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Chepeha JC, Silveira A, Luciak-Corea C, Sheps D, Beaupre LA. Use of a surgical referral algorithm within a standardized shoulder physical therapy program to assist clinical decision-making. Disabil Rehabil 2024:1-7. [PMID: 39205451 DOI: 10.1080/09638288.2024.2397079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Determine (a) utility of a shoulder referral algorithm, (b) patients improving ≥15% on the Western Ontario Rotator Cuff(WORC) score with standardized Physical Therapy(PT) +home exercises, and (c) presenting characteristics among PT-Only, PT + Surgical Consult and Surgery participants. MATERIALS AND METHODS Prospective cohort study of patients 30-65 years old with shoulder pain. A standardized PT program assessed pain, ROM, strength and exercise tolerance (i.e., referral algorithm) at 2-, 6- and 12-weeks to determine if a surgical consultation might be beneficial. A blinded research assessor evaluated pain, ROM, strength and WORC score at 6-, 12-weeks and 6-months. The proportion improving WORC scores ≥15% and group differences were also evaluated. RESULTS 32/128 (25%) participants underwent consultation with 16 (12.5%) undergoing surgery. WORC scores improved ≥15% by 12-weeks in most PT-Only/PT + Surgical Consult participants (n = 77[70%]) and was maintained at 6-months. Surgery participants used more NSAIDs (p = 0.01), injections (p = 0.002) and trended to higher opioid use (p = 0.06). PT + Surgical Consult/Surgery participants (n = 16/32; 50%) knew diagnostic imaging results more than PT-Only (n = 26; 31%) (p = 0.02). Surgery participants presented with worse pain, ROM, strength and WORC scores than PT-Only (p < 0.05). CONCLUSIONS The algorithm identified those with worse symptomology (25%), 50% of whom underwent surgery. WORC scores improved ≥15% in most participants (70%). Presenting characteristics were significantly worse between PT-Only and Surgery participants.
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Affiliation(s)
- Judy C Chepeha
- Collaborative Orthopedic Research (CORe), University of Alberta, Edmonton, Canada
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Anelise Silveira
- Collaborative Orthopedic Research (CORe), University of Alberta, Edmonton, Canada
| | | | - David Sheps
- Collaborative Orthopedic Research (CORe), University of Alberta, Edmonton, Canada
| | - Lauren A Beaupre
- Collaborative Orthopedic Research (CORe), University of Alberta, Edmonton, Canada
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
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Xue X, Kuati A, Fu H, Song Q, Liu Q, Cui G. Effect of low-intensity pulsed ultrasound on postoperative rehabilitation of rotator cuff tears: Protocol for a systematic review and meta-analysis. PLoS One 2024; 19:e0308354. [PMID: 39146275 PMCID: PMC11326639 DOI: 10.1371/journal.pone.0308354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/19/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Rotator cuff tears are a common shoulder injury that significantly impacts patients' daily lives and work abilities. Although surgical treatment methods for rotator cuff tears have been continuously improved with advances in medical technology, postoperative rehabilitation remains challenging. Therefore, finding effective rehabilitation treatments is crucial for improving patient prognosis and enhancing quality of life. This study will aim to systematically evaluate the impact of low-intensity pulsed ultrasound (LIPUS) on postoperative rehabilitation of rotator cuff tears, comprehensively assessing the efficacy and safety of LIPUS in postoperative recovery. METHODS This protocol will search multiple databases including PubMed/MEDLINE, Embase, Cochrane Library, CNKI, Scopus, and Web of Science to identify randomized controlled trials related to LIPUS for postoperative rehabilitation of rotator cuff tears. The search will encompass literature published from the inception of the databases up to April 2024. Methodological quality assessment and data extraction will be conducted using the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. Meta-analysis will be performed on appropriate studies using either random-effects or fixed-effects models, and subgroup analyses will be conducted to explore potential heterogeneity. Studies meeting the inclusion criteria will be included in the analysis. All analyses will be performed using Stata version 16.0. RESULTS The incidence of rotator cuff tear rates will be assessed by imaging techniques such as MRI or ultrasound. Pain intensity will be scored using standardized pain assessment scales, such as the Visual Analog Scale (VAS). Improved range of motion (ROM) in shoulder flexion, abduction, and rotation. Functional outcomes will be evaluated using effective measures such as Constant-Murley scores (CMS) and shoulder joint scores by American Shoulder and Elbow Surgeons (ASES). Adverse events associated with LIPUS therapy, including skin irritation, increased pain, or any other complications. Subgroup analysis will also be carried out if possible. DISCUSSION AND CONCLUSION Following the meta-analysis, we will assess the overall effect of LIPUS on postoperative rehabilitation of rotator cuff tears, and further explore its impact on aspects such as pain relief, functional improvement, and postoperative complications. It is anticipated that this study will provide comprehensive evidence regarding the role of LIPUS in postoperative rehabilitation of rotator cuff tears, guiding clinical practice and future research. The resultant manuscript will be submitted for publication in a peer-reviewed journal. PROTOCOL REGISTRATION NUMBER CRD42024530798.
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Affiliation(s)
- Xiali Xue
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Amila Kuati
- Department of Rehabilitation, Peking University Third Hospital, Beijing, China
| | - Hao Fu
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Qingfa Song
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Qiang Liu
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Guoqing Cui
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
- Department of Rehabilitation, Peking University Third Hospital, Beijing, China
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
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Kararti C, Özyurt F, Kodak Mİ, Basat HÇ, Özsoy G, Özsoy İ, Tayfur A. Pain Neuroscience Education Following Arthroscopic Rotator Cuff Repair for Patients With Rotator Cuff Tears: A Double-Blind Randomized Controlled Clinical Trial. Am J Phys Med Rehabil 2024; 103:690-697. [PMID: 38547029 DOI: 10.1097/phm.0000000000002481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
OBJECTIVE This trial examines the efficacy of the pain neuroscience education on clinical outcomes in patients with arthroscopic rotator cuff repair. DESIGN A total of 36 participants undergoing arthroscopic rotator cuff repair were assigned to either the experimental group ( n = 18) or control group ( n = 18) in this randomized study. A 6-wk-long conventional physiotherapy program was administered for both groups. In addition, a pain neuroscience education protocol was administered for the experimental group for a whole period of 6 wks (1 session/week, 15-60 mins per session). The primary outcomes were to compare pretreatment and posttreatment scores of the experimental versus control groups on the pain and disability. Our secondary outcomes included the comparisons of scores on the catastrophizing, anxiety, depression, kinesiophobia, and quality of life. The participants were assessed both at baseline and posttreatment. RESULTS The improvement in pain catastrophizing, anxiety, depression, and kinesiophobia was greater in the experimental group ( P < 0.05). The improvement was similar in both groups in terms of the rest of outcome measures. CONCLUSIONS This study showed that the pain neuroscience education improved only psychological aspects of the chronic pain in arthroscopic rotator cuff repair. Therefore, adding pain neuroscience education to the conventional program might be useful to improve pain catastrophizing, anxiety, depression, and kinesiophobia in patients with arthroscopic rotator cuff repair.
