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Hurley ET, Doyle TR, Levin JM, Klifto CS, Anakwenze O. Defining pseudoparalysis and pseudoparesis: a consensus study. J Shoulder Elbow Surg 2024; 33:2111-2117. [PMID: 38871046 DOI: 10.1016/j.jse.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The purpose of this study was to establish consensus statements via a modified Delphi process on the definition of shoulder pseudoparalysis and pseudoparesis. METHODS A consensus process on the definition of a diagnosis of pseudoparalysis utilizing a modified Delphi technique was conducted, and 26 shoulder/sports surgeons from 11 countries, selected based on their level of expertise in the field, participated in these consensus statements. Consensus was defined as achieving 80%-89% agreement, whereas strong consensus was defined as 90%-99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement. RESULTS Three statements regarding the diagnosis of pseudoparalysis reached strong (>89%) consensus: passive range of motion should be unaffected, the passive range of abduction should not be considered, and diagnosis should be excluded if lidocaine injection produces a substantial improvement in range of motion. Additionally, consensus (>79%) was reached that the active range of external rotation should not be considered for diagnosis, pain as a cause of restricted motion must be excluded, and that distinctions between restricted active flexion and external rotation should be made by range of motion rather than tear characteristics. No consensus could be reached on statements regarding the size, number of tendons or chronicity of cuff tears. Nor was there agreement on the active range of flexion permitted or on the difference between pseudoparalysis and pseudoparesis. CONCLUSION A modified Delphi process was utilized to establish consensus on the definition of shoulder pseudoparalysis and pseudoparesis. Unfortunately, almost half of the statements did not reach consensus, and agreement could not be reached across all domains for a unifying definition for the diagnosis of pseudoparalysis in the setting of rotator cuff tears. Furthermore, it was not agreed how or whether pseudoparalysis should be differentiated from pseudoparesis. Based on the lack of a consensus for these terms, studies should report explicitly how these terms are defined when they are used.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopedics, Duke University, Durham, NC, USA.
| | - Tom R Doyle
- Department of Orthopedics, Duke University, Durham, NC, USA
| | - Jay M Levin
- Department of Orthopedics, Duke University, Durham, NC, USA
| | | | - Oke Anakwenze
- Department of Orthopedics, Duke University, Durham, NC, USA
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Tokish JM, Brinkman JC. Pseudoparalysis and Pseudoparesis of the Shoulder: Definitions, Management, and Outcomes. J Am Acad Orthop Surg 2024:00124635-990000000-01021. [PMID: 38935855 DOI: 10.5435/jaaos-d-23-00863] [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: 09/26/2023] [Accepted: 05/19/2024] [Indexed: 06/29/2024] Open
Abstract
Loss of shoulder function can be a complex condition to manage. Specifically, the definition between the terms pseudoparalysis and pseudoparesis remains inconsistent in the literature based on various factors including chronicity, present pathology, and the role of pain in the loss of function. There is also debate as to the optimal management strategies for these challenging conditions. In the setting of advanced glenohumeral arthritis or arthropathy in the correct patient, arthroplasty provides consistent and reliable results. However, in younger patients or the patient without arthritis, arthroplasty may not be the best option. In some cases, addressing pain with biceps procedures, balloon spacer placement, débridement, or others may be appropriate. However, other instances may require attempts at improving shoulder kinematics with procedures such as rotator cuff repair, superior capsular reconstruction, and tendon transfer. In this review, we discuss current definitions for pseudoparalysis and pseudoparesis, in addition to reviewing the indications for the various treatment options and their respective outcomes.
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Affiliation(s)
- John M Tokish
- From the Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
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Kanatlı U, Ayas İH, Tokgöz MA, Bahadır B. Does the Extent of Tear Influence Pseudoparesis in Patients With Isolated Subscapularis Tears? Clin Orthop Relat Res 2024:00003086-990000000-01652. [PMID: 38913554 DOI: 10.1097/corr.0000000000003173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/07/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Surgeons tend to associate pseudoparesis with massive rotator cuff tears. However, little is known about the degree to which isolated subscapularis tears might be associated with pseudoparesis of the shoulder. QUESTION/PURPOSE Is the extent of subscapularis tears associated with pseudoparesis? METHODS A retrospective analysis identified all patients with subscapularis tears from 2010 to 2021 in the longitudinally maintained shoulder arthroscopy archive of one university hospital's shoulder section of the orthopaedic department. After exclusion, 106 of 152 patients with isolated subscapularis tears who underwent arthroscopic surgery were included in the study. Sixty percent of the patients were women, and the mean ± SD age was 52 ± 11 years. Patients who were scheduled for arthroscopic surgery were divided into two groups according to the presence or absence of pseudoparesis preoperatively. Pseudoparesis was considered to be active forward elevation > 45º but < 90º, which is a simple and reproducible measurement that can be taken using a goniometer, and demonstrated complete passive forward elevation. Pseudoparesis was present in 41% (43 of 106) of patients with an isolated subscapularis tear. Data on tear severity (according to Lafosse type, noted during arthroscopy), integrity of the subscapularis tendon (noted during arthroscopy), fatty degeneration (using the Goutallier grading system on MRI), arthroscopic findings of biceps disorder, superior labrum anterior to posterior (SLAP) lesions, and pain severity (measured by VAS score) were recorded. We used logistic regression analysis to examine the relationship between pseudoparesis and disruption of the tendinous part of the subscapularis. RESULTS After accounting for potentially confounding factors such as biceps disorders and muscle atrophy, we found that pseudoparesis was associated with decreased tear severity according to the Lafosse classification (adjusted OR 0.2 [95% CI 0.1 to 0.7]; p = 0.01) and with disruption of the tendinous portion of the subscapularis (adjusted OR 21 [4 to 128]; p = 0.001). Patients with less severe tears (Lafosse type I) have lower odds of experiencing pseudoparesis compared with those with more severe tears (Lafosse types II, III, and IV), and patients with disruption of the tendinous portion of the subscapularis have substantially higher odds of pseudoparesis compared with those with an intact tendinous portion. No association was found between pseudoparesis and subscapularis fatty degeneration, biceps disorder, or SLAP lesions. CONCLUSION This study provides initial evidence suggesting that isolated subscapularis tears are associated with pseudoparesis. The main finding of this study is that isolated subscapularis tears that involve the tendon extending to the inferior part of the subscapularis have higher odds of being found with pseudoparesis. These findings highlight the importance of maintaining the integrity of the superior tendinous part of the subscapularis for active forward elevation > 90°. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Ulunay Kanatlı
- Department of Orthopaedics and Traumatology, Gazi University School of Medicine, Ankara, Turkey
| | - İnci Hazal Ayas
- Department of Physiotherapy and Rehabilitation, Gazi University Faculty of Health Science, Ankara, Turkey
| | - Mehmet Ali Tokgöz
- Department of Orthopaedics and Traumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Batuhan Bahadır
- Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
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Brinkman JC. Editorial Commentary: Tuberoplasty Is a Reliable Option to Address Pain in Massive Irreparable Rotator Cuff Tears. Arthroscopy 2024; 40:1906-1907. [PMID: 38458550 DOI: 10.1016/j.arthro.2024.02.036] [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: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
The massive irreparable rotator cuff tear remains a challenging condition for which there are many reported treatment options, including biceps tenotomy or tenodesis, subacromial decompression, cuff debridement, partial or augmented rotator cuff repair, bursal acromial reconstruction, balloon spacer placement, superior capsular reconstruction, reverse total shoulder arthroplasty, and tendon transfer, among others. Optimally treating the condition relies on paying attention to several patient factors, including correctly identifying whether function loss is driven by pain or compromised shoulder kinematics. If pain is the primary limiting factor, then tuberoplasty, or "reversed subacromial decompression," seems to be a reliable option that can afford encouraging results in terms of pain and range of motion in correctly indicated individuals. It is important to note, however, that these results should not be expected in the patient with anterior-superior humeral escape or pseudoparalysis, in whom a kinematic-restoring option may be more appropriate. Considering a history of inconsistent terminology and definitions when it comes to defining massive tears, when they are irreparable, and when the patient has pseudoparesis versus pseudoparalysis, it is paramount to accurately describe patient factors, including preoperative function, in ongoing research.
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Reddy RP, Herman ZJ, Como M, James MG, Steuer FW, Adida S, Singh-Varma A, Nazzal EM, Njoku-Austin C, Karimi A, Lin A. Reversing chronic pseudoparesis secondary to massive, irreparable rotator cuff tear: superior capsular reconstruction vs. reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:S16-S24. [PMID: 38104716 DOI: 10.1016/j.jse.2023.10.026] [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: 08/26/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Recent studies have defined pseudoparesis as limited active forward elevation between 45° and 90° and maintained passive range of motion (ROM) in the setting of a massive rotator cuff tear (RCT). Although pseudoparesis can be reliably reversed with reverse total shoulder arthroplasty (RSA) or superior capsular reconstruction (SCR), the optimal treatment for this indication remains unknown. The purpose of this study was to compare the clinical outcomes of RSA to SCR in patients with pseudoparesis secondary to massive, irreparable RCT (miRCT). METHODS This was a retrospective cohort study of consecutive patients aged 40-70 years with pseudoparesis secondary to miRCT who were treated with either RSA or SCR by a single fellowship-trained shoulder surgeon from 2016 to 2021 with a minimum 12-month follow-up. Multivariate linear regression modeling was used to compare active ROM, visual analog pain scale (VAS), Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score between RSA and SCR while controlling for confounding variables. RESULTS Twenty-seven patients were included in the RSA cohort and 23 patients were included in the SCR cohort with similar mean follow-up times (26.2 ± 21.1 vs. 21.9 ± 14.7 months, respectively). The patients in the RSA group were significantly older than those in the SCR group (65.2 ± 4.4 vs. 54.2 ± 7.8 years, P < .001) and had more severe arthritis (1.8 ± 0.9 vs. 1.2 ± 0.5 Samilson-Prieto, P = .019). The pseudoparesis reversal rate among the RSA and SCR cohorts was 96.3% and 91.3%, respectively. On univariate analysis, the RSA cohort demonstrated significantly greater mean improvement in active FF (89° ± 26° vs. 73° ± 30° change, P = .048), greater postoperative SSV (91 ± 8% vs. 69 ± 25%, P < .001), lower postoperative VAS pain scores (0.6 ± 1.2 vs. 2.2 ± 2.9, P = .020), and less postoperative internal rotation (IR; 4.6° ± 1.6° vs. 6.9° ± 1.8°, P = .004) compared with SCR. On multivariate analysis controlling for age and osteoarthritis, RSA remained a significant predictor of greater SSV (β = 21.5, P = .021) and lower VAS scores (β = -1.4, P = .037), whereas SCR was predictive of greater IR ROM (β = 3.0, P = .043). CONCLUSION Although both RSA and SCR effectively reverse pseudoparesis, patients with RSA have higher SSV and lower pain scores but less IR after controlling for age and osteoarthritis. The results of this study may inform surgical decision making for patients who are suitable candidates for either procedure.
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Affiliation(s)
- Rajiv P Reddy
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Matthew Como
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Michael G James
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Fritz W Steuer
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Samuel Adida
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Anya Singh-Varma
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Ehab M Nazzal
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Confidence Njoku-Austin
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Amin Karimi
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA.
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6
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Seo JB, Jung JW, Yoo JS. Combination of arthroscopic biologic tuberoplasty and bursal acromial reconstruction. J Orthop 2024; 51:1-6. [PMID: 38299060 PMCID: PMC10825636 DOI: 10.1016/j.jor.2023.10.004] [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: 08/09/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 02/02/2024] Open
Abstract
Background Recently, among the various method for irreparable rotator cuff tears, the "tension-free allodermis graft technique" has been introduced as a method for arthroscopic biologic tuberoplasty(ABT) and bursal acromial reconstruction(BAR).The objective was to analyze the outcomes of ABT and BAR combination surgical technique. Methods Eighteen cases who underwent simultaneous ABT and BAR procedures were retrospectively recruited. Before the surgery and at one year post-surgery, the researchers assessed the patients' Visual Analog Scale(VAS), American Shoulder and Elbow Surgeons(ASES) scores, pain scores, range of motion(ROM), retear, and acromiohumeral distance (AHD). Results One year post-surgery, both the VAS pain scores, ASES scores, and ROM showed statistically significant improvement compared to before the surgery. Upon reviewing the radiological results, the AHD significantly improved from 4.3 ± 4.1 mm before surgery to 9.2 ± 1.9 mm at one year post-surgery (p < 0.001). Moreover, in the one year follow-up, there was no observed failure of the allodermis graft in any of the cases. Conclusion The combination of ABT and BAR demonstrated significantly improved clinical outcomes after surgery, showing a substantial increase in AHD and preventing graft failure effectively.
