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Ruiz Ibán MÁ, García Navlet M, Moros Marco S, Diaz Heredia J, Hernando Sánchez A, Ruiz Díaz R, Vaquero Comino C, Rosas Ojeda ML, Del Monte Bello G, Ávila Lafuente JL. Augmentation of a Transosseous-Equivalent Repair in Posterosuperior Nonacute Rotator Cuff Tears With a Bioinductive Collagen Implant Decreases the Retear Rate at 1 Year: A Randomized Controlled Trial. Arthroscopy 2024; 40:1760-1773. [PMID: 38158165 DOI: 10.1016/j.arthro.2023.12.014] [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: 08/23/2023] [Revised: 11/25/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To determine whether the addition of a bioinductive collagen implant (BCI) over a transosseous equivalent (TOE) repair of medium-to-large posterosuperior rotator cuff tears improves the healing rate determined by magnetic resonance imaging (MRI) at 12-month follow-up. METHODS A Level I randomized controlled trial was performed in 124 subjects with isolated, symptomatic, reparable, full-thickness, medium-to-large posterosuperior nonacute rotator cuff tears, with fatty infiltration ≤2. These were randomized to 2 groups in which an arthroscopic posterosuperior rotator cuff tear TOE repair was performed alone (Control group) or with BCI applied over the TOE repair (BCI group). The primary outcome was the retear rate (defined as Sugaya 4-5) determined by MRI at 12 months of follow-up. Secondary outcomes were characteristics of the tendon (Sugaya grade and thickness of the healed tendon) and clinical outcomes (pain levels, EQ-5D-5L, American Shoulder and Elbow Surgeons, and Constant-Murley scores) at 12 months of follow-up. RESULTS Of the 124 randomized patients, 122 (60 in the BCI group and 62 in the Control group) were available for MRI evaluation 12.2 ± 1.02 months after the intervention. There were no relevant differences in preoperative characteristics. Adding the BCI reduced the retear rate (8.3% [5/60] in the BCI group vs 25.8% [16/62] in the Control group, P = .010; relative risk of retear of 0.32 [95% confidence interval 0.13-0.83]). Sugaya grade was also better in the BCI group (P = .030). There were no differences between groups in the percentage of subjects who reached the MCID for CMS (76.7% vs 81.7%, P = .654) or American Shoulder and Elbow Surgeons (75% vs 80%, P = .829), in other clinical outcomes or in complication rates at 12.4 ± 0.73 (range 11.5-17) months of follow-up. CONCLUSIONS Augmentation with a BCI of a TOE repair in a medium-to-large posterosuperior rotator cuff tear reduces the retear rate at 12-month follow-up by two-thirds, yielding similar improvements in clinical outcomes and without increased complication rates. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Miguel Ángel Ruiz Ibán
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Universitario Ramón y Cajal, Madrid, Spain; Departamento de de Cirugía, Ciencias Sanitarias Y Medicosociales, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain; Área De Traumatología y Ortopedia, Universidad CEU San Pablo, Madrid, Spain.
| | - Miguel García Navlet
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Asepeyo Coslada, Madrid, Spain
| | - Santos Moros Marco
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Maz Zaragoza, Zaragoza, Spain
| | - Jorge Diaz Heredia
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Universitario Ramón y Cajal, Madrid, Spain; Departamento de de Cirugía, Ciencias Sanitarias Y Medicosociales, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | - Arántzazu Hernando Sánchez
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Asepeyo Coslada, Madrid, Spain
| | - Raquel Ruiz Díaz
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Universitario Ramón y Cajal, Madrid, Spain; Departamento de de Cirugía, Ciencias Sanitarias Y Medicosociales, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | - Carlos Vaquero Comino
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Asepeyo Coslada, Madrid, Spain
| | - Maria Luisa Rosas Ojeda
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Gabriel Del Monte Bello
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Fraternidad-Muprespa Habana, Madrid, Spain
| | - Jose Luis Ávila Lafuente
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Maz Zaragoza, Zaragoza, Spain
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Clinker C, Ishikawa H, Presson AP, Zhang C, Joyce C, Chalmers PN, Tashjian RZ. The effect of lateralization and distalization after Grammont-style reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2024:S1058-2746(24)00348-3. [PMID: 38754540 DOI: 10.1016/j.jse.2024.03.049] [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: 09/04/2023] [Revised: 03/10/2024] [Accepted: 03/25/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The purpose of this study was to evaluate the relationship between multiple radiographic measures of lateralization and distalization and clinical outcome scores after a reverse total shoulder arthroplasty (RTSA). METHODS We retrospectively evaluated all RTSAs performed by the senior author between January 1, 2007, and November 1, 2017. We then evaluated the visual analog scale for pain (VAS pain), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) scores and complication and reoperation rates at a minimum of 2-year follow-up. We measured preoperative and postoperative (2-week) radiographs for the lateralization shoulder angle (LSA), the distalization shoulder angle (DSA), lateral humeral offset, and the distance from the glenoid to the lateral aspect of the greater tuberosity. A multivariable analysis was performed to evaluate the effect of the postoperative radiographic measurements on final patient-reported outcomes (ASES scores, SST, and VAS pain). RESULTS The cohort included 216 shoulders from unique patients who had patient-reported outcome scores available at a minimum of 2-year follow-up (average, 4.0 ± 1.9 years) for a total follow-up rate of 70%. In the multivariable models, more lateralization (LSA) was associated with worse final ASES scores -0.52 (95% confidence interval [CI]: -0.88, -0.17; P = .004), and more distalization (DSA) was associated with better final ASES scores 0.40 (95% CI: 0.11, 0.69; P = .007). More lateralization (LSA) was associated with worse final SST scores -0.06 (95% CI: -0.11, -0.003; P = .039). Finally, greater distalization (DSA) was associated with lower final VAS pain scores, ratio = 0.98 (95% CI: 0.96, 1.00; P = .021). CONCLUSIONS Greater distalization and less lateralization are associated with better function and less pain after a Grammont-style RTSA. When using a Grammont-style implant, remaining consistent with Grammont's principles of implant placement will afford better final clinical outcomes.
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Affiliation(s)
- Chris Clinker
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Hiroaki Ishikawa
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Christopher Joyce
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
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Gupta A, Italia K, Jomaa MN, Ker AM, Pareyon R, Tok AEH, Maharaj J, Whitehouse SL, Cutbush K. All-Arthroscopic Supraspinatus and Infraspinatus Muscle Advancement Leads to High Healing Rate and Excellent Outcomes in Patients With Massive, Retracted Rotator Cuff Tears, Even in Patients With Pseudoparalysis. Arthroscopy 2024:S0749-8063(24)00264-0. [PMID: 38599536 DOI: 10.1016/j.arthro.2024.03.041] [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: 11/01/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE To evaluate the clinical and radiographic outcomes of an all-arthroscopic rotator cuff repair technique involving muscle advancement and double-layer lasso loop (DLLL) repair for massive, retracted posterosuperior cuff tears. METHODS This was a retrospective case series of patients with massive, retracted posterosuperior cuff tears who underwent the all-arthroscopic muscle advancement technique from March 2017 to September 2021, with a minimum follow-up of 12 months. Key steps included suprascapular nerve release, advancement of the supraspinatus and infraspinatus muscles, and DLLL repair. Preoperative and postoperative visual analog scale score for pain, American Shoulder and Elbow Surgeons (ASES) shoulder score, Constant score, University of California, Los Angeles (UCLA) shoulder score, active range of motion, and strength were compared. Preoperative and postoperative structural radiologic characteristics were analyzed. RESULTS We evaluated 43 shoulders in 38 patients with a mean follow-up period of 18.8 months (range, 12-55 months). Of the 43 shoulders, 4 showed repair failure (9.3% retear rate). Visual analog scale, ASES, Constant, and UCLA scores significantly improved (P < .001) in patients who showed healing on postoperative magnetic resonance imaging (n = 39). ASES, Constant, and UCLA scores were significantly better in the healed group, with 100% exceeding the minimal clinically important difference for the ASES score and UCLA score and 84.2%, for Constant score. A lower proportion of patients in the retear group achieved the minimal clinically important difference. Active range of motion in all planes significantly improved for patients who had healed repairs (P < .001). Relative abduction strength, supraspinatus strength, and infraspinatus strength were at least 90% of those on the contralateral side. The recovery rate of pseudoparalysis (7 patients) was 100%. CONCLUSIONS All-arthroscopic muscle advancement, coupled with DLLL repair, leads to a high healing rate with excellent clinical outcomes and recovery of strength to at least 90%, even in patients with pseudoparalysis. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ashish Gupta
- Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia; Australian Shoulder Research Institute, Brisbane, Australia; Greenslopes Private Hospital, Brisbane, Australia.
| | - Kristine Italia
- Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia
| | - Mohammad N Jomaa
- Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia; Australian Shoulder Research Institute, Brisbane, Australia; Greenslopes Private Hospital, Brisbane, Australia; St Andrews War Memorial Hospital, Brisbane, Australia
| | - Andrew M Ker
- Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia
| | - Roberto Pareyon
- Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia; Australian Shoulder Research Institute, Brisbane, Australia; Greenslopes Private Hospital, Brisbane, Australia; St Andrews War Memorial Hospital, Brisbane, Australia
| | - Amaris En-Hui Tok
- Greenslopes Private Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | - Jashint Maharaj
- Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia; Australian Shoulder Research Institute, Brisbane, Australia
| | - Sarah L Whitehouse
- Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia
| | - Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia; Australian Shoulder Research Institute, Brisbane, Australia; St Andrews War Memorial Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
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Shinohara I, Mifune Y, Inui A, Nishimoto H, Yoshikawa T, Kato T, Furukawa T, Tanaka S, Kusunose M, Hoshino Y, Matsushita T, Mitani M, Kuroda R. Re-tear after arthroscopic rotator cuff tear surgery: risk analysis using machine learning. J Shoulder Elbow Surg 2024; 33:815-822. [PMID: 37625694 DOI: 10.1016/j.jse.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/06/2023] [Accepted: 07/16/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Postoperative rotator cuff retear after arthroscopic rotator cuff repair (ARCR) is still a major problem. Various risk factors such as age, gender, and tear size have been reported. Recently, magnetic resonance imaging-based stump classification was reported as an index of rotator cuff fragility. Although stump type 3 is reported to have a high retear rate, there are few reports on the risk of postoperative retear based on this classification. Machine learning (ML), an artificial intelligence technique, allows for more flexible predictive models than conventional statistical methods and has been applied to predict clinical outcomes. In this study, we used ML to predict postoperative retear risk after ARCR. METHODS The retrospective case-control study included 353 patients who underwent surgical treatment for complete rotator cuff tear using the suture-bridge technique. Patients who initially presented with retears and traumatic tears were excluded. In study participants, after the initial tear repair, rotator cuff retears were diagnosed by magnetic resonance imaging; Sugaya classification types IV and V were defined as re-tears. Age, gender, stump classification, tear size, Goutallier classification, presence of diabetes, and hyperlipidemia were used for ML parameters to predict the risk of retear. Using Python's Scikit-learn as an ML library, five different AI models (logistic regression, random forest, AdaBoost, CatBoost, LightGBM) were trained on the existing data, and the prediction models were applied to the test dataset. The performance of these ML models was measured by the area under the receiver operating characteristic curve. Additionally, key features affecting retear were evaluated. RESULTS The area under the receiver operating characteristic curve for logistic regression was 0.78, random forest 0.82, AdaBoost 0.78, CatBoost 0.83, and LightGBM 0.87, respectively for each model. LightGBM showed the highest score. The important factors for model prediction were age, stump classification, and tear size. CONCLUSIONS The ML classifier model predicted retears after ARCR with high accuracy, and the AI model showed that the most important characteristics affecting retears were age and imaging findings, including stump classification. This model may be able to predict postoperative rotator cuff retears based on clinical features.