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Affiliation(s)
- Caner Kararti
- From the Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey (CK, FÖ, MIK, AT); Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey (HCB); and Department of Physiotherapy and Rehabilitation, Selçuk University, Selçuk, Turkey (GÖ, IÖ)
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Cha HJ, Han CH, Jeon JH, Jeong JK, Jung IC, Yang C, Kang BK, Kim MJ, Choi YE, Kim YI. A Pilot Study for Effectiveness and Safety of Adjunctive Pharmacopuncture to Acupuncture Treatment for Rotator Cuff Diseases: A Pragmatic Randomized Controlled Trial. J Pain Res 2024; 17:2203-2221. [PMID: 38947130 PMCID: PMC11213161 DOI: 10.2147/jpr.s457425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 05/12/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose Pharmacopuncture therapy has been used in the conservative treatment of rotator cuff disease adjuvant to acupuncture treatment. Despite the increasing utilization of pharmacopuncture therapy, there is still a lack of high-quality research to support its effectiveness. This pilot study aimed to assess the feasibility of pharmacopuncture therapy adjuvant to acupuncture treatment for rotator cuff disease. Patients and Methods This was a parallel-grouped, pragmatic randomized controlled, pilot study. Forty patients were randomly allocated to either the experimental or the control group. All patients received acupuncture treatment for four weeks, and pharmacopuncture was additionally administered to the experimental group. After eight treatments were delivered over four weeks, follow-up assessments were performed. The primary outcome was the mean change in the visual analog scale (VAS) score for shoulder pain from baseline to visit 8. Secondary outcomes included shoulder pain and disability index (SPADI) at visits 4, 8, and 9, shoulder range of motion (ROM) at visits 4, 8, and 9, EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) at visits 8 and 9, patient global impression of change (PGIC) at visits 8 and 9, and mean rescue medication consumption at visits 8 and 9. Results Both groups showed that each treatment effectively improved rotator cuff disease in most assessments. Particularly, the group that received acupuncture plus pharmacopuncture required fewer rescue medications than the group that received acupuncture alone. However, there was little statistically significant difference between the two groups. There were no serious adverse events experienced by patients in this study. Conclusion Although there was little statistical difference between the two groups, the combination of acupuncture and pharmacopuncture for rotator cuff disease was associated with a reduction in the rescue medicine dosage compared with acupuncture alone. Also, it confirmed the safety of pharmacopuncture therapy. This pilot study would help design future research on the effectiveness of pharmacopuncture in rotator cuff disease.
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Affiliation(s)
- Hyun Ji Cha
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Chang-Hyun Han
- Korean Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Convergence Medicine, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ju Hyun Jeon
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Jeong Kyo Jeong
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - In Chul Jung
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Changsop Yang
- Korean Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Byoung-Kab Kang
- Korean Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Min Ji Kim
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Young Eun Choi
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Young Il Kim
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
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Liu A, Zhang B, Lai T, Wang M, Wu G, Liu S, Zhang T. Comparison of functional outcomes following early and delayed arthroscopic repair for traumatic and non-traumatic rotator cuff injuries. J Orthop Surg Res 2024; 19:368. [PMID: 38902793 PMCID: PMC11191288 DOI: 10.1186/s13018-024-04858-x] [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: 04/14/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND The effects of the timing of surgical repair on the outcomes of traumatic and non-traumatic rotator cuff injuries (RCI) remain elusive. Thus, this study aimed to compare differences in outcomes following the repair of traumatic and non-traumatic RCI at varying time points. METHODS The study population comprised 87 patients with traumatic and non-traumatic RCI who underwent arthroscopic rotator cuff repair and were followed up for a minimum of 6 months. Next, the trauma and the non-trauma groups were stratified into subgroups according to the time of injury (early repair: occurring within 3 months; delayed repair: occurring after 3 months). Measurements before and after surgical interventions were compared to evaluate the effect of the duration of RCI on the functional status of patients in the trauma and non-trauma groups. Primary evaluation indices included the Visual Analog Scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Constant shoulder function score, and the University of California, Los Angeles (UCLA) shoulder score. Secondary evaluation indices consisted of shoulder range of motion (ROM), postoperative rotator cuff retear rate, and incidence of joint stiffness. RESULTS Among the 40 patients in the trauma group, 22 underwent early repair, whereas the remaining 18 underwent delayed repair. In the non-trauma group consisting of 47 patients, 18 underwent early repair, whereas the remaining 29 underwent delayed repair. The minimum clinical follow-up time was 6 months, with an average follow-up time of 10.2 months. During postoperative follow-up, 1 and 6 patients who underwent early and delayed repair experienced re-tear in the trauma group, respectively. Contrastingly, 3 and 8 patients who underwent early and delayed repair presented with re-tear in the non-trauma group, respectively. CONCLUSION Early repair of traumatic RCI yielded superior outcomes, including improved range of motion, lower pain symptoms, and lower risk of postoperative re-tears compared to delayed repair. Additionally, non-surgical treatment is recommended as the preferred approach for patients with non-traumatic RCI.