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Affiliation(s)
- Joong-Bae Seo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Jae-Wook Jung
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Jae-Sung Yoo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
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Velasquez Garcia A, Nieboer MJ, de Marinis R, Morrey ME, Valenti P, Sanchez-Sotelo J. Mid- to long-term outcomes of latissimus dorsi tendon transfer for massive irreparable posterosuperior rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg 2024; 33:959-974. [PMID: 37993088 DOI: 10.1016/j.jse.2023.10.002] [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: 06/29/2023] [Revised: 09/20/2023] [Accepted: 10/08/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND This study aims to analyze the mid-to long-term results of the latissimus dorsi tendon for the treatment of massive posterosuperior irreparable rotator cuff tears as reported in high-quality publications and to determine its efficacy and safety. METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and EMBASE databases were searched until December 2022 to identify studies with a minimum 4 year follow-up. Clinical and radiographic outcomes, complications, and revision surgery data were collected. The publications included were analyzed quantitatively using the DerSimonian Laird random-effects model to estimate the change in outcomes from the preoperative to the postoperative condition. The proportion of complications and revisions were pooled using the Freeman-Tukey double arcsine transformation. RESULTS Of the 618 publications identified through database search, 11 articles were considered eligible. A total of 421 patients (432 shoulders) were included in this analysis. Their mean age was 59.5 ± 4 years. Of these, 277 patients had mid-term follow-up (4-9 years), and 144 had long-term follow-up (more than 9 years). Postoperative improvements were considered significant for the following outcome parameters: Constant-Murley Score (0-100 scale), with a mean difference (MD) = 28 points (95% confidence interval [CI] 21, 36; I2 = 89%; P < .001); visual analog scale, with a standardized MD = 2.5 (95% CI 1.7, 3.3; P < .001; I2 = 89%; P < .001); forward flexion, with a MD = 43° (95% CI 21°, 65°; I2 = 95% P < .001); abduction, with a MD = 38° (95% CI 20°, 56°; I2 = 85%; P < .01), and external rotation, with a MD = 8° (95% CI 1°, 16°; I2 = 87%; P = .005). The overall reported mean complication rate was 13% (95% CI 9%, 19%; I2 = 0%), while the reported mean revision rate was 6% (95% CI: 3%, 9%; I2 = 0%). CONCLUSIONS Our pooled estimated results seem to indicate that latissimus dorsi tendon transfer significantly improves patient-reported outcomes, pain relief, range of motion, and strength, with modest rates of complications and revision surgery at mid-to long-term follow-up. In well-selected patients, latissimus dorsi tendon transfer may provide favorable outcomes for irreparable posterosuperior cuff tears.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Clinica Universidad de los Andes, Santiago, Chile
| | - Micah J Nieboer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rodrigo de Marinis
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile; Shoulder and Elbow Unit, Hospital Dr. Sótero del Rio, Santiago, Chile
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Mahatme RJ, Modrak M, Wilhelm C, Lee MS, Owens JS, Gillinov SM, Fong S, Pettinelli N, Islam W, Jimenez AE. Glenohumeral Superior Translation and Subacromial Contract Pressure Are Both Improved With Superior Capsular Reconstruction: A Systematic Review and Meta-analysis of Biomechanical Investigations. Arthroscopy 2024; 40:1279-1287. [PMID: 37634706 DOI: 10.1016/j.arthro.2023.08.025] [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: 02/16/2023] [Revised: 07/26/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To review cadaveric studies evaluating the biomechanical outcomes of superior capsular reconstruction (SCR) with different graft types for the treatment of irreparable rotator cuff (RTC) tears. METHODS PubMed, Cochrane, and Embase were queried in January 2022 to conduct this meta-analysis using the following key words: "superior capsule reconstruction," "superior capsular reconstruction," and "biomechanics." Articles were included if they reported glenohumeral superior translation or subacromial contact pressure following SCR in cadaveric RTC tears. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Number of shoulders, graft types, and biomechanical outcomes were recorded and analyzed with forest plots. RESULTS Twelve studies (95 shoulders) were included in the statistical analysis. There was a significant reduction in glenohumeral superior translation following SCR compared with RTC tear across 10 studies (79 shoulders) with standardized mean difference (SMD) -2.48 mm; confidence interval (CI) -3.28 mm, -1.69 mm. The SMD between fascia lata graft and RTC tear was -3.84 mm (CI -4.82 mm, -2.86 mm) and between dermal allograft and RTC tear was -2.05 mm (CI -3.10 mm, -1.00 mm). There was a significant reduction in subacromial contact pressure following SCR compared with RTC tear across 5 studies (55 shoulders) with SMD -3.49 MPa (CI -4.54 MPa, -2.44 MPa). The SMD between fascia lata graft and RTC tear was -3.21 MPa (CI -5.08 MPa, -1.34 MPa) and between dermal allograft and RTC tear was -3.89 MPa (CI -5.91 MPa, -1.87 MPa). CONCLUSIONS Independent of graft type, biomechanical studies suggest that SCR improves glenohumeral superior translation and subacromial contact pressure in comparison with RTC tear at time zero. There was no definitive evidence identified in this study to suggest a biomechanically superior SCR graft option. CLINICAL RELEVANCE Investigating the biomechanical outcomes of several graft types for superior capsular reconstruction will help surgeons better understand the efficacies of different graft types for use in superior capsule reconstruction surgery.
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Affiliation(s)
- Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | - Maxwell Modrak
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Christopher Wilhelm
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Michael S Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jade S Owens
- Keck School of Medicine of USC, Los Angeles, California, U.S.A
| | - Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Scott Fong
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | | | - Wasif Islam
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A..
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Reddy RP, Sabzevari S, Karimi A, Dadoo S, Ramraj R, Issa M, Charles S, Como CJ, Singh-Varma A, Como M, Lin A. Pseudoparesis and pseudoparalysis in the setting of massive irreparable rotator cuff tear: demographic, anatomic, and radiographic risk factors. J Shoulder Elbow Surg 2024; 33:e88-e96. [PMID: 37481105 DOI: 10.1016/j.jse.2023.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The primary purpose of this study was to identify demographic, anatomic, and radiographic risk factors for active forward elevation (AFE) <90° in the setting of massive, irreparable rotator cuff tear (miRCT). The secondary purpose was to identify characteristics differentiating between patients with pseudoparalysis (AFE <45°) and pseudoparesis (AFE >45° but <90°). METHODS This was a retrospective case-control study reviewing patients with miRCTs at a single institution between January 12, 2016 and November 26, 2020. Patients were separated into 2 cohorts based on presence or absence of preoperative AFE <90° with maintained passive range of motion. Demographics, RCT pattern, and radiographic parameters were assessed as risk factors for AFE <90°. A secondary analysis was conducted to compare patients with pseudoparalysis and pseudoparesis. RESULTS There were 79 patients in the AFE <90° cohort and 50 patients in the control cohort. Univariate analysis confirmed significant differences between the AFE <90° and control cohort in age (71.9 ± 11.0 vs. 65.9 ± 9.1 years), arthritis severity (34.2% vs. 16.0% grade 3 Samilson-Prieto), acromiohumeral distance (AHD; 4.8 ± 2.7 vs. 7.6 ± 2.6 mm), fatty infiltration of the supraspinatus (3.3 ± 0.9 vs. 2.8 ± 0.8) and subscapularis (2.0 ± 1.2 vs. 1.5 ± 1.0), and proportion of subscapularis tears (55.7% vs. 34.0%). On multivariate analysis, age (odds ratio [OR] 1.08, P = .014), decreased AHD (OR 0.67, P < .001), severe arthritis (OR 2.84, P = .041), and subscapularis tear (OR 6.29, P = .015) were independent factors predictive of AFE <90°. Secondary analysis revealed tobacco use (OR 3.54, P = .026) and grade 4 fatty infiltration of the supraspinatus (OR 2.22, P = .015) and subscapularis (OR 3.12, P = .042) as significant predictors for pseudoparalysis compared to pseudoparesis. CONCLUSIONS In patients with miRCT, increased age, decreased AHD, severe arthritis, and subscapularis tear are associated with AFE <90°. Furthermore, patients with AFE <90° tend to have greater supraspinatus and subscapularis fatty infiltration. Lastly, among patients with AFE <90°, tobacco use and grade 4 fatty infiltration of the supraspinatus and subscapularis are associated with pseudoparalysis compared with pseudoparesis.
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Affiliation(s)
- Rajiv P Reddy
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Soheil Sabzevari
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Amin Karimi
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Raghav Ramraj
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Mohamad Issa
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Shaquille Charles
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Christopher J Como
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Anya Singh-Varma
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Matthew Como
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA.
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10
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Takayama K, Ito H. Clinical outcomes and temporal changes in the range of motion following reverse total shoulder arthroplasty. J Orthop Sci 2023; 28:1258-1265. [PMID: 36243593 DOI: 10.1016/j.jos.2022.09.008] [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: 10/28/2021] [Revised: 07/09/2022] [Accepted: 09/25/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty is a definitive solution for the treatment of massive rotator cuff tear and shoulder pseudoparalysis since it can improve shoulder function, especially in elderly individuals. For many elderly individuals, the concern is when they can return to their daily lives after surgery. This study aimed to clarify the characteristics of temporal postoperative values following reverse total shoulder arthroplasty and investigate the factors that affect clinical outcomes. METHODS This study included 52 patients (mean 79.2 years, range 70-87 years) who underwent primary reverse total shoulder arthroplasty for shoulder pseudoparalysis at a single institution by a single surgeon using the same implant between October 2014 and June 2019. We divided 52 patient into the following groups (1) female (n = 34)vs. male (n = 18) patients; (2) with (n = 19) vs. without (n = 33) arthritic changes in glenohumeral joints (Hamada grade 2, 3 vs. 4, 5); (3) with (n = 23) vs. without (n = 29) subscapularis tendon repair; and investigated the temporal changes in the range of motion (flexion, abduction, external rotation, and internal rotation) and American Shoulder and Elbow Surgeons scores. RESULTS Significant differences were observed in postoperative shoulder flexion (P = .046) and abduction (P = .049) between the female and male groups. The male patients were able to obtain quick functional recovery. However, no significant differences were observed in postoperative American Shoulder and Elbow Surgeons scores, and the shoulder range of motion between patients with Hamada grade 2, 3 and 4, 5, and between the subscapularis repair and no repair groups. CONCLUSION The factor that affected the final and temporal values of range of motion after reverse total shoulder arthroplasty was sex, rather than the arthritic changes in glenohumeral joint and the treatment of the subscapularis tendon.
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Affiliation(s)
- Kazumasa Takayama
- Department of Orthopaedics, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 7108602, Japan.
| | - Hiromu Ito
- Department of Orthopaedics, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 7108602, Japan
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11
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Verma NN, Dasari SP, Menendez ME, Khan ZA, Vadhera AS, Garrigues GE, Nicholson GP. Minimal inter-surgeon agreement on the diagnosis of pseudoparalysis in patients with massive rotator cuff tears. J Shoulder Elbow Surg 2023; 32:1960-1966. [PMID: 37044300 DOI: 10.1016/j.jse.2023.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/20/2023] [Accepted: 03/13/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Pseudoparalysis is commonly used to describe patients with severe loss of active elevation associated with advanced rotator cuff disease, but its definition in the literature has been variable. This study aimed to determine how 15 expert shoulder surgeons use the term "pseudoparalysis" when presented with clinical cases and assess clinical agreement on the diagnosis of pseudoparalysis. METHODS Fifteen expert shoulder surgeons were surveyed regarding 18 patients with magnetic resonance imaging-diagnosed massive rotator cuff tears, restricted active range of motion (ROM), full passive ROM, and without advanced rotator cuff arthropathy (Hamada grade <3). The survey included 18 patient vignettes with key clinical details and a deidentified video demonstrating the physical examination of the patient. For all patients, surgeons were instructed to assume that the patient has a full passive ROM. An anteroposterior radiograph and T2 sequences of the patient's coronal, axial, and sagittal magnetic resonance imaging were also provided. After each case, the surgeons were asked: (1) does the patient have pseudoparalysis, and (2) if so, how severe it is. At the end of the patient vignettes, surgeons were asked to define pseudoparalysis using a checklist with predefined options. Surgeons were also asked if there was a difference between the term pseudoparalysis and pseudoparesis. Fleiss' kappa (κ) correlation coefficient was used to determine intersurgeon agreement. RESULTS There was minimal inter-rater agreement on the diagnosis of pseudoparalysis (κ = 0.360) and no agreement on describing the severity of pseudoparalysis (κ = -0.057). Although 80% of surgeons stated that an active glenohumeral elevation less than 90° was a diagnostic feature of pseudoparalysis, there was disagreement on the remaining criteria, leading to no agreement on a set of universal criteria that defines pseudoparalysis. A total of 67% included maintained full passive elevation, 33% included the absence of pain, 67% included elevation causing anterosuperior escape, and 27% included an additional unlisted factor. There was minimal agreement among the 15 surgeons on the diagnostic criteria of pseudoparalysis (κ = 0.092). Finally, 7 surgeons stated that pseudoparalysis and pseudoparesis are identical, whereas 8 surgeons stated that they are 2 different clinical diagnoses. CONCLUSION Among this panel of expert shoulder surgeons, there was a lack of consensus on the definition of pseudoparalysis and minimal agreement on the diagnosis of pseudoparalysis based on clinical scenarios. In addition, half the surgeons believed that pseudoparalysis and pseudoparesis are identical, whereas the other half believed that they represent 2 separate clinical entities. A standardized definition of pseudoparalysis would be of value to facilitate communication and research efforts.
