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Zhao J, Huang H, Zeng L, Pan J, Liu J, Luo M. Acromioplasty combined with arthroscopic rotator cuff repair can reduce the risk of reoperation: a systematic review and meta-analysis. Postgrad Med 2024; 136:666-677. [PMID: 38975648 DOI: 10.1080/00325481.2024.2377533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Whether to perform acromioplasty in arthroscopic rotator cuff repair (ARCR) is controversial, and the optimal surgical approach for rotator cuff tear repair is unknown. The purpose of this study was to compare the reoperation rate, retear rate and patient-reported outcomes (PROs) of ARCR with those of ARCR combined with acromioplasty (ARCR-A). METHODS PubMed, Embase and Cochrane Library were searched for relevant literature dated between database inception and 4 December 2023. The primary outcomes of this study were the reoperation rate and the retear rate. The secondary outcomes were PROs, including the visual analogue scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the University of California-Los Angeles (UCLA) score, the Constant score and the Western Ontario Rotator Cuff (WORC) score. The quality of the included studies was evaluated by using the risk of bias assessment tool. RevMan 5.3 software was used for meta-analysis. Fixed (I2 <50%) or random (I2 ≥50%) effects models were applied to calculate the effect size. RESULTS Meta-analysis revealed that ARCR-A had a lower reoperation rate (OR = 0.35, 95%CI: 0.15-0.85, p = 0.02), but the difference in the retear rate between ARCR-A and ARCR was not significant (p = 0.25). In type 2 acromion patients, the reoperation rate was not significantly different between ARCR and ARCR-A (p = 0.12), but, for type 3 acromion patients, the retear rate was lower for ARCR-A than for ARCR (OR = 0.12, 95%CI: 0.01-0.94, p = 0.04). There were statistically significant differences in the 6-month postoperative Constant scores (p < 0.001), VAS pain scores (p = 0.003) 12-month postoperative ASES scores (p = 0.02) and 24-month postoperative WORC scores (p = 0.04), but these differences were not clinically significant. CONCLUSIONS Combining ARCR with acromioplasty can reduce the rate of reoperation, especially in patients with type 3 acromion, but it provides no clinically important change in the retear rate and postoperative PRO compared with ARCR.
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Affiliation(s)
- Jinlong Zhao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Hetao Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Lingfeng Zeng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jianke Pan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
| | - Minghui Luo
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Zhuhai, China
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Noh KC, Lee S, Park CW, Bai H, Kim JY. Three-Dimensional Morphological Analysis of the Suprascapular Notch in Patients with Arthroscopic Rotator Cuff Repair. Clin Orthop Surg 2024; 16:586-593. [PMID: 39092301 PMCID: PMC11262953 DOI: 10.4055/cios24013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 08/04/2024] Open
Abstract
Background The morphology of the suprascapular notch (SSN) and the ossification of the superior transverse suprascapular ligament (STSL) are risk factors for injury of the suprascapular nerve (SN) during arthroscopic shoulder procedures. The purpose of the current study was to compare preoperative clinical and radiologic characteristics between patients with and without STSL ossification and to evaluate SSN morphology in patients who underwent arthroscopic rotator cuff repair using a 3-dimensional (3D) reconstructed model. Methods Patients who underwent arthroscopic rotator cuff repair and were given a computed tomography (CT) scan from March 2018 to August 2019 were included in this study. Patients were divided into 2 groups: those without STSL ossification (group I) and those with STSL ossification (group II). Tear size of the rotator cuff and fatty infiltration of rotator cuff muscles were assessed in preoperative magnetic resonance imaging. The morphology of the SSN was classified following Rengachary's classification. The transverse and vertical diameters of the SSN and the distances from anatomical landmarks to the STSL were measured. All measurements were completed using a 3D CT reconstructed scapula model. Results A total of 200 patients were included in this study. One hundred seventy-eight patients (89.0%) without STSL ossification were included in group I, and 22 patients (11.0%) with STSL ossification were included in group II. Group II showed a significantly advanced age (61.0 ± 7.4 vs. 71.0 ± 7.3 years, p < 0.001) and a shorter transverse diameter of SSN (10.7 ± 3.1 mm vs. 6.1 ± 3.7 mm, p < 0.001) than group I. In the logistic regression analysis, age was an independent prognostic factor for STSL ossification (odds ratio, 1.201; 95% confidence interval, 1.112-1.296; p < 0.001). Patients in type VI showed significantly shorter transverse diameters than other types (p < 0.001). The patient with type I showed a significantly shorter distance from the articular surface of the glenoid to the SSN than those with other types (p < 0.001). Conclusions In the 3D morphological analysis, age was the independent factor associated with STSL ossification in patients who underwent arthroscopic rotator cuff repair. Type VI showed significantly shorter transverse diameters than other types. Type I showed a significantly shorter distance from the articular surface of the glenoid to the SSN than other types.
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Affiliation(s)
- Kyu Cheol Noh
- Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Korea
| | - Sanghyeon Lee
- Department of Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Chang Won Park
- Department of Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Haotian Bai
- Department of Orthopedic Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Jung-Youn Kim
- Department of Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
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Thorpe CR, Ucer Ozgurel S, Simko LC, Goldstein R, Grant GG, Pagani C, Hwang C, Vasquez K, Sorkin M, Vaishampayan A, Goverman J, Sheridan RL, Friedstat J, Schulz JT, Schneider JC, Levi B, Ryan CM. Investigation into Possible Association of Oxandrolone and Heterotopic Ossification Following Burn Injury. J Burn Care Res 2020; 40:398-405. [PMID: 31053861 DOI: 10.1093/jbcr/irz063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Oxandrolone, a testosterone analog, is used to counteract the catabolic effects of burn injury. Recent animal studies suggest a possible hormonal association with heterotopic ossification (HO) development postburn. This work examines oxandrolone administration and HO development by exploring historical clinical data bridging the introduction of oxandrolone into clinical practice. Additionally, we examine associations between oxandrolone administration and HO in a standardized mouse model of burn/trauma-related HO. Acutely burned adults admitted between 2000 and 2014, survived through discharge, and had a HO risk factor of 7 or higher were selected for analysis from a single burn center. Oxandrolone administration, clinical and demographic data, and elbow HO were recorded and were analyzed with logistic regression. Associations of oxandrolone with HO were examined in a mouse model. Mice were administered oxandrolone or vehicle control following burn/tenotomy to examine any potential effect of oxandrolone on HO and were analyzed by Student's t test. Subjects who received oxandrolone had a higher incidence of elbow HO than those that did not receive oxandrolone. However, when controlling for oxandrolone administration, oxandrolone duration, postburn day oxandrolone initiation, HO risk score category, age, sex, race, burn size, and year of injury, there was no significant difference between rates of elbow HO between the two populations. In agreement with the review, in the mouse model, while there was a trend toward the oxandrolone group developing a greater volume of HO, this did not reach statistical significance.
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Affiliation(s)
- Catherine R Thorpe
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts
| | | | - Laura C Simko
- Shriners Hospitals for Children-Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | | | - Gabrielle G Grant
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts
| | | | | | | | | | | | - Jeremy Goverman
- Massachusetts General Hospital, Boston.,Harvard Medical School, Cambridge, Massachusetts
| | - Robert L Sheridan
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Jonathan Friedstat
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - John T Schulz
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Jeffrey C Schneider
- Massachusetts General Hospital, Boston.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Benjamin Levi
- Shriners Hospitals for Children-Boston, Massachusetts
| | - Colleen M Ryan
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
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Cohn MR, Cregar WM, Drager J, Lu Y, Garrigues GE. Suprascapular Nerve Entrapment due to an Ossified Spinoglenoid Ligament After Scapular Fracture: A Case Report. JBJS Case Connect 2020; 10:e2000477. [PMID: 33784447 DOI: 10.2106/jbjs.cc.20.00477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CASE A 46-year-old man underwent open reduction and internal fixation (ORIF) of left scapular, humerus, and clavicle fractures after a snowmobile accident. He subsequently developed severe left infraspinatus weakness with electromyogram evidence of suprascapular entrapment at the spinoglenoid notch. Intraoperatively, suprascapular nerve compression from an ossified spinoglenoid ligament was observed. Scapular hardware was removed, the ossified ligament was resected, and neurolysis was performed. At 6 months postoperatively, the patient demonstrated return of infraspinatus function. CONCLUSION An ossified spinoglenoid ligament can contribute to suprascapular neuropathy after scapular fracture and ORIF. Open resection of the ossified ligament may lead to improved infraspinatus function.
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Affiliation(s)
- Matthew R Cohn
- 1Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
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LiBrizzi CL, Rojas JL, Bontrager NC, Srikumaran U, McFarland EG. Suprascapular nerve entrapment in young kayaker: a case report. PHYSICIAN SPORTSMED 2020; 48:236-240. [PMID: 31469970 DOI: 10.1080/00913847.2019.1662273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Kayaking has become one of the most popular paddle sports throughout the world. The shoulder is the most commonly injured area of the body among kayaking participants as a result of acute traumatic events and chronic overuse injuries. Therefore, kayaking participants may often seek advice for shoulder problems and there is a scarcity of studies regarding shoulder injuries in this population. In this case report, we present a young male recreational whitewater kayaker with a severe suprascapular nerve (SSN) entrapment who presented with shoulder pain and inability to perform his sport. He was initially evaluated elsewhere and was treated with nonsteroidal anti-inflammatory medications and physical therapy for presumptive diagnosis of subacromial impingement. After 5 months of failed non-operative treatment, the patient sought a second opinion with our group. SSN entrapment diagnosis was confirmed by a thorough careful physical examination, magnetic resonance imaging and electrodiagnostic study. Given the failure of non-operative treatment, the patient was treated with arthroscopic SSN decompression and successfully returned to kayaking without symptoms. While SSN entrapment has been reported in a variety of sports, especially those involving overhead movements, this is the first case report of SSN entrapment reported which impaired participation in kayaking. This case report supports the consideration of SSN entrapment in the differential diagnosis of painful shoulder among kayaking participants and highlights the importance of undressing the patient and examining the posterior shoulder for atrophy, winging or deformity.
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Affiliation(s)
- Christa L LiBrizzi
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Jorge L Rojas
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Nicholas C Bontrager
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Uma Srikumaran
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Edward G McFarland
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Long R, Wang N, Liu W, Liu Z, Cheng S, Zhang X, Geng X, Liu C, Wang J, Ding M, Tian Z, Li J. An anatomical study of the superior transverse scapular ligament of Jining population. Surg Radiol Anat 2019; 41:1345-1349. [PMID: 31506842 DOI: 10.1007/s00276-019-02330-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/31/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to determine the anatomical variations of the superior transverse scapular ligament (STSL) for better understanding the possible predisposing factors for suprascapular nerve entrapment. METHODS The study was using fifty 10% formalin solution-fixed human cadaveric shoulders. After dissection of the suprascapular region, the length, medial width, lateral width and middle width of the suprascapular opening were measured for each STSL. RESULTS The STSL displayed six types as: (1) band-shaped in 11 cases; (2) fan-shaped in 27 cases; (3) triangular-shaped in 5 cases; (4) linear type in 2 cases; (5) bifid in 1 case; (6) absent in 1 case. The ossified type of STSL was found in 3 cases. There were statistically significant differences in the length (P = 0.009), medial width (P = 0.001), lateral width (P = 0.029) of the three types of fan-shaped, band-shaped and triangular-shaped. However, there was no statistical difference in the middle width of the suprascapular opening of the three types (P = 0.340). CONCLUSION Knowing the morphological features and variations of the STSL is important for better understanding the anatomical conditions, which could be taken into consideration during open suprascapular operations or arthroscopic decompressions.
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Affiliation(s)
- Runyu Long
- Grade 2017 of Academy of Basic Medicine, Jining Medical University, Jining, Shandong, China
| | - Nan Wang
- Grade 2017 of Academy of Basic Medicine, Jining Medical University, Jining, Shandong, China
| | - Wentao Liu
- Grade 2017 of Academy of Basic Medicine, Jining Medical University, Jining, Shandong, China
| | - Zhiyang Liu
- Grade 2017 of Academy of Basic Medicine, Jining Medical University, Jining, Shandong, China
| | - Shihua Cheng
- Grade 2017 of Academy of Basic Medicine, Jining Medical University, Jining, Shandong, China
| | - Xin Zhang
- Grade 2018 of Academy of Basic Medicine, Jining Medical University, Jining, Shandong, China
| | - Xu Geng
- Grade 2018 of Academy of Basic Medicine, Jining Medical University, Jining, Shandong, China
| | - Chaotong Liu
- Grade 2017 of Academy of Basic Medicine, Jining Medical University, Jining, Shandong, China
| | - Ji Wang
- Grade 2017 of Academy of Basic Medicine, Jining Medical University, Jining, Shandong, China
| | - Mingqi Ding
- Grade 2017 of Academy of Basic Medicine, Jining Medical University, Jining, Shandong, China
| | - Ze Tian
- Grade 2018 of Academy of Basic Medicine, Jining Medical University, Jining, Shandong, China
| | - Jing Li
- Department of Anatomy, Academy of Basic Medicine, Jining Medical University, Jining, Shandong, China.
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