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Affiliation(s)
- Aixin Liu
- Department of Orthopaedic Surgery, Lu'an Hospital of Traditional Chinese Medicine Affiliated of Anhui University of Traditional Chinese Medicine, Lu'an, Anhui, 237000, China
| | - Baorui Zhang
- Department of Rehabilitation, Lu'an Hospital of Traditional Chinese Medicine Affiliated of Anhui University of Traditional Chinese Medicine, Lu'an, Anhui, 237000, China
| | - Tong Lai
- Department of Rehabilitation, Lu'an Hospital of Traditional Chinese Medicine Affiliated of Anhui University of Traditional Chinese Medicine, Lu'an, Anhui, 237000, China
| | - Mingxing Wang
- Department of Oncology, Lu'an Hospital of Traditional Chinese Medicine Affiliated of Anhui, University of Traditional Chinese Medicine, Lu'an, Anhui, 237000, China
| | - Gongyi Wu
- Department of Orthopaedic Surgery, Lu'an Hospital of Traditional Chinese Medicine Affiliated of Anhui University of Traditional Chinese Medicine, Lu'an, Anhui, 237000, China
| | - Shilin Liu
- Department of Neurocritical Care Unit, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China.
| | - Tao Zhang
- Department of Orthopaedic Surgery, Lu'an City Hospital of Traditional Chinese Medicine, Lu'an, Anhui, 237000, China.
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Oda H, Kaizawa Y, Franklin A, Rangel US, Min JG, Akerman J, Storaci H, Wang Z, Abrams GD, Chang J, Fox PM. Biomechanical, Histologic, and Micro-Computed Tomography Characterization of Partial-Width Full-Thickness Supraspinatus Tendon Injury in Rats. J Hand Surg Am 2024; 49:612.e1-612.e9. [PMID: 36280554 DOI: 10.1016/j.jhsa.2022.08.027] [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: 01/19/2022] [Revised: 07/08/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Partial rotator cuff tears can cause shoulder pain and dysfunction and are more common than complete tears. However, few studies examine partial injuries in small animals and, therefore a robust, clinically relevant model may be lacking. This study aimed to fully characterize the established rat model of partial rotator cuff injury over time and determine if it models human partial rotator cuff tears. METHODS We created a full-thickness, partial-width injury at the supraspinatus tendon-bone interface bilaterally in 31 Sprague-Dawley rats. Rats were euthanized immediately, and at 2-, 3-, 4-, and 8-weeks after surgery. Fourteen intact shoulders were used as controls. Samples were assessed biomechanically, histologically, and morphologically. RESULTS Biomechanically, load to failure in controls and 8 weeks after injury was significantly greater than immediately and 3 weeks after injury. Load to failure at 8 weeks was comparable to control. However, the locations of failure were different between intact shoulders and partially injured samples. Bone mineral density at 8 weeks was significantly greater than that at 2 and 3 weeks. Although no animals demonstrated propagation to complete tear and the injury site remodeled histologically, the appearance at 8 weeks was not identical to that in the controls. CONCLUSIONS The biomechanical properties and bone quality decreased after the injury and was restored gradually over time with full restoration by 8 weeks after injury. However, the findings were not equivalent to the intact shoulder. This study demonstrated the limitations of the current model in its application to long-term outcome studies, and the need for better models that can be used to assess chronic partial rotator cuff injuries. CLINICAL RELEVANCE There is no small animal model that mimics human chronic partial rotator cuff tears, which limits our ability to improve care for this common condition.
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Affiliation(s)
- Hiroki Oda
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Yukitoshi Kaizawa
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Austin Franklin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Uriel Sanchez Rangel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jung Gi Min
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jack Akerman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Hunter Storaci
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA
| | - Zhen Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Geoffrey D Abrams
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Paige M Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
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Centeno CJ, Fausel Z, Dodson E, Berger DR, Steinmetz NJ. Percutaneous bone marrow concentrate and platelet products versus exercise therapy for the treatment of rotator cuff tears: a randomized controlled, crossover trial with 2-year follow-up. BMC Musculoskelet Disord 2024; 25:392. [PMID: 38762734 PMCID: PMC11102209 DOI: 10.1186/s12891-024-07519-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/13/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Surgical repair is recommended for the treatment of high-grade partial and full thickness rotator cuff tears, although evidence shows surgery is not necessarily superior to non-surgical therapy. The purpose of this study was to compare percutaneous orthobiologic treatment to a home exercise therapy program for supraspinatus tears. METHODS In this randomized-controlled, crossover design, participants with a torn supraspinatus tendon received either 'BMC treatment', consisting of a combination of autologous bone marrow concentrate (BMC) and platelet products, or underwent a home exercise therapy program. After three months, patients randomized to exercise therapy could crossover to receive BMC treatment if not satisfied with shoulder progression. Patient-reported outcomes of Numeric Pain Scale (NPS), Disabilities of the Arm, Shoulder, and Hand, (DASH), and a modified Single Assessment Numeric Evaluation (SANE) were collected at 1, 3, 6, 12, and 24 months. Pre- and post-treatment MRI were assessed using the Snyder Classification system. RESULTS Fifty-one patients were enrolled and randomized to the BMC treatment group (n = 34) or the exercise therapy group (n = 17). Significantly greater improvement in median ΔDASH, ΔNPS, and SANE scores were reported by the BMC treatment group compared to the exercise therapy group (-11.7 vs -3.8, P = 0.01; -2.0 vs 0.5, P = 0.004; and 50.0 vs 0.0, P < 0.001; respectively) after three months. Patient-reported outcomes continued to progress through the study's two-year follow-up period without a serious adverse event. Of patients with both pre- and post-treatment MRIs, a majority (73%) showed evidence of healing post-BMC treatment. CONCLUSIONS Patients reported significantly greater changes in function, pain, and overall improvement following BMC treatment compared to exercise therapy for high grade partial and full thickness supraspinatus tears. TRIAL REGISTRATION This protocol was registered with www. CLINICALTRIALS gov (NCT01788683; 11/02/2013).