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Affiliation(s)
- Issei Shinohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tomoya Yoshikawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tatsuo Kato
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takahiro Furukawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shuya Tanaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masaya Kusunose
- Department of Orthopaedic Surgery, Himeji St Mary's Hospital, Himeji, Hyogo, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Makoto Mitani
- Department of Orthopaedic Surgery, Himeji St Mary's Hospital, Himeji, Hyogo, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Bae GC, Kwon WH, Na Y, Hwang YJ, Ryu DJ, D’Lima DD, Jeon YS. Clinical Outcomes and Repair Integrity After Double-Row Modified Mason-Allen Repair Technique With a Single Knot in Small to Medium Supraspinatus Tears. Orthop J Sports Med 2024; 12:23259671241246768. [PMID: 38665386 PMCID: PMC11044770 DOI: 10.1177/23259671241246768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/05/2023] [Indexed: 04/28/2024] Open
Abstract
Background Various arthroscopic rotator cuff repair techniques are being used for the treatment of rotator cuff tears with the development of surgical instruments. However, retears after repair are not completely avoidable, and efforts to reduce retears remain a challenge. Purpose/Hypothesis To introduce a new repair technique, the double-row modified Mason-Allen technique with a single knot, and to compare clinical outcomes and retear rates with the single-row modified Mason-Allen technique. It was hypothesized that this new technique would have a better clinical outcome and significantly lower retear rate than the single-row modified Mason-Allen technique. Study Design Cohort study; Level of evidence, 3. Methods A total of 110 patients with small- to medium-sized (<1.5 cm) full-thickness supraspinatus tears were enrolled into 2 groups, with 65 patients receiving the single-row modified Mason-Allen technique (group A) and 45 patients receiving the double-row modified Mason-Allen technique with a single knot (group B). The clinical and functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score; Disabilities of the Arm, Shoulder and Hand (DASH) score; and visual analog scale (VAS) for pain and satisfaction scores. All patients enrolled in this study were monitored for a minimum of 24 months. Magnetic resonance imaging was performed to analyze the integrity of tendons and retear at 6 months after surgery. Results No statistically significant differences between the 2 groups were found regarding the VAS for pain, ASES, and DASH scores. However, retear was found in 9 patients (13.8%) in group A and 1 patient (2.2%) in group B. The difference in the retear rate was statistically significant between the 2 groups (P = .037). Conclusion A significantly lower retear rate and comparable clinical outcomes were seen after the double-row modified Mason-Allen repair technique with a single knot when compared with the single-row modified Mason-Allen technique. Based on these findings, the double-row modified Mason-Allen repair technique with a single knot can be considered a surgical treatment option that can provide sufficient stability in small- to medium-sized supraspinatus tears.
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Affiliation(s)
- Gi Cheol Bae
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Won Hwan Kwon
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Yeop Na
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Yoon Joong Hwang
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Dong Jin Ryu
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Darryl D. D’Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - Yoon Sang Jeon
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
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Werthel JD, Fleurette J, Besnard M, Favard L, Boileau P, Bonnevialle N, Nové-Josserand L. Long-term results of revision rotator cuff repair for failed cuff repair: a minimum 10-year follow-up study. J Shoulder Elbow Surg 2024; 33:300-305. [PMID: 37468031 DOI: 10.1016/j.jse.2023.06.009] [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: 02/18/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 07/21/2023]
Abstract
HYPOTHESIS Rotator cuff repair remains associated with high retear rates, which range from 13% to 79%. The objective of this study was to evaluate the long-term clinical and structural results after revision rotator cuff repair at a minimum 10-year follow-up. METHODS We retrospectively studied the records of all patients who underwent revision rotator cuff repair in 3 different institutions between July 2001 and December 2007 with a minimum 10-year follow-up. A total of 54 patients (61% males, mean age 52 ± 6 years old) met the inclusion criteria. Outcome measures included pain (visual analog scale [VAS]), range of motion (ROM), Subjective Shoulder Value (SSV), and the Constant score. Superior migration, osteoarthritis, and acromiohumeral interval (AHI) were assessed on standard radiographs. Fatty infiltration and structural integrity of the repaired tendon were evaluated on magnetic resonance imaging or computed tomographic arthrogram. RESULTS At a mean 14.1 years (10.4-20.5), range of motion did not progress significantly in elevation and internal rotation between pre- and postoperation (158° [range, 100°-180°] to 164° [range, 60°-180°], P = .33, and L3 [range, sacrum-T12] to T12 [range, buttocks-T7], P = .34, respectively) and decreased in active external rotation from 45° (range, 10°-80°) to 39° (range, 10°-80°) (P = .02). However, VAS, SSV, and Constant score were all significantly improved at last follow-up (P < .001). AHI decreased significantly (P = .002) from 10 mm (7-14 mm) to 8 mm (0-12 mm). Two percent of the supraspinatus/infraspinatus tendons were Sugaya 1, 24% were Sugaya 2, 35% were Sugaya 3, 12% were Sugaya 4, and 27% were Sugaya 5. Goutallier score progressed for all muscles, but this did not reach significance and mean Goutallier remained <2 for all 4 muscles at last follow-up. Hamada score progressed from 0% >grade 2 preoperatively to 6% >grade 2 at last follow-up. CONCLUSION Revision rotator cuff repair provides significant pain relief and improvement in functional scores at long-term follow-up. The mild progression of fatty infiltration, AHI, and Hamada score suggests that despite high retear rates (39% of stage 4 and 5 in the Sugaya classification), revision repair could possibly have a protective role on the evolution toward cuff tear arthropathy.
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Affiliation(s)
- Jean-David Werthel
- Orthopedic Department, Hôpital Ambroise Paré, Boulogne-Billancourt, France.
| | - Justine Fleurette
- Orthopedic Department, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Marion Besnard
- Orthopedic Department, Centre Hospitalier Intercommunal Amboise- Château-Renault, Amboise, France
| | - Luc Favard
- Orthopedic Department, CHRU Tours-Trousseau, Chambray-lès-Tours, France
| | - Pascal Boileau
- Institut de Chirurgie Réparatrice, Groupe Kantys, Nice, France
| | | | - Laurent Nové-Josserand
- Ramsay Générale de Santé, Jean Mermoz Private Hospital, Centre Orthopédique Santy, Lyon, France
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Abed V, Kapp S, Nichols M, Brunty N, Conley CEW, Jacobs CA, Robinson LE, Stone AV. ASES and UCLA Are Responsive Patient-Reported Outcome Measures After Rotator Cuff Repair: A Systematic Review and Meta-analysis. Am J Sports Med 2024:3635465231213870. [PMID: 38391128 DOI: 10.1177/03635465231213870] [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: 02/24/2024]
Abstract
BACKGROUND Multiple patient-reported outcome measures (PROMs) have been used to assess shoulder function, but it is unknown which are the most effective. PURPOSE/HYPOTHESIS The purpose of this study was to report the multiple PROMs used after rotator cuff repair (RCR) and to compare the responsiveness between them. It was hypothesized that the Western Ontario Rotator Cuff PROM would be the most responsive and commonly used in patients undergoing RCR. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS A systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PRISMA-Searching extension guidelines via PubMed/MEDLINE, Embase (Elsevier), and Web of Science (Clarivate). Patient and study characteristics were extracted. From the studies that met inclusion criteria for responsiveness analysis (≥2 PROMs reported, 1-year minimum follow-up, and pre- and postoperative PROM means and standard deviations reported), the authors compared the responsiveness between PROM instruments using effect size and relative efficiency (RE) if a PROM could be compared with another in ≥10 articles. RESULTS A total of 252 studies met inclusion criteria (32,072 patients; mean age, 59.6 years; mean body mass index, 28.7; mean follow-up time, 27.8 months). Range of motion was reported in 131 (52%) studies and imaging findings were reported in 123 (49%) studies. There were 67 PROM instruments identified; the most commonly used were the American Shoulder and Elbow Surgeon (ASES) (n = 183; 73%), Visual Analog Scale (VAS) (n = 163; 65%), and Constant (n = 118; 47%) scores. The 3 PROMs with the highest effect sizes were the University of California, Los Angeles (UCLA) (2.51), Western Ontario Rotator Cuff (2.42), and ASES (2.00) scores. Overall, UCLA and ASES scores were the most responsive PROMs. The ASES PROM was more responsive than the VAS (RE, 1.70), Constant (RE, 2.76), Simple Shoulder Test (RE, 1.67), and Single Assessment Numeric Evaluation (RE, 2.14) scores. The UCLA PROM was more responsive than the ASES (RE, 1.03), VAS (RE, 3.66), Constant (RE, 1.72), and Simple Shoulder Test (RE, 1.66) scores. CONCLUSION ASES and UCLA scores were the most responsive PROMs after RCR. The authors recommend widespread adoption of ASES and UCLA scores for clinical and research standardization; however, the UCLA PROM requires in-person range of motion and strength testing, which is a practical limitation and barrier to long-term follow-up.
