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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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Gu Z, Wu S, Yang Y, Ren T, Zhang KW. Comparison of Arthroscopic Single-row and Double-row Repair for Rotator Cuff Injuries With Different Tear Sizes: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231180854. [PMID: 37655249 PMCID: PMC10467404 DOI: 10.1177/23259671231180854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/09/2023] [Indexed: 09/02/2023] Open
Abstract
Background There is no clinical gold standard for the indications for single-row (SR) versus double-row (DR) repair according to small, large, or massive rotator cuff tear size. Purpose To conduct a meta-analysis to compare the clinical outcomes and retear rates after arthroscopic SR and DR repair for rotator cuff injuries with different tear sizes. Study Design Systematic review; Level of evidence, 3. Methods On the basis of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, the PubMed, Embase, Cochrane Library databases, Web of Science, China National Knowledge Infrastructure, and China BioMedical Literature database were searched for relevant studies published before November 1, 2021, using the following search terms: "Rotator Cuff Injuries," "Rotator Cuff Tears," "Arthroscopy," "Arthroscopic Surgery," "single-row," and "double-row"; a total of 489 articles were retrieved. Quality evaluation was conducted for all the studies that met the inclusion criteria. This study evaluated the Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, and range of motion (ROM) as well as retear rate. A fixed-effects or random-effects model was adopted to calculate the results and assess risk. Results A total of 10 clinical studies were included, with 404 cases of DR and 387 cases of SR. Regarding overall results, DR had better forward elevation ROM (mean difference [MD] = -4.03° [95% CI, -6.00° to -2.06°]; P < .0001; I 2 = 46%) and a lower retear rate (MD = 2.39 [95% CI, 1.40 to 4.08]; P = .001; I 2 = 0%) compared with SR repair. With regard to small tears (<3 cm), there was no noticeable difference on any of the 3 outcome scores between SR and DR. For large rotator cuff tears (≥3 cm), DR repair showed significantly better ASES scores (MD = -3.09 [95% CI, -6.19 to 0.02]; P = .05; I 2 = 73%) and UCLA scores (MD = -1.47 [95% CI, -2.21 to -0.72]; P = .0001; I 2 = 31%) compared with SR repair. Conclusion Our meta-analysis revealed that DR had better UCLA scores, ASES scores, and ROM in forward elevation and lower retear rates. In rotator cuff tears <3 cm, there were no statistical differences in clinical outcome between SR and DR.
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Affiliation(s)
- Zhangyang Gu
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Shengguang Wu
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Yu Yang
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Tao Ren
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Kai-Wei Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
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Yoon TH, Kim SJ, Choi YR, Kang KT, Chun YM. Age, Tear Size, Extent of Retraction, and Fatty Infiltration Associated With a High Chance of a Similar Rotator Cuff Tear in the Contralateral Shoulder Regardless of Symptoms in Patients Undergoing Cuff Repair in the Index Shoulder. Arthroscopy 2023:S0749-8063(23)00174-3. [PMID: 36804457 DOI: 10.1016/j.arthro.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/26/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To investigate the prevalence of a contralateral rotator cuff tear (RCT) in patients with a symptomatic RCT requiring repair and to determine whether findings from magnetic resonance imaging (MRI) of the affected shoulder can predict the presence of a contralateral tear. METHODS Patients with atraumatic RCTs who had undergone arthroscopic repair between March 2019 and February 2021 were reviewed in this study. MRI of both shoulder joints was performed to evaluate the bilaterality of RCT. Demographic factors and MRI findings of index shoulders were assessed using logistic regression analysis to reveal any correlations with the presence of RCT in the contralateral shoulder. RESULTS A total of 428 patients were enrolled in this study. When the affected shoulders had a posterosuperior rotator cuff (PSRC) or subscapularis tear including either an isolated or combined tear, 63.6% and 67.8% had the same tears on the contralateral side, respectively. A contralateral-side tear was found in 74.6% (185/248) of symptomatic cases and 44.8% (65/145) of asymptomatic cases, which represents a significant difference (P < .001). Logistic regression analysis revealed that age ≥67.5 years, tear size ≥17 mm, Goutallier grade ≥1.5, and Patte grade ≥1.5 were found to be indicative of potential contralateral PSRC tears. By contrast, the presence of a subscapularis tear in the affected shoulder was the only significant risk factor in predicting a potential subscapularis tear in the contralateral shoulder. CONCLUSIONS Among patients with a symptomatic RCT requiring arthroscopic repair, 63.6% with a PSRC tear and 67.8% with a subscapularis tear in the affected shoulder were found to have a similar tear in the contralateral shoulder regardless of symptoms. Age, tear size, extent of retraction, fatty infiltration of PSRC tears, and the presence of subscapularis tears were identified as factors predictive of tears on the contralateral side. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Jae Kim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Tae Kang