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Affiliation(s)
- Christopher J Centeno
- Centeno-Schultz Clinic, Broomfield, CO, 80021, USA
- Regenexx, LLC, Research and Development, Broomfield, CO, 80021, USA
| | - Zachary Fausel
- Regenexx, LLC, Research and Development, Broomfield, CO, 80021, USA
| | - Ehren Dodson
- Regenexx, LLC, Research and Development, Broomfield, CO, 80021, USA.
| | - Dustin R Berger
- Regenexx, LLC, Research and Development, Broomfield, CO, 80021, USA
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McConnell R, Klopper M, Rhon DI, Young JL. The influence of exercise therapy dosing on pain and functional outcomes in patients with subacromial pain syndrome: A systematic review. Shoulder Elbow 2024; 16:42-58. [PMID: 38425738 PMCID: PMC10901176 DOI: 10.1177/17585732221124303] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/05/2022] [Accepted: 08/18/2022] [Indexed: 03/02/2024]
Abstract
Background The objective was to identify exercise therapy dosing parameters for subacromial pain syndrome (SAPS) associated with improved pain and function outcomes (via effect sizes) and determine the extent of exercise intervention reproducibility. Methods An electronic search of PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Cochrane Database of Systematic Reviews, and SportDiscus identified studies that used exercise therapy exclusively to treat SAPS. Exercise therapy dosing parameters were extracted and within-group effect sizes were calculated for all pain and functional outcomes. Template for Intervention Description and Replication and Consensus on Exercise Reporting were used to record intervention reporting. The risk of bias and Grading of Recommendations, Assessment, Development, and Evaluation were assessed by two reviewers. Results Twenty-one trials with 674 subjects were included. Effect sizes for pain and function were large in 18 studies, medium in six studies, and small or no effect in four studies, despite the type of supervision. With moderate certainty, effect sizes of pain and function were not influenced by exercise therapy dosing parameters. Intervention reporting was generally poor. Discussion Exercise therapy for SAPS was associated with large effect sizes for improvement in pain and function but optimal exercise therapy dosing parameters could not be identified. Strong recommendations conditionally suggest treating SAPS with a variety of exercise therapy dosing parameters.
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Affiliation(s)
- Ryan McConnell
- Bellin College, Green Bay, WI, USA
- Department of Physical Therapy, Belmont University, Nashville, TN, USA
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St Pierre P. When is a Reverse Shoulder Arthroplasty Indicated for a Rotator Cuff Tear? Sports Med Arthrosc Rev 2024; 32:17-21. [PMID: 38695499 DOI: 10.1097/jsa.0000000000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
Rotator cuff tears are the most frequent shoulder injury in patients over 50 years old. Treatment of rotator cuff tears is individualized based on the age, demands, and symptoms of the patient. Nonoperative treatment may often be effective, especially in lower-demand or elderly patients. Surgical repair is indicated after failure of nonoperative treatment or in patients whose high-demand lifestyle requires full strength and function of the shoulder. In older patients, larger tears are less likely to heal and rotator cuff repair may not reliable. In cases of failed previous rotator cuff repair, there may not be enough viable tissue for complete repair. If there is underlying arthritis, a rotator cuff repair is unlikely to resolve all symptoms, and treatment to care for the arthritis and rotator cuff tear is indicated. Reverse shoulder arthroplasty provides the surgical answer for these scenarios and is now being used for numerous indications of shoulder pathology.
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Affiliation(s)
- Patrick St Pierre
- Shoulder and Elbow Service, Desert Orthopedic Center, Eisenhower Health, Rancho Mirage, CA
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Ribeiro LP, Curiel-Montero F, Rodrigues-de-Souza DP, Camargo PR, Alburquerque-Sendín F. Assessment of description and implementation fidelity of clinical trials involving exercise-based treatment in individuals with rotator cuff tears: a scoping review. Braz J Phys Ther 2024; 28:101062. [PMID: 38640642 PMCID: PMC11039315 DOI: 10.1016/j.bjpt.2024.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND For evidence-based practice, clinicians and researchers can rely on well-conducted randomized clinical trials that exhibit good methodological quality, provide adequate intervention descriptions, and implementation fidelity. OBJECTIVE To assess the description and implementation fidelity of exercise-based interventions in clinical trials for individuals with rotator cuff tears. METHODS A systematic search was conducted in PubMed, Embase, CINAHL, LILACS, Cochrane Library, Web of Science, SCOPUS and SciELO. Randomized clinical trials that assessed individuals with rotator cuff tears confirmed by imaging exam were included. All individuals must have received an exercise-based treatment. The methodological quality was scored with the Physiotherapy Evidence Database (PEDro) scale. The Template for Intervention Description and Replication (TIDieR) checklist and the National Institutes of Health Behaviour Change Consortium (NIHBCC) were used to assess intervention description and implementation fidelity, respectively. RESULTS A total of 13 studies were included. Despite their adequate methodological quality, the description of the intervention was poor with TIDieR scores ranging from 6 to 15 out of 24 total points. The TIDieR highest-scoring item was item 1 (brief name) that was reported in all studies. Considering fidelity, only one of the five domains of NIHBCC (i.e., treatment design) reached just over 50%. CONCLUSION Exercise-based interventions used in studies for individuals with rotator cuff tears are poorly reported. The description and fidelity of the intervention need to be better reported to assist clinical decision-making and support evidence-based practice.
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Affiliation(s)
- Larissa Pechincha Ribeiro
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Francisca Curiel-Montero
- Department of Nursing, Pharmacology and Physical Therapy, Universidad de Córdoba, Córdoba, Spain
| | - Daiana Priscila Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Universidad de Córdoba, Córdoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Universidad de Córdoba, Córdoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
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Hill M, Allen C, Williamson TK, Martinez V, Vangeli S, Zaheer A, Kingery MT, Checketts JX. Top 50 most impactful publications on massive rotator cuff tears. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:20-32. [PMID: 38323204 PMCID: PMC10840572 DOI: 10.1016/j.xrrt.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background Bibliometric analysis is a useful tool for measuring the scholarly impact of a topic and its more and less heavily studied aspects. The purpose of this study is to use bibliometric analysis to comprehensively analyze the 50 articles with the highest citation indices in studies evaluating the treatment and outcomes of massive rotator cuff tears (mRCTs). Methods This cross-sectional study identified articles within the Scopus database published through December 2022. Keywords used were "massive rotator cuff tear." Articles were sorted in chronological order. The year published and number of citations were recorded. A citation index (CI) was calculated for each article by dividing the number of citations by number of years published [1 citation/1 year published (2021) = CI of 1]. Of these, the 50 articles with the highest CIs were carried forward for evaluation. Frequencies and distributions were assessed for data of each variable collected. Results These search methods produced 625 articles regarding mRCT research (ranging from January 1986 to December 2022). Four of the top 10 most impactful articles were published in the 2010s. The level of evidence (LOE) published with the greatest frequency was level of evidence 4 (41%). The journal Arthroscopy published the highest number within the top 50 (26%) followed by the Journal of Bone and Joint Surgery and the American Journal of Sports Medicine (20% each). Clinical studies composed 88% of the top 50. Case series (38%) predominated, while systematic reviews (20%) and randomized control trials (8%) were less prevalent. The majority of studies concentrated on the clinical outcomes of certain interventions (62%), mainly comparing multiple interventions. Conclusion Despite the relatively high prevalence of mRCTs (40% of all tears), this topic comprises only a small proportion of all rotator cuff research. This analysis has identified gaps within and limitations of the findings concerning mRCTs for researchers to propose research questions targeting understudied topics and influence the future treatment and outcomes of this clinically difficult diagnosis.