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Affiliation(s)
- Varag Abed
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Sabryn Kapp
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Michael Nichols
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Nathan Brunty
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Caitlin E W Conley
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Cale A Jacobs
- Mass General Brigham Sports Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lauren E Robinson
- Medical Center Library, University of Kentucky, Lexington, Kentucky, USA
| | - Austin V Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
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Pak T, Hwang S, Ardebol J, Ghayyad K, Menendez ME, Gobezie R, Denard PJ. Arthroscopic Repair of Massive Rotator Cuff Tears Leads to Functional Improvement in Most Patients at 4-Year Follow-up. Arthrosc Sports Med Rehabil 2023; 5:100750. [PMID: 37645387 PMCID: PMC10461212 DOI: 10.1016/j.asmr.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/16/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To assess functional outcomes and healing 4 years after arthroscopic repair of massive rotator cuff tears (MRCTs). Methods We conducted a retrospective study of patients who underwent arthroscopic rotator cuff repair of an MRCT-defined as a complete 2-tendon tear or a tear greater than 5 cm in any dimension-performed by 2 surgeons at different institutions between January 2015 and December 2018. At a minimum of 4 years postoperatively, patient-reported outcomes collected included the visual analog scale pain score, American Shoulder and Elbow Surgeons (ASES) score, Veterans RAND 12 (VR-12) score, and Subjective Shoulder Value (SSV) score. Repair technique and concomitant procedures were also gathered. Tendon healing was evaluated via ultrasound at final follow-up. Results Functional outcomes were available for 101 patients at a mean of 63.6 ± 8.8 months (range, 48-82 months) postoperatively. Mean ASES scores improved from 40.1 to 78 (P < .001); VR-12 scores, from 37.1 to 47.7 (P < .001); and SSV scores, from 36.7 to 84.6 (P < .001). Forward flexion improved from 126° to 144° (P = .001), external rotation remained unchanged (from 47° to 44°, P = .268), and internal rotation improved by 2 spinal levels (from L4 to L2, P = .0001). Eighty-eight percent of patients (89 of 101) were satisfied with the procedure, and only 5% underwent reverse shoulder arthroplasty within the study period. Among the 39 patients who underwent postoperative ultrasound to assess healing, 56% showed complete tendon healing. There was no difference in healing or outcomes according to tear pattern. Additionally, tendon healing did not affect outcomes. Conclusions Arthroscopic repair of MRCTs leads to functional improvements and patient satisfaction in most cases at 4-year follow-up. The rates of patients achieving the minimal clinically important difference were 77.5%, 87.6%, 59.7%, and 80.6% for the ASES score, SSV score, VR-12 score, and visual analog scale pain score, respectively. Complete tendon healing is difficult to achieve but does not appear to limit functional improvements. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Theresa Pak
- Oregon Shoulder Institute, Medford, Oregon, U.S.A
| | - Simon Hwang
- Oregon Shoulder Institute, Medford, Oregon, U.S.A
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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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Affiliation(s)
- Mihir M. Sheth
- Baylor College of Medicine, Houston, Texas, USA
- Mihir M. Sheth, MD, Baylor College of Medicine, 7200 Cambridge Street, Suite 10A, Houston, TX 77030, USA () (Twitter: @mihirmsheth)
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Imbergamo C, Sequeira SB, Patankar A, Means KR, Stein JA. The statistical fragility of studies on rotator cuff repair with graft augmentation. J Shoulder Elbow Surg 2023; 32:1121-1125. [PMID: 36681109 DOI: 10.1016/j.jse.2022.12.017] [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: 09/02/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Clinical decision-making often relies on evidence-based medicine. Our purpose was to determine the fragility index (FI) and fragility quotient (FQ) for studies evaluating rotator cuff repair (RCR) with graft augmentation. A lost to follow-up (LTF) value greater than the FI indicates statistical instability for the reported outcomes and conclusions. METHODS We performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, the Cochrane library, and Embase in June 2022 to identify studies of RCR with graft augmentation. Comparative studies with at least 1 statistically analyzed dichotomous outcome were included. Seventeen studies published in seven peer-reviewed journals from 2003 to 2019 were subsequently evaluated. The FI was determined by changing each reported outcome event within 2 × 2 contingency tables until statistical significance or nonsignificance was reversed. The associated FQ was determined by dividing the FI by the sample size. LTF values were also extracted from each included study. RESULTS The included studies had a total of 1098 patients with 36 dichotomous outcomes. The associated median FI was 4 (interquartile range 2-5), indicating that the reversal of 4 patients' outcomes would have reversed the finding of significant difference. The median FQ was 0.08 (interquartile range 0.04-0.15), indicating that in a sample of 100 patients, reversal of 8 patients' outcomes would reverse statistical significance. The median number of patients LTF was 3 (range 0-25), with 56% of reported outcomes having LTF greater than their respective FI. CONCLUSION Studies of RCR with graft augmentation lack statistical stability, with few altered outcome events required to reverse statistical significance. Larger comparative studies with better follow-up will strengthen the statistical stability of the evidence for RCR with graft augmentation. For future investigations and reports, we recommend including FI and FQ along with traditional statistical significance analyses to provide better context on the strength of conclusions.
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Affiliation(s)
- Casey Imbergamo
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Sean B Sequeira
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Aneesh Patankar
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Kenneth R Means
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Jason A Stein
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
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Tsuchiya S, Bois AJ, Matthewson G, Oiwa S, More KD, Lo IKY. The relationship between preoperative Goutallier stage and retear rates following posterosuperior rotator cuff repair: a systematic review. J Shoulder Elbow Surg 2023; 32:435-443. [PMID: 36252788 DOI: 10.1016/j.jse.2022.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND An association between higher preoperative Goutallier stage and higher retear rates following primary rotator cuff repairs has been previously reported. However, there are few reviews which have described clear retear rates for each repaired tendon classified according to preoperative Goutallier stage. The purpose of this study was therefore to systematically review the literature on the relationship between preoperative Goutallier stage and retear rates and provide predictable retear rates following primary repair of posterosuperior rotator cuff tears. METHODS A systematic literature review was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist utilizing PubMed, MEDLINE, and Cochrane Library. English-language studies of Level I through IV evidence examining the clinical results of primarily repaired posterosuperior rotator cuff tears as a function of Goutallier stage using magnetic resonance imaging were included. The primary outcome of interest was retear rates according to preoperative Goutallier stage. As a secondary outcome, rotator cuff tears were divided into 2 subgroups (Goutallier stage 0-2 and 3-4) and retear rates were assessed between the 2 subgroups. A random effects model with binomial within-study variance was used for both outcomes. RESULTS Nine studies (687 shoulders) satisfied all inclusion criteria and reported sufficient data for statistical analysis. In the supraspinatus muscle group, rotator cuff muscles with preoperative Goutallier stages of 0, 1, and 2 had retear rates of 19.1%, 27.8%, and 33.5%, respectively, with no significant differences between each category. In contrast, when preoperative Goutallier stage of 3 and 4 existed, significant differences compared to Goutallier 0, 1, and 2 were observed with a retear rate of 74.1% and 78.5%, respectively. In the infraspinatus muscle group, the retear rates following rotator cuff repairs were 20.0%, 32.1%, and 35.1% in Goutallier 0, 1, and 2, respectively, with no significant differences between each category. In Goutallier 3 and 4, the rate was 76.6% and 100.0%, respectively, with significant differences compared to Goutallier 0, 1, and 2. CONCLUSION The results of this study have clearly demonstrated that retear rates following surgical repair of the rotator cuff increased in proportion to the preoperative Goutallier stage in both the supraspinatus and infraspinatus muscles.
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Affiliation(s)
- Saho Tsuchiya
- Department of Orthopaedic Surgery, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Aaron J Bois
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada; University of Calgary Sport Medicine Centre, University of Calgary, Calgary, AB, Canada
| | - Graeme Matthewson
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Shin Oiwa
- Department of Orthopaedic Surgery, Akabane East Side Hospital, Tokyo, Japan
| | - Kristie D More
- University of Calgary Sport Medicine Centre, University of Calgary, Calgary, AB, Canada
| | - Ian K Y Lo
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.
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Arthroscopic Rotator Cuff Repair Results in Improved Clinical Outcomes and Low Revision Rates at 10-Year Follow-Up: A Systematic Review. Arthroscopy 2023; 39:452-458. [PMID: 36604006 DOI: 10.1016/j.arthro.2022.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/05/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To study the literature to evaluate the functional outcomes, radiologic outcomes, and revision rates following arthroscopic rotator cuff repair (ARCR) at a minimum of 10-years follow-up. METHODS Two independent reviewers performed a literature search of PubMed, Embase, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Only studies reporting on outcomes of ARCR with a minimum 10-year follow-up were considered for inclusion. Patient demographics, satisfaction, and clinical, radiologic, and surgical outcomes were evaluated. RESULTS Our search found 9 studies including 455 shoulders in 448 patients (51.6% male patients), with age at time of surgery ranging from 45 to 90 years met our inclusion criteria. Overall follow-up ranged from 10 to 18 years. At final follow-up, the ranges of American Shoulder & Elbow Surgeons, age- and sex-adjusted Constant-Morley, and University of California Los Angeles scores were reported in 5, 6, and 3 studies, respectively, as 79.4 to 93.2, 73.2 to 94, and 26.5 to 33, respectively. Of the included studies, satisfaction rates varied in 6 studies from 85.7% to 100% in the long-term. Additionally, the overall radiologic retear rate ranged from 9.5% to 63.2%. The overall surgical revision rates ranged in 6 studies from 3.8% to 15.4%, with from 0% to 6.7% requiring revision ARCR and from 1.0% to 3.6% requiring revision subacromial decompression in 6 and 2 studies, respectively, at minimum 10-years' follow-up. CONCLUSIONS In this study, we found that ARCR results in high rates of patient satisfaction, satisfactory clinical outcomes with respect to patient-reported functional outcomes and range of motion, and low revision rates at minimum 10-years' follow-up. However, an overall 30% retear rate was observed in asymptomatic patients. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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13
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No difference in clinical outcome after rotator cuff repair performed within or later than 3 months after trauma: a retrospective cohort study. Knee Surg Sports Traumatol Arthrosc 2023; 31:672-680. [PMID: 36287225 PMCID: PMC9898400 DOI: 10.1007/s00167-022-07193-y] [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: 03/04/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Rotator cuff (RC) tear is one of the most common injuries of the shoulder. Patients with RC tears often report a trauma initiating shoulder pain and impaired function. The aim of this retrospective analysis of a prospectively registered cohort was to elucidate whether the time interval between the trauma and RC repair, using a cut off of 3 months, affects the functional outcome after 2 years. METHODS In a single orthopedic unit, 819 consecutive patients were treated with rotator cuff repair during the period from 2010 to 2014 and 733 of the patients completed the Western Ontario Rotator Cuff (WORC) index preoperatively and at 2-year follow-up. The Constant-Murley (CM) score was completed by trained physiotherapists after a clinical examination both preoperatively and at 2-year follow-up. Preoperative magnetic resonance imaging (MRI) was performed in all patients and postoperatively in 65% of the included patients. Re-tears and partial repairs were excluded, as were patients with pseudoparalysis who were given high priority and underwent surgery during the first 3 weeks after trauma. RESULTS Of the 733 treated patients, 437 (60%) reported having had a shoulder trauma in their medical history initiating their shoulder symptoms, and of these, 358 met the inclusion criteria. 296 patients with non-traumatic tears, 9 repairs done within 3 weeks after trauma, 25 partial repairs, 33 re-tears and 12 others were excluded. At 2-year follow-up there was no significant difference in WORC index (n.s.) or CM score (n.s.) between patients who had their RC repaired within or more than 3 months after trauma. In patients where RC repair was performed within 3 months, the WORC index improved by 42.9%, and in the group of patients operated later than 3 months, the increase was 38.7%. This difference between the groups was neither statistically significant (n.s.) nor clinically relevant. On postoperative MRI, 80% of the repairs were healed in both groups. CONCLUSION In this retrospective cohort study, no differences in clinical outcome were found when RC repair was performed between 3 weeks and 3 months or later than 3 months after injury in patients describing their onset of symptoms as traumatic. LEVEL OF EVIDENCE III.
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Wolf GJ, Reid JJ, Rabinowitz JR, Barcel DA, Barfield WR, Eichinger JK, Friedman RJ. Does glenohumeral offset affect clinical outcomes in a lateralized reverse total shoulder arthroplasty? J Shoulder Elbow Surg 2023; 32:50-58. [PMID: 35872171 DOI: 10.1016/j.jse.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/19/2022] [Accepted: 06/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (rTSA) exhibits high rates of success and low complication rates. rTSA has undergone numerous design adaptations over recent years, and lateralization of implant components provides theoretical and biomechanical benefits in stability and range of motion (ROM) as well as decreased rates of notching. However, the magnitude of implant lateralization and its effect on these outcomes is less well understood. The purpose of this study was to evaluate how increasing glenohumeral offset affects outcomes after rTSA, specifically in a lateralized humerus + medialized glenoid implant model. METHODS Primary rTSA using a lateralized humeral + medialized glenoid implant model performed at a single academic institution between 2012 and 2018 were retrospectively reviewed. Patient-reported outcome (PRO) parameters and clinical outcomes including ROM were evaluated both pre- and postoperatively. Pre- and postoperative radiographs were analyzed for measurement of glenohumeral offset, defined as the acromial-tuberosity offset (ATO) distance on the anteroposterior radiograph. RESULTS A total of 130 rTSAs were included in the analysis, with a mean follow-up of 35 mo. The mean postoperative absolute ATO was 16 mm, and the mean delta ATO (difference from pre- to postoperatively) was 4.6 mm further lateralized. Among all study patients, improvements in all ROM parameters and all PROs were observed from pre- to postoperative assessments. When assessing for the effects of lateralization on these outcomes, multivariate analysis failed to reveal a significant effect from the absolute postoperative ATO or the delta ATO on any outcome parameter. CONCLUSIONS rTSA using a lateralized humeral + medialized glenoid implant model exhibits excellent clinical outcomes in ROM and PROs. However, the magnitude of lateralization as measured radiographically by the ATO did not significantly affect these outcomes; patients exhibited universally good outcomes irrespective of the degree of offset restoration.
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Affiliation(s)
- G Jacob Wolf
- Medical University of South Carolina, Charleston, SC, USA
| | - Jared J Reid
- Medical University of South Carolina, Charleston, SC, USA
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15
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Baumgarten KM. Can the Single Assessment Numeric Evaluation be used as a stand-alone subjective outcome instrument in patients undergoing rotator cuff repair? J Shoulder Elbow Surg 2022; 31:2542-2553. [PMID: 35750155 DOI: 10.1016/j.jse.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND/HYPOTHESIS There is no consensus to which patient-determined shoulder outcome scores should be considered when analyzing patient outcomes. Use of multiple patient-determined outcomes may be redundant and cause increased responder burden. The Single Assessment Numeric (SANE) has not been widely accepted as a stand-alone shoulder-specific outcome measure. The hypothesis was that SANE will correlate with and be comparable in responsiveness to other subjective outcome measures that have been used in a stand-alone fashion in patients undergoing rotator cuff repair (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], Western Ontario Rotator Cuff Index [WORC], and the Simple Shoulder Test [SST]). In addition, the SANE will be more relevant to each patient compared to the ASES, further supporting its use as a stand-alone shoulder-specific outcomes measure. METHODS A retrospective review of a database of patients undergoing rotator cuff repair was reviewed where the SANE was recorded with the ASES, WORC, and/or SST. Correlations were determined using the Pearson coefficient. Subgroup analysis was performed to determine if correlations differed in (1) preoperative and (2) postoperative outcome determinations. Responsiveness was determined by calculating the standardized response mean (SRM) and the effect size (ES) of all scores. Relevance and precision of the SANE and ASES were examined using 150 consecutive patients to determine the number of questions in each score that were not answered. RESULTS Correlation was excellent for the SANE and the ASES (n = 1838, r = 0.81, P < .0001), the WORC (n = 1793, r = 0.82, P < .0001), and the SST (n = 1836, r = 0.76, P < .0001). Correlation of preoperative scores was moderate and postoperative scores were excellent when comparing the SANE with all 3 scores. All scores were highly responsive, with the SRM of the SANE = 2.1, ASES = 2.2, WORC = 2.4, and the SST = 1.8. The ES of the SANE = 2.4, ASES = 2.7, WORC = 3.0, and the SST = 2.1. One hundred percent of the SANE scores were answered completely compared with 57% (P < .0001) of the ASES, with significant variability found in the answers to the "work" and "score" questions. CONCLUSION In patients undergoing rotator cuff repair, the SANE highly correlated and has equivalent responsiveness with the WORC, ASES, and SST, which have been used as stand-alone shoulder-specific outcomes measures. The SANE may provide the same information as the WORC, ASES, and SST regarding outcome with significant reduction in responder burden. This study supports that the SANE can be used as a subjective, stand-alone instrument for patients undergoing rotator cuff repair.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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Green A, Loyd K, Molino J, Evangelista P, Gallacher S, Adkins J. Long-term functional and structural outcome of rotator cuff repair in patients 60 years old or less. JSES Int 2022; 7:58-66. [PMID: 36820436 PMCID: PMC9937847 DOI: 10.1016/j.jseint.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background The long-term outcomes of rotator cuff repair (RCR) have not been well studied. The purpose of this study was to evaluate long-term functional and structural outcomes after RCR in younger patients. Methods A total of 49 patients (34 [69%] male) with a mean age of 51 ± 6 years were evaluated preoperatively, and at short- and long-term follow-ups (minimum 15 years). There were 13 (27%) small, 17 (35%) medium, 14 (29%) large, and 5 (10%) massive tears. 15 (31%) had an acute repair of a traumatic tear. Long-term evaluation included physical examination, plain radiographs, ultrasound, and patient reported outcome measures (PROMs) (visual analog scale pain, Disability of Arm, Shoulder and Hand, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, and Short Form-36). Statistical analysis was performed to determine associations between preoperative and intraoperative factors and long-term functional and structural outcome. Results There were significant improvements in the mean short- and long-term PROMs compared to preoperatively that exceeded reported minimal clinically important differences and substantial clinical benefits. There was a slight decrease in the PROMs from the short-term to long-term follow-up. Male sex and traumatic rotator cuff tears were associated with better long-term outcomes. The number of medical co-morbidities was associated with worse long-term outcomes. Smaller initial tear size was associated with better long-term outcomes. There were 15 (31%) full thickness and 9 (18%) partial thickness recurrent rotator cuff tears, 17 (35%) had rotator cuff tear arthropathy (2 Hamada grade 1, 15 Hamada grade 2), 5 (10%) had revision surgery (2 revision RCR, 2 anatomic total shoulder, and 1 reverse total shoulder), and 13 (26%) had subsequent contralateral RCR. There were weak correlations between the presence of arthropathy and DASH (r = 0.34; P = .02) and visual analog scale pain (r = 0.29; P = .049). There were no significant correlations between the structural outcomes (recurrent rotator cuff tear, recurrent full thickness tear, acromiohumeral space, and critical shoulder angle,) and the PROMs. Discussion and Conclusion Long-term follow-up of RCR in this relatively young patient cohort demonstrated substantial and durable patient reported functional outcome and improvement despite considerable structural deterioration. This suggests that while RCR does not arrest the progression of rotator cuff disease it may delay this progression and that patients adapt to the structural changes as they age.
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Affiliation(s)
- Andrew Green
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA,Corresponding author: Andrew Green, MD, Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA.
| | - Kelsey Loyd
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Janine Molino
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Peter Evangelista
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Stacey Gallacher
- Advanced Orthopedics and Sports Medicine Institute, Freehold, NJ, USA
| | - Jacob Adkins
- Warren Alpert Medical School, Brown University, Providence, RI, USA
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Yu XK, Cao JX, Li L, Guo WB, Zhang L, Li JX. The correlation between types of posterior upper rotator cuff tears and intramuscular fat infiltration based on magnetic resonance imaging: A retrospective observational study. Front Bioeng Biotechnol 2022; 10:859174. [PMID: 36082165 PMCID: PMC9445121 DOI: 10.3389/fbioe.2022.859174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: This study investigated the correlation between types of posterior upper rotator cuff tears (RCTs) and intramuscular fat infiltration (FI) in magnetic resonance imaging (MRI). Methods: The shoulder joints of 50 adults with a full-thickness posterior upper RCT diagnosed by MRI, from January 2019 to December 2021, were retrospectively analyzed. The patients were divided into three groups according to tear type: 1) an L-shaped tear group; 2) a crescent/U-shaped tear group; 3) a complete tear group. The correlation among age, gender, tear range, trauma history, and the duration of clinical symptoms was analyzed. The MRI images were used by two musculoskeletal imaging physicians to evaluate the type and range of tears, the Goutallier grade of the supraspinatus and infraspinatus, and the correlations and reliability were analyzed. Results: Differences in the tear range (p < 0.001) and the Goutallier grade of the infraspinatus muscle (p = 0.036) among the L-shaped, crescent/U-shaped, and complete tear groups were statistically significant; however, differences in the Goutallier grade of the supraspinatus muscle was not statistically significant (p = 0.356). In the crescent/U-shaped tear group, age was significantly correlated with the Goutallier grade of the supraspinatus muscle (RS = 0.720, p = 0.029) and the infraspinatus muscle (RS = 0.713, p = 0.032). In the complete tear group, tear range was significantly correlated with the Goutallier grade of the supraspinatus muscle (RS = 0.801, p = 0.001) and the infraspinatus muscle (RS = 0.802, p = 0.001). The Goutallier grades of the supraspinatus muscle (kappa, 0.489) and the infraspinatus muscle (kappa, 0.424) presented with interobserver consistency. Conclusion: The type of posterior upper RCT correlates with the degree of FI. There is a positive correlation between the FI of crescent/U-shaped full-thickness RCTs and age. Additionally, the range of complete tears in the posterior upper RC has a positive correlation with FI.
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Macciacchera M, Siddiqui S, Ravichandiran K, Khan M, Sheth U, Abouali J. Risk factors for the development of degenerative changes among patients undergoing rotator cuff repair: A systematic review. Shoulder Elbow 2022; 14:352-359. [PMID: 35846400 PMCID: PMC9284300 DOI: 10.1177/17585732211047225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Osteoarthritis (OA) of the glenohumeral joint results in significant pain and functional limitations. It is unclear which risk factors increase the risk of developing glenohumeral OA amongst Rotator Cuff Repair (RCR) patients. The purpose of this systematic review was to examine the risk factors which may contribute to the development of osteoarthritic changes post-operatively. METHODS MEDLINE, Embase, and PubMed databases were searched to identify studies reporting on demographics of patients who develop OA following RCR. RESULTS Seventeen articles were identified investigating a total of 1292 patients. The overall quality of evidence was low. Pooled assessment of OA incidence following RCR at minimum 5 years follow-up found 26% of patients developed OA. Patients requiring revision surgery following retears developed OA at a rate of 29%. Surgical technique and patient demographics may also contribute to degenerative changes. DISCUSSION This review found correlations between the aforementioned risk factors and glenohumeral joint degeneration at long-term follow-up after RCR. These findings suggest that future long-term studies should aim to identify prognostic factors that may place a patient at increased risk of developing OA. Such data can be used to counsel patients with respect to long-term outcomes following surgical intervention.
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Affiliation(s)
| | | | | | - Moin Khan
- McMaster University, Hamilton, Canada
| | | | - Jihad Abouali
- University of Toronto, Toronto, Canada,Jihad Abouali, Division of Orthopaedic
Surgery, University of Toronto, Toronto, 304-840 Coxwell Ave, Ontario, Canada,
M4C5T2.
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Retear After Arthroscopic Rotator Cuff Repair Results in Functional Outcome Deterioration Over Time. Arthroscopy 2022; 38:2399-2412. [PMID: 35219797 DOI: 10.1016/j.arthro.2022.02.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to evaluate the effect of retear on long-term functional outcomes and glenohumeral joint osteoarthritis (OA) progression after arthroscopic rotator cuff repair (ASRCR). METHODS We retrospectively reviewed 201 patients who underwent ASRCR and were followed up for at least 5 years. Rotator cuff tendon structural integrity was evaluated using magnetic resonance imaging and/or ultrasonography. Pain, active range of motion, and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) were evaluated for functional outcomes. To evaluate deterioration over time, the minimal clinically important difference value of pain and ASES were used. RESULTS The mean follow-up period was 8.6 ± 2.2 years and overall retear rate was 21.4%. OA progression was strongly associated with retear (odds ratio 5.1, P < .001). Functional outcomes at the 2-year postoperative follow-up significantly improved compared to the preoperative status (all P < .017), regardless of retear. However, the retear group presented worse functional outcomes at the final follow-up (pain: 3.1 ± 2.6; ASES: 72.0 ± 17.4) than at the 2-year postoperative follow-up (pain: 1.2 ± 2.3, P = .014; ASES: 91.1 ± 9.9, P= .015) than the healed tendon group at final follow-up (pain: .6 ± 1.7; P < .001; ASES 95.5 ± 11.8; P < .001). The time for deterioration of pain (healed group vs. retear group: 5.5 ± 0.5 vs. 10.6 ± 0.4 years; P < .001) and ASES (healed group vs. retear group: 7.5 ± 0.5 vs. 12.8 ± 0.2 years; P < .001) decreased in the retear group. CONCLUSIONS The functional status improved after ASRCR in short- and long-term follow-up, regardless of retear. However, retear was strongly associated with OA progression, and long-term functional outcomes deteriorated over time in retear cases, which was not observed during short-term follow-up. STUDY DESIGN III, retrospective cohort study.
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Kirsch JM, Patel M, Hill BW, McPartland C, Namdari S, Lazarus MD. Preoperative Single Assessment Numeric Evaluation Score Predicts Poor Outcomes After Reverse Shoulder Arthroplasty for Massive Rotator Cuff Tears Without Arthritis. Orthopedics 2022; 45:215-220. [PMID: 35245141 DOI: 10.3928/01477447-20220225-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Limited clinical evidence is available to help to predict poor outcomes after reverse shoulder arthroplasty (RSA) among patients with massive rotator cuff tears without glenohumeral arthritis. A retrospective case-control study was performed for patients who underwent RSA for massive rotator cuff tear without glenohumeral arthritis (Hamada score ≤3) and had a minimum of 2 years of follow-up. Preoperative risk factors for poor outcomes were subsequently analyzed. Sixty patients (mean age, 71.4±7.4 years) met the inclusion criteria. Of these, 18 (30%) patients had poor outcomes (case group). The case group had significantly worse postoperative Single Assessment Numeric Evaluation (SANE) (61.6±29.5 vs 84.9±14.1, respectively; P=.002), American Shoulder and Elbow Surgeons (58.9±22.5 vs 82.2±14.2, respectively; P<.001), and Simple Shoulder Test (5.4±3.6 vs 8.5±2.4, respectively; P=.002) scores compared with the control group. Patients with poor outcomes had significantly higher preoperative SANE scores compared with control subjects (40.4±28.4 vs 18.8±15.7, respectively; P=.021). The results of this study suggest that patients with better overall preoperative function, as represented by higher SANE scores, have a greater likelihood of poor functional outcomes after RSA for massive rotator cuff tears without glenohumeral arthritis. For these patients, alternative treatment options should be considered. [Orthopedics. 2022;45(4):215-220.].
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Sahoo S, Stojanovska M, Imrey PB, Jin Y, Bowles RJ, Ho JC, Iannotti JP, Ricchetti ET, Spindler KP, Derwin KA, Entezari V. Changes From Baseline in Patient- Reported Outcomes at 1 Year Versus 2 Years After Rotator Cuff Repair: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:2304-2314. [PMID: 34473586 PMCID: PMC10510728 DOI: 10.1177/03635465211023967] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most orthopaedic journals currently require reporting outcomes of surgical interventions for at least 2 postoperative years, but there have been no rigorous studies on this matter. Various patient-reported outcome (PRO) measures (PROMs) have been used to assess the status of the shoulder after rotator cuff repair (RCR). HYPOTHESIS We hypothesized that the mean shoulder-specific PROMs at 1 year improve substantially over baseline but that there is no clinically meaningful difference between the mean 1- and 2-year PROMs after RCR. STUDY DESIGN Meta-analysis; Level of evidence, 2. METHODS We conducted a systematic review of published randomized controlled trials (RCTs) and prospective cohort studies (level of evidence 1 and 2) reporting the shoulder-specific American Shoulder and Elbow Surgeons (ASES), the Constant, or the Western Ontario Rotator Cuff (WORC) Index scores at baseline, 1 year, and 2 years after RCR. The methodologic quality of studies was assessed. Also, the random effects meta-analyses of changes in PROMs for each of the first and second postoperative years were conducted. RESULTS Fifteen studies (n = 11 RCTs; n = 4 cohort studies) with a total of 1371 patients were included. Studies were highly heterogeneous, but no visual evidence of major publication bias was observed. The weighted means of the baseline PROMs were 46.2 points for the ASES score, 46.4 points for the Constant score, and 38.8 points for the WORC Index. The first-year summary increments were 41.1 (95% CI, 36.0-46.2) points for the ASES score, 34.2 (95% CI, 28.8-39.6) points for the Constant score, and 42.9 (95% CI, 37.3-48.4) points for the WORC Index. In contrast, the second-year summary increments were 2.3 (95% CI, 1-3.6) points for the ASES score, 3.2 (95% CI, 1.9-4.4) points for the Constant score, and 2 (95% CI, -0.1 to 4) points for the WORC Index. CONCLUSION All PROMs improved considerably from baseline to 1 year, but only very small gains that were below the minimal clinically important differences were observed between 1 year and 2 years after RCR. This study did not find any evidence for requiring a minimum of 2 years of follow-up for publication of PROs after RCR. Our results suggest that focusing on 1-year PROMs after RCR would foster more timely reporting, better control of selection bias, and better allocation of research resources.
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Affiliation(s)
- Sambit Sahoo
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Martina Stojanovska
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter B. Imrey
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Yuxuan Jin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard J. Bowles
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jason C. Ho
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Joseph P. Iannotti
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Eric T. Ricchetti
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Kurt P. Spindler
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Kathleen A. Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Vahid Entezari
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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22
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Li HS, Zhou M, Huang P, Liu J, Tang H, Zhang CK, Wang YJ, Shi YX, Liao YT, Jin BY, Tang KL, Zhou B. Histologic and biomechanical evaluation of the thoracolumbar fascia graft for massive rotator cuff tears in a rat model. J Shoulder Elbow Surg 2022; 31:699-710. [PMID: 34775038 DOI: 10.1016/j.jse.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/30/2021] [Accepted: 10/14/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fascial autografts, which are easily available grafts, have provided a promising option in patients with massive rotator cuff tears. However, no fascial autografts other than the fascia lata have been reported, and the exact healing process of the fascia-to-bone interface is not well understood. The objective of this study is to histologically and biomechanically evaluate the effect of the thoracolumbar fascia (TLF) on fascia-to-bone healing. METHODS A total of 88 rats were used in this study. Eight rats were killed at the beginning to form an intact control group, and the other rats were divided randomly into 2 groups (40 rats per group): the TLF augmentation group (TLF group) and the repair group (R group). The right supraspinatus was detached, and a 3 × 5 mm defect of the supraspinatus was created. The TLF was used to augment the torn supraspinatus in the TLF group, whereas in the R group, the torn supraspinatus was repaired in only a transosseous manner. Histology and biomechanics were assessed at 1, 2, 4, 8, and 16 weeks postoperatively. RESULTS The modified tendon maturation score of the TLF group was higher than that of the R group at 8 weeks (23.00 ± 0.71 vs. 24.40 ± 0.89, P = .025) and 16 weeks (24.60 ± 0.55 vs. 26.40 ± 0.55, P ≤ .001). The TLF group showed a rapid vascular reaction, and the peak value appeared at 1 week. Later, the capillary density decreased, and almost no angiogenesis was observed at 8 weeks postoperatively. Immunohistochemistry results demonstrated a significantly higher percentage of collagen I in the TLF group at 4, 8, and 16 weeks (24.78% ± 2.76% vs. 20.67% ± 2.11% at 4 weeks, P = .046; 25.46% ± 1.77% vs. 21.49% ± 2.33% at 8 weeks, P = .026; 34.77% ± 2.25% vs. 30.01% ± 3.17% at 16 weeks, P = .040) postoperatively. Biomechanical tests revealed that the ultimate failure force in the TLF group was significantly higher than that in the R group at the final evaluation (29.13 ± 2.49 N vs. 23.10 ± 3.47 N, P = .022). CONCLUSIONS The TLF autograft can promote a faster biological healing process and a better fixation strength. It could be used as an alternative reinforcement or bridging patch when the fascia lata is not appropriate or available for superior capsule reconstruction (SCR).