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Baumgarten KM. Can the Single Assessment Numeric Evaluation be used as a stand-alone subjective outcome instrument in patients undergoing rotator cuff repair? J Shoulder Elbow Surg 2022; 31:2542-2553. [PMID: 35750155 DOI: 10.1016/j.jse.2022.05.017] [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: 03/20/2022] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND/HYPOTHESIS There is no consensus to which patient-determined shoulder outcome scores should be considered when analyzing patient outcomes. Use of multiple patient-determined outcomes may be redundant and cause increased responder burden. The Single Assessment Numeric (SANE) has not been widely accepted as a stand-alone shoulder-specific outcome measure. The hypothesis was that SANE will correlate with and be comparable in responsiveness to other subjective outcome measures that have been used in a stand-alone fashion in patients undergoing rotator cuff repair (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], Western Ontario Rotator Cuff Index [WORC], and the Simple Shoulder Test [SST]). In addition, the SANE will be more relevant to each patient compared to the ASES, further supporting its use as a stand-alone shoulder-specific outcomes measure. METHODS A retrospective review of a database of patients undergoing rotator cuff repair was reviewed where the SANE was recorded with the ASES, WORC, and/or SST. Correlations were determined using the Pearson coefficient. Subgroup analysis was performed to determine if correlations differed in (1) preoperative and (2) postoperative outcome determinations. Responsiveness was determined by calculating the standardized response mean (SRM) and the effect size (ES) of all scores. Relevance and precision of the SANE and ASES were examined using 150 consecutive patients to determine the number of questions in each score that were not answered. RESULTS Correlation was excellent for the SANE and the ASES (n = 1838, r = 0.81, P < .0001), the WORC (n = 1793, r = 0.82, P < .0001), and the SST (n = 1836, r = 0.76, P < .0001). Correlation of preoperative scores was moderate and postoperative scores were excellent when comparing the SANE with all 3 scores. All scores were highly responsive, with the SRM of the SANE = 2.1, ASES = 2.2, WORC = 2.4, and the SST = 1.8. The ES of the SANE = 2.4, ASES = 2.7, WORC = 3.0, and the SST = 2.1. One hundred percent of the SANE scores were answered completely compared with 57% (P < .0001) of the ASES, with significant variability found in the answers to the "work" and "score" questions. CONCLUSION In patients undergoing rotator cuff repair, the SANE highly correlated and has equivalent responsiveness with the WORC, ASES, and SST, which have been used as stand-alone shoulder-specific outcomes measures. The SANE may provide the same information as the WORC, ASES, and SST regarding outcome with significant reduction in responder burden. This study supports that the SANE can be used as a subjective, stand-alone instrument for patients undergoing rotator cuff repair.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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Chu J, Shieh JS, Wu K, Guan H, Roche S, Held MFG, Yang H, Guo JJ. Simultaneous or Staged Bilateral Arthroscopic Rotator Cuff Repair: An Observational Study of Intraoperative and Postoperative Outcomes. Orthop J Sports Med 2021; 9:23259671211041994. [PMID: 34708140 PMCID: PMC8543723 DOI: 10.1177/23259671211041994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Bilateral arthroscopic rotator cuff repair (ARCR) is frequently performed in
patients with symptomatic bilateral rotator cuff tears. Purpose: To compare patient-reported outcomes and mobility between simultaneous and
staged bilateral ARCR. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 51 patients who underwent simultaneous (anesthetized once) and
42 patients who underwent staged (anesthetized twice) bilateral ARCR between
January 2014 and January 2018; for the staged group, the interval between
procedures was at least 12 months. All operations were performed by the same
surgeon, and all patients had minimum 24-month follow up in both shoulders.
Patient-reported outcomes and range of motion (ROM) were assessed
preoperatively and postoperatively and compared between groups. Outcome
measures included the Constant-Murley score (CMS) and American Shoulder and
Elbow Surgeons (ASES) score as well as measures of psychological status,
health-related quality of life, activities of daily living (ADL), and
patient satisfaction with the state of one’s shoulders. Results: The mean follow-up times for the staged and simultaneous ARCR groups were
44.1 months (range, 36-60 months) and 37.5 months (range, 25-59 months),
respectively. There were no significant differences in age, tear size, or
fatty degeneration of rotator cuff muscles between the groups. The
cumulative length of hospital stay in the staged group was significantly
longer than in the simultaneous group (P < .001). At the
final follow-up, both groups showed significant improvement in ROM, CMS, and
ASES scores (P < .05). No significant differences
between the groups were observed in terms of ROM, CMS, and ASES scores
postoperatively. At 24 months postoperatively, psychological status and
health-related quality of life in both groups improved significantly
(P < .05), and there were no significant
between-group differences. Patients were able to perform most essential ADL.
Both groups had high patient satisfaction, but patient satisfaction for the
second shoulder of the staged group was lower than that of the simultaneous
group (P = .039). Conclusion: Simultaneous bilateral ARCR was shown to be effective, resulting in similar
improvements in clinical outcomes to staged bilateral ARCR at 2-year
follow-up. In addition to higher patient satisfaction, simultaneous
bilateral ARCR also had a shorter treatment cycle.
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Affiliation(s)
- Jiabao Chu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ju-Sheng Shieh
- Center for Health Policy and Management Studies, Nanjing University, China
| | - Kailun Wu
- Department of Orthopedics, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Huaqing Guan
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Stephen Roche
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Michael F G Held
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiong Jiong Guo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
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Cancienne JM, Denard PJ, Garrigues GE, Werner BC. The Relationship of Staged, Bilateral Arthroscopic Primary Rotator Cuff Repair Timing and Postoperative Complications. Am J Sports Med 2021; 49:2027-2034. [PMID: 34081550 DOI: 10.1177/03635465211015198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although previous studies have reported acceptable clinical outcomes after simultaneous, single-stage bilateral and staged bilateral rotator cuff repair (RCR), few studies have been adequately powered to compare postoperative complication rates at various time intervals between procedures. PURPOSE To examine the relationship between the timing of bilateral arthroscopic RCR and complications. STUDY DESIGN Descriptive epidemiology study. METHODS Patients from the Medicare data set within the PearlDiver database who underwent bilateral RCR between 2005 and 2014 were identified. These patients were then stratified by time between surgeries into cohorts: (1) single stage, (2) <3 months, (3) 3 to 6 months, (4) 6 to 9 months, (5) 9 months to 1 year, and (6) 1 to 2 years. Surgical and medical complications of these cohorts were compared with those of a control cohort of patients who underwent bilateral RCR >2 years apart using a regression analysis. RESULTS A total of 11,079 patients who underwent bilateral RCR were identified. Patients who underwent single-stage bilateral arthroscopic RCR experienced higher rates of revision RCR (odds ratio [OR], 2.1; P < .0001), reverse total shoulder arthroplasty (RTSA) (OR, 2.47; P < .0001), and postoperative infection (OR, 2.18; P = .007) in addition to higher rates of venous thromboembolism (VTE) (OR, 1.78; P = .031) and emergency department visits (OR, 1.51; P = .002) compared with the control group. Patients who underwent bilateral RCR with a <3-month interval had higher rates of revision surgery (OR, 1.56; P = .003), RTSA (OR, 1.89; P = .002), and lysis of adhesions (OR, 2.31; P < .0001) in addition to increased rates of VTE (OR, 1.92; P = .015) and emergency department visits (OR, 1.62; P < .0001) compared with the control group. There were no differences in any surgical or medical complications when surgeries were staged by ≥3 months compared with controls. CONCLUSION Patients with Medicare undergoing single-stage and staged bilateral RCR who had the second repair within 3 months had significantly higher rates of multiple medical and surgical complications compared with patients waiting >2 years between procedures.
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Affiliation(s)
| | | | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
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Wang C, Yang P, Zhang D, Jeon IH, Yu T, Zhang Y, Qi C. Bilateral single-staged arthroscopic rotator cuff repair is comparable to staged procedures: a retrospective follow up study of 2 years. BMC Musculoskelet Disord 2021; 22:409. [PMID: 33947360 PMCID: PMC8094466 DOI: 10.1186/s12891-021-04304-7] [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: 01/06/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Bilateral rotator cuff tears are not uncommon and the timing of the surgical treatment of both shoulders is debated. In the present study, we aimed to compare the clinical outcomes of patients who underwent single-stage or staged bilateral arthroscopic rotator cuff repair. Methods From March 2013 to May 2018, a retrospective review on all patients who underwent bilateral arthroscopic rotator cuff repair at our department was performed. Patients were separated into 2 groups: single-stage and staged. The minimum follow-up period was 2 years. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, Constant-Murley (Constant) score, the range of motion (ROM) of the shoulder and the hospitalization costs were evaluated for comparison between the two groups before and after the operation. Differences between groups were assessed using t-tests and ANOVA. Results All 51 patients completed follow-up of 2 years, single stage (n = 24) and staged group (n = 27). There was no significant difference in the VAS, ASES, UCLA and Constant scores between the single-stage group and the staged group before the operation. Postoperative clinical scores were significantly improved in both groups (P < 0.05). All outcome scores were significantly different between the two groups at 6 months postoperatively, and the staged scored better than the single-stage (P < 0.05). At 12, 18, and 24 months after the operation, the outcome scores were not significantly different between the two groups. At follow-up, the ROM of the shoulder was not significantly different between the two groups. In the single-stage group, the outcome scores and ROM were similar for both shoulders and comparable to the staged group. We also found significant cost savings in the single-stage group (4440.89 ± 130.55 USD) compared to the staged group (5065.73 ± 254.76 USD) (p < 0.05). Conclusions Patients receiving single-stage or staged bilateral arthroscopic rotator cuff repair showed similarly good clinical outcomes at follow-ups longer than 6 months. Moreover, good outcomes were observed on both sides of the single-stage group.
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Affiliation(s)
- Chen Wang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - Pu Yang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - Dongfang Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - In-Ho Jeon
- Department of Orthopedic Surgery, College of Medicine, Asan Medical Center, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Republic of Korea
| | - Tengbo Yu
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - Yingze Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - Chao Qi
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China.
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Imam M, Sallam A, Ernstbrunner L, Boyce G, Bardakos N, Abdelkafy A, Moussa M, Ghazal MA. Three-year functional outcome of transosseous-equivalent double-row vs. single-row repair of small and large rotator cuff tears: a double-blinded randomized controlled trial. J Shoulder Elbow Surg 2020; 29:2015-2026. [PMID: 32951642 DOI: 10.1016/j.jse.2020.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The trial aimed to prospectively compare the functional outcomes of patients undergoing arthroscopic rotator cuff repair using transosseous-equivalent double-row (TEDR) or single-row (SR) suture anchor techniques at 3 years postoperatively for both large (>3 cm) and small (<3 cm) tears. METHODS Eighty patients with a symptomatic and magnetic resonance imaging (MRI)-proven full-thickness rotator cuff tear, who had failed conservative management of at least 6 months' duration and who had a complete passive range of motion of the affected shoulder, were enrolled in the trial. Patients were randomized to TEDR repair (n = 40) or SR repair (n = 40). Subgroup analysis was conducted for tears <3 cm (TEDR n = 17, SR n = 19) and tears >3 cm (TEDR n = 23, SR n = 21). Primary outcomes included the Oxford Shoulder Score (OSS), the University of California, Los Angeles (UCLA) score, and the Constant-Murley score (CMS). The secondary outcomes included a 0-100-mm visual analog scale (VAS) score for pain, range of motion (ROM), and EQ-5D scores. All patients completed a follow-up of 3 years. RESULTS There was a significant difference in the mean OSS postoperative score for tears >3 cm (P = .01) and mean improvement from baseline in the TEDR group (P = .001). For tears >3 cm, mean postoperative scores were also significantly higher in the TEDR group for UCLA (P = .015) and CMS (P = .001). Post hoc testing showed that the differences between these groups was statistically significant (P < .05). For tears <3 cm, a significant postoperative difference in favor of SR repair was seen in the mean CMSs (P = .011), and post hoc testing showed that the difference was statistically significant (P = .015). No significant difference was seen with mean postoperative OSS or UCLA, and post hoc testing did not show a statistically significant difference between groups. CONCLUSIONS TEDR repair showed improved functional outcomes for tears >3 cm compared with SR repair. For tears <3 cm, no clear benefit was seen with either technique.