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Affiliation(s)
- Marcheta Hill
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Christian Allen
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Tyler K. Williamson
- Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Victor Martinez
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Sydney Vangeli
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Aroob Zaheer
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Matthew T. Kingery
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Jake X. Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
- St Francis Medical Center, Tulsa, OK, USA
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Yuan Z, Zhu X, Dai Y, Shi L, Feng Z, Li Z, Diao N, Guo A, Yin H, Ma L. Analysis of differentially expressed genes in torn rotator cuff tendon tissues in diabetic patients through RNA-sequencing. BMC Musculoskelet Disord 2024; 25:31. [PMID: 38172847 PMCID: PMC10763306 DOI: 10.1186/s12891-023-07149-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Rotator cuff tears (RCT) is a common musculoskeletal disorder in the shoulder which cause pain and functional disability. Diabetes mellitus (DM) is characterized by impaired ability of producing or responding to insulin and has been reported to act as a risk factor of the progression of rotator cuff tendinopathy and tear. Long non-coding RNAs (lncRNAs) are involved in the development of various diseases, but little is known about their potential roles involved in RCT of diabetic patients. METHODS RNA-Sequencing (RNA-Seq) was used in this study to profile differentially expressed lncRNAs and mRNAs in RCT samples between 3 diabetic and 3 nondiabetic patients. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis were performed to annotate the function of the differentially expressed genes (DEGs). LncRNA-mRNA co-expression network and competing endogenous RNA (ceRNA) network were constructed to elucidate the potential molecular mechanisms of DM affecting RCT. RESULTS In total, 505 lncRNAs and 388 mRNAs were detected to be differentially expressed in RCT samples between diabetic and nondiabetic patients. GO functional analysis indicated that related lncRNAs and mRNAs were involved in metabolic process, immune system process and others. KEGG pathway analysis indicated that related mRNAs were involved in ferroptosis, PI3K-Akt signaling pathway, Wnt signaling pathway, JAK-STAT signaling pathway and IL-17 signaling pathway and others. LncRNA-mRNA co-expression network was constructed, and ceRNA network showed the interaction of differentially expressed RNAs, comprising 5 lncRNAs, 2 mRNAs, and 142 miRNAs. TF regulation analysis revealed that STAT affected the progression of RCT by regulating the apoptosis pathway in diabetic patients. CONCLUSIONS We preliminarily dissected the differential expression profile of lncRNAs and mRNAs in torn rotator cuff tendon between diabetic and nondiabetic patients. And the bioinformatic analysis suggested some important RNAs and signaling pathways regarding inflammation and apoptosis were involved in diabetic RCT. Our findings offer a new perspective on the association between DM and progression of RCT.
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Affiliation(s)
- Ziyang Yuan
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Xu Zhu
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
- Department of Orthopaedics, Beijing Lu He Hospital, Capital Medical University, Beijing, 101149, China
| | - Yike Dai
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Lin Shi
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Ziyang Feng
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Zhiyao Li
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Naicheng Diao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Ai Guo
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China.
| | - Heyong Yin
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China.
| | - Lifeng Ma
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China.
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13
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Zeng LF, Zhang XQ, Yang WY, Liu J. Guidelines for the Diagnosis and Treatment of Rotator Cuff Tear with Integrated Traditional Chinese and Western Medicine. Comb Chem High Throughput Screen 2024; 27:2187-2205. [PMID: 38279748 DOI: 10.2174/0113862073276030231219115111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 01/28/2024]
Abstract
Rotator cuff tear is a common injury among middle-aged and elderly people, and it has a great impact on patients' physical and mental health and quality of life. Integrative medicine based on Traditional Chinese Medicine (TCM) has certain advantages in the diagnosis and treatment of rotator cuff tears. TCM, which mainly involves the use of plant-based products, has relatively stable and reliable curative effects. It is of great significance to formulate a combined diagnosis and treatment plan for rotator cuff tear based on evidence-based medicine, which can help to standardize the clinical diagnosis and treatment techniques of TCM and Western medicine and achieve better therapeutic effects. This guideline standardizes the diagnosis and treatment process of rotator cuff tear from the aspects of range, terminology and definition, diagnosis, TCM syndrome differentiation, treatment, functional exercise, and prevention and care. It makes recommendations that cover the adoption of manual therapy, acupuncture, and other integrative medicine based on TCM. Users of these guidelines are most likely to include clinicians and health managers in healthcare settings.
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Affiliation(s)
- Ling-Feng Zeng
- State Key Laboratory of Traditional Chinese Medicine Syndrome/The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
- Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases/The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, China
| | - Xian-Quan Zhang
- State Key Laboratory of Traditional Chinese Medicine Syndrome/The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Wei-Yi Yang
- Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases/The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, China
| | - Jun Liu
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Enginering Technology Research Institute of Traditional Chinese Medicine), Guangzhou 510095, China
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Zuo J, Chen C, Guo J, Lin J, You T, Chen P, Li C, Li W. Efficacy of rotator cuff suture and arthroscopic 360° capsular release in patients with rotator cuff tear with limited shoulder movement. BMC Surg 2023; 23:379. [PMID: 38093270 PMCID: PMC10720149 DOI: 10.1186/s12893-023-02157-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/16/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND To determine the clinical efficacy of rotator cuff suture and arthroscopic 360° capsular release in patients with rotator cuff tendinopathy to improve the Constant-Murley and Visual Analogue Scale (VAS) scores, and shoulder flexion. METHODS Fifty-one patients with full-thickness rotator cuff tears and limited shoulder movement who were admitted to our hospital from October 2017 to October 2020 were selected; all patients were treated with arthroscopic rotator cuff suture and 360° capsular release. The Constant-Murley score, VAS score, and shoulder flexion angle were used to evaluate shoulder joint function before and during follow-up. Rotator cuff healing was assessed by MRI with the Sugaya classification. RESULTS After treatment, the Constant-Murley score (58.98 ± 9.84) was significantly improved compared with pre-treatment (29.33 ± 9.71), the VAS score (1.23 ± 0.87) was significantly lower than pre-treatment (7.54 ± 1.22), and the shoulder flexion angle (142.67 ± 8.59°) was significantly improved compared with pre-treatment (51.50 ± 2.10°); the difference was statistically significant (P < 0.05). CONCLUSIONS Arthroscopic rotator cuff suture and simultaneous 360° capsular release have a significant effect on the treatment of rotator cuff tear with limited shoulder movement.
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Affiliation(s)
- Jianwei Zuo
- Department of Sports Medicine, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P.R. China.
| | - Chen Chen
- Department of Anesthesiology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P.R. China
| | - Jiang Guo
- Department of Sports Medicine, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P.R. China
| | - Jianjing Lin
- Department of Sports Medicine, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P.R. China
| | - Tian You
- Department of Sports Medicine, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P.R. China
| | - Peng Chen
- Department of Sports Medicine, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P.R. China
| | - Canfeng Li
- Department of Sports Medicine, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P.R. China
| | - Wei Li
- Department of Sports Medicine, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P.R. China
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Dias D, Neto MG, Sales SDSR, Cavalcante BDS, Torrierri P, Roever L, de Araújo RPC. Effect of Mobilization with Movement on Pain, Disability, and Range of Motion in Patients with Shoulder Pain and Movement Impairment: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:7416. [PMID: 38068468 PMCID: PMC10706990 DOI: 10.3390/jcm12237416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/30/2023] [Accepted: 11/17/2023] [Indexed: 08/08/2024] Open
Abstract
BACKGROUND Shoulder pain is a disabling musculoskeletal disorder worldwide. Thus, it is important to identify interventions able to improve pain and disability. OBJECTIVE To investigate the effects of mobilization with movement (MWM) on pain, disability, and range of motion in patients with shoulder pain and movement impairment. METHODS A systematic search of different databases was performed. The systematic review protocol has been registered in PROSPERO (CRD42023404128). A random-effects model for meta-analysis was used to determine the mean difference (MD), standardized mean differences (SMD), and 95% confidence interval for the outcome of interest. RESULTS Twenty-six studies were included. Of these, eighteen were included in the meta-analysis. MWM improved pain during movement with a moderate effect SMD of (-0.6; 95% confidence interval, -1.1 to -0.1, I2 = 0%; N = 66;) and shoulder abduction MD of (12.7°; 1.3 to 24.0; I2 = 73%; N = 90) compared to sham MWM in the short term (0-6 weeks). Combined MWM and conventional rehabilitation improved pain at rest, with a MD of (-1.2; -2.2 to -0.2; I2 = 61%; N = 100), and disability SMD of (-1.3; confidence interval -2.2 to -0.4; I2 = 87%; N = 185) compared to conventional rehabilitation alone in the short term. Combined MWM and conventional rehabilitation also resulted in improvement in shoulder abduction and external rotation. Compared to Maitland, MWM resulted in improvement in the shoulder abduction MD (20.4°; confidence interval 4.3 to 36.5; I2 = 89%; N = 130) in the short term. There is no information regarding long-term effects. CONCLUSION Evidence suggests that MWM may reduce shoulder pain and restore shoulder range of motion and function. Our findings are promising, but the evidence is not strong enough to recommend it pragmatically.
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Affiliation(s)
- Daniela Dias
- Physiotherapy Department, Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia (UFBA), Salvador 40110-170, Brazil;
- Postgraduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia (UFBA), Salvador 40170-110, Brazil;
- Physiotherapy Research Group, Physiotherapy Department, Federal University of Bahia (UFBA), Salvador 40210-905, Brazil; (S.d.S.R.S.); (B.d.S.C.)
| | - Mansueto Gomes Neto
- Physiotherapy Department, Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia (UFBA), Salvador 40110-170, Brazil;
- Postgraduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia (UFBA), Salvador 40170-110, Brazil;
- Physiotherapy Research Group, Physiotherapy Department, Federal University of Bahia (UFBA), Salvador 40210-905, Brazil; (S.d.S.R.S.); (B.d.S.C.)
| | - Stephane da Silva Ribeiro Sales
- Physiotherapy Research Group, Physiotherapy Department, Federal University of Bahia (UFBA), Salvador 40210-905, Brazil; (S.d.S.R.S.); (B.d.S.C.)
| | - Bárbara dos Santos Cavalcante
- Physiotherapy Research Group, Physiotherapy Department, Federal University of Bahia (UFBA), Salvador 40210-905, Brazil; (S.d.S.R.S.); (B.d.S.C.)
| | - Palmiro Torrierri
- Physiotherapy Research Group, Physiotherapy Department, Federal University of Bahia (UFBA), Salvador 40210-905, Brazil; (S.d.S.R.S.); (B.d.S.C.)
| | - Leonardo Roever
- Department of Clinical Research, Brazilian Evidence-Based Health Network, Uberlândia 38408-100, Brazil
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut 1401, Lebanon
| | - Roberto Paulo Correia de Araújo
- Postgraduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia (UFBA), Salvador 40170-110, Brazil;
- Biochemistry Department, Federal University of Bahia (UFBA), Salvador 40170-110, Brazil
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Wörner T, Sirard P, Nero H, Hörder H, Misini Ignjatovic M, Eek F. Changes in pain and disability in patients with shoulder pain after three months of digitally delivered exercise and patient education. J Rehabil Med 2023; 55:jrm9415. [PMID: 38835146 PMCID: PMC10658804 DOI: 10.2340/jrm.v55.9415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/09/2023] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE To describe and examine potential predictors of changes in pain and disability in patients with shoulder pain who have completed 3 months of digitally delivered treatment comprising exercise and patient education. DESIGN Retrospective cohort study (clinicaltrials.org Nr: NCT05402514). SUBJECTS Patients with shoulder pain who completed treatment (n = 682). METHODS Primary outcome was change in shoulder pain (numerical rating scale 0-10; minimal clinical important change: at least 2 points). Pain and disability were reported on the Shoulder Pain and Disability Index. Changes in outcomes were analysed with paired sample t-tests. Association with potential predictors (sex, age, education, body mass index, physical activity, symptom duration, baseline pain/function, and treatment adherence) were explored with linear regression models Results: Statistically significant improvements were found for all treatment outcomes. Minimal clinically important change in pain was reached by 54.5% (n = 372). Higher baseline level of symptoms, short symptom duration, and high treatment adherence were associated with greater changes. CONCLUSION Patients with shoulder pain reported significant reductions in pain and disability following treatment, but the clinical relevance of the improvements has not been confirmed. Satisfactory treatment adherence, higher baseline pain and shorter symptom duration predicted larger improvements. A control group is needed to evaluate the actual effect of the treatment.
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Affiliation(s)
- Tobias Wörner
- Department of Health Sciences, Lund University, Lund, Sweden.
| | | | - Håkan Nero
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | - Helena Hörder
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | | | - Frida Eek
- Department of Health Sciences, Lund University, Lund, Sweden
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Gultekin O, Kilinc BE, Akpolat AO, Cumbul A, Yilmaz B. Investigation of the effects of subacromial bursal tissue preservation and microfracture procedure on healing after rotator cuff repair in a rat model. Orthop Traumatol Surg Res 2023; 109:103608. [PMID: 36958622 DOI: 10.1016/j.otsr.2023.103608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION The aim of this study is to compare the preservation of bursal tissue and microfracture techniques and to examine the effectiveness of the combination of the two methods in rotator cuff tear healing in the rat shoulder. HYPOTHESIS Bursal tissue preservation combined with microfracture is more effective in the rotator cuff repair. MATERIALS AND METHODS Twenty-three male Sprague-Dawley rats were randomly divided into two groups. The bursal tissue was preserved in group 1 (n=11) and excised in group 2 (n=12). Groups were categorized into subgroups as L (left) and R (right) based on the shoulder side receiving microfracture (L received microfracture, R did not). Histopathological examination was performed using modified Bonar Score System. RESULTS Cell morphology grades of group 1 were lower than group 2 (p<0.05). In terms of collagen measurements, the grade of group 1L (bursa preservation+microfracture) was lower than groups 1R, 2L, and 2R, and the grade of group 1R was lower than groups 2L and 2R. Cellularity grades of group 2 were higher than group 1 (p<0.05). Extracellular matrix grades of group 1 were lower than group 2 (p<0.05). The overall grades were lower in group 1 than in group 2 (p<0.05). DISCUSSION Combined treatment of bursal tissue preservation and microfracture was the most efficient method as determined by healing findings in histopathological specimens. Preservation of bursal tissue was a more effective option in tendon healing than performing only microfracture. LEVEL OF PROOF II, animal research.
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Affiliation(s)
- Onur Gultekin
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Bekir Eray Kilinc
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - Ahmet Onur Akpolat
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Alev Cumbul
- Department of Histology, Yeditepe University, Istanbul, Turkey
| | - Baris Yilmaz
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Tiryaki P, Çelik D, Bilsel K, Erşen A. Effectiveness of Exercises With Electromyographic Biofeedback in Conservative Treatment of Massive Rotator Cuff Tears: A Randomized Controlled Study. Am J Phys Med Rehabil 2023; 102:419-426. [PMID: 36166658 DOI: 10.1097/phm.0000000000002111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study is to investigate the effectiveness of a rehabilitation program with electromyographic biofeedback compared with the control group on patients with massive rotator cuff tear. DESIGN Forty-six adults with massive rotator cuff tears, randomly assigned to 2 groups (23 electromyographic biofeedback group vs. 23 control group). The electromyographic biofeedback group (experimental group) performed the exercises under the guidance of electromyographic biofeedback, unlike the control group. All patients underwent a 45-minute training session a day, 3 times a week over a 6-wk duration, and followed up until 1-year. The outcome measures were American Shoulder and Elbow score, shoulder flexion strength, shoulder range of motion, Numeric Pain Rating Scale, and Global Rating of Change Scale. RESULTS Compared with the control group, the electromyographic biofeedback group demonstrated a significant change in shoulder flexion strength and patient satisfaction from baseline to 6 wks (posttraining) and from baseline to 12-mo follow-up ( F = 4.671, P = 0.005). There were significant improvements in within groups statistics for American Shoulder and Elbow score, shoulder flexion strength, shoulder range of motion, and Numeric Pain Rating Scale in both groups ( P < 0.05). CONCLUSIONS The results demonstrate that deltoid-focused structured rehabilitation program combined with electromyographic biofeedback can be used to increase shoulder flexion strength and patient satisfaction in conservative treatment of massive rotator cuff tear.
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Affiliation(s)
- Pelin Tiryaki
- From the Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Yalova University, Yalova, Turkey (PT); Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey (PT); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey (DÇ); Department of Orthopaedics and Traumatology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey (KB); and Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey (AE)
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Emam M, Cohen C, Willeford S, Mahesh K, Le MQ, Wilckens J. Role of Conservative Treatment vs Surgical Treatment for Rotator Cuff Tears: A Narrative Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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Desai V, Stambulic T, Daneshvar P, Bicknell RT. Lower trapezius tendon transfer for irreparable rotator cuff injuries: a scoping review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:1-9. [PMID: 37588064 PMCID: PMC10426520 DOI: 10.1016/j.xrrt.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Rotator cuff tears are a common source of shoulder pain and dysfunction. An irreparable rotator cuff tear poses a particular treatment challenge. There have been few studies reporting the outcomes of lower trapezius tendon (LTT) transfer for irreparable rotator cuff injuries. Therefore, the purpose of this review is to summarize the postoperative functional outcomes and complications of patients undergoing a LTT transfer for massive irreparable rotator cuff injuries. Methods A scoping review was performed using the Medline, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases with the search terms "trapezius" AND "transfer." Of 362 studies included for initial screening, 37 full-text citations were reviewed, with 5 studies meeting all the inclusion criteria to be included in the review. Two reviewers extracted data on study design, patient demographics, surgical technique, functional outcomes, range of motion (ROM), and complications for each study according to the predefined criteria. Results Improvements in the preoperative to postoperative functional status, identified using the Disabilities of the Arm, Shoulder, and Hand (50.34 to 18), The American Shoulder and Elbow Surgeons Score (48.56 to 80.24), Visual Analog Scale (5.8 to 1.89), Single Assessment Numeric Evaluation (34.22 to 69.86), and Subjective Shoulder Value (52.24 to 77.66), were evident across all 5 studies. Preoperative to postoperative increases in ROM were seen for flexion (85 to 135), external rotation (18 to 52), and abduction (50 to 98). The overall complication rate was 18%, with seroma formation (8%) as the most common postoperative complication. Discussion/Conclusion Our analysis showed that LTT transfer improved postoperative function, ROM, and pain for patients with irreparable rotator cuff tears with an overall complication rate of 18%. Future controlled studies are required to directly compare LTT transfer to other tendon transfers and other surgical techniques for irreparable rotator cuff tears.
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Affiliation(s)
- Veeral Desai
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Thomas Stambulic
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Parham Daneshvar
- Department of Othopaedic Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Ryan T. Bicknell
- Department of Othopaedic Surgery, Queen’s University, Kingston, Ontario, Canada
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Mandalia K, Ames A, Parzick JC, Ives K, Ross G, Shah S. Social determinants of health influence clinical outcomes of patients undergoing rotator cuff repair: a systematic review. J Shoulder Elbow Surg 2023; 32:419-434. [PMID: 36252786 DOI: 10.1016/j.jse.2022.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Social determinants of health (SDOH) are the collection of environmental, institutional, and intrinsic conditions that may bias access to, and utilization of, health care across an individual's lifetime. The effects of SDOH are associated with disparities in patient-reported outcomes after hip and knee arthroplasty, but its impact on rotator cuff repair (RCR) is poorly understood. This study aimed to investigate the influences that SDOH have on accessing appropriate orthopedic treatment, as well as its effects on patient-reported outcomes following RCR. METHODS This systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and guidelines outlined by the Cochrane Collaboration. A search of PubMed, the Cochrane Library, and Embase from inception until March 2022 was conducted to identify studies reporting at least 1 SDOH and its effect on access to health care, clinical outcomes, or patient-reported outcomes following RCR. The search term was created with reference to the PROGRESS-Plus framework. Methodological quality of included primary studies was appraised using the Newcastle-Ottawa Scale (NOS) for nonrandomized studies, and the Cochrane Risk of Bias Tool for randomized studies. RESULTS Thirty-two studies (level I-IV evidence) from 18 journals across 7 countries, published between 1999 and 2022, met inclusion criteria, including 102,372 patients, 669 physical therapy (PT) clinics, and 71 orthopedic surgery practices. Multivariate analysis revealed female gender, labor-intensive occupation and worker's compensation claims, comorbidities, tobacco use, federally subsidized insurance, lower education level, racial or ethnic minority status, low-income place of residence and low-volume surgery regions, unemployment, and preoperative narcotic use contribute to delays in access to health care and/or more severe disease state on presentation. Black race patients were found to have significantly worse postoperative clinical and patient-reported outcomes and experienced more pain following RCR. Furthermore, Black and Hispanic patients were more likely to present to low-volume surgeons and low-volume facilities. A lower education level was shown to be an independent predictor of poor surgical and patient-reported outcomes as well as increased pain and worse patient satisfaction. Patients with federally subsidized insurance demonstrated significantly worse postoperative clinical and patient-reported outcomes CONCLUSIONS: The impediments created by SDOH lead to worse clinical and patient-reported outcomes following RCR including increased risk of postoperative complications, failed repair, higher rates of revision surgery, and decreased ability to return to work. Orthopedic surgeons, policy makers, and insurers should be aware of the aforementioned SDOH as markers for characteristics that may predispose to inferior outcomes following RCR.
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Affiliation(s)
- Krishna Mandalia
- Tufts University School of Medicine, Boston, MA, USA; New England Shoulder and Elbow Center, Boston, MA, USA.
| | - Andrew Ames
- New England Baptist Hospital, Boston, MA, USA
| | - James C Parzick
- Tufts University School of Medicine, Boston, MA, USA; New England Shoulder and Elbow Center, Boston, MA, USA
| | | | - Glen Ross
- New England Baptist Hospital, Boston, MA, USA
| | - Sarav Shah
- New England Baptist Hospital, Boston, MA, USA
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22
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Oda H, Kaizawa Y, Franklin A, Sanchez Rangel U, Storaci H, Min JG, Wang Z, Abrams GD, Chang J, Fox PM. Assessment of a Synergistic Effect of Platelet-Rich Plasma and Stem Cell-Seeded Hydrogel for Healing of Rat Chronic Rotator Cuff Injuries. Cell Transplant 2023; 32:9636897231190174. [PMID: 37592455 PMCID: PMC10467370 DOI: 10.1177/09636897231190174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 08/19/2023] Open
Abstract
Outcomes after repair of chronic rotator cuff injuries remain suboptimal. Type-1 collagen-rich tendon hydrogel was previously reported to improve healing in a rat chronic rotator cuff injury model. Stem cell seeding of the tendon hydrogel improved bone quality in the same model. This study aimed to examine whether there was a synergistic and dose-dependent effect of platelet-rich plasma (PRP) on tendon-bone interface healing by combining PRP with stem cell-seeded tendon hydrogel. Human cadaveric tendons were processed into a hydrogel. PRP was prepared at two different platelet concentrations: an initial concentration (initial PRP group) and a higher concentration (concentrated PRP group). Tendon hydrogel was mixed with adipose-derived stem cells and one of the platelet concentrations. Methylcellulose, as opposed to saline, was used as a negative control due to comparable viscosity. The supraspinatus tendon was detached bilaterally in 33 Sprague-Dawley rats (66 shoulders). Eight weeks later, each detached tendon was repaired, and a hydrogel mixture or control was injected at the repair site. Eight weeks after repair, shoulder samples were harvested and assigned for biomechanical testing (n = 42 shoulders) or a combination of bone morphological and histological assessment (n = 24 shoulders). Biomechanical testing showed significantly higher failure load and stiffness in the concentrated PRP group than in control. Yield load in the initial and concentrated PRP groups were significantly higher than that in the control. There were no statistically significant differences between the initial and concentrated PRP groups. The addition of the highly concentrated PRP to stem cells-seeded tendon hydrogel improved healing biomechanically after chronic rotator cuff injury in rats compared to control. However, synergistic and dose-dependent effects were not seen.
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Affiliation(s)
- Hiroki Oda
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Yukitoshi Kaizawa
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Austin Franklin
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Uriel Sