pain and difficulty associated with 4 commonly prescribed exercises. Methods Forty (9 females) patients with various shoulder disorders and a limited flexion ROM performed 4 exercises for regaining shoulder flexion ROM in a randomized order. Exercises included the self-assisted flexion, forward bow, table slide and rope-and-pulley. Participants were videotaped while performing all exercises and the maximal flexion angle reached during each exercise was recorded using Kinovea motion analysis freeware (Kinovea 0.8.15). Pain intensity and the perceived level of difficulty associated with each exercise were also recorded. Results The forward bow and table slide generated significantly greater ROM compared with the self-assisted flexion and rope-and-pulley (P ≤ 0.005). The self-assisted flexion was associated with a greater pain intensity compared with the table slide and rope-and-pulley (P = 0.002) and a greater perceived level of difficulty compared with the table slide (P = 0.006). Conclusions Due to the greater ROM allowed, and similar or even lower level of pain or difficulty, clinicians may wish to initially recommend the forward bow and table slide for regaining shoulder flexion ROM.
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Affiliation(s)
- Alon Rabin
- Department of Physiotherapy, Ariel University, Ariel, Israel
| | - Eran Maman
- Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oleg Dolkart
- Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Efi Kazum
- Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Zvi Kozol
- Department of Physiotherapy, Ariel University, Ariel, Israel
| | - Timothy L Uhl
- Department of Physical therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Ofir Chechik
- Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Rehabilitation and Return to Work and Sport After Rotator Cuff. Clin Sports Med 2023; 42:175-184. [DOI: 10.1016/j.csm.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ishikawa H, Muraki T, Yamamoto N, Itoi E, Izumi SI. Effect of shoulder immobilization position and activities of daily living on the stiffness of the repaired supraspinatus tendon. Clin Biomech (Bristol, Avon) 2023; 101:105856. [PMID: 36512943 DOI: 10.1016/j.clinbiomech.2022.105856] [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: 08/15/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although tension on the supraspinatus tendon may be increased by wearing an abduction brace in an improper position or activities of daily living with the operated arm in the brace, the amount of tension has not been objectively evaluated. METHODS Eighteen patients who underwent arthroscopic rotator cuff repair were enrolled. The stiffness of the repaired supraspinatus tendon was measured with ultrasound elastography to estimate the tension on the repaired tendon. Measurements were performed in 5 immobilization positions (0°, 30°, and 45° of arm elevation in the scapular plane; 30° of arm elevation in the scapular plane+60° (horizontal adduction) and -60° (horizontal abduction)) and 3 static positions simulating drinking, brushing teeth, and dressing. FINDINGS Stiffness at 30° of scapular plane elevation was lower than 0° of scapular plane elevation (P = 0.034), 30° of elevation in the scapular plane+60° (P < 0.001), and -60° (P < 0.001). There was no significant difference in the stiffness between 30° and 45° of scapular plane elevation (P = 1.000). The stiffness was the greatest at 30° of elevation in the scapular plane-60° among the 5 immobilization positions. The stiffnesses at drinking and brushing teeth were greater than 30° of scapular plane elevation (P < 0.001). INTERPRETATION Immobilization with the arm ≥30° of elevation in the scapular plane may be an optimal position for minimizing stiffness or tension on the repaired tendon. Drinking and brushing teeth may need to be performed using the non-operated arm to protect the repaired tendon.
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Affiliation(s)
- Hiroaki Ishikawa
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Takayuki Muraki
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
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Uchida R, Hombu A, Ishida Y, Nagasawa M, Chosa E. Investigation of cryotherapy for pain relief after arthroscopic shoulder surgery. J Orthop Surg Res 2022; 17:553. [PMID: 36536379 PMCID: PMC9764510 DOI: 10.1186/s13018-022-03404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Recently, cryotherapy has become a common practice for postoperative pain management. The current accepted practice in Japan is the use of cryotherapy at 5 °C after arthroscopic shoulder surgery. However, this therapy has been reported to be highly intense because the sustained low temperature causes discomfort for patients. The optimum temperature and duration of cooling required for comfortable and effective cryotherapy after arthroscopic shoulder surgery were investigated. METHODS Because pain levels might differ depending on the condition, we selected 52 patients with rotator cuff injuries, which were the most common disorders indicated for arthroscopic shoulder surgery. Patients were treated with cryotherapy at 5 °C or 10 °C for 16 h or 24 h. The pain level was determined using the visual analogue scale, and deep shoulder joint temperatures were recorded at different time points for analysis. RESULTS Pain after arthroscopic shoulder surgery was found to be related to the presence of a brachial plexus block using the interscalene approach during surgical anesthesia. To obtain effective analgesia with cryotherapy, the cooling temperature and duration of cryotherapy had to be changed based on the presence or absence of the brachial plexus block. Patients who received brachial plexus blocks had the lowest recorded pain scores after receiving cryotherapy at 5 °C for 24 h after surgery. Patients who did not receive the block had the lowest recorded pain scores when receiving cryotherapy at either 5 °C for 16 h or 10 °C for 24 h. CONCLUSIONS Using universal cryotherapy intensity and duration settings regardless of the use of other interventions is likely to unintentionally increase postoperative pain levels. This study revealed that cryotherapy at 5 °C for 24 h was optimal for patients who received an anesthesia block and at 5 °C for 16 h or at 10 °C for 24 h for those who did not receive the anesthesia block. These results can be used as a reference for setting the temperature and duration of cryotherapy after arthroscopic shoulder surgery.
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Affiliation(s)
- Rinko Uchida
- grid.410849.00000 0001 0657 3887School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake-Cho, Miyazaki-City, Miyazaki 889-1692 Japan
| | - Amy Hombu
- grid.410849.00000 0001 0657 3887Center for Language and Cultural Studies, University of Miyazaki, Miyazaki, Japan
| | | | - Makoto Nagasawa
- grid.410849.00000 0001 0657 3887Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- grid.410849.00000 0001 0657 3887Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Assessment of several postoperative protocols after rotator cuff repair: A network meta-analysis. Orthop Traumatol Surg Res 2022; 108:103418. [PMID: 36152940 DOI: 10.1016/j.otsr.2022.103418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/24/2022] [Accepted: 09/09/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There are presently 3 postoperative protocols after rotator cuff repair: strict immobilization, passive motion and early active motion. There is no consensus as to which is to be preferred. The aim of the present study was to conduct a network meta-analysis to determine whether one particular protocol shows advantages in terms of healing, motion, clinical scores and complications. METHODS A search of the PubMed, Embase and Central databases extracted all randomized controlled trials (RCTs) comparing at least 2 protocols. Eighteen RCTs were thus included, for a total 1704 patients (mean age, 58.1 years) and 1726 shoulders. RESULTS Strict immobilization was associated with lower flexion at 1 year than passive motion (mean difference, 2.66 [95% CI, 0.42-6.20]) and active motion (mean difference, 3.76 [95% CI, 0.17-7.80]). There were no differences between protocols for external rotation, healing at 1 year or Constant, ASES and STT scores in the short and medium terms. There was no difference in complications rate. CONCLUSION Early motion, whether passive or active, leads to greater flexion than does strict immobilization. No other differences were found between the protocols. Taking certain prognostic factors (lesion size, patient age, activity level, etc.) into account could guide specific rehabilitation according to type of lesion. LEVEL OF EVIDENCE I, network meta-analysis.
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Gutiérrez-Espinoza H, Araya-Quintanilla F, Pinto-Concha S, Sepúlveda-Loyola W, Ramírez-Vélez R, Fuentes-Contreras J. Effects of a postoperative program in patients with shoulder stiffness following arthroscopic rotator cuff repair. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221116387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The most common complication in the surgery for rotator cuff (RC) tears is postoperative shoulder stiffness. The evidence for the postoperative treatment of this condition is scarce. This study assessed the effects of a postoperative program at the onset of shoulder stiffness following arthroscopic RC repair. Methods A single-group pre- and post-test design was included. Participants performed a 6-week program. Primary outcomes were shoulder and upper limb function assessed with the Constant–Murley and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires, respectively. Secondary outcomes included pain intensity at rest and during movement with the visual analog scale (VAS), and shoulder range of motion assessed with a goniometer. Results A total of 115 adult males were included. The intervention produced a positive effect on the Constant–Murley (+35.6 points, p<0.001) and DASH questionnaire (−26.2 points, p = 0.005); VAS at rest (−2.8 cm, p<0.001); VAS at movement (−2.7 cm, p<0.001); and shoulder ROMs. Conclusion The program showed clinically and statistically significant benefits in most of the functional outcomes in the study participants.
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Affiliation(s)
- Héctor Gutiérrez-Espinoza
- Research Rehabilitation and Health Research Center (CIRES), Universidad de las Américas, Santiago, Chile
- Escuela de Fisioterapia, Universidad de las Américas, Quito, Ecuador
| | | | | | - Walter Sepúlveda-Loyola
- Londrina State University, Londrina, Brazil
- Faculty of Health and Social Sciences, Universidad de las Américas, Santiago, Chile
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Navarra Institute for Health Research (IdiSNA), Universidad Pública de Navarra (UPNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge Fuentes-Contreras
- Clinical Research Lab, Department of Physical Therapy, Catholic University of Maule, Talca, Chile
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Berhouet J, Samargandi R, Charousset C. Management of normal long head of the biceps tendon in isolated grade-1 supraspinatus tear: Research protocol for a multicenter prospective single-blind randomized study. Orthop Traumatol Surg Res 2022; 108:103404. [PMID: 36108818 DOI: 10.1016/j.otsr.2022.103404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/20/2022] [Accepted: 09/02/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The long head of the biceps (LHB) tendon is a common locus of pain in rotator cuff tear and of residual pain after tendon repair. Therefore, systematic LHB tenotomy, with or without tenodesis, is usually recommended. However, the recent literature suggests that long-term functional results of supraspinatus tendon repair are comparable between conservation of a normal biceps and tenotomy. The study objective is to compare functional results between sectioning and sparing a normal LHB in treating isolated grade-1 supraspinatus tendon tear. The study hypothesis is that sparing the normal LHB is clinically preferable to sectioning in the particular case of distal supraspinatus tear. METHODS AND ANALYSIS A French nationwide prospective single-blind randomized clinical study will include 194 patients undergoing arthroscopic repair of grade-1 supraspinatus tear with normal LHB. They will be randomized to 2 parallel groups: LHB sparing and sectioning. The main endpoint is Constant-Murley score, and secondary endpoints comprise ASES and SSV scores, clinical assessment of the biceps, pain on VAS, ultrasound assessment of cuff repair healing and conserved LHBs, impact on return to work and sport, pathologic assessment of sectioned LHBs, and analysis of risk factors for cuff repair failure. ETHICAL APPROVAL AND PUBLICATION The protocol has been approved by the data protection committee (art.L.1122-1) and meets the criteria of the Declaration of Helsinki and of the SPIRIT statement defining standard protocol items for clinical trials. Results will be published in a peer-reviewed journal. LEVEL OF EVIDENCE not applicable.
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Affiliation(s)
- Julien Berhouet
- Université de Tours-Faculté de Médecine de Tours-CHRU Trousseau, Service d'Orthopédie Traumatologie de Tours, avenue de la République, 37170 Chambray-Les-Tours, France.
| | - Ramy Samargandi
- Université de Tours-Faculté de Médecine de Tours-CHRU Trousseau, Service d'Orthopédie Traumatologie de Tours, avenue de la République, 37170 Chambray-Les-Tours, France
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- 115, rue Ampère, 92500 Rueil-Malmaison, France
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Misir A, Oguzkaya S, Kizkapan TB, Eken G, Sayer G. The effect of postoperative sling immobilization and early mobilization on clinical and functional outcomes after arthroscopic rotator cuff repair: A propensity score-matched analysis. J Back Musculoskelet Rehabil 2022; 35:1391-1398. [PMID: 35723088 DOI: 10.3233/bmr-210358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKROUND Optimal postoperative management is controversial after arthroscopic rotator cuff repair (ARCR). OBJECTIVE The aim of the study was to evaluate outcomes of patients with and without postoperative sling immobilization after undergoing arthroscopic RCR rotator cuff repair. METHOD 369 arthroscopic full thickness superior rotator cuff tears (RCT) with a minimum follow-up of 6 months were included in this study. Propensity score matching was performed for age, sex, BMI, and tear size. Pain (VAS score), shoulder range of motion (ROM), functional outcome (ASES, Constant-Murley [CM] and Oxford shoulder score [OSS]), and health related quality of life (SF-36) scores were compared between patients with and without sling immobilization. RESULTS According to the propensity match score, 92 patients (50 sling immobilization and 42 no sling immobilization) were matched to be almost identical in age (62.5 ± 8.0 vs. 61.8 ± 5.9), sex (female 78% vs. 76.2%), BMI (28.1 ± 2.8 vs. 27.8 ± 2.6), and tear size (2.7 ± 1.1 vs. 2.9 ± 0.8). The postoperative physical functioning domain of SF-36 scores was found to be significantly higher in the no sling group (p= 0.034). CONCLUSION Early mobilization after arthroscopic small and medium sized full thickness superior rotator cuff repair is associated with improved ROM and quality of life scores.
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Affiliation(s)
- Abdulhamit Misir
- Department of Orthopedics and Traumatology, Istanbul Medicana International Hospital, Istanbul, Turkey
| | - Sinan Oguzkaya
- Department of Orthopedics and Traumatology, Cekirge State Hospital, Bursa, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopedics and Traumatology, Istanbul Basaksehir Pine and Sakura City Training and Research Hospital, Istanbul, Turkey
| | - Gokay Eken
- Department of Orthopedics and Traumatology, Uludag University Medical Faculty, Bursa, Turkey
| | - Gokhan Sayer
- Department of Orthopedics and Traumatology, Mus State Hospital, Mus, Turkey
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Chen J, Lou J, Wang W, Xu G. Association of Preoperative Vitamin D Deficiency With Retear Rate and Early Pain After Arthroscopic Rotator Cuff Repair: A Retrospective Cohort Study. Orthop J Sports Med 2022; 10:23259671221130315. [PMID: 36276423 PMCID: PMC9580096 DOI: 10.1177/23259671221130315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background Although the function of vitamin D in bone metabolism has been well studied, the question remains whether vitamin D deficiency impairs tendon healing after rotator cuff repair. Purpose To investigate the correlation between preoperative vitamin D deficiency and the retear rate and pain after arthroscopic rotator cuff repair. Study Design Cohort study; Level of evidence, 3. Methods Patients with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair between January 2018 and August 2019 were enrolled. Included patients were divided into a control group (vitamin D level ≥20 μg/L) and a deficiency group (vitamin D level <20 μg/L). We investigated the association between preoperative vitamin D level and patient characteristics, MRI findings, pain and function scores (visual analog scale [VAS] for pain; Constant-Murley; University of California, Los Angeles; and American Shoulder and Elbow Surgeons scores), and healing status using the Pearson or Spearman correlation coefficient. The clinical characteristics were compared between the groups using the chi-square test or Fisher exact test. Results Included were 89 patients (control group, 44 patients; deficiency group, 45 patients). The mean vitamin D levels were 25.07 ± 5.38 and 14.61 ± 3.43 μg/L in the control and deficiency groups, respectively (P < .001); otherwise, there were no significant differences between the groups in the variables under study. Vitamin D levels were not related to age, symptom duration, tear size, extent of retraction, VAS pain score preoperatively and at 6 and 24 months postoperatively, or any function scores. Supraspinatus fatty infiltration and VAS scores at 1 and 3 months postoperatively were significantly associated with vitamin D level (r = -0.360, -0.362, and -0.316, respectively; P < .05 for all). VAS scores were significantly lower in the control group than in the deficiency group at postoperative 1 month (1.09 ± 0.56 vs 1.47 ± 0.66, respectively) and 3 months (1.14 ± 0.77 vs 1.44 ± 0.66) (P < .05 for both). The retear rate was significantly lower in the control group than in the deficiency group (9.09% vs 26.67%, respectively; P < .05). Conclusion Our study revealed that preoperative vitamin D deficiency was associated with a higher retear rate and early pain (1 and 3 months) after arthroscopic rotator cuff repair.
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Affiliation(s)
- Jun Chen
- Department of Orthopedics, Dongyang People’s Hospital, Wenzhou Medical University, Dongyang, People’s Republic of China
| | - Juexiang Lou
- Department of Orthopedics, Dongyang People’s Hospital, Wenzhou Medical University, Dongyang, People’s Republic of China
| | - Weikai Wang
- Department of Orthopedics, Dongyang People’s Hospital, Wenzhou Medical University, Dongyang, People’s Republic of China
| | - Guohong Xu
- Department of Orthopedics, Dongyang People’s Hospital, Wenzhou Medical University, Dongyang, People’s Republic of China.,Guohong Xu, MD, Department of Orthopedics, Dongyang People’s Hospital, Wenzhou Medical University, 60 Wuning West Road, 322100, Dongyang, People’s Republic of China ()
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Wellington IJ, Davey AP, Mancini MR, Hawthorne BC, Trudeau MT, Uyeki CL, Mazzocca AD. Management of Failed Rotator Cuff Repairs: A Review. Orthop Clin North Am 2022; 53:473-482. [PMID: 36208889 DOI: 10.1016/j.ocl.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Failed rotator cuff repairs present a complex issue for treating surgeons. Many methods of management exist for this pathology including revision repair with biologic augmentation, repairs with allograft, tendon transfers, superior capsular reconstruction, balloon arthroplasty, bursal acromial reconstruction, and reverse total shoulder arthroplasty. This review discusses the current literature associated with these management options.
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Affiliation(s)
- Ian J Wellington
- University of Connecticut, 120 Dowling Way, Farmington, CT 06032, USA.
| | - Annabelle P Davey
- University of Connecticut, 120 Dowling Way, Farmington, CT 06032, USA
| | - Michael R Mancini
- University of Connecticut, 120 Dowling Way, Farmington, CT 06032, USA
| | | | - Maxwell T Trudeau
- University of Connecticut, 120 Dowling Way, Farmington, CT 06032, USA
| | - Colin L Uyeki
- Frank H. Netter School of Medicine, Quinnipiac University, 370 Bassett Rd, North Haven, CT 06473, USA
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Effect of the Trunk and Upper Limb Passive Stabilization on Hand Movements and Grip Strength Following Various Types of Strokes—An Observational Cohort Study. Brain Sci 2022; 12:brainsci12091234. [PMID: 36138970 PMCID: PMC9497157 DOI: 10.3390/brainsci12091234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Almost half of the patients surveyed report impaired function of the upper limbx and handx after stroke. The effect of the passive trunk and shoulder stabilization on the recovery of coordinated hand movement is unclear. This study examined whether passive stabilization of the trunk and shoulder could improve the functional state of the hands after various types of strokes. It is an observational prospective cohort study conducted at the Rehabilitation Clinic in two parallel groups of patients with four different types of strokes (hemorrhagic and ischemic of the brain, similar to the cerebellum). A total of 120 patients were analyzed. Patients were examined in various positions: sitting without a backrest with the upper limb adjacent to the body, supine with the upper limb perpendicular to the body, and supine with the arm stabilized in relation to the patient’s body. Hand Tutor devices and a hand dynamometer were used for the measurements. The frequency and maximum range of motion as well as the grip strength were measured in three different positions of the trunk and upper limb. Passive stabilization of the trunk and shoulder showed more statistically significant differences in Group II. In group II, both in patients after hemorrhagic stroke (wrist Hz p = 0.019; wrist ROM p = 0.005; Hz F5 p = 0.021; Hz F4 p = 0.016; Hz F3 p = 0.019; Hz F2 p = 0.021) and ischemic stroke (p = 0.001 for wrist Hz, wrist ROM, Hz F from 5 to F2; and ROM F1; ROM F3 p = 0.009; ROM F2 p = 0.010), and hemorrhagic cerebellum, improvement of parameters was observed. Stabilization of the upper limb and passive stabilization of the trunk improved the frequency and range of movements in the radiocarpal joint and in the fingers of patients after stroke, regardless of the type of stroke.
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Pang L, Li T, Li Y, Cao Y, Li J, Zhu J, Tang X. Combined arthroscopic rotator cuff repair leads to better clinical outcomes than isolated removal of calcific deposits for shoulder calcific tendinitis: A 2- to 5-year follow-up study. Front Surg 2022; 9:912779. [PMID: 36061068 PMCID: PMC9428341 DOI: 10.3389/fsurg.2022.912779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/04/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The optimal treatment procedure for shoulder calcific tendinitis (CT) remains controversial. This study aimed to assess the efficacy of arthroscopic treatment for CT, and to compare the clinical outcomes following combined rotator cuff repair and isolated removal of calcific deposits. Methods This retrospective cohort study included 46 patients (47 shoulders) with confirmed shoulder CT, and the diameter of the calcific deposit was over 1 cm. All patients suffered from CT for a mean period of 17.82 months and had a poor response to conservative treatment. With 12 males and 34 females included, the mean age was 53.94 years. After failed conservative treatment, 23 shoulders underwent combined rotator cuff repair (repair group), and 24 shoulders underwent isolated removal of calcific deposits (debridement group). The clinical outcomes were evaluated at baseline, 3, 6, and 12 months after the surgery and annually thereafter. The efficacy measures included the visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) score and radiographic outcomes. Results Remarkable improvement in clinical outcomes at the final follow-up (2- to 5-year) compared with those at baseline were observed (p < 0.0001 for all outcomes). Compared with isolated removal of calcific deposits, combined rotator cuff repair led to worse postoperative 3- and 6-month VAS (p = 0.004 and p = 0.026, respectively), and 3-month ASES scores (p = 0.012). However, better VAS (p = 0.035 and p = 0.007, respectively) and ASES (p = 0.034 and p = 0.020, respectively) scores at 24-month and final follow-up were found in the repair group. All these differences reached the minimal clinical important difference (MCID). MRI scans at the final follow-up showed significantly better outcomes in patients with rotator cuff repair (p = 0.021). Conclusions Arthroscopic removal of calcific deposits is safe and effective for treating CT. Compared with isolated debridement, combined rotator cuff repair led to worse short-term (<12 months) but better medium- (12–48 months) to long-term (≥48 months) improvements in pain, function and integrity of tendons.
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Affiliation(s)
- Long Pang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yinghao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- West China Medical School, Sichuan University, Chengdu, China
| | - Yuanyinuo Cao
- West China Medical School, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Correspondence: Jing Zhu Xin Tang
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Correspondence: Jing Zhu Xin Tang
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Mental health status, not resilience, influences functional recovery after arthroscopic rotator cuff repairs. J Shoulder Elbow Surg 2022; 31:S117-S122. [PMID: 35288297 DOI: 10.1016/j.jse.2022.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recent literature has shown the importance of patient psychosocial status in overcoming stressful events, such as surgery. Resilience, the ability to "bounce back" from adversity, has been recently correlated to outcomes following arthroscopic rotator cuff repair (RCR). Overall mental well-being has also been shown to be important because patients with clinical depression and anxiety may have worse outcomes. Substantial clinical benefit (SCB) is the threshold of outcome improvement that a patient perceives as considerable. The purpose of this study was to assess the influence of preoperative resilience, mental health status, and rotator cuff tear size on patient outcome recovery measured by the American Shoulder and Elbow Surgeons (ASES) score. METHODS Patients undergoing arthroscopic RCR performed from 2016 through 2019 at a single tertiary institution by fellowship-trained sports surgeons with a high-volume shoulder practice were included. The Brief Resilience Scale (BRS) score and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Score (MCS) were collected preoperatively. ASES scores were obtained preoperatively, as well as 6 and 12 months postoperatively. Patients were divided into 2 groups based on the SCB threshold of 87 for the ASES score based on validated, established literature. Rotator cuff tear size was classified as small (≤3 cm) or large (>3 cm). VR-12 MCS, BRS, and ASES scores were compared at baseline, 6 months, and 1 year using separate mixed-model analyses of variance between the tear size and SCB groups. For ASES score comparison, the VR-12 MCS was used as a covariate to account for differences in baseline mental status. RESULTS RCR was performed in 119 patients, with an average age of 61 years (standard deviation, 10 years). There were 71 male and 48 female patients. At 6 months, 43% of patients met the SCB threshold. The VR-12 MCS was significantly different between RCR patients who met the SCB threshold for the ASES score and those who did not at 6 and 12 months for large rotator cuff tears (P = .001) but not small tears (P = .07). The BRS score was not different between the tear size and SCB groups at any time point (P = .12). CONCLUSION Our results show that patients who met the SCB threshold at 6 months postoperatively after arthroscopic RCR demonstrated higher preoperative VR-12 MCS values; however, higher preoperative BRS scores were not seen in those meeting the SCB threshold. In fact, when baseline VR-12 MCS values were accounted for in patients with large rotator cuff tears, the differences in ASES scores normalized. This finding suggests that baseline mental health status, as measured by the VR-12 MCS, significantly influenced patients' functional recovery following RCR. Future research should focus on preoperative psychosocial well-being to optimize postoperative outcomes.
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Wang HN, Rong X, Yang LM, Hua WZ, Ni GX. Advances in Stem Cell Therapies for Rotator Cuff Injuries. Front Bioeng Biotechnol 2022; 10:866195. [PMID: 35694228 PMCID: PMC9174670 DOI: 10.3389/fbioe.2022.866195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Rotator cuff injury is a common upper extremity musculoskeletal disease that may lead to persistent pain and functional impairment. Despite the clinical outcomes of the surgical procedures being satisfactory, the repair of the rotator cuff remains problematic, such as through failure of healing, adhesion formation, and fatty infiltration. Stem cells have high proliferation, strong paracrine action, and multiple differentiation potential, which promote tendon remodeling and fibrocartilage formation and increase biomechanical strength. Additionally, stem cell-derived extracellular vesicles (EVs) can increase collagen synthesis and inhibit inflammation and adhesion formation by carrying regulatory proteins and microRNAs. Therefore, stem cell-based therapy is a promising therapeutic strategy that has great potential for rotator cuff healing. In this review, we summarize the advances of stem cells and stem cell-derived EVs in rotator cuff repair and highlight the underlying mechanism of stem cells and stem cell-derived EVs and biomaterial delivery systems. Future studies need to explore stem cell therapy in combination with cellular factors, gene therapy, and novel biomaterial delivery systems.
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Affiliation(s)
- Hao-Nan Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Xiao Rong
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Lu-Ming Yang
- Musculoskeletal Sonography and Occupational Performance Lab, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Wei-Zhong Hua
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Guo-Xin Ni
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- *Correspondence: Guo-Xin Ni,
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Xiao H, Zhang T, Li CJ, Cao Y, Wang LF, Chen HB, Li SC, Guan CB, Hu JZ, Chen D, Chen C, Lu HB. Mechanical stimulation promotes enthesis injury repair by mobilizing Prrx1+ cells via ciliary TGF-β signaling. eLife 2022; 11:73614. [PMID: 35475783 PMCID: PMC9094755 DOI: 10.7554/elife.73614] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
Proper mechanical stimulation can improve rotator cuff enthesis injury repair. However, the underlying mechanism of mechanical stimulation promoting injury repair is still unknown. In this study, we found that Prrx1+ cell was essential for murine rotator cuff enthesis development identified by single-cell RNA sequence and involved in the injury repair. Proper mechanical stimulation could promote the migration of Prrx1+ cells to enhance enthesis injury repair. Meantime, TGF-β signaling and primary cilia played an essential role in mediating mechanical stimulation signaling transmission. Proper mechanical stimulation enhanced the release of active TGF-β1 to promote migration of Prrx1+ cells. Inhibition of TGF-β signaling eliminated the stimulatory effect of mechanical stimulation on Prrx1+ cell migration and enthesis injury repair. In addition, knockdown of Pallidin to inhibit TGF-βR2 translocation to the primary cilia or deletion of Ift88 in Prrx1+ cells also restrained the mechanics-induced Prrx1+ cells migration. These findings suggested that mechanical stimulation could increase the release of active TGF-β1 and enhance the mobilization of Prrx1+ cells to promote enthesis injury repair via ciliary TGF-β signaling.
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Affiliation(s)
- Han Xiao
- Department of Sports Medicine, Xiangya Hospital Central South University, Changsha, China
| | - Tao Zhang
- Department of Sports Medicine, Xiangya Hospital Central South University, Changsha, China
| | - Chang Jun Li
- Department of Endocrinology, Xiangya Hospital Central South University, Changsha, China
| | - Yong Cao
- Department of Spine Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Lin Feng Wang
- Department of Sports Medicine, Xiangya Hospital Central South University, Changsha, China
| | - Hua Bin Chen
- Department of Sports Medicine, Xiangya Hospital Central South University, Changsha, China
| | - Sheng Can Li
- Department of Sports Medicine, Xiangya Hospital Central South University, Changsha, China
| | - Chang Biao Guan
- Department of Sports Medicine, Xiangya Hospital Central South University, Changsha, China
| | - Jian Zhong Hu
- Department of Spine Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Di Chen
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Can Chen
- Department of Orthopedic, Xiangya Hospital Central South University, Changsha, China
| | - Hong Bin Lu
- Department of Sports Medicine, Xiangya Hospital Central South University, Changsha, China
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Bravi M, Fossati C, Giombini A, Macaluso A, Lazzoli JK, Santacaterina F, Bressi F, Vorini F, Campi S, Papalia R, Pigozzi F. Criteria for Return-to-Play (RTP) after Rotator Cuff Surgery: A Systematic Review of Literature. J Clin Med 2022; 11:jcm11082244. [PMID: 35456339 PMCID: PMC9024603 DOI: 10.3390/jcm11082244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
This systematic review of the literature aimed to highlight which criteria are described in the literature to define when a patient, after rotator cuff repair (RCR), is ready for return-to-play (RTP), which includes return to unrestricted activities, return to work, leisure, and sport activities. An online systematic search on the US National Library of Medicine (PubMed/MEDLINE), SCOPUS, Web of Science (WOS), and the Cochrane Database of Systematic Reviews, was performed with no data limit until December 2021. A total of 24 studies that reported at least one criterion after RCR were included. Nine criteria were identified and among these, the most reported criterion was the time from surgery, which was used by 78% of the studies; time from surgery was used as the only criterion by 54% of the studies, and in combination with other criteria, in 24% of the studies. Strength and ROM were the most reported criteria after time (25%). These results are in line with a previous systematic review that aimed to identify RTP criteria after surgical shoulder stabilization and with a recent scoping review that investigated RTP criteria among athletes after RCR and anterior shoulder stabilization. Compared to this latest scoping review, our study adds the methodological strength of being conducted according to the Prisma guidelines; furthermore, our study included both athletes and non-athletes to provide a comprehensive view of the criteria used after RCR; moreover, ten additional recent manuscripts were examined with respect to the scoping review.
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Affiliation(s)
- Marco Bravi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico, 00128 Rome, Italy; (M.B.); (F.S.); (F.B.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
- Correspondence:
| | - Arrigo Giombini
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
| | - José Kawazoe Lazzoli
- Biomedical Institute, Medical School, Fluminense Federal University, Niterói 24220-008, Brazil;
| | - Fabio Santacaterina
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico, 00128 Rome, Italy; (M.B.); (F.S.); (F.B.)
| | - Federica Bressi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico, 00128 Rome, Italy; (M.B.); (F.S.); (F.B.)
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, 00128 Rome, Italy; (F.V.); (S.C.); (R.P.)
| | - Stefano Campi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, 00128 Rome, Italy; (F.V.); (S.C.); (R.P.)
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, 00128 Rome, Italy; (F.V.); (S.C.); (R.P.)
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
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Ponce-Fuentes F, Cuyul-Vásquez I, Bustos-Medina L, Fuentes J. Effects of pain neuroscience education and rehabilitation following arthroscopic rotator cuff repair. A randomized clinical trial. Physiother Theory Pract 2022:1-10. [PMID: 35412432 DOI: 10.1080/09593985.2022.2061394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the effectiveness of pain neuroscience education (PNE) versus biomedical education (BME) in a rehabilitation program following arthroscopic rotator cuff repair (ARCR) in patients with chronic shoulder pain. METHODS Twenty-nine patients who participated in a rehabilitation program were randomly assigned to either an experimental PNE group (N = 16) or a control BME group (N = 13). Measurements included pain intensity at rest and in movement, pain catastrophizing, kinesiophobia, disability and health-related quality of life (HRQoL). Outcomes were evaluated at baseline and at 4 and 8 weeks after the intervention. RESULTS A main effect for time was observed for: intensity of pain at rest (p < .01); pain with movement (p < .01); pain catastrophizing (p < .01); kinesiophobia (p < .01); disability (p < .01); and HRQoL (p < .01). No group interactions were significant for any variable, except for pain with movement, which favored the PNE group (p = .03). Large effect sizes (ranging from d = 0.79 to d = 2.65) were found for both interventions in all outcomes. CONCLUSION A rehabilitation program including either PNE or BME are equally effective in improving rest pain, pain catastrophizing, kinesiophobia, disability, and HRQoL in patients after ARCR, except for pain at movement in favor of the PNE group. The inclusion of PNE in the rehabilitation program appears to lead to clinically meaningful improvements in pain at rest in short term when treating patients with ARCR.
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Affiliation(s)
| | - Iván Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - Luis Bustos-Medina
- Gestión para la Salud (CIGES), Facultad de Medicina, Universidad de La FronteraDepartamento de Salud Pública, Centro de Investigación y , Temuco, Chile
| | - Jorge Fuentes
- Clinical Research Lab, Department of Physical Therapy, Catholic University of Maule, Talca, Chile.,Faculty of Rehab Medicine, University of Alberta, Edmonton,AB, Canada
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Ruder MC, Zauel R, Diefenbach BJ, Bey MJ. Quantifying shoulder activity after rotator cuff repair: Technique and preliminary results. J Orthop Res 2022; 40:917-924. [PMID: 34191325 DOI: 10.1002/jor.25122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/13/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023]
Abstract
Repair tissue healing after rotator cuff repair remains a significant clinical problem, and excessive shoulder activity after surgical repair is believed to contribute to re-tears. In contrast, small animal studies have demonstrated that complete removal of activity impairs tendon healing and have advocated for an "appropriate" level of activity, but in humans the appropriate amount of shoulder activity to enhance healing is not known. As an initial step toward understanding the relationship between postoperative shoulder activity and repair tissue healing, the objectives of this study were to assess the precision, accuracy, and feasibility of a wrist-worn triaxial accelerometer for measuring shoulder activity. Following assessments of precision (±0.002 g) and accuracy (±0.006 g), feasibility was assessed by measuring 1 week of shoulder activity in 14 rotator cuff repair patients and 8 control subjects. Shoulder activity was reported in terms of volume (mean acceleration, activity count, mean activity index, active time) and intensity (intensity gradient). Patients had significantly less volume (p ≤ .03) and intensity (p = .01) than controls. Time post-surgery was significantly associated with the volume (p ≤ .05 for mean acceleration, activity count, and mean activity index) and intensity (p = .03) of shoulder activity, but not active time (p = .08). These findings indicate this approach has the accuracy and precision necessary to continuously monitor shoulder activity with a wrist-worn sensor. The preliminary data demonstrate the ability to discriminate between healthy control subjects and patients recovering from rotator cuff repair and provide support for using a wearable sensor to monitor changes over time in shoulder activity.
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Affiliation(s)
| | - Roger Zauel
- Henry Ford Health System, Detroit, Michigan, USA
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50
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[Analysis of influencing factors of early pain after arthroscopic rotator cuff repair]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:284-290. [PMID: 35293168 PMCID: PMC8923925 DOI: 10.7507/1002-1892.202111020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the influencing factors that affect early pain after arthroscopic rotator cuff repair. METHODS A clinical data of 592 patients who met the selection criteria and underwent arthroscopic rotator cuff repair between June 2018 and October 2020 were retrospectively analyzed. There were 239 males and 353 females, with an average age of 58.1 years (range, 32-81 years). Before operation and at 3 days, 6 weeks, and 3 months after operation, the pain degree of patients was evaluated by visual analogue scale (VAS) score; and the patients were divided into no pain or mild pain group and moderate to severe pain group according to the postoperative VAS score. Preoperative and intraoperative related factors were included for univariate analysis, including age, gender, body mass index, preoperative VAS score, history of frozen shoulder, history of hypertension, history of diabetes, history of smoking, affected tendons (supraspinatus, infraspinatus, or subscapularis tendon injury), supraspinatus muscle atrophy, fatty infiltration, operation time, degree of rotator cuff tear, number of anchors, and whether to perform acromioplasty. The influencing factors of postoperative pain were screened; further logistic regression was used to conduct multivariate analysis to screen for risk factors. RESULTS Moderate to severe pain occurred in 440 patients (74.3%) at 3 days after operation, 382 patients (66.2%) at 6 weeks, and 141 patients (23.8%) at 3 months. Multivariate analysis showed that the women, partial-thickness rotator cuff tear, and acromioplasty were risk factors for pain at 3 days after operation ( P<0.05); the women, combined with fatty infiltration, partial-thickness rotator cuff tear, and acromioplasty were the risk factors at 6 weeks ( P<0.05); and the women, combined with fatty infiltration, and partial-thickness rotator cuff tear were risk factors at 3 months ( P<0.05). CONCLUSION Among patients undergoing arthroscopic rotator cuff repair, women, those with smaller rotator cuff tears, combined with fatty infiltration, and acromioplasty have more severe pain within 3 months after operation, and attention should be paid to postoperative analgesia in these patients management, providing an individualized approach to rehabilitation, and closer follow-up.
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