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Affiliation(s)
- Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Suhas P Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Zeeshan A Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Amar S Vadhera
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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12
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Sheth MM, Shah AA. Massive and Irreparable Rotator Cuff Tears: A Review of Current Definitions and Concepts. Orthop J Sports Med 2023; 11:23259671231154452. [PMID: 37197034 PMCID: PMC10184227 DOI: 10.1177/23259671231154452] [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: 10/21/2022] [Accepted: 11/09/2022] [Indexed: 05/19/2023] Open
Abstract
Background While massive and irreparable rotator cuff tears (MIRCTs) have been abundantly studied, inconsistent definitions in the literature and theories about pain and dysfunction related to them can be difficult to navigate when considering an individual patient. Purpose To review the current literature for definitions and critical concepts that drive decision-making for MIRCTs. Study Design Narrative review. Methods A search of the PubMed database was performed to conduct a comprehensive literature review on MIRCTs. A total of 97 studies were included. Results Recent literature reflects added attention to clarifying the definitions of "massive, "irreparable," and "pseudoparalysis." In addition, numerous recent studies have added to the understanding of what generates pain and dysfunction from this condition and have reported on new techniques for addressing them. Conclusion The current literature provides a nuanced set of definitions and conceptual foundations on MIRCTs. These can be used to better define these complex conditions in patients when comparing current surgical techniques to address MIRCTs, as well as when interpreting the results of new techniques. While the number of effective treatment options has increased, high-quality and comparative evidence on treatments for MIRCTs is lacking.
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13
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Checchia CS, da Silva LA, do Val Sella G, Checchia SL, de Moraes Barros Fucs PM, Miyazaki AN. Allograft-enhanced latissimus dorsi transfer is better than the conventional technique for irreparable posterosuperior rotator cuff tears. A retrospective matched cohort. INTERNATIONAL ORTHOPAEDICS 2023; 47:1527-1534. [PMID: 36951977 DOI: 10.1007/s00264-023-05775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Latissimus dorsi tendon (LDT) transfer (LDTT) to the greater tuberosity to treat irreparable posterosuperior rotator cuff tears (RCTs) in young active patients has been shown to have up to 36% of clinical failures, most of them happening because of either deltoid origin disruption or post-operative transfer rupture from the greater tuberosity. In an attempt to simultaneously prevent both complications, a modified technique includes the following adaptations to the original technique: reinforcement and augmentation of the LDT with a tendinous allograft, enabling the use of a single deltopectoral approach. The aim of this study is to compare mid-term outcomes of the traditional LDTT technique with this modified transfer. METHODS Retrospective cohort study comparing two groups who underwent either the traditional (group 1; n = 19) or the modified technique (group 2; n = 27). Group homogenization was assured by statistical comparison of 24 baseline independent variables. The outcome variables were the gains to active shoulder range of motions (ROM) and UCLA scores (and all its subscores, independently), at a minimum follow-up of two years. A p value < .05 was considered to be statistically significant. RESULTS At a mean follow-up of 25 months, both groups have shown improvements to most variables. However, group two (modified technique) achieved greater improvements to UCLA score (p = .009), active external rotation (p = .006) and internal rotation (p = .008). CONCLUSION At mid-term follow-up, improvements to outcomes of the modified (single approach, allograft-enhanced) latissimus dorsi transfer were greater than those of the original technique.
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Affiliation(s)
- Caio Santos Checchia
- Department of Orthopaedics, Santa Casa School of Medicine, São Paulo, Brazil.
- Hospital Sírio-Libanês, São Paulo, Brazil.
| | | | | | - Sergio Luiz Checchia
- Department of Orthopaedics, Santa Casa School of Medicine, São Paulo, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Alberto Naoki Miyazaki
- Department of Orthopaedics, Santa Casa School of Medicine, São Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
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Ó Conaire E, Delaney R, Lädermann A, Schwank A, Struyf F. Massive Irreparable Rotator Cuff Tears: Which Patients Will Benefit from Physiotherapy Exercise Programs? A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5242. [PMID: 37047860 PMCID: PMC10094518 DOI: 10.3390/ijerph20075242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
Massive irreparable rotator cuff tears can cause significant shoulder pain, disability and reduction in quality of life. Treatment approaches can be operative or non-operative. Operative approaches include reverse total shoulder arthroplasty, arthroscopic debridement, partial rotator cuff repair, subacromial balloon spacers, superior capsule reconstruction, and tendon transfer procedures. Non-operative approaches include physiotherapy exercise programs and corticosteroid injections. There are no randomized controlled trials comparing the different treatment approaches. It is therefore challenging for clinicians to advise patients on what is their best treatment pathway. Physiotherapy exercise programs are less expensive and have lower risks for patients than surgical approaches. However, the success of physiotherapy in patients with massive irreparable rotator cuff tears is highly variable with published success rates of 32-96%. Several cohort studies have sought to identify if certain factors are predictive of success with physiotherapy. Several biomechanical factors were identified as possibly being related to a successful or unsuccessful outcome following physiotherapy, with complete tear of subscapularis demonstrating the strongest evidence. However, there were no appropriately designed prognostic studies. There has been a strong emphasis on biomechanical factors. Other domains such as psychosocial factors, which are important in similar patient populations, have not been explored. We recommend that further research is needed in this area and should include randomized controlled trials comparing treatment approaches and longitudinal prospective prognostic studies to identify predictors of treatment success.
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Affiliation(s)
- Eoin Ó Conaire
- Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; (A.S.); (F.S.)
- Evidence-Based Therapy Centre, First Floor Geata na Cathrach, Fairgreen Road, H91 W26K Galway, Ireland
| | - Ruth Delaney
- Dublin Shoulder Institute, Sports Surgery Clinic, Santry, D09 C523 Dublin, Ireland;
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, 1217 Meyrin, Switzerland;
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Ariane Schwank
- Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; (A.S.); (F.S.)
- Institute for Therapy and Rehabilitation, Canton Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; (A.S.); (F.S.)
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15
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Okafor C, Levin J, Boadi P, Cook C, George S, Klifto C, Anakwenze O. Pain Associated Psychological Distress is More Strongly Associated with Shoulder Pain and Function than Tear Severity in Patients Undergoing Rotator Cuff Repair. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023] Open
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16
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Kimmeyer M, Schmalzl J, Rentschler V, Jessen M, Gerhardt C, Lehmann LJ. Functional results and unfavorable events after treatment of proximal humerus fractures using a new locking plate system. BMC Musculoskelet Disord 2023; 24:63. [PMID: 36694169 PMCID: PMC9872058 DOI: 10.1186/s12891-023-06176-5] [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: 09/22/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Proximal humerus fractures are often treated with a fixed-angle titanium plate osteosynthesis. Recently, plates made of alternative materials such as carbon fibre-reinforced polyetheretherketone (CFR-PEEK) have been introduced. This study presents the postoperative results of patients treated with a CFR-PEEK plate. METHODS Patients with proximal humerus fractures treated with a CFR-PEEK plate (PEEKPower™ Humeral Fracture Plate (HFP)) were included. In follow-up examination, age and gender adjusted Constant-Murley Score (ACS), Subjective Shoulder Value (SSV), Quick Disabilities of the Arm, Shoulder and Hand Score (QDASH) and pain score (Visual Analog Scale (VAS)) were analyzed. General condition at follow-up was measured by European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L). Range of motion was recorded. In addition, radiographs at follow-up, unfavorable events and revision rate were analyzed. RESULTS In total, 98 patients (66.0 ± 13.2 years, 74 females, 24 males) were reexamined. Mean follow-up was 27.6 ± 13.2 months. There were 15 2-part, 28 3-part and 55 4-part fractures. The functional scores showed good results: SSV 83.3 ± 15.6%, QDASH 13.1 ± 17.0 and ACS 80.4 ± 16.0. A 4-part-fracture, head split component, nonanatomic head shaft reposition and preoperative radiological signs of osteoarthritis were significant negative predictors for poorer clinical scores. Unfavourable events were observed in 27 patients (27.6%). Revision surgery was performed in 8 (8.2%) patients. Risk factors for an unfavourable event were female gender, age of 50 years and older, diabetes, affected dominant hand, 4-part fracture, head split and preoperative radiological signs of osteoarthritis. CONCLUSION There are several advantages of the CFR-PEEK plate (PEEKPower™ Humeral Fracture Plate (HFP)) such as the polyaxial screw placement and higher stability of locking screws. In summary, the CFR-PEEK plate osteosynthesis is a good alternative with comparable clinical results and some biomechanical advantages. Proximal humerus fractures show good clinical results after treatment with a CFR-PEEK plate. The revision rate and the risk of unfavorable events are not increased compared to conventional titanium plate osteosynthesis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Michael Kimmeyer
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeuserstr. 18, 76135 Karlsruhe, Germany
| | - Jonas Schmalzl
- grid.411760.50000 0001 1378 7891Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Oberduerrbacher Str. 6, 97080 Wuerzburg, Germany
| | - Verena Rentschler
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeuserstr. 18, 76135 Karlsruhe, Germany
| | - Malik Jessen
- grid.6936.a0000000123222966Department of Trauma Surgery, University Clinic Rechts Der Isar, Technical University Munich, Ismaninger Str. 22, D-81675 Munich, Germany
| | - Christian Gerhardt
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeuserstr. 18, 76135 Karlsruhe, Germany
| | - Lars-Johannes Lehmann
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeuserstr. 18, 76135 Karlsruhe, Germany
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Ganokroj P, Peebles AM, Vopat ML, Provencher MT. Superior Capsular Reconstruction for Irreparable Rotator Cuff Tear. Clin Sports Med 2023; 42:109-124. [DOI: 10.1016/j.csm.2022.08.005] [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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18
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Tendon Transfers, Balloon Spacers, and Bursal Acromial Reconstruction for Massive Rotator Cuff Tears. Clin Sports Med 2023; 42:125-140. [DOI: 10.1016/j.csm.2022.08.011] [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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Lee A, Farooqi AS, Novikov D, Li X, Kelly JD, Parisien RL. Clinical and Functional Outcomes by Graft Type in Superior Capsular Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:3998-4007. [PMID: 34633206 DOI: 10.1177/03635465211040440] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In recent years, superior capsular reconstruction (SCR) has emerged as a promising treatment for massive rotator cuff tears and has been performed with an array of graft options, most commonly dermal allograft and tensor fascia lata (TFL) autograft. PURPOSE To compare the clinical outcomes, functional outcomes, and complication rates after SCR performed with dermal allograft, TFL autograft, long head of the biceps tendon (LHBT) autograft, and porcine xenograft. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS PubMed, Cochrane Library, and Embase were systematically reviewed for studies that enrolled ≥10 patients who underwent SCR and presented clinical outcome data at a minimum follow-up of 12 months. When available, pre- and postoperative patient-reported outcome scores and clinical examination data were extracted. Outcome data were then compared by graft type. A meta-analysis was also conducted of graft tear and reoperation rates after SCR with dermal allograft and TFL autograft. RESULTS Human dermal allograft and TFL autograft were each utilized in 7 studies, LHBT autograft in 2 studies, and porcine xenograft in 1 study. Dermal allograft, TFL autograft, and LHBT autograft demonstrated comparable median (range) postoperative American Shoulder and Elbow Surgeons scores of 85.3 (77.5-89), 88.6 (73.7-94.3), and 82.7 (80-85.4), respectively. The median postoperative pain scores per visual analog scale for dermal allograft, TFL autograft, and LHBT autograft were 0.8, 2.5, and 1.4. Median postoperative forward elevation was 159.0°, 147.0°, 163.8°, and 151.4° for dermal allograft, TFL autograft, LHBT autograft, and porcine xenograft. Meta-analysis demonstrated a comparable pooled graft tear rate between TFL autograft (9%; 95% CI, 4%-16%) and dermal allograft (7%; 95% CI, 2%-13%). Similarly, the pooled reoperation rate was similar for TFL autograft (3%; 95% CI, 0%-7%) and dermal allograft (6%; 95% CI, 2%-12%). Among the 3 studies with pre- and postoperative information on pseudoparalysis, 73 of 76 (96%) patients with an intact/repairable subscapularis had a reversal of their pseudoparalysis after SCR. CONCLUSION Dermal allograft, TFL autograft, and LHBT autograft are all suitable options for SCR and demonstrate significant improvements in American Shoulder and Elbow Surgeons score, pain score per visual analog scale, and forward elevation. Moreover, dermal allograft and TFL autograft have comparable rates of graft tear and reoperation.
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Affiliation(s)
- Alexander Lee
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali S Farooqi
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Novikov
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Xinning Li
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - John D Kelly
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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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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Recurrence of glenohumeral instability in patients with isolated rotator cuff repair after a traumatic shoulder dislocation. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04628-6. [PMID: 36149486 DOI: 10.1007/s00402-022-04628-6] [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: 06/23/2022] [Accepted: 09/18/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The primary objective of this study was to assess the incidence of recurrent glenohumeral instability in patients over 40 years with isolated rotator cuff (RC) repair for traumatic shoulder dislocation. The secondary objectives were to identify risk factors for glenohumeral recurrence after RC repair and to describe the causes and incidences of re-intervention. MATERIALS AND METHODS In this retrospective cohort study, data of consecutive patients at a single trauma center between January 2014 and July 2019 were reviewed, and 84 patients with a mean age of 57 (range: 40-75) years and follow-up duration of 3.9 (2-6) years were included. The inclusion criteria were as follows: first traumatic anterior shoulder dislocation, reparable RC tear, primary arthroscopic RC repair, no labral or bony Bankart lesion repair, and at least 2 years of follow-up. Patients less than 40 years of age were excluded. Shoulder instability recurrences and surgical reinterventions were reviewed with medical records. Statistical analysis was performed for qualitative variables using the Chi-squared test. Statistical significance was set at P ≤ 0.05. RESULTS There was one patient with a redislocation episode (1.2%) at 2.5 years after surgery, who was surgically treated. Age, subscapular tears, bony Bankart injuries, humeral defects, and associated neurological injuries were not risk factors for recurrence in this study. Ten patients (11.9%) required reintervention. Nine patients (10.7%) re-tore their RCs. CONCLUSIONS Recurrent glenohumeral instability in active patients over 40 years with isolated RC repair after traumatic shoulder dislocation was infrequent, despite the incidence of significant Hill-Sachs defects, anterior glenoid defects, bipolar bone defects, size of the RC injury, and tendon re-tears. The incidence of re-interventions was 11.9%, with symptomatic RC retear as the main cause.
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22
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Ishiwata S, Iizuka Y, Shitara H, Mieda T, Takasawa E, Tsunoda D, Kakuta Y, Honda A, Ito S, Inomata K, Sasaki T, Hamano N, Tajika T, Chikuda H. The Association Between the Rotator Cuff Status and the Severity and Recovery of Weakness in the Shoulder Abductor Strength in a Case of Proximal Type Cervical Spondylotic Amyotrophy. Global Spine J 2022; 12:1375-1379. [PMID: 33375855 PMCID: PMC9393992 DOI: 10.1177/2192568220980441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Case series study. OBJECTIVE We aimed to clarify the prevalence of rotator cuff tear (RCT), and the association between RCT and the severity and prognosis in patients with proximal type cervical spondylotic amyotrophy (CSA). METHODS We retrospectively analyzed 35 proximal type CSA patients who were treated conservatively. The following data was collected: age, rotator cuff status on MRI, manual muscle test (MMT) score of shoulder abductor and biceps brachii muscles both at the first visit and final follow-up. We investigated the prevalence of RCT and the association between the rotator cuff status, and the severity and recovery of upper extremity weakness in patients with proximal type CSA. RESULTS Of the 35 patients, 21 had an RCT on MRI, indicating that the prevalence of RCT in patients with proximal type CSA was 60%. An age-adjusted analysis showed that the presence of RCT was significantly associated with the MMT score of the shoulder abductor muscles both at the first visit and at the final follow-up. The presence of RCT was significantly associated with the recovery of the shoulder abductor muscles. The size of the RCT was negatively correlated with the MMT score of the shoulder abductor muscles at the final follow-up. The size of the RCT was independently correlated with the change of the MMT score of the shoulder abductor muscles. CONCLUSION RCT was detected in >50% in patients with proximal type CSA, and the presence and severity of RCT can be used as prognostic factors for proximal type CSA patients who are treated conservatively.
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Affiliation(s)
- Sho Ishiwata
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan,Sho Ishiwata, MD, Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan.
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tokue Mieda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Eiji Takasawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Daisuke Tsunoda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yohei Kakuta
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Akira Honda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shunsuke Ito
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kazuhiro Inomata
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Fonseca Filho JM, Sella GDV, Souza LHLD, Miyadahira R, Rosa JRP, Miyazaki AN. Evaluation of the Clinical Outcomes of the Arthroscopic Treatment of Rotator Cuff Tears Using the Modified Suture Bridge Technique. Rev Bras Ortop 2022; 57:984-991. [PMID: 36540743 PMCID: PMC9757973 DOI: 10.1055/s-0042-1746179] [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: 04/24/2021] [Accepted: 02/18/2022] [Indexed: 10/16/2022] Open
Abstract
Objective To evaluate the postoperative clinical outcomes of the arthroscopic repair of rotator cuff injuries using a suture configuration we have developed based on a modification of the Suture Bridge (Arthrex, Naples, FL, United States). Methods A retrospective study with 28 male (41.2%) and 40 female (58.8%) subjects with a mean age of 60 years. All patients underwent rotator cuff repair with the modified Suture Bridge technique and follow-up for a minimum period of 18 months. The clinical assessment was performed using the University of California, Los Angeles (UCLA) Shoulder Score. Results The mean postoperative range of motion was of 134° (range: 110° to 140°) for elevation, 58° (range: 40° to 70°) for lateral rotation, and T10 (range: L4 to T7) for medial rotation. The mean increase was of 15° for elevation, 14° for lateral rotation, and 2 vertebral levels for medial rotation. The outcomes were excellent in 61 (83.6%) cases, good in 8 (10.9%), and regular in 4 cases (5.5%). Conclusion The modified Suture Bridge technique for the arthroscopic repair of rotator cuff injuries led to excellent or good postoperative clinical outcomes in most cases (69; 94.5%).
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Affiliation(s)
- João Manoel Fonseca Filho
- Grupo de Cirurgia do Ombro e Cotovelo, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil,Endereço para correspondência João Manoel Fonseca Filho, MD Rua Frei Caneca, 640, apto. 264, Torre Natura, São Paulo, SP, 01307-000Brasil
| | - Guilherme do Val Sella
- Grupo de Cirurgia do Ombro, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brasil
| | - Luis Henrique Lima de Souza
- Grupo de Cirurgia do Ombro, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brasil
| | - Renato Miyadahira
- Grupo de Cirurgia do Ombro, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brasil
| | - João Roberto Polydoro Rosa
- Grupo de Cirurgia de Trauma do Esporte, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brasil
| | - Alberto Naoki Miyazaki
- Grupo de Cirurgia do Ombro e Cotovelo, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil,Grupo de Cirurgia do Ombro, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brasil
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Recall Bias in Retrospective Assessment of Preoperative American Shoulder and Elbow Surgeons Scores After Reverse Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2022; 30:e1051-e1057. [PMID: 35587509 DOI: 10.5435/jaaos-d-21-01163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/04/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Although reverse total shoulder arthroplasty (RTSA) has been shown to be effective for the treatment of cuff tear arthropathy (CTA), the patient's inability to accurately recall their preoperative shoulder condition could skew their perception of the effectiveness of the procedure. Identifying patients who are susceptible to notable recall bias before surgery can help surgeons counsel patients regarding expectations after surgery. The purpose of this study was to evaluate whether patients who undergo RTSA are susceptible to recall bias and, if so, which factors are associated with poor recollection. METHODS Patients who underwent RTSA for CTA by the senior author between September 2016 and September 2018 were identified. All patients completed the American Shoulder and Elbow Surgeons (ASES scores) Standardized Assessment Form at the time of preoperative assessment. Patients were contacted at a minimum of 24 months after surgery to retrospectively assess their preoperative condition. RESULTS A total of 72 patients with a mean age of 72.2 ± 7.65 years completed a retrospective shoulder assessment at 28.3 ± 7.3 months postoperatively. Patient assessment of shoulder condition showed poor reliability (intraclass correlation coefficient = 0.453, confidence interval, 0.237-0.623). Greater preoperative shoulder ASES scores were associated with a greater difference between preoperative ASES scores and recall ASES scores (β = 0.275, P < 0.001). CONCLUSION Patients who undergo RTSA for CTA are susceptible to clinically significant recall bias. Patients with better preoperative condition recall worse preoperative shoulder conditions compared with patients with worse preoperative conditions and are susceptible to a higher degree of recall bias. This patient population should be identified preoperatively and have notable counseling before and after surgery to help them better understand their disease burden and what to expect after surgical intervention. LEVEL OF EVIDENCE III, diagnostic cohort study.
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Patel AV, Matijakovich DJ, Brochin RL, Zastrow RK, Parsons BO, Flatow EL, Hausman MR, Cagle PJ. Mid-term outcomes after reverse total shoulder arthroplasty with latissimus dorsi transfer. Shoulder Elbow 2022; 14:286-294. [PMID: 35599719 PMCID: PMC9121289 DOI: 10.1177/1758573221996349] [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: 07/31/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
Background Reverse total shoulder arthroplasty is a common treatment for patients with rotator cuff arthropathy who have failed a prior rotator cuff repair. Latissimus dorsi transfer can be performed simultaneously to reverse total shoulder arthroplasty for patients with preoperative external rotation deficiency. Current literature is limited with several studies providing functional and pain improvements at short-term follow-up; however, there is a deficit in data regarding mid-term outcomes. The purpose of this study was to evaluate the clinical and radiographic outcomes following reverse total shoulder arthroplasty with latissimus dorsi transfer with mid-term follow-up. We hypothesized significant improvement in external rotation and shoulder functionality for patients with preoperative external rotation lag. Methods We retrospectively reviewed patients who underwent reverse total shoulder arthroplasty with latissimus dorsi transfer. Preoperative and postoperative changes in range of motion were assessed. American Shoulder and Elbow Surgeon Score and the Simple Shoulder Test were used to evaluate changes in shoulder function while pain scores were assessed using the Visual Analog Scale (VAS). Radiographs were reviewed for rotator cuff arthropathy, fatty infiltration, scapular notching, baseplate loosening, and osteolysis. We reported frequency and mean ± standard deviation for categorical and continuous variables, respectively. Means were compared using the paired Student's t-test and proportions using the Chi-square test. Results Fifteen patients met the inclusion criteria. The mean age of the cohort was 71.7 ± 8.4 years (range 51.2-87.8 years) with a mean follow-up of 6.3 ± 4.1 years (range 1.0-14.5 years). Reverse total shoulder arthroplasty with latissimus dorsi transfer improved external rotation (-7 ± 21.3° to 38 ± 15.8°; p value = 0.001). There was no statistically significant difference regarding forward flexion (116.3 ± 45.4° to 133.7 ± 14.7°; p value = 0.17) and internal rotation (T12 to L2; p value = 0.57). The procedure led to an increase in American Shoulder and Elbow Surgeon Score scores (37 ± 19 to 62 ± 22; p = 0.005) and Simple Shoulder Test scores (2 ± 2 to 6 ± 3; p value = 0.001) with a significant reduction in Visual Analog Scale scores (5 ± 3 to 2 ± 3; p value = 0.022). The procedure corrected external rotation lag in 10 patients. Radiographically, rotator cuff arthropathy was found to be grade 3 in two patients, grade 4 A in four patients, grade 4B in eight patients, and grade 5 in one patient. On postoperative imaging, scapular notching was found in six patients (40%). Twelve patients had cortical humeral erosion at the site of the latissimus dorsi transfer. Only one patient experienced a shoulder-related complication which was aseptic baseplate loosening and required a revision reverse total shoulder arthroplasty with allograft. Conclusions In this study, patients undergoing reverse total shoulder arthroplasty with latissimus dorsi transfer experienced improvements in range of motion, functional scores, and pain at mid-term follow-up. The shoulder-related complication rate was low.Level of evidence: IV; Case series.
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Okutan AE, Gül O. Pseudoparalysis and Acromiohumeral Interval Reversibility Are the Most Important Factors Affecting the Achievement of Patient-Acceptable Symptom State After Arthroscopic-Assisted Latissimus Dorsi Tendon Transfer. Arthroscopy 2022; 38:1824-1830. [PMID: 34915140 DOI: 10.1016/j.arthro.2021.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the patient-acceptable symptom state (PASS) values for American Shoulder and Elbow Surgeons (ASES) score and the Constant-Murley (CM) score after arthroscopic-assisted latissimus dorsi tendon transfer (LDTT) and to identify potential factors affecting the achievement of PASS. METHODS Fifty consecutive patients who underwent arthroscopic-assisted LDTT between 2015 and 2020 were retrospectively analyzed. In total, 42 patients met the inclusion criteria with minimum follow-up of 1 year postoperative. Patients were evaluated preoperatively and 1-year postoperatively with multiple clinical measurements including ASES, CM, score and PASS. The primary outcome was identified as patient satisfaction which assessed with achievement of a PASS. Potential factors affecting the patient satisfaction including age, sex, body mass index, previous surgery, presence of pseudoparalysis, critical shoulder angle, shoulder abduction moment index, acromiohumeral interval (AHI) reversibility, Hamada grade and fatty infiltration were evaluated for their association with PASS value by stepwise logistic regression analysis. RESULTS A total of 42 patients were evaluated with mean follow-up 27.8 ± 8.21 months. The ASES and CM scores improved from preoperative means of 21.6 ± 6.5 and 25.2 ± 8.5 to 65.6 ± 20.7 points and 56.8 ± 16.5 points, respectively (P < .001). The PASS values for the ASES and CM scores were 62.4 and 52.5, respectively. The univariate analysis showed that older age (P = .021), presence of pseudoparalysis (P < .001), previous surgery (P = .016), lower preoperative AHI (P = .028), and lower AHI reversibility (P < .001) were all significantly associated with worse patient satisfaction. The multivariable logistic regression analysis showed that pseudoparalysis (P = .038) and AHI reversibility (P = .021) were independent prognostic factors affecting the achievement of a PASS after arthroscopic-assisted LDTT. The cutoff value for AHI reversibility to predict an achievement of PASS was found to be 4.0 mm. CONCLUSIONS Arthroscopic-assisted LDTT led to satisfactory results in patients with massive rotator cuff tears. However, pseudoparalysis and AHI reversibility were the most important independent prognostic factors that consistently reduced and increased, respectively, the odds of achieving a PASS. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ahmet Emin Okutan
- Orthopaedic and Traumatology Dept., Karadeniz Technical University, School of Medicine, Trabzon, Turkey.
| | - Orkun Gül
- Orthopaedic and Traumatology Dept., Karadeniz Technical University, School of Medicine, Trabzon, Turkey
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Barragan Echenique DM, Dolan MT, Koh JL, Goldberg BA, Amirouche F. Infraspinatus Muscle Fiber Moment Arms During Abduction: A Biomechanical Comparison of Values for Intact Rotator Cuff, Supraspinatus Tear, Superior Capsular Reconstruction, and Reverse Total Shoulder Arthroplasty. Orthop J Sports Med 2022; 10:23259671221098378. [PMID: 35651480 PMCID: PMC9149620 DOI: 10.1177/23259671221098378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Lines of action of the superior, middle, and inferior infraspinatus muscle
fibers work together to produce moment arms that change throughout abduction
in an intact shoulder, after a supraspinatus tear, and after superior
capsular reconstruction (SCR) and reverse total shoulder arthroplasty
(rTSA). Purpose: To use moment arm values to indicate the efficacy of SCR and rTSA to restore
infraspinatus function during shoulder abduction. Study Design: Descriptive laboratory study. Methods: A total of 5 human cadaveric shoulders placed in a testing apparatus were
each actively abducted (0°-90°) under the following 4 conditions: intact,
complete supraspinatus tear, SCR, and rTSA. The 3-dimensional coordinates of
points were tracked along the origin and insertion of the superior, middle,
and inferior infraspinatus fibers during abduction. Moment arm values were
calculated using the origin-insertion method to determine abduction
contribution of infraspinatus fiber sections. Analysis of variance and post
hoc Tukey testing were used to compare differences in moment arms between
the 4 conditions and between fiber sections. Results: In the intact condition, the superior infraspinatus fibers had an abduction
moment that decreased with elevation until shifting to adduction.
Conversely, the middle and inferior fibers had an adduction moment that
turned to abduction (mean moment arm values from 0° to 90°: inferior, from
–5.9 to 19.4 mm; middle, from –4.7 to 15.9 mm; superior, from 5.6 to –5.1
mm; P < .05). After a supraspinatus tear, superior
fibers lacked any torque, and inferior and middle fibers lost adduction
potential (inferior, from 4.8 to 14.0 mm; middle, from –0.2 to 9.6 mm;
superior, from 1.0 to 0.7 mm; P < .05). SCR restored the
initial superior fiber abduction moment (5.6 mm at 0°; P
< .05); middle and inferior fibers had some restoration but were weaker
than intact fibers. Loss of abduction moment in all fibers was seen with
rTSA (inferior, from –9.6 to –1.6 mm; middle, from –10.5 to –3.6 mm;
superior, from –1.7 to –4.6 mm; P < .05). Conclusion: Infraspinatus fiber groups had different and inverse moment arms during
scapular plane elevation. SCR most closely resembled the intact shoulder,
whereas rTSA transformed the infraspinatus into an adductor. Clinical Relevance: These results support the efficacy of SCR at restoring biomechanical muscle
function and suggest that the changes in moment arms for each fiber group be
considered when choosing treatment modalities and rehabilitation protocols
after rotator cuff tear.
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Affiliation(s)
| | - Martine T. Dolan
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, USA
| | - Jason L. Koh
- Orthopaedic and Spine Institute, Department of Orthopaedic Surgery, Northshore University HealthSystem, an Affiliate of University of Chicago Pritzker School of Medicine, Evanston, Illinois, USA
- Department of Orthopaedics, Shoulder and Elbow Surgery, University of Chicago, Chicago, Illinois, USA
| | - Benjamin A. Goldberg
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, USA
| | - Farid Amirouche
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, USA
- Orthopaedic and Spine Institute, Department of Orthopaedic Surgery, Northshore University HealthSystem, an Affiliate of University of Chicago Pritzker School of Medicine, Evanston, Illinois, USA
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Youn SM, Lee HS, Rhee SM, Rhee YG. Medialized vs. lateralized humeral implant in reverse total shoulder arthroplasty: the comparison of outcomes in pseudoparalysis with massive rotator cuff tear. J Shoulder Elbow Surg 2022; 31:736-746. [PMID: 34543745 DOI: 10.1016/j.jse.2021.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND With the increasing use of lateralized humeral implants in reverse total shoulder arthroplasty (RTSA), it is still unclear whether this design will be as advantageous as the medialized humeral implants in the setting of pseudoparalysis (PP). METHODS A total of 51 eligible RTSA cases for PP signs due to massive rotator cuff deficiency were selected for the retrospective review. Twenty-five patients were allocated to group L in which the isolated humeral side lateralization was performed (neck-shaft angle of 145°), and 26 patients were allocated to group M (neck-shaft angle of 155°). Pre- and postoperative radiologic measurements including critical shoulder angle, acromiohumeral distance (AHD), lateral humeral offset (LHO), and deltoid wrapping offset (DWO), as well as range of motion (ROM) and clinical outcome scores, were compared. The mean age was 71.0 ± 6.5 years for group L and 70.3 ± 7.0 years for group M, and the overall mean follow-up period was 49.0 ± 13.5 months (range, 25.7-68.9). RESULTS The preoperative radiologic measurements were similar, but the postoperative LHO and DWO were significantly larger for group L, whereas the postoperative AHD was larger for group M compared with group L, with the values being 39.8 ± 9.7 mm and 33.6 ± 10.4 mm, respectively (P = .034). For the ROM, active forward elevation did improve significantly for both, starting preoperatively with the active ranges of 39° ± 19° (passively 153° ± 24°) for group L and 42° ± 18° (passively 156° ± 11°) for group M-the final postoperative active ranges being 142° ± 16° and 133° ± 33°, respectively, without significant difference between the groups (P = .426). The postoperative recovery of PP for group L was 100% (25 of 25), whereas for group M, it was 96.2% (25 of 26). The final visual analog scale (VAS) scores and University of California Los Angeles (UCLA) shoulder scores improved significantly for both groups, but the differences between the groups at the final assessments were insignificant. The 4 complications were periprosthetic fracture, acromial stress fracture, periprosthetic joint infection, and neuropraxia, all of which were in group M, and scapular notching with higher grades were more prevalent for group M (26.9%, 7 of 26). CONCLUSIONS With RTSA, good outcomes and recovery were achieved in most cases of PP. The postoperative active elevation range and functional outcomes were not affected by medialization or lateralization of the humeral implant. Earlier recovery of motion was observed with the lateralized group, but no significant differences were seen in the final ROM between the groups.
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Affiliation(s)
- Seung-Min Youn
- Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Hee Sung Lee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Sung-Min Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
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CENGİZ B, OGUZKAYA S. Comparison of labral repair and biceps tenodesis concomitant with arthroscopic rotator cuff repair in patients between the age of 40 and 60. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1035458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Soderlund M, Boren M, O’Reilly A, San Juan A, Mahylis JM. Arthroscopic debridement for management of massive, irreparable rotator cuff tears: a systematic review of outcomes. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:1-7. [PMID: 37588294 PMCID: PMC10426654 DOI: 10.1016/j.xrrt.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Surgical management of massive irreparable rotator cuff tears remains controversial. Arthroscopic debridement (AD) has shown promising results especially in the population older than 65 years; however, there is no consensus on the benefits of various AD procedures. The aim of this systematic review was to evaluate the functional midterm to long-term outcomes in patients treated with AD in combination with subacromial decompression, biceps tenotomy, tuberoplasty, or bursectomy, without repair of the rotator cuff tear. Methods A comprehensive search was performed in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane databases for studies reporting clinical outcomes of AD of massive rotator cuff tears. Quality was determined using the Methodological Index for Nonrandomized Studies (MINORS) criteria by two independent reviewers. Pooled frequency-weighted means and standard deviations were calculated for patient-reported outcomes. Results Sixteen articles containing 643 patients and 662 shoulders met the eligibility criteria. The mean age at the time of surgery was 65.9 ± 4.4 years with a mean follow-up period of 46.5 ± 27.3 months. There was notable clinically significant improvement across all patient-reported outcome scores postoperatively: Constant 70.4 ± 8.9 (P value = .06), University of California, Los Angeles ultrasonography 26.7 ± 5.2 (P value = .001), American Shoulder and Elbow Surgeons score 71.7 ± 2.1 (P value = .12), Disabilities of the Arm, Shoulder, and Hand score 35.3, and visual analog score 1.7 ± 0.9. Forty-nine patients (7%) required reoperation, which most commonly was a reverse total shoulder arthroplasty for the development of rotator cuff arthropathy. Conclusion Arthroscopic debridement with a combination of subacromial decompression, tuberoplasty, subacromial bursectomy, and biceps tenotomy, for treatment of massive irreparable rotator cuff tears, produces good functional outcomes and improvement in pain at mid to long term follow up for the low-demand population greater than 65 years of age looking for pain relief over substantial increase in function.
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Affiliation(s)
- Matthew Soderlund
- Department of Orthopaedic Surgery, Midwestern University/Franciscan Health-Olympia Fields, Olympia Fields, IL, USA
| | - Morgan Boren
- Department of Orthopaedic Surgery, Midwestern University/Franciscan Health-Olympia Fields, Olympia Fields, IL, USA
| | - Andrew O’Reilly
- Department of Orthopaedic Surgery, Midwestern University/Franciscan Health-Olympia Fields, Olympia Fields, IL, USA
| | - Angielyn San Juan
- Department of Orthopedic Surgery, Northshore University Health System, Evanston, IL, USA
| | - Jared M. Mahylis
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA
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Berthold DP, Ravenscroft M, Bell R, Obopilwe E, Cote MP, Kane Z, Morgan BW, Mühlenfeld N, Mazzocca AD, Muench LN. Bursal Acromial Reconstruction (BAR) Using an Acellular Dermal Allograft for Massive, Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Investigation. Arthroscopy 2022; 38:297-306.e2. [PMID: 34329702 DOI: 10.1016/j.arthro.2021.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of bursal acromial reconstruction (BAR) using an acellular dermal allograft on glenohumeral joint kinematics including maximum abduction angle, glenohumeral superior translation, cumulative deltoid force, and subacromial contact pressure. METHODS In this dynamic biomechanical cadaveric shoulder study, 8 fresh-frozen cadaveric shoulders (age 53.4 ± 14.2 years, mean ± standard deviation) were tested using a dynamic shoulder testing system. Maximum abduction angle (MAA), glenohumeral superior translation (ghST), maximum cumulative deltoid force (cDF), and subacromial peak contact pressure (sCP) were compared across 3 conditions: (1) intact shoulder; (2) massive retracted irreparable posterosuperior rotator cuff tear (psRCT) according to Patte III; and (3) BAR. Additionally, humeral head containment was measured using contact pressure. RESULTS Compared with the simulated psRCT, BAR significantly increased mean MAA and significantly decreased ghST (P < .001, respectively) and cDF (P = .017) Additionally, BAR was found to significantly decrease sCP compared with psRCT (P = .024). CONCLUSION In a dynamic biomechanical cadaveric shoulder simulator, resurfacing the undersurface of the acromion using the BAR technique leads to significantly improved ghST, MAA, cDF, and sCP compared with the irreparable rotator cuff tear. CLINICAL RELEVANCE With the BAR technique, native humeral containment may be restored, which can potentially delay progressive subacromial and glenoidal abrasive wear and improve overall shoulder function. As such, the proposed BAR technique can be considered as a technically feasible and potentially cost- and timesaving procedure, as no bone anchors are needed, glenoidal or humeral side graft ruptures can be avoided, and postoperative rehabilitation can be started immediately. However, future clinical studies are needed.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A..
| | | | | | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Zenon Kane
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | | | - Nils Mühlenfeld
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Orthoteam Centre, Manchester, UK
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Chen C, Wu C, Xu J, Chen J, Li Y, Wang L, Jiang J, Xu C, Zhao J. Are scapular morphologic characteristics or rotator cuff tear patterns associated with acetabularization of the coracoacromial arch? JSES Int 2022; 6:479-487. [PMID: 35572443 PMCID: PMC9091933 DOI: 10.1016/j.jseint.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Caiqi Xu
- Corresponding authors: Jinzhong Zhao, MD or Caiqi Xu, MD, Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, China, 200233.
| | - Jinzhong Zhao
- Corresponding authors: Jinzhong Zhao, MD or Caiqi Xu, MD, Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, China, 200233.
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Furuhata R, Matsumura N, Oki S, Kimura H, Suzuki T, Iwamoto T, Matsumoto M, Nakamura M. Risk Factors for Loss of Active Shoulder Range of Motion in Massive Rotator Cuff Tears. Orthop J Sports Med 2022; 10:23259671211071077. [PMID: 35097147 PMCID: PMC8796088 DOI: 10.1177/23259671211071077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Patients with massive rotator cuff tears often exhibit loss of active range of shoulder motion, which can interfere with activities of daily living. The risk factors for loss of motion remain largely unknown. Purpose: To clarify the predictive factors that affect the range of motion in chronic massive rotator cuff tears using multivariate analyses. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively reviewed 204 consecutive patients who were evaluated at their institution with chronic massive rotator cuff tears. In this study, the dependent variable was determined to be active anterior elevation limited to ≤90° or external rotation (ER) with the arm at the side limited to ≤0°. Explanatory variables included age; sex; affected side; duration of symptoms; smoking history; existence of diabetes, hypertension, or rheumatoid arthritis; involved tendons; presence of a 3-tendon tear; rupture of the long head of biceps tendon; superior migration of the humeral head; and cuff tear arthropathy. Baseline variables that were observed to be significant in the univariate analyses were included in multivariate models, which used logistic regression to identify independent predictors of loss of motion. Results: Overall, 73 patients (35.8%) exhibited limited anterior elevation, and 27 (13.2%) exhibited limited ER. Multivariate analyses showed that inferior subscapularis tear (odds ratio [OR], 14.66; 95% CI, 2.95-72.93; P = .001), smoking (OR, 4.13; 95% CI, 1.94-8.79; P < .001), superior migration of humeral head (OR, 3.92; 95% CI, 1.80-8.53; P = .001), and 3-tendon tear (OR, 3.29; 95% CI, 1.32-8.20; P = .011) were significantly associated with the loss of anterior elevation. Teres minor tear (OR, 73.37; 95% CI, 9.54-564.28; P < .001) and superior migration of the humeral head (OR, 3.55; 95% CI, 1.04-12.19; P = .044) were significantly associated with loss of ER. Conclusion: In the current study, a history of smoking, type of torn tendons, and superior migration of the humeral head were associated with loss of active shoulder motion. In particular, the status of inferior subscapularis or teres minor contributed to the onset of pseudoparalysis in massive rotator cuff tears.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopaedic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya-shi, Tochigi, Japan
| | - Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Luciani P, Farinelli L, De Berardinis L, Gigante A. The Arthroscopic Intra-Articular Stabilization of the Shoulder for Irreparable Rotator Cuff Tear: A New Technique Proposal. Front Surg 2021; 8:624100. [PMID: 34938765 PMCID: PMC8685248 DOI: 10.3389/fsurg.2021.624100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Superior capsular reconstruction (SCR) has shown good results in the management of irreparable rotator cuff tears due to the depressive effect on the humeral head, but it is a technically demanding and expensive procedure. Purpose: We hypothesized that an intra-articular neoligament that prevents the superior translation of the humeral head could give similar results in terms of the superior translation of humerus (STH) and range of motion (ROM). Study Design: To compare our proposed technique and the SCR, we conducted a biomechanical study on 10 porcine shoulders in a custom shoulder testing system. Methods: STH and total rotational ROM were quantified in the following four scenarios: (1) when the rotator cuff was intact, (2) after cutting the supraspinatus tendon, (3) after the reconstruction of the superior capsule by long head of the biceps tendon (LHB), and (4) after an arthroscopic intra-articular stabilization by an intra-articular graft. Our proposed technique provides the creation of a humeral and glenoid tunnel, the passage of a graft through these tunnels under arthroscopic guidance, and the graft fixation in the two tunnels. We analyzed the STH and total ROM in each scenario. Results: With respect to the STH, we reported that the present proposed technique is characterized by a significant reduction of superior translation at 0 and 45° compared to scenario 2. In addition, the comparison between our proposed technique and SCR showed a significant difference of the STH at 0° of abduction. Total rotational ROMs of the two tenchinques were similar to scenario 2. Therefore, the use of an intra-articular ligament that prevents the STH can restore shoulder stability in irreparable rotator cuff injuries at both 0 and 45° of glenohumeral abduction without apparently limiting the total rotational ROM. Conclusion: Our proposed technique could be an important treatment option in irreparable rotator cuff tears, especially in patients under 65 years in whom reverse shoulder arthroplasty (RSA) has shown poor results and many complications.
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Affiliation(s)
- Pierfrancesco Luciani
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
| | - Luca De Berardinis
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
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Shah NS, Foote AM, Steele CA, Woods OA, Schumaier AP, Sabbagh RS, Schramm VT, Grawe BM. Does preoperative disease severity influence outcomes in reverse shoulder arthroplasty for cuff tear arthropathy? J Shoulder Elbow Surg 2021; 30:2745-2752. [PMID: 34015436 DOI: 10.1016/j.jse.2021.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The degree of symptomatic disease and functional burden has been demonstrated to influence patient results and satisfaction in total hip and knee arthroplasty. Although the relationship between preoperative diagnosis and patient outcomes has been an area of study for reverse total shoulder arthroplasty (RTSA), the influence of the progression of cuff tear arthropathy (CTA) has not yet been examined. The purpose of this study was to evaluate whether preoperative radiographic disease burden and scapular geometry impact patient outcomes and satisfaction in a cohort of patients with CTA treated with RTSA. METHODS Eighty-six patients were treated for CTA with RTSA performed by the senior author (B.G.) between September 2016 and September 2018 and were enrolled in an institutional registry. At the time of initial evaluation, the baseline American Shoulder and Elbow Surgeons (ASES) score, patient demographic characteristics, history of shoulder surgery, and presence of pseudoparalysis were collected. Radiographs were obtained to evaluate the critical shoulder angle, acromial index, and progression of CTA as assessed by Hamada grading and the Seebauer classification. Patients were contacted to reassess the ASES score and their satisfaction with the improvement in their shoulder function. RESULTS A total of 79 patients (91.6%) were available for evaluation at a minimum of 24 months of follow-up. Multivariate logistic regression modeling revealed that scapular geometry measurements (critical shoulder angle and acromial index) and the degree of CTA (Seebauer and Hamada classifications) were not associated with worse outcomes as assessed by the ASES score. However, degenerative changes as assessed by the Hamada grade (odds ratio, 0.13 [95% confidence interval, 0.02-0.86]; P = .03) and preoperative ASES score (odds ratio, 1.04 [95% confidence interval, 1.01-1.07]; P = .008) were independently associated with higher satisfaction at 24 months of follow-up. CONCLUSION The results indicate that patients with greater CTA disease progression did not show differing outcomes after RTSA compared with patients with milder disease. In contrast, both poorer preoperative function and degenerative changes as assessed by the Hamada classification were associated with greater satisfaction after RTSA for CTA. Given the broad spectrum of disease in CTA, there is likely a corresponding range in patient expectations that requires further study to maximize patient satisfaction.
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Affiliation(s)
- Nihar S Shah
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
| | - Austin M Foote
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Chase A Steele
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Olivia A Woods
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Adam P Schumaier
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Ramsey S Sabbagh
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Violet T Schramm
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Brian M Grawe
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Lee JH, Chun YM, Kim DS, Lee DH, Shin SJ. Early restoration of shoulder function in patients with the Grammont prosthesis compared to lateralized humeral design in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:2533-2542. [PMID: 33813010 DOI: 10.1016/j.jse.2021.03.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to compare the clinical outcomes and radiographic parameters of patients after reverse shoulder arthroplasty (RSA) between the Grammont prosthesis and lateralized humeral design prosthesis. METHODS A total of 114 patients who underwent RSA with a lateralized humeral design (group L; 71 shoulders) and medialized humeral design (group M; 43 shoulders) prosthesis for cuff tear arthropathy or irreparable rotator cuff tear were enrolled. Clinical outcomes including visual analog scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Constant scores and range of motion (ROM) were serially followed up at postoperative 3, 6, 12, and 24 months. Radiographic parameters were measured to evaluate preoperative and postoperative status. RESULTS Both prostheses demonstrated similar clinical outcomes and shoulder function preoperatively and at postoperative 2 years (P >.05). However, patients in group M had significantly better postoperative active forward flexion (postoperative 3 months, 115° ± 12° vs. 101° ± 14°; P <.001; 6 months, 125° ± 13° vs. 118° ± 13°; P <.013) and abduction (3 months, 105° ± 12° vs. 98° ± 12°; P = .002); VAS (3 months, 3.1 ± 1.2 vs. 3.7 ± 1.4; P = .031; 6 months, 2.3 ± 1.1 vs. 2.8 ± 1.3; P = .038); ASES (3 months, 64.2 ± 7.0 vs. 60.4 ± 9.2; P = .022; 6 months, 70.6 ± 6.0 vs. 66.6 ± 8.1; P = .007); and Constant scores (6 months, 59.6 ± 6.9 vs. 55.7 ± 9.3; P = .020). Group L showed a significantly lower rate of scapular notching than group M (15.5% vs. 41.8%; P < .001). The position of the proximal humerus in group L was more lateralized and less distalized than in group M after RSA. CONCLUSIONS RSA with both the Grammont and lateralized humeral design prostheses provided similar shoulder ROM restoration and functional improvements at a minimum of 2 years. However, patients with a humeral lateralized prosthesis showed slower recovery of shoulder function and ROM up to postoperative 6 months despite a lower incidence of scapular notching.
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Affiliation(s)
- Jae-Hoo Lee
- Department of Orthopaedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Doo-Sup Kim
- Department of Orthopaedic Surgery, Wonju College of Medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju, Republic of Korea
| | - Doo-Hyung Lee
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopaedic Surgery, Ewha Shoulder Disease Center, Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
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Takayama K, Yamada S, Kobori Y. Clinical outcomes and temporal changes in the range of motion following superior capsular reconstruction for irreparable rotator cuff tears: comparison based on the Hamada classification, presence or absence of shoulder pseudoparalysis, and status of the subscapularis tendon. J Shoulder Elbow Surg 2021; 30:e659-e675. [PMID: 33930558 DOI: 10.1016/j.jse.2021.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsular reconstruction (SCR) has recently gained popularity as a surgical solution for patients with massive rotator cuff tears or shoulder pseudoparalysis (PPS). Good clinical outcomes have been reported after SCR; however, the factors that influence its clinical outcomes remain unclear. Therefore, in this study, we aimed to clarify the factors influencing postoperative outcomes after SCR using tensor fascia lata graft, for which we evaluated the Hamada grade, patients with or without PPS, and the status of the subscapularis tendon (SSC). METHODS In total, 54 consecutive patients with irreparable rotator cuff tears or PPS who underwent SCR between June 2014 and October 2018 were included. The enrolled patients were grouped and compared as follows: (1) Hamada grade 2 (11 patients) and Hamada grade 3 (43 patients) and (2) non-PPS (22 patients), moderate PPS (16 patients), and severe PPS (16 patients). For subanalysis, the 32 PPS patients were divided into 3 groups: intact SSC (11 patients), repairable SSC (16 patients), and irreparable SSC (5 patients). To assess shoulder function, the American Shoulder and Elbow Surgeons (ASES) score was evaluated before surgery and at 24 months postoperatively; shoulder range of motion was evaluated at 2, 3, 4, 5, 6, 8, 10, 12, and 24 months postoperatively. RESULTS No significant differences in postoperative ASES scores and shoulder range of motion were observed between the Hamada grade 2 and grade 3 groups or between the non-PPS, moderate PPS, and severe PPS groups. However, significant differences in postoperative shoulder elevation and ASES scores were observed between the intact SSC and irreparable SSC groups (P = .006) and between the repairable SSC and irreparable SSC groups (P = .003). CONCLUSIONS This study demonstrated that the status of the SSC, rather than the Hamada grade or the presence or absence of PPS, influences the clinical outcomes after SCR. Therefore, reparability or intactness of the SSC is an important factor in considering the surgical indication for SCR.
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Affiliation(s)
- Kazumasa Takayama
- Department of Orthopedics, Kurashiki Central Hospital, Kurashiki, Japan.
| | - Shunsuke Yamada
- Department of Orthopedics, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yuu Kobori
- Department of Orthopedics, Kurashiki Central Hospital, Kurashiki, Japan
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Sommer MC, Wagner E, Zhu S, McRae S, MacDonald PB, Ogborn D, Woodmass JM. Complications of Superior Capsule Reconstruction for the Treatment of Functionally Irreparable Rotator Cuff Tears: A Systematic Review. Arthroscopy 2021; 37:2960-2972. [PMID: 33887411 DOI: 10.1016/j.arthro.2021.03.076] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review is to characterize the complications associated with superior capsule reconstruction (SCR) for the treatment of functionally irreparable rotator cuff tears (FIRCTs). METHODS This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two independent reviewers completed a search of PubMed, Embase, and Medline databases. Studies were deemed eligible for inclusion if they reported postoperative outcomes of arthroscopic SCR for FIRCTs and considered at least 1 postoperative complication. Statistical heterogeneity was quantified via the I2 statistic. Due to marked heterogeneity, pooled proportions were not reported. All complications and patient-reported outcomes were described qualitatively. RESULTS Fourteen studies met the inclusion/exclusion criteria. The overall complication rate post-SCR ranged from 5.0% to 70.0% (I2 = 84.9%). Image-verified graft retear ranged from 8% to 70%, I2 = 79.4%), with higher rates reported when SCR was performed using allograft (19%-70%, I2 76.6%) compared to autograft (8%-29%, I2 = 66.1%). Reoperation (0%-36%, I2 = 73.4%), revision surgeries (0%-21%, I2 = 81.2%), medical complications (0%-5%, I2 = 0.0%), and infections (0%-5%, I2 = 0.0%) were also calculated. CONCLUSIONS SCR carries a distinct complication profile when used for the treatment of FIRCTs. The overall rate of complications ranged from 5.0% to 70.0%. The most common complication is graft retear with higher ranges in allografts (19%-70%) compared to autografts (8%-29%). The majority of studies reported at least 1 reoperation (range, 0%-36%), most commonly for revision to reverse shoulder arthroplasty. LEVEL OF EVIDENCE Level IV, systematic review of Level IV or better investigations.
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Affiliation(s)
- Micah C Sommer
- Pan Am Clinic, Winnipeg, Manitoba, Canada; Department of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eric Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Sophie Zhu
- Pan Am Clinic, Winnipeg, Manitoba, Canada; Department of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheila McRae
- Pan Am Clinic, Winnipeg, Manitoba, Canada; Department of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter B MacDonald
- Pan Am Clinic, Winnipeg, Manitoba, Canada; Department of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Ogborn
- Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Jarret M Woodmass
- Pan Am Clinic, Winnipeg, Manitoba, Canada; Department of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
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St Pierre P, Millett PJ, Abboud JA, Cordasco FA, Cuff DJ, Dines DM, Dornan GJ, Duralde XA, Galatz LM, Jobin CM, Kuhn JE, Levine WN, Levy JC, Mighell MA, Provencher MT, Rakowski DR, Tibone JE, Tokish JM. Consensus statement on the treatment of massive irreparable rotator cuff tears: a Delphi approach by the Neer Circle of the American Shoulder and Elbow Surgeons. J Shoulder Elbow Surg 2021; 30:1977-1989. [PMID: 34116192 DOI: 10.1016/j.jse.2021.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/09/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Management of massive irreparable rotator cuff tears (MIRCTs) remains controversial owing to variability in patient features and outcomes contributing to a lack of unanimity in treatment recommendations. The purpose of this study was to implement the Delphi process using experts from the Neer Circle of the American Shoulder and Elbow Surgeons to determine areas of consensus regarding treatment options for a variety of MIRCTs. METHODS A panel of 120 shoulder surgeons were sent a survey regarding MIRCT treatments including arthroscopic débridement and partial cuff repair, graft augmentation, reverse shoulder arthroplasty (RSA), superior capsular reconstruction (SCR), and tendon transfer. An iterative Delphi process was then conducted with a first-round questionnaire consisting of 13 patient factors with the option for open-ended responses to identify important features influencing the treatment of MIRCTs. The second-round survey sought to determine the importance of patient factors related to the 6 included treatment options. A third-round survey asked participants to classify treatment options for 60 MIRCT patient scenarios as either preferred treatment, acceptable treatment, not acceptable/contraindicated, or unsure/no opinion. Patient scenarios were declared to achieve consensus for the preferred and not acceptable/contraindicated categories when at least 80% of the survey respondents agreed on a response, and a 90% threshold was required for the acceptable treatment category, defined by an acceptable treatment or preferred treatment response. RESULTS Seventy-two members agreed to participate and were deemed to have the requisite expertise to contribute based on their survey responses regarding clinical practice and patient volume. There were 20 clinical scenarios that reached 90% consensus as an acceptable treatment, with RSA selected for 18 scenarios and arthroscopic débridement and/or partial repair selected for 2. RSA was selected as the singular preferred treatment option in 8 scenarios. Not acceptable/contraindicated treatment options reached consensus in 8 scenarios, of which, 4 related to SCR, 3 related to RSA, and 1 related to partial repair with graft augmentation. CONCLUSION This Delphi process exhibited significant consensus regarding RSA as a preferred treatment strategy in older patients with pseudoparesis, an irreparable subscapularis, and dynamic instability. In addition, the process identified certain unacceptable treatments for MIRCTs such as SCR in older patients with pseudoparesis and an irreparable subscapularis or RSA in young patients with an intact or reparable subscapularis without pseudoparesis or dynamic instability. The publication of these scenarios and areas of consensus may serve as a useful guide for practitioners in the management of MIRCTs.
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Affiliation(s)
- Patrick St Pierre
- Eisenhower Health, Desert Orthopedic Center, Rancho Mirage, CA, USA.
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Joseph A Abboud
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Frank A Cordasco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Derek J Cuff
- Suncoast Orthopaedic Surgery and Sports Medicine, Venice, FL, USA
| | - David M Dines
- Sports Medicine Institute, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | | | - Leesa M Galatz
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Charles M Jobin
- Department of Orthopedic Surgery, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - John E Kuhn
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | | | | | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | | | - James E Tibone
- Kerlan-Jobe Orthopedic Clinic, Keck USC School of Medicine, Los Angeles, CA, USA
| | - John M Tokish
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Misir A, Uzun E, Kizkapan TB, Ozcamdalli M, Sekban H, Guney A. Factors Affecting Prolonged Postoperative Pain and Analgesic Use After Arthroscopic Full-Thickness Rotator Cuff Repair. Orthop J Sports Med 2021; 9:23259671211012406. [PMID: 34368377 PMCID: PMC8299889 DOI: 10.1177/23259671211012406] [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: 01/04/2021] [Accepted: 02/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Postoperative pain and analgesic use after arthroscopic rotator cuff repair remain important issues that affect rehabilitation and overall outcomes. Purpose: To evaluate the pre- and intraoperative factors that may cause prolonged duration of postoperative pain and analgesic use. Study Design: Case-control study; Level of evidence, 3. Methods: We included 443 patients who underwent arthroscopic rotator cuff repair and subacromial decompression. Visual analog scale (VAS) scores for pain were obtained preoperatively and at 30 and 90 days postoperatively. Patients were divided into a group who had prolonged postoperative pain (duration ≥1 and <3 months; n = 86 patients) and a group with nonprolonged pain (duration <1 month; n = 357 patients). The following factors were compared between groups: age, sex, body mass index, repair technique, tear size, retraction amount, repair tension, tendon degeneration, preoperative pseudoparesis, symptom duration, application of microfracture to the rotator cuff footprint for marrow stimulation, smoking, degree of fatty degeneration, preoperative narcotic analgesic use, diabetes, acromioclavicular joint degeneration, and preoperative Douleur Neuropathique 4 (DN4) and American Shoulder and Elbow Society (ASES) scores. Results: Significant differences were seen between the prolonged and nonprolonged groups regarding the median duration of pain (54 vs 27 days, respectively; P < .001) and analgesic use (42 vs 28 days, respectively; P < .001). Significant differences were noted between the groups for symptom duration (P = .007), smoking status (P = .001), degree of fatty degeneration (P = .009), preoperative narcotic analgesic use (P < .001), preoperative DN4 and ASES scores, 30-day VAS score (P < .001), duration of opioid and nonopioid analgesic use (P < .001), tear size (P = .026), and retraction stage (P = .032). Tear size (P = .009), retraction amount (P = .005), preoperative narcotic analgesic use (P < .001), degree of fatty degeneration (P < .001), and preoperative DN4 score (P = .024) were factors independently associated with prolonged postoperative pain and analgesic use. Conclusion: Patients with larger size tears, retracted tendons, preoperative use of narcotic analgesics, higher tensioned tendon after repair, and Goutallier grade 3 or 4 fatty degeneration faced an increased risk of prolonged postoperative pain and analgesic use after arthroscopic rotator cuff repair. These factors might be mitigated by psychosocial support; gentle, controlled, and individualized postoperative rehabilitation approaches; detailed preoperative evaluation; and closer follow-up of patients who are treated operatively.
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Affiliation(s)
- Abdulhamit Misir
- Istanbul Basaksehir Pine and Sakura City Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Erdal Uzun
- Erciyes University Faculty of Medicine, Department of Orthopaedics and Traumatology, Kayseri, Turkey
| | - Turan Bilge Kizkapan
- Bursa Cekirge State Hospital, Department of Orthopaedics and Traumatology, Bursa, Turkey
| | - Mustafa Ozcamdalli
- Istanbul Basaksehir Pine and Sakura City Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Hazim Sekban
- Health Sciences University Kayseri City Training and Research Hospital, Department of Orthopaedics and Traumatology, Kayseri, Turkey
| | - Ahmet Guney
- Erciyes University Faculty of Medicine, Department of Orthopaedics and Traumatology, Kayseri, Turkey
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Checchia CS, Silva LAD, Sella GDV, Fregoneze M, Miyazaki AN. Current Options in Tendon Transfers for Irreparable Posterosuperior Rotator Cuff Tears. Rev Bras Ortop 2021; 56:281-290. [PMID: 34239191 PMCID: PMC8249074 DOI: 10.1055/s-0040-1709988] [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: 07/07/2019] [Accepted: 01/10/2020] [Indexed: 10/28/2022] Open
Abstract
Massive irreparable posterosuperior rotator-cuff tears are debilitating lesions that usually require surgical treatment. Even though there is no consensus regarding the best surgical technique, tendinous transfers around the shoulder are the most commonly performed procedures. The latissimus dorsi tendon remains the most commonly used, but different modifications to the original technique have been shown to minimize complications and to improve functional results and satisfaction. Other techniques, such as the transfer of the lower trapezius tendon, are promising and should be considered, especially for patients with isolated loss of external rotation. The present paper is a literary review regarding tendon transfers for irreparable posterosuperior rotator-cuff tears.
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Affiliation(s)
- Caio Santos Checchia
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Luciana Andrade da Silva
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Guilherme do Val Sella
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Marcelo Fregoneze
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Alberto Naoki Miyazaki
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
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Kim DH, Jung YS, Kim KR, Yoon JP. The best options in superior capsular reconstruction. Clin Shoulder Elb 2021; 24:114-121. [PMID: 34078021 PMCID: PMC8181844 DOI: 10.5397/cise.2021.00136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022] Open
Abstract
Irreparable massive rotator cuff tears cause pain, loss of function, and a decrease in range of motion, which cause serious disturbances in daily life. Young patients, in particular, are active and have relatively high functional requirements, and their surgical options are limited. Superior capsular reconstruction (SCR) was first proposed for irreparable massive rotator cuff tears, good clinical results have been reported in short-term follow up. Since then, SCR has been used increasingly worldwide for irreparable massive rotator cuff tears, and various studies have been published on clinical outcomes, biomechanical outcomes, surgical techniques, and graft types. This article reviews the optimal graft and surgical options for improving clinical outcomes in SCR.
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Affiliation(s)
- Dong Hyun Kim
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young Soo Jung
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyung-Rock Kim
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong Pil Yoon
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Kim JH, Lee HJ, Park TY, Lee JU, Kim YS. Preliminary outcomes of arthroscopic biceps rerouting for the treatment of large to massive rotator cuff tears. J Shoulder Elbow Surg 2021; 30:1384-1392. [PMID: 32919044 DOI: 10.1016/j.jse.2020.08.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND We aimed to evaluate the short-term outcomes of arthroscopic biceps rerouting (ABR) for the treatment of large to massive rotator cuff tears (LMRCTs). METHODS A prospective evaluation of patients treated with ABR for the repair of LMRCTs was performed, with a minimum follow-up period of 18 months. Range of motion and functional outcomes (visual analog scale pain score, American Shoulder and Elbow Surgeons score, and Korean Shoulder Scale score) were assessed preoperatively and at final follow-up. Radiographs were used to evaluate the acromiohumeral interval (AHI). Magnetic resonance imaging was performed at 2 and 12 months postoperatively to examine the integrity of the repaired rotator cuff tendons. RESULTS Eighty patients who met the study criteria underwent ABR from March 2017 to January 2019 in our hospital. Of these patients, 61 could be evaluated ≥18 months after surgery. The average age of the enrolled patients was 64.5 years. The visual analog scale pain score decreased from 3.7 preoperatively to 1.6 at final follow-up (P = .019), the American Shoulder and Elbow Surgeons score improved from 60.0 to 85.2 (P < .001), and the Korean Shoulder Scale score improved from 64.3 to 85.3 (P = .001). Assessment of range of motion showed significant improvement in forward flexion (from 138° to 146°, P < .001), external rotation at 90° of abduction (from 80° to 85°, P = .037), and internal rotation (from spinal level 9 to spinal level 10, P = .015) from preoperatively to last follow-up. The AHI was 7.1 mm at baseline and improved significantly to 9.7 mm at 3 months postoperatively (P < .001). The mean AHI at last follow-up was only 9 mm, but this was still significantly better than the mean preoperative AHI (P < .001). Of the patients, 16 (26%) exhibited a retear of the repaired rotator cuff on magnetic resonance imaging at 12 months postoperatively. Male sex was the only significant risk factor for retear (P = .037). CONCLUSION ABR improved the functional and radiologic outcomes of patients with LMRCTs. The ABR technique can be a useful treatment option for LMRCTs.
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Affiliation(s)
- Jong-Ho Kim
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyo-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Yong Park
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-U Lee
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Inui H, Yamada J, Nobuhara K. Does Margin Convergence Reverse Pseudoparalysis in Patients with Irreparable Rotator Cuff Tears? Clin Orthop Relat Res 2021; 479:1275-1281. [PMID: 33394763 PMCID: PMC8133065 DOI: 10.1097/corr.0000000000001617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/02/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Margin convergence has been shown to restore muscle tension in a cadaveric model of a rotator cuff tear. However, the clinical utility of this technique remains uncertain for patients with pseudoparalysis caused by an irreparable rotator cuff tear. QUESTIONS/PURPOSES (1) For patients with massive irreparable rotator cuff tears, in what proportion of patients does margin convergence reverse pseudoparalysis? (2) In patients with massive irreparable rotator cuff tears, does margin convergence improve American Shoulder and Elbow Surgeons (ASES) scores? (3) What is the survivorship free from MRI evidence of retear after margin convergence? METHODS Between 2000 and 2015, we treated 203 patients for pseudoparalysis with a rotator cuff tear. Pseudoparalysis was defined as active elevation less than 90° with no stiffness, which a physical therapist evaluated in the sitting position using a goniometer after subacromial injection of 10 cc lidocaine to eliminate pain. Of those, we considered patients who underwent at least 3 weeks of unsuccessful nonoperative treatment in our hospital as potentially eligible. Twenty-one percent (43 of 203) who either improved or were lost to follow-up within 3 weeks of nonoperative treatment were excluded. A further 12% (25 of 203) were excluded because of cervical palsy, axillary nerve palsy after dislocation or subluxation, and development of severe shoulder stiffness (passive shoulder elevation < 90°). Repair was the first-line treatment, but if tears were considered irreparable with the torn tendon unable to reach the original footprint after mobilizing the cuff during surgery, margin convergence was used. When margin convergence failed, the procedure was converted to hemiarthroplasty using a small humeral head to help complete the repair. Therefore, 21% (42 of 203) of patients treated with regular repair (18% [36 of 203]) or hemiarthroplasty (3% [6 of 203]) were excluded. That left 93 patients eligible for consideration. Of those, 13 patients were lost before the minimum study follow-up of 2 years or had incomplete datasets, and 86% (80 of 93) were analyzed (49 men and 31 women; mean age 68 ± 9 years; mean follow-up 26 ± 4 months). Seventy-six percent (61 of 80) were not evaluated in the last 5 years. We considered reversal of pseudoparalysis as our primary study outcome of interest; we defined this as greater than 90° active forward elevation; physical therapists in care measured this in the sitting position by using goniometers. Clinical outcomes were evaluated based on the ASES score from chart review, active ROM in the shoulder measured by the physical therapists, and the 8-month Kaplan-Meier survivorship free from MRI evidence of retear graded by the first author. RESULTS Pseudoparalysis was reversed in 93% (74 of 80) patients, and improvement in ASES scores was observed at the final follow-up (preoperative 22 ± 10 to postoperative 62 ± 21, mean difference 40 [95% CI 35 to 45]; p < 0.01). The 8-month Kaplan-Meier survivorship free from MRI evidence of retear after surgery was 72% (95% CI 63% to 81%). There were no differences in clinical scores between patients with and without retears (intact ASES 64 ± 24, re-tear ASES 59 ± 10, mean difference 6 [95% CI -5 to 16]; p = 0.27). CONCLUSION Margin convergence can be a good option for treating patients with pseudoparalysis and irreparable rotator cuff tears despite the relatively high retear rates. The proportion of pseudoparalysis reversal was lower in patients with three-tendon involvement. Further studies will be needed to define the appropriate procedure in this group. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Hiroaki Inui
- H. Inui, J. Yamada, K. Nobuhara, Nobuhara Hospital & Institute of Biomechanics, Hyogo, Japan
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Fahey CJ, Delaney RA. Exploring expert variability in defining pseudoparalysis: an international survey. J Shoulder Elbow Surg 2021; 30:e237-e244. [PMID: 32919050 DOI: 10.1016/j.jse.2020.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is currently disagreement among experts in the field of shoulder surgery when attempting to define the term "pseudoparalysis." Multiple surgical techniques to address this condition have been investigated; however, many studies have recruited heterogeneous patient populations and have used varying definitions of pseudoparalysis. This makes it difficult to compare outcomes among various techniques. To our knowledge, no previous study has surveyed international experts regarding the definition of pseudoparalysis using a questionnaire and video-based patient assessment. The purpose of this study was to evaluate the level of agreement among shoulder surgeons in defining and applying the term "pseudoparalysis." We hypothesized that inter-rater agreement for classifying patients as having pseudoparalysis would be poor. METHODS Members of the American Shoulder and Elbow Surgeons, the European Society for Surgery of the Shoulder and the Elbow, and our national shoulder and elbow society were surveyed on 2 occasions using an electronic questionnaire. All surgeons were asked to identify their preferred definition of pseudoparalysis from 1 of 4 options. The surgeons then viewed video examinations of 10 patients and labeled them as having pseudoparalysis or not. Inter-rater reliability and intrarater reliability were calculated as κ coefficients. The Pearson χ2 test was used to detect associations between the preferred definition and demographic information. RESULTS A total of 246 surgeons responded to at least 1 survey. Overall inter-rater agreement on classifying patients as having pseudoparalysis based on video consultation showed a κ value of 0.59 (95% confidence interval [CI], 0.58-0.60). The same verbal definition was selected by 56.1% of surgeons. The surgeons were not internally consistent in their choice of definition, with intrarater reliability showing a κ value of 0.64 (95% CI, 0.48-0.81). Intrarater reliability for classifying patients as having pseudoparalysis was better, with a κ value of 0.78 (95% CI, 0.72-0.83). An association was observed between how surgeons defined pseudoparalysis and their age (P = .03), as well as their shoulder caseload percentage (P = .04). CONCLUSION Shoulder surgeons do not agree on how best to define pseudoparalysis of the shoulder. Inter-rater agreement based on video consultation was weak overall and improved with the elimination of an outlier video. Intrarater agreement was less frequent when selecting a preferred definition compared with classifying patients as having pseudoparalysis based on video examinations. Surgeons may rely less on explicit criteria and more on a conceptual framework when assigning a "pseudoparalytic" label. Care should be taken with use of the term "pseudoparalysis" in clinical outcome studies when there is clearly a lack of consensus among experts in defining this term.
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Affiliation(s)
- Curtis J Fahey
- School of Medicine, University College Cork, Cork, Ireland
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Sahara W, Yamazaki T, Inui T, Konda S. Three-dimensional kinematic features in large and massive rotator cuff tears with pseudoparesis. J Shoulder Elbow Surg 2021; 30:720-728. [PMID: 32750530 DOI: 10.1016/j.jse.2020.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although massive rotator cuff tears occasionally lead to severe impairment of shoulder function, the criteria for losing the ability to elevate the arm are unclear. This study aimed to analyze the features of both tear size and 3-dimensional (3D) shoulder kinematics that correspond to the loss of the ability to elevate the arm in patients with large and massive rotator cuff tears. METHODS We prospectively enrolled patients with rotator cuff tears, including the supraspinatus and more than half of the subscapularis or more than two-thirds of the infraspinatus, without severe pain. A total of 13 patients (15 shoulders) were divided into 2 groups: 9 shoulders in the pseudoparesis (P) group and 6 shoulders in the non-pseudoparesis (NP) group. Fluoroscopic images were collected during active scapular-plane elevation, and 3D shoulder kinematics was analyzed using 2-dimensional-3D registration techniques. The radiographic findings and 3D kinematic results were compared between the groups. The correlation between tear size and 3D kinematics was also investigated. RESULTS The most superior position of the humeral head center was significantly higher in the P group (6.7 ± 3.0 mm in P group vs. 3.6 ± 1.3 mm in NP group, P = .0321). Superior migration, which was defined as the most superior position > 5 mm, was significantly more frequent in the P group (7 shoulders and 1 shoulder in the P and NP groups, respectively; P = .0201). Thoracohumeral external rotation was significantly smaller in the P group (16° ± 31° in P group vs. 91° ± 21° in NP group, P < .0001). The total tear size and the tear sizes of the anterior and posterior rotator cuffs were significantly correlated with the superior (r = 0.68, P = .0056), anterior (r = 0.68, P = .0058), and posterior (r = -0.80, P = .0004) positions of the humeral head center. The tear size of the posterior rotator cuff also tended to be correlated with glenohumeral external rotation (r = -0.48, P = .0719). CONCLUSION Anterior and posterior rotator cuff tears cause significant superior and anteroposterior translations of the humeral head, and posterior cuff tears may lead to loss of glenohumeral external rotation. With these abnormal kinematics, superior migration and loss of thoracohumeral external rotation were identified as features of pseudoparesis.
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Affiliation(s)
- Wataru Sahara
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Takaharu Yamazaki
- Department of Information Systems, Saitama Institute of Technology, Fukaya, Japan
| | - Tetsuya Inui
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shoji Konda
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Suita, Japan
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Young BL, Hamid N. Response to Letter to the Editor regarding: "Reverse shoulder arthroplasty with and without latissimus and teres major transfer for patients with combined loss of elevation and external rotation: a prospective, randomized investigation". J Shoulder Elbow Surg 2021; 30:e173-e174. [PMID: 33359904 DOI: 10.1016/j.jse.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Bradley L Young
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Nady Hamid
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA; OrthoCarolina Shoulder and Elbow Center, Charlotte, NC, USA.
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Reverse total shoulder arthroplasty for patients with minimal preoperative pain: a matched-cohort analysis. J Shoulder Elbow Surg 2021; 30:609-615. [PMID: 32650079 DOI: 10.1016/j.jse.2020.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Profound improvements in function have been described in patients following reverse total shoulder arthroplasty (RSA). Previous studies have demonstrated young age, high preoperative function, and neurologic dysfunction to be predictors of poor functional improvement. However, no study to date has focused on patients electing to undergo RSA for function more than pain. The purpose of this study was to compare the outcomes of RSA in patients with minimal preoperative pain with those in patients who have higher baseline pain. METHODS We performed a retrospective matched-cohort study of RSA patients treated by a single surgeon with a minimum of 2 years' follow-up. Patients with at least moderate baseline pain (function-pain group), predefined by existing literature as a visual analog scale pain score > 3, were matched 3:1 based on sex, indication, and age to patients with minimal pain (function group), defined as a visual analog scale score ≤ 3. Patient-reported outcome measures, active range of motion, and overall satisfaction were compared. The percentage of maximal improvement in outcomes and the proportion of patients exceeding the established threshold that predicts excellent satisfaction were also compared. RESULTS A total of 260 patients (195 in function-pain group and 65 in function group) were selected for matched analysis with a similar sex distribution; the mean age was 73.1 years, and the mean follow-up period was 50 months. No differences in most recent postoperative function, overall improvement in functional scores, and active motion were found between patients in the 2 groups (P > .05). However, pain scores improved only in patients with at least moderate baseline pain (P < .0001). Patient satisfaction was significantly different (P = .035), as 10.8% of patients who elected to undergo RSA for function were unsatisfied. The function cohort also had worse percentage of maximal Simple Shoulder Test score (P = .034) and American Shoulder and Elbow Surgeons score (P < .0001) improvement, and a lower proportion of these patients exceeded the threshold for the percentage of maximal improvement that predicts an "excellent" outcome (P < .0001). CONCLUSION RSA patients with minimal preoperative pain achieve significant improvements in function and motion similar to those who choose to undergo RSA for both pain and function, but they are less satisfied and are less likely to achieve an excellent outcome. Patients electing to proceed with RSA with minimal pain should be counseled accordingly.
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Plachel F, Siegert P, Moroder P, Pauzenberger L, Laky B, Anderl W, Heuberer P. Treatment of non-arthritic pseudoparetic shoulders with irreparable massive rotator cuff tears: arthroscopic procedures yield comparable midterm results to reverse arthroplasty. BMC Musculoskelet Disord 2021; 22:190. [PMID: 33593357 PMCID: PMC7885458 DOI: 10.1186/s12891-021-04050-w] [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: 10/29/2020] [Accepted: 02/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background Irreparable massive rotator cuff tears (IMRCTs) are a well-known cause for functional limitation and difficult to treat. Although several joint-preserving as well as joint-replacing procedures were found to provide pain relief and gain of function, midterm results are scarce, particularly in pseudoparetic shoulder joints unaccompanied by severe osteoarthritis. The purpose of this study was to compare the midterm functional outcomes of arthroscopic procedures to those of reverse total shoulder arthroplasty (RTSA) in pseudoparetic shoulders with IMRCTs unaccompanied by severe osteoarthritis. Methods All patients who underwent either joint-preserving (group A) or joint-replacing (group B) procedures for IMRCT unaccompanied by severe osteoarthritis with a pseudoparetic shoulder function were retrospectively included. Clinical assessment included the Constant Score (CS), the Subjective Shoulder Value (SSV) and the Visual Analog Score (VAS) at baseline and at latest follow-up. Furthermore, the complication and revision rates were assessed. Results Overall, a total 56 patients were included of whom each 28 patients formed group A (male, 36%) and B (male, 53%) with a mean patient age at time of surgery of 70 ± 7 years and 72 ± 7 years, respectively. The mean follow-up period was 56 ± 17 months. At final follow-up, the total CS (group A: 66 ± 14 points; group B 54 ± 15 points) was significantly increased after arthroscopic treatment when compared to RTSA (p=0.011). However, no significant differences were detected with SSV (p=0.583) and VAS (p=0.536). Although complication rate (11% versus 18%) was not significantly different (p=0.705), number of revision surgeries was significantly higher in group B when compared to group A (p=0.041). Conclusions In non-arthritic pseudoparetic shoulders, both joint-preserving and joint-replacing procedures yielded good clinical midterm outcomes for the treatment of degenerative IMRCTs. Despite of comparable functional and satisfactory functional improvement, increased complication rates and surgical invasiveness outweigh the benefits of primary RTSA and therefore reserve this procedure to a second-line treatment in pseudoparetic patients without any signs of severe cuff arthropathy.
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Affiliation(s)
- Fabian Plachel
- Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin, Berlin, Germany.,Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Paul Siegert
- Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin, Berlin, Germany
| | - Philipp Moroder
- Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin, Berlin, Germany
| | - Leo Pauzenberger
- Department of Orthopedics, St. Vincent Hospital Vienna, Hartmanngasse 15/9, 1050, Vienna, Austria
| | - Brenda Laky
- Department of Orthopedics, St. Vincent Hospital Vienna, Hartmanngasse 15/9, 1050, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine, Hartmanngasse 15/9, 1050, Vienna, Austria
| | - Werner Anderl
- Department of Orthopedics, St. Vincent Hospital Vienna, Hartmanngasse 15/9, 1050, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine, Hartmanngasse 15/9, 1050, Vienna, Austria
| | - Philipp Heuberer
- Department of Orthopedics, St. Vincent Hospital Vienna, Hartmanngasse 15/9, 1050, Vienna, Austria. .,Austrian Research Group for Regenerative and Orthopedic Medicine, Hartmanngasse 15/9, 1050, Vienna, Austria.
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Irreparable Rotatorenmanschette. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00445-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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