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Affiliation(s)
- Mohamed Imam
- Norfolk and Norwich University Hospitals, Norfolk, England; Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| | - Asser Sallam
- Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt.
| | - Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Glenn Boyce
- Bendigo Orthopaedic and Sports Medicine, and University Hospital Geelong, Ryrie and Bellarine Street Geelong, Geelong, VIC, Australia
| | | | - Ashraf Abdelkafy
- Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| | - Moussa Moussa
- Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| | - Mohamed-Adel Ghazal
- Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
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Beck EC, Gowd AK, Liu JN, Waterman BR, Nicholson KF, Forsythe B, Yanke AB, Cole BJ, Verma NN. How Is Maximum Outcome Improvement Defined in Patients Undergoing Shoulder Arthroscopy for Rotator Cuff Repair? A 1-Year Follow-Up Study. Arthroscopy 2020; 36:1805-1810. [PMID: 32201303 DOI: 10.1016/j.arthro.2020.02.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/16/2020] [Accepted: 02/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To (1) determine the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Constant-Murley subjective score thresholds for achieving maximal outcome improvement (MOI) after arthroscopic rotator cuff repair and (2) identify preoperative predictors of reaching the ASES threshold for achieving MOI. METHODS A retrospective cohort study was performed to identify patients undergoing rotator cuff repair at a high-volume institution from January 2014 to January 2017 with a 1-year minimum follow-up. Patient characteristics, as well as preoperative and postoperative outcome scores, were analyzed. MOI for the ASES and SANE score were calculated as previously described, and a receiver operating characteristic (ROC) curve analysis was used to determine thresholds for percentage of maximal improvements for each outcome measure based on a satisfaction anchor question. Last, a logistic regression model was used to identify predictors of reaching the ASES threshold for achieving MOI. RESULTS A total of 220 patients were included in the final analysis. There was a statistically significant increase in score average across all 3 outcome measures (P < .001 for all), with 162 (73.6%) patients rating their surgical outcome as satisfactory at 1-year follow-up. The ROC curve analysis demonstrated that ASES, SANE, and Constant-Murley threshold percentages for achieving MOI was 69.5% (area under the curve [AUC], 0.86; 95% confidence interval [CI], 0.81-0.91; P < .001), 75% (AUC, 0.814; 95% CI, 0.758-0.871; P < .001), and 55.1% (AUC, 0.84; 95% CI, 0.783-0.898; P < .001), respectively. Logistic regression demonstrated that workers compensation cases (odds ratio, 0.69; 95% CI, 0.55-0.86; P = .001) and dominant-sided surgery (odds ratio, 0.72; 95% CI, 0.59-0.88; P = .002) were predictors of not achieving maximal improvement on the ASES score. CONCLUSION Achieving 69.5% of maximal ASES score improvement or 75% of maximal SANE score improvement is indicative of achieving patient satisfaction after arthroscopic rotator cuff repair. Preoperative variables including workers compensation cases and surgery to the dominant side were predictors of not achieving maximal improvement. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Edward C Beck
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
| | - Anirudh K Gowd
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Joseph N Liu
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Brian R Waterman
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kristen F Nicholson
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | - Adam B Yanke
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
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Kim HJ, Kee YM, Kim JY, Rhee YG. Safe time frame of staged bilateral arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2019; 28:1707-1715. [PMID: 31053388 DOI: 10.1016/j.jse.2019.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have assessed the outcomes of staged bilateral arthroscopic rotator cuff repair (ARCR). This study aimed to determine the influencing factors related to the outcomes of patients who underwent staged bilateral ARCR and to verify an optimal interval for performing the second rotator cuff repair in staged bilateral ARCR. METHODS We analyzed 166 shoulders that underwent staged bilateral ARCR. The average interval between the first- and second-side surgical procedures was 21.9 ± 19.7 months. The minimum follow-up period was 2 years. RESULTS Clinical outcomes and retear rates were not significantly different according to the order of surgical procedures, sex, arm dominance, age, and tear size (P > .05 for all). The cutoff value for the optimal interval between the first and second surgical procedures for the University of California, Los Angeles score and American Shoulder and Elbow Surgeons score was 9 months, with the area under the curve equal to 0.815 (P < .001) for the University of California, Los Angeles score and 0.806 (P < .001) for the American Shoulder and Elbow Surgeons score. The group with an interval of 9 months or less between the first- and second-side surgical procedures showed significantly inferior clinical outcomes and a higher retear rate (35%) compared with the group with an interval greater than 9 months (retear rate, 10%) (P < .05). CONCLUSION Staged bilateral ARCR resulted in significant improvements in clinical outcomes regardless of the order of surgical procedures, sex, arm dominance, age, and tear size. To optimize clinical outcomes of staged bilateral ARCR, second-side surgery should be delayed until 9 months after the first-side surgical procedure.
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Affiliation(s)
- Hwan Jin Kim
- Department of Orthopaedic Surgery, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Young Moon Kee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Youn Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Simultaneous, Bilateral Acute Subscapularis Ruptures and Their Arthroscopic Management. Case Rep Orthop 2019; 2019:7964351. [PMID: 31183236 PMCID: PMC6512045 DOI: 10.1155/2019/7964351] [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: 10/22/2018] [Revised: 02/22/2019] [Accepted: 04/02/2019] [Indexed: 11/17/2022] Open
Abstract
We present the first known case of bilateral, acute ruptures of the subscapularis tendons following a bicycle accident in a 43-year-old male. He underwent right shoulder arthroscopic, anatomic subscapularis tendon repair two weeks postinjury, with the left side staged for surgical treatment six weeks after the index procedure. Postoperatively, the patient remained in a sling for 6 weeks before advancing with therapy protocols. The interval between arthroscopic treatments allowed for independence with activities of daily living and focused, early therapy for each shoulder. This approach yielded a right-sided constant score of 89 and subjective shoulder value of 90%; the left side was 87 and 90%, respectively, at 33 months postoperatively. The patient’s only postoperative complaint was slightly diminished external rotation, a near-universal limitation after unilateral repair. This represents a successful outcome that balances functional independence, concentrated rehabilitation, and adherence to safe indications for primary repair. While bilateral traumatic shoulder injuries in a young person is a rare clinical entity, early and staged treatment can lead to good patient outcomes.
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Favorito P. Editorial Commentary: The Second Side Is as Good as the First After Bilateral Rotator Cuff Repair: Preach Patience to the Patients. Arthroscopy 2018; 34:2808-2809. [PMID: 30286880 DOI: 10.1016/j.arthro.2018.07.025] [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: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 02/02/2023]
Abstract
Symptomatic bilateral rotator cuff tears are common. How patients compare and rate each shoulder at different time points following staged repair is variable. At a minimum of 1-year follow-up after rotator cuff repair, patients should expect similar improvement in pain and validated outcome measures for each side.
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Rhee SM, Kim DH, Kim SH, Jeong HJ, Oh JH. The Clinical Outcomes and Their Associated Factors in Staged Bilateral Arthroscopic Rotator Cuff Repair. Arthroscopy 2018; 34:2799-2807. [PMID: 30195959 DOI: 10.1016/j.arthro.2018.06.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare perioperative characteristics and postoperative outcomes of both shoulders in patients who underwent arthroscopic bilateral rotator cuff repair sequentially and to assess the associated factors that would affect the anatomic healing in staged bilateral rotator cuff repair. METHODS The study enrolled 64 patients who underwent bilateral rotator cuff repair with follow-up imaging at least 12 months postoperatively. We allocated the shoulders operated on first to the surgery I group and those operated on second to the surgery II group. Visual analog scale (VAS) pain and satisfaction scores, range of motion, the American Shoulder and Elbow Surgeons score, the Simple Shoulder Test score, and healing failure were evaluated. RESULTS Range of motion improved with no significant between-group differences (all P > .05). In the surgery II group, VAS pain and VAS satisfaction scores were significantly worse at 6 months postoperatively (P = .048 and P = .041, respectively) but were comparable at final follow-up (P = .598 and P = .065, respectively). American Shoulder and Elbow Surgeons and Simple Shoulder Test scores at 6 months were worse in the surgery II group (P = .038 and P = .048, respectively) but similar at final follow-up (P = .786 and P = .087, respectively). Tear size was similar between the 2 surgical procedures (κ = 0.537, P < .001). Of the 11 patients with nonhealing in the surgery I group, 7 (63.6%) had subsequent failure in the other shoulder, and if one shoulder had healing failure, the other shoulder had a high possibility of healing failure as well (κ = 0.373, P = .004). CONCLUSIONS Bilateral arthroscopic rotator cuff repair showed good outcomes at final follow-up on both sides. Tear size was closely related in both shoulders, and healing failure after the first rotator cuff repair was an associated factor with healing failure after the second operation. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Sung-Min Rhee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | | | - Sae Hoon Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
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Abstract
PURPOSE OF REVIEW To outline the radiographic and clinical outcomes after a rotator cuff surgery in order to set the expectations with the patient before the surgery to obtain a better outcome, taking into account the factors that can affect the outcome and the technique used for the repair. RECENT FINDINGS The majority of surgeons use arthroscopic repair. The double-row repair has better biomechanical strength, footprint coverage, and radiographic healing rates. The principal factors that can affect the outcome of the surgery are the tendon quality, tear size and retraction, fatty infiltration, chronicity of the tear, and concomitant pathologies. Arthroscopic rotator cuff repair can decrease pain and increase function allowing patients to improve their quality of life; 90% of patients are happy 6 months after the surgery and maintain stability during 5 years. Greater preoperative expectations would show better outcomes and patient satisfaction after the surgery.
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Affiliation(s)
- Alejandro Novoa-Boldo
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Lawrence V. Gulotta
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Aydin N, Karaismailoglu B. High-grade bursal-side partial rotator cuff tears: comparison of mid- and long-term results following arthroscopic repair after conversion to a full-thickness tear. J Orthop Surg Res 2017; 12:118. [PMID: 28732544 PMCID: PMC5521121 DOI: 10.1186/s13018-017-0619-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/12/2017] [Indexed: 01/08/2023] Open
Abstract
Background Partial-thickness rotator cuff tears (PTRCTs) are one of the leading causes of shoulder dysfunction. Successful results have been reported with different treatment techniques, but the long-term consequences of these procedures are not yet clearly known. The purposes of this study were to evaluate and compare the mid- and long-term clinical outcomes of arthroscopically repaired bursal-side PTRCTs after conversion to full-thickness tears and identify the possible effects of age, gender, and hand dominance on clinical outcomes. Methods Twenty-nine patients who had undergone arthroscopic repair of a significant bursal-side PTRCT were functionally evaluated. The repair was made after conversion to a full-thickness tear. The average patient age was 55.2 years (range 35–69 years, SD ±7.6 years). Clinical outcomes were evaluated at 2 and 5 years after surgery. Constant Shoulder Score (CSS) and Visual Analogue Scale for Pain (VAS pain) were used as outcome measures. Results The average CSS improved from 38.9 preoperatively to 89.2 and 87.8 at 2 and 5 years after surgery, respectively (p < 0.001). The average VAS pain score decreased from 7.90 preoperatively to 1.17 and 1.31 at 2 and 5 years after surgery, respectively (p < 0.001). A significant improvement was detected in patient functional outcomes and VAS pain scores at 2 and 5 years after surgery compared with the preoperative period. The patients who underwent surgery from their non-dominant extremity showed a significantly higher CSS increase relative to those who underwent surgery on the dominant extremity (p = 0.022). Conclusions Arthroscopic repair of high-grade bursal-side PTRCTs after conversion to full-thickness tears is a reliable surgical technique with good functional outcomes and pain relief both at mid- and long-term follow-ups. Surgery on the non-dominant side may be related to better functional outcomes.
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Affiliation(s)
- Nuri Aydin
- Orthopaedics and Traumatology Department, Istanbul University Cerrahpasa Medical Faculty, Kocamustafapasa Cad. No:53, Fatih, Istanbul, Turkey
| | - Bedri Karaismailoglu
- Orthopaedics and Traumatology Department, Istanbul University Cerrahpasa Medical Faculty, Kocamustafapasa Cad. No:53, Fatih, Istanbul, Turkey.
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