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Affiliation(s)
- Huai-Sheng Li
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Mei Zhou
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Pan Huang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Juan Liu
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Hong Tang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Chen-Ke Zhang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Yun-Jiao Wang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - You-Xing Shi
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Ya-Tao Liao
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Bao-Yong Jin
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Kang-Lai Tang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China.
| | - Binghua Zhou
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China.
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23
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Plachel F, Jo OI, Rüttershoff K, Andronic O, Ernstbrunner L. A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs. Am J Sports Med 2022:3635465211073332. [PMID: 35179393 DOI: 10.1177/03635465211073332] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic rotator cuff repair (aRCR) has shown similar midterm functional results and retear rates as open/mini-open rotator cuff repair (oRCR). A pooled analysis of long-term results of both techniques is yet missing. PURPOSE To evaluate the long-term results of aRCR and oRCR for full-thickness rotator cuff tears. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The CENTRAL (Cochrane), MEDLINE (PubMed), and Embase databases were searched for studies that reported on long-term clinical and radiographic outcomes of full-thickness aRCR and oRCR with a minimum follow-up of 9 years. RESULTS Eleven studies were included: 5 studies on aRCR and 6 studies on oRCR. Studies were based on 550 shoulders (539 patients) with a mean patient age of 56.3 years (range, 25-77). After a mean follow-up of 14.0 years (range, 9-20), the mean preoperative absolute Constant score (CS) and American Shoulder and Elbow Surgeons (ASES) shoulder score were significantly improved postoperatively (CS, 44 to 78 points; ASES, 52% to 91%; both comparisons, P < .001). The retear rate was 41% (141 of 342 shoulders) without a significant difference between groups (aRCR, 43%; oRCR, 39%) (P = .364). A retear was associated with significantly reduced CS as compared with a healed repair (P = .004). No significant differences were found in postoperative functional scores, complications, and retear rates after failed cuff repairs between the arthroscopic and open/mini-open repair groups. CONCLUSION Pooled analysis of arthroscopic and open rotator cuff repairs demonstrated sustained improvement in long-term shoulder scores and pain with a substantial retear rate in both groups, which was associated with inferior shoulder function. There were no significant differences in long-term functional outcomes, retear rates, and complications. Both surgical techniques may be used on the basis of factors such as patient or surgeon preference and cost. Further studies using a more robust randomized controlled trial or larger cohort design are recommended to ascertain whether one surgical repair technique is superior to the other. REGISTRATION CRD42020180448 (PROSPERO).
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Affiliation(s)
- Fabian Plachel
- Charité-Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Olivia Imkyeong Jo
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Katja Rüttershoff
- Charité-Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Octavian Andronic
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.,Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia.,Melbourne Orthopaedic Group, Windsor, Victoria 3181, Australia
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24
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Shah NS, Suriel Peguero E, Umeda Y, Crawford ZT, Grawe BM. Long-Term Outcomes of Massive Rotator Cuff Tear Repair: A Systematic Review. HSS J 2022; 18:130-137. [PMID: 35087343 PMCID: PMC8753535 DOI: 10.1177/15563316211008137] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND With an increase in the treatment options available for massive rotator cuff tears, understanding the long-term outcomes of the chosen modality is important. QUESTIONS/PURPOSE The purpose of this study was to systematically review the available literature on repair of massive rotator cuff repairs and learn the longevity of outcomes, the failure rate, outcomes after failure, and any contributing factors to poor outcomes or failure. METHODS We conducted a systematic review of the MEDLINE, Cochrane, and Embase databases to find studies that investigated the long-term results of repair of massive rotator cuff repairs. Studies were excluded if they did not stratify results of massive tears, provide a definition for a massive rotator cuff tear, or report isolate patients with long-term follow-up. RESULTS Six studies met the inclusion criteria, for a total of 472 shoulders; average patient age was 57.6 years. Follow-up ranged from 119 to 240 months. Outcome scores improved significantly following repair and were maintained throughout follow-up. The repair failure rate across studies was 39.2%. Patients who suffered retear had significantly worse outcome scores than patients with intact tendons at long-term follow-up. CONCLUSIONS The existing literature on long-term follow-up after massive rotator cuff repair is scarce and not of high level of evidence. This review found repair of massive rotator cuff tears leads to long-term maintained improvements in outcome measures. Failure of repair is quite common, but results following failure are superior to preoperative outcomes.
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Affiliation(s)
- Nihar S. Shah
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA,Nihar S. Shah, MD, Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, 231 Albert Sabin Way, Cincinnati, OH 45267-0212, USA.
| | | | - Yuta Umeda
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Zachary T. Crawford
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Brian M Grawe
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
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25
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Collotte P, Gauci MO, Vieira TD, Walch G. Bony increased-offset reverse shoulder arthroplasty (BIO-RSA) associated with eccentric glenosphere and an onlay 135° humeral component : Clinical and Radiological Outcomes at a minimum 2 year follow-up. JSES Int 2022; 6:434-441. [PMID: 35572427 PMCID: PMC9091798 DOI: 10.1016/j.jseint.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Various implant designs have been proposed to increase active range of motion (ROM) and avoid notching in patients treated by reverse total shoulder arthroplasty (RSA). The purpose of this study was to investigate the efficacy and safety of an onlay prosthesis design combining a 135° humeral neck-shaft angle with the glenoid component lateralized and inferiorized. Methods A retrospective descriptive study was conducted of the clinical and radiological outcomes at the final follow-up (≥24 months) of all RSAs performed by the same surgeon between September 2015 and December 2016 in the study center. At the last follow-up, patients were clinically assessed for ROM, Constant score, and subjective shoulder value and radiologically for scapular notching and glenoid radiolucent lines. Patients were followed up radiographically at 1 month and clinically at between 6 and 12 months (midterm) and again at between 24 and 48 months (final follow-up). Scapular notching was graded as per the Sirveaux classification at the last follow-up on anterior-posterior radiographs. Results Seventy-nine RSAs were included with a mean follow-up time of 31 months. The mean Constant score at the final follow-up was 42 points higher than before surgery (69 vs. 27, P < .001). There were also significant postoperative improvements in ROM (active anterior elevation, active external rotation, and active internal rotation). The final means for motions were 133° for active anterior elevation, 32° active external rotation, and level 7 for active internal rotation. The overall notching rate was 3% (2/67), and there were no cases of severe notching. Radiolucent lines were observed in 8 of 70 prostheses (11.5%) around the peg, and they were observed in 9 prostheses (13%) around the screws. Among the 79 RSAs included, there were 11 complications (13.9%) (two infections, two fractures, four cases of glenoid component loosening, and three cases of instability), 2 reoperations, and 4 prosthesis revisions. Conclusion This study shows that an RSA design with a 135° humeral neck-shaft angle and an inferiorized and lateralized glenoid component is associated with significant improvements in active ROM, especially in rotation, and a low notching rate. However, rates of 3.8% for dislocation and 5% for glenoid loosening are certainly a concern at such a short follow-up of two years. Future studies with a larger population are needed to confirm these rates.
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Kim JH, Min YK, Kim DY, Kim JW. Evaluation of Scapula and Humerus Bone Change after Repair of Small- to Medium-Sized Rotator Cuff Tears: Comparison between Healing and Retear Groups Using Three-Dimensional Computed Tomography. Clin Orthop Surg 2022; 14:564-575. [DOI: 10.4055/cios21127] [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: 07/28/2021] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jung-Han Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young-Kyoung Min
- Department of Orthopedic Surgery, Busan Medical Center, Busan, Korea
| | - Dae-Yoo Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jeong-Woo Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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P2Y2 promotes fibroblasts activation and skeletal muscle fibrosis through AKT, ERK, and PKC. BMC Musculoskelet Disord 2021; 22:680. [PMID: 34380439 PMCID: PMC8359595 DOI: 10.1186/s12891-021-04569-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/22/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Skeletal muscle atrophy and fibrosis are pathological conditions that contribute to morbidity in numerous conditions including aging, cachexia, and denervation. Muscle atrophy is characterized as reduction of muscle fiber size and loss of muscle mass while muscle fibrosis is due to fibroblasts activation and excessive production of extracellular matrix. Purinergic receptor P2Y2 has been implicated in fibrosis. This study aims to elucidate the roles of P2Y2 in sleketal muscle atrophy and fibrosis. METHODS Primary muscle fibroblasts were isolated from wild type and P2Y2 knockout (KO) mice and their proliferating and migrating abilities were assessed by CCK-8 and Transwell migration assays respectively. Fibroblasts were activated with TGF-β1 and assessed by western blot of myofibroblast markers including α-SMA, CTGF, and collagen I. Muscle atrophy and fibrosis were induced by transection of distal sciatic nerve and assessed using Masson staining. RESULTS P2Y2 KO fibroblasts proliferated and migrated significantly slower than WT fibroblasts with or without TGF-β1.The proliferation and ECM production were enhanced by P2Y2 agonist PSB-1114 and inhibited by antagonist AR-C118925. TGF-β1 induced fibrotic activation was abolished by P2Y2 ablation and inhibited by AKT, ERK, and PKC inhibitors. Ablation of P2Y2 reduced denervation induced muscle atrophy and fibrosis. CONCLUSIONS P2Y2 is a promoter of skeletal muscle atrophy and activation of fibroblasts after muscle injury, which signaling through AKT, ERK and PKC. P2Y2 could be a potential intervention target after muscle injury.
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28
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Takeuchi N, Kozono N, Nishii A, Matsuura K, Ishitani E, Onizuka T, Zaitsu Y, Okada T, Mizuki Y, Kimura T, Yuge H, Uchimura T, Iura K, Mori T, Ueda K, Miake G, Senju T, Takagishi K, Nakashima Y. Stump classification was correlated with retear in the suture-bridge and double-row repair techniques for arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2021; 29:2587-2594. [PMID: 33459835 DOI: 10.1007/s00167-020-06415-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/10/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The Stump classification is significantly correlated with a retear after arthroscopic rotator cuff repair. However, no study has evaluated whether or not the stump classification is correlated with retear in the suture-bridge or double-row repair techniques. The aim of this study was to evaluate the relationship between a retear and the stump classification in the suture-bridge and double-row repair techniques. METHODS Among 389 patients who underwent arthroscopic repairs of full-thickness rotator cuff tears using suture-bridge or double-row repair techniques, 326 patients (median age 67.0 years; range 25-85) were included. There were 51 small, 172 medium, 83 large, and 20 massive tears. Two hundred forty patients were treated with the suture-bridge technique, and 86 patients were treated with the double-row technique. The following variables were analyzed: age, sex, the Cofield classification, anteroposterior and mediolateral tear size on preoperative MRI, global fatty degeneration index, and the stump classification. Cuff integrity was evaluated on magnetic resonance imaging at 6 months after surgery. The patients were divided into the intact and retear groups and the relationship between the variables and retear was evaluated by multivariate logistic regression analysis. RESULTS The overall retear rate was 10.1%. In the multivariate logistic regression analysis, the independent predictors of a retear were the stump classification type 3 (Odds ratio: 4.71, p = 0.0246), global fatty degeneration index (Odds ratio: 3.87, p = 0.0030), and anteroposterior tear size (Odds ratio: 1.07, p = 0.0077) in the suture bridge technique. In the double-row technique, the independent predictors of retear were stump classification type 3 (Odds ratio: 7.82, p = 0.0348), and age (Odds ratio: 1.22, p = 0.0163). CONCLUSION The stump classification was significantly correlated with retear in the suture-bridge and double-row repair technique. Stump classification type 3 was indicated to be an important risk factor for predicting retear. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Naohide Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan.
| | - Naoya Kozono
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Akihiro Nishii
- Department of Orthopaedic Surgery, Kitakyushu Municipal Medical Center, Kitakyushu City, Fukuoka, 802-0077, Japan
| | - Koumei Matsuura
- Department of Orthopaedic Surgery, Saiseikai Yahata General Hospital, Kitakyushu City, Fukuoka, 805-0050, Japan
| | - Eiichi Ishitani
- Department of Orthopaedic Surgery, Fukuoka Shion Hospital, Ogori City, Fukuoka, 838-0101, Japan
| | - Toshihiro Onizuka
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Kitakyushu City, Fukuoka, 800-0296, Japan
| | - Yoshihisa Zaitsu
- Department of Orthopaedic Surgery, Mizoguchi Orthopaedic Hospital, Fukuoka City, Fukuoka, 810-0001, Japan
| | - Takamitsu Okada
- Department of Orthopaedic Surgery, Nakabaru Hospital, Kasuya District, Fukuoka, 811-2233, Japan
| | - Yasuhiro Mizuki
- Department of Orthopaedic Surgery, Sasebo Kyosai Hospital, Sasebo City, Fukuoka, 857-0879, Japan
| | - Takehiro Kimura
- Department of Orthopaedic Surgery, Moro-oka Orthopaedic Hospital, Chikushi District, Fukuoka, 811-1201, Japan
| | - Hidehiko Yuge
- Department of Orthopaedic Surgery, Mizoguchi Orthopaedic Hospital, Fukuoka City, Fukuoka, 810-0001, Japan
| | - Taiki Uchimura
- Department of Orthopaedic Surgery, Sasebo Kyosai Hospital, Sasebo City, Fukuoka, 857-0879, Japan
| | - Kunio Iura
- Department of Orthopaedic Surgery, Fukuoka Orthopaedic Hospital, Fukuoka City, Fukuoka, 815-0063, Japan
| | - Tatsuya Mori
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Kitakyushu City, Fukuoka, 800-0296, Japan
| | - Koki Ueda
- Department of Orthopaedic Surgery, Sasebo Kyosai Hospital, Sasebo City, Fukuoka, 857-0879, Japan
| | - Go Miake
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Kitakyushu City, Fukuoka, 800-0296, Japan
| | - Takahiro Senju
- Department of Orthopaedic Surgery, Sasebo Kyosai Hospital, Sasebo City, Fukuoka, 857-0879, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Sada Hospital, Fukuoka City, Fukuoka, 810-0004, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
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Significance of the acromiohumeral distance on stress radiography for predicting healing and function after arthroscopic repair of massive rotator cuff tears. J Shoulder Elbow Surg 2021; 30:e471-e481. [PMID: 33271320 DOI: 10.1016/j.jse.2020.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND A decreased acromiohumeral distance (AHD) is commonly detected in patients with massive rotator cuff tears (mRCTs). Most studies evaluating fixed humeral elevation have used preoperative or postoperative standardized radiography and not stress radiography. This study aimed to evaluate the predictive role of the preoperative AHD measured using stress radiography (AHD_stress) in rotator cuff healing and function after arthroscopic repair of mRCTs. METHODS The data of 113 patients who underwent arthroscopic repair of mRCTs were analyzed. Postoperative cuff integrity was evaluated using magnetic resonance imaging at 1 year, and shoulder function was evaluated at a mean of 34.9 ± 17.8 months (range, 24-92 months) postoperatively. Forty-seven patients showed healing failure. Propensity score matching (1-1) was performed between the healed group and healing failure group. Thirty-eight patients in each group were matched in the final analysis. The AHD and AHD_stress were defined as the shortest distances from the inferior acromion to the superior humerus on standard anteroposterior radiography and stress radiography (5.4-kg weight applied inferiorly in a neutral position), respectively. The AHD difference (AHD_diff) was defined as the difference between the AHD and AHD_stress values. Receiver operating characteristic curve analysis was performed to determine cutoff values for significant variables. RESULTS No difference in the mean preoperative AHD was found between the healed group (7.5 ± 2.0 mm) and healing failure group (6.9 ± 2.2 mm, P = .234). The AHD_diff value was significantly higher in the healed group (4.4 ± 2.1 mm) than in the healing failure group (3.0 ± 2.0 mm, P = .002; cutoff, 3.2 mm). Patients with an AHD_diff value ≥ 3.2 mm showed a lower healing failure rate (28.9% vs. 71.1%, P < .001) and higher functional scores than patients with an AHD_diff value < 3.2 mm. The AHD_diff value was higher in patients with an American Shoulder and Elbow Surgeons (ASES) score ≥ 80 (4.9 ± 1.9 mm) than in those with an ASES score < 80 (3.1 ± 2.1 mm, P = .024). Among patients with healing failure, only the postoperative AHD showed a significant difference between those with an ASES score ≥ 80 (7.0 ± 2.5 mm) and those with an ASES score < 80 (4.8 ± 2.1 mm, P = .009; cutoff, 4.8 mm). CONCLUSION A reducible AHD, which increased by ≥ 3.2 mm under stress radiography, can be a favorable predictor of rotator cuff healing and function after arthroscopic repair of mRCTs. Our findings suggest that this new and simple radiologic parameter should be considered preoperatively and would be helpful to determine appropriate treatment strategies.
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Misir A, Uzun E, Kizkapan TB, Ozcamdalli M, Sekban H, Guney A. Factors associated with the development of early- to mid-term cuff-tear arthropathy following arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2021; 30:1572-1580. [PMID: 33038498 DOI: 10.1016/j.jse.2020.09.016] [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: 05/07/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have specifically evaluated the development of cuff-tear arthropathy (CTA) after a rotator cuff repair in the postoperative early to mid-term. This study aimed to identify the factors associated with the development of CTA, to evaluate the effect of arthropathy on functional outcomes, and to evaluate the incidence of CTA 3-10 years after an arthroscopic rotator cuff repair. METHODS A total of 312 patients who underwent an arthroscopic repair of a large or massive full-thickness rotator cuff tear with a minimum follow-up of 3 years were retrospectively divided into 2 groups for analysis: those with postrepair CTA (arthritic glenohumeral changes due to rotator cuff insufficiency) and those without. CTA was assessed using the Seebauer and modified Hamada-Fukuda classification systems. Pre-, intra-, and postoperative patient characteristics; characteristics of the rotator cuff tear; clinical and radiological parameters; and pre- and postoperative functional scores were compared. RESULTS The rate of development of CTA was 11.5% (36 of 312 patients, 13 centric and 23 eccentric arthropathy). CTA was more frequently associated with the poor integrity of the supraspinatus tendon after repair (P < .001) and massive tears (P = .006). Postoperative pseudoparalysis (P < .001), symptomatic retear (P < .001), tear size (P = .026), critical shoulder angle (P = .001), preoperative acromiohumeral interval (P = .046), and the humeral head superior migration (P = .001) were found to be associated with the development of CTA. However, only postoperative pseudoparalysis was found to be an independent risk factor (P < .001, odds ratio: 2.965). Patients with postrepair CTA had significantly worse functional outcome scores. CONCLUSION The postoperative development of pseudoparalysis may be a marker of CTA in the future and that closer follow-up may be necessary.
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Affiliation(s)
- Abdulhamit Misir
- Department of Orthopaedics and Traumatology, Health Sciences University, Gaziosmanpasa Training and Research Hospital, Gaziosmanpasa, Istanbul, Turkey.
| | - Erdal Uzun
- Department of Orthopaedics and Traumatology, Erciyes University School of Medicine, Melikgazi, Kayseri, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopaedics and Traumatology, Bursa Cekirge State Hospital, Osmangazi, Bursa, Turkey
| | - Mustafa Ozcamdalli
- Department of Orthopaedics and Traumatology, Ahi Evran University School of Medicine, Kirsehir Merkez, Kirsehir, Turkey
| | - Hazim Sekban
- Department of Orthopaedics and Traumatology, Health Sciences University, Kayseri City Hospital, Kocasinan, Kayseri, Turkey
| | - Ahmet Guney
- Department of Orthopaedics and Traumatology, Erciyes University School of Medicine, Melikgazi, Kayseri, Turkey
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Gupta A, Ker AM, Maharaj JC, Veen EJ, Cutbush K. All-Arthroscopic Muscle Slide and Advancement Technique to Repair Massive Retracted Posterosuperior Rotator Cuff Tears. Arthrosc Tech 2021; 10:e1439-e1446. [PMID: 34258188 PMCID: PMC8252854 DOI: 10.1016/j.eats.2021.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/07/2021] [Indexed: 02/03/2023] Open
Abstract
Symptomatic massive posterosuperior rotator cuff tears without glenohumeral joint arthritis and chronic medial retraction often are deemed "irreparable." These patients often are treated with alternative joint-sparing procedures including superior capsular reconstruction or tendon transfer procedures. Open and arthroscopic-assisted muscle advancement techniques allow maximal lateral tendon mobilisation during rotator cuff repair. In this report, we present an all-arthroscopic technique of complete supraspinatus and infraspinatus muscle scapular detachment and advancement in retracted massive posterosuperior rotator cuff tears. This allows for an anatomical tendon footprint reduction and tension-free repair.
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Affiliation(s)
- Ashish Gupta
- Greenslopes Private Hospital, Brisbane, Australia,Shoulder Surgery QLD Research Institute (SSQRI), Brisbane, Australia
| | - Andrew M. Ker
- Greenslopes Private Hospital, Brisbane, Australia,Brisbane Private Hospital, Brisbane, Australia,Address correspondence to Andrew Ker, Greenslopes Private Hospital, Newdegate Street, Greenslopes, QLD 4120, Australia.
| | | | - Egbert J.D. Veen
- Greenslopes Private Hospital, Brisbane, Australia,Brisbane Private Hospital, Brisbane, Australia
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Abstract
Background The irreparability of rotator cuff repair is generally determined during surgery. We have been performing partial repairs for rotator cuff tears that are deemed irreparable with primary repair. The aim of this study is to report, for the first time, the long-term postoperative outcome of our partial repair method and to clarify the criteria for the irreparability of primary repair. Methods The UCLA score, radiographic findings, and magnetic resonance imaging findings of 156 shoulders that underwent rotator cuff repair (primary repair, 126 shoulders; partial repair, 30 shoulders) were retrospectively evaluated at preoperative and >10-year postoperative follow-up (mean evaluation time, 11.5 ± 1.0 years). Osteoarthritic (OA) changes were evaluated by radiographic findings, and the cuff integrity (Sugaya classification) and fatty infiltration (Goutallier classification) were evaluated by magnetic resonance imaging findings. These evaluations were compared between a primary repair group and partial repair group. Results Although no significant difference was observed between preoperative and postoperative findings for the UCLA score, the strength of forward flexion was significantly lower at 10 years postoperatively in the partial repair group. Preoperative image evaluation showed no significant difference in OA changes between the 2 groups; however, fatty infiltration showed significantly greater progression in the partial repair group than the primary repair group. At >10-year postoperative follow-up, the OA changes, cuff integrity, and fatty infiltration showed significantly greater progression in the partial repair group compared to the primary repair group. Although the long-term outcome of the partial repair group was inferior to that of the primary repair group in imaging evaluations, good functional outcome of the shoulder joint was maintained. Conclusion Our results suggested that partial repair could be an effective treatment option for irreparable rotator cuff tear. In terms of the feasibility of primary repair, the cutoff value for preoperative fatty infiltration was stage 2; thus, we believe that primary repair should be performed for cases with stage 2 fatty infiltration or lower, and partial repair should be performed for cases with stage 3 fatty infiltration or higher. However, manual workers and athletes with stage 3 fatty infiltration or higher should be advised in advance that mild muscle weakness may remain after surgery.
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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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Dierckman BD, Frousiakis P, Burns JP, Barber FA, Wodicka R, Getelman MH, Karzel RP, Snyder SJ. Arthroscopic Repair of Medium to Large Rotator Cuff Tears With a Triple-Loaded Medially Based Single-Row Technique Augmented With Marrow Vents. Arthroscopy 2021; 37:28-37. [PMID: 32805317 DOI: 10.1016/j.arthro.2020.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary purpose of this study was to evaluate the repair integrity on magnetic resonance imaging (MRI), and secondarily, clinical outcomes, of medium to large (2-4 cm) rotator cuff tears treated using an arthroscopic triple-loaded medially based single-row repair technique augmented laterally with bone marrow vents. METHODS This is a retrospective outcomes study of patients with full-thickness medium to large (2-4 cm) rotator cuff tears repaired by 4 surgeons at a single institution over a 2-year period with a minimum of 24 months' follow-up. A single-row repair with tension-minimizing medially based triple-loaded anchors and laterally placed bone marrow vents was used. Patients completed a satisfaction and pain survey, the Western Ontario Rotator Cuff index questionnaire, and a Short Form-36 version 2 survey to evaluate clinical outcomes. MRI was obtained at a minimum of 24 months follow-up to assess repair integrity. RESULTS A total of 64 males and 27 females with a mean age of 59.7 (range, 34-82) were included. The mean tear size was 2.6 cm in anteroposterior dimension, treated with a mean of 2.2 anchors. Eighty-three of 91 shoulders (91%) reported being completely satisfied with their result. The median Western Ontario Rotator Cuff score was 95.2% of normal, with a significant difference found between those with an intact repair and those with a full-thickness recurrent defect (median, 95.9% vs. 73.8%; P = .003). Postoperative MRI obtained at a median of 32 months (range, 24-48) demonstrated an intact repair in 84 of 91 shoulders (92%), with failure defined as a full-thickness defect of the tendon. CONCLUSIONS Arthroscopic repair of medium to large rotator cuff tears using triple-loaded medially based single-row repair augmented with marrow vents resulted in a 92% healing rate by MRI and excellent patient-reported outcomes LEVEL OF EVIDENCE: Level IV, retrospective case series.
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Affiliation(s)
| | | | - Joseph P Burns
- Southern California Orthopedic Institute, Van Nuys, California, U.S.A
| | - F Alan Barber
- Plano Orthopedic and Sports Medicine Center, Plano, Texas, U.S.A
| | - Ross Wodicka
- Holy Cross Orthopedic Institute, Fort Lauderdale, Florida, U.S.A
| | - Mark H Getelman
- Southern California Orthopedic Institute, Van Nuys, California, U.S.A
| | - Ronald P Karzel
- Southern California Orthopedic Institute, Van Nuys, California, U.S.A
| | - Stephen J Snyder
- Southern California Orthopedic Institute, Van Nuys, California, U.S.A
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Tashjian RZ, Hillyard B, Childress V, Kawakami J, Presson AP, Zhang C, Chalmers PN. Outcomes after a Grammont-style reverse total shoulder arthroplasty? J Shoulder Elbow Surg 2021; 30:e10-e17. [PMID: 32778382 PMCID: PMC7726007 DOI: 10.1016/j.jse.2020.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/07/2020] [Accepted: 04/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the factors associated with outcomes after reverse total shoulder arthroplasty (RTSA). METHODS We retrospectively evaluated all RTSAs performed by the senior author between January 1, 2007, and November 1, 2017. We evaluated pain visual analog scale (VAS), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores and complication and reoperation rates at a minimum of 2-year follow-up. We evaluated preoperative and 2-week postoperative radiographs for glenoid inclination (GI), medialization as distance between the center of the humeral head or glenosphere and the line of the deltoid, and distalization via the acromial-greater tuberosity distance. We performed inter- and intrarater reliabilities via intraclass correlation coefficients (ICCs) and conducted a multivariable analysis. RESULTS We included 230 RTSAs in the analysis, with 70% follow-up at a median of 3.4 years. Reliability was acceptable with all ICCs >.678. Increased postoperative GI was significantly associated with increased VAS pain postoperatively (P = .008). Increased distalization was associated with an increased rate of complications and reoperations (P = .032). Younger age (P = .008), female gender (P = .009), and lower body mass index (BMI) (P = .006) were associated with worse ASES scores. Female gender (P < .001) and lower BMI (P = .039) were associated with worse SST scores. Female gender (P = .013) and lower BMI (P = .005) were associated with worse VAS-pain scores. CONCLUSION Age, gender, and BMI are associated with outcome after RTSA. In this retrospective analysis of a Grammont-style RTSA, superior inclination is associated with increased pain postoperatively, whereas excessive arm lengthening is associated with increased risk for complication or reoperation.
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Affiliation(s)
- Robert Z Tashjian
- Deptartment of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Bradley Hillyard
- Deptartment of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Victoria Childress
- Deptartment of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jun Kawakami
- Deptartment of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Deptartment of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
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Miller M, Chalmers PN, Nyfeler J, Mhyre L, Wheelwright C, Konery K, Kawakami J, Tashjian RZ. Rheumatoid arthritis is associated with increased symptomatic acromial and scapular spine stress fracture after reverse total shoulder arthroplasty. JSES Int 2020; 5:261-265. [PMID: 33681846 PMCID: PMC7910737 DOI: 10.1016/j.jseint.2020.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The purpose of this study was to determine factors associated with early symptomatic acromial and scapular spine fractures in patients who underwent reverse total shoulder arthroplasty (RTSA). Methods We retrospectively evaluated all RTSAs performed by the senior author between 1/1/2013 and 6/1/2019. We evaluated patient demographics including gender, age, prevalence of comorbidities including osteoporosis, inflammatory arthritis, diabetes, and endocrine disorders such as hypothyroidism. We also evaluated preoperative and 2-week postoperative radiographs for center of rotation medialization (CORM) as distance between the center of the humeral head or glenosphere and the line of the deltoid, and distalization via the acromial-greater tuberosity distance (AGT). We evaluated inter- and intra-rater reliability via intraclass correlation coefficients. Results We included 335 RTSAs with a minimum of 3 months of follow-up in the analysis. Reliability was acceptable with all intraclass correlation coefficients> 0.75. Symptomatic acromial and scapular spine stress fractures were significantly more common in those with inflammatory arthritis than those without (18% vs. 5%, P = 0.016). The rate of fracture was highest in patients with rheumatoid arthritis (24% vs. 5.2%, P = 0.003). There was no statistically significant association between symptomatic fractures and preoperative CORM or AGT (P = 0.557, P = 0.528) or postoperative CORM or AGT (P = 0.56, P = 0.102). There also was no statistically significant correlation between symptomatic stress fracture and patient age, gender, BMI, smoking, osteoporosis, gout, medical comorbidity, or previous shoulder surgery. Conclusion In this retrospective analysis of postoperative RTSA, symptomatic acromial and scapular stress fractures were significantly more common in patients with rheumatoid arthritis and thus precautions should be taken in these patients.
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Affiliation(s)
- Matt Miller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jacob Nyfeler
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Luke Mhyre
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Cade Wheelwright
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kristin Konery
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jun Kawakami
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Guevara JA, Entezari V, Ho JC, Derwin KA, Iannotti JP, Ricchetti ET. An Update on Surgical Management of the Repairable Large-to-Massive Rotator Cuff Tear. J Bone Joint Surg Am 2020; 102:1742-1754. [PMID: 32740266 DOI: 10.2106/jbjs.20.00177] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jonathan A Guevara
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vahid Entezari
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jason C Ho
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kathleen A Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph P Iannotti
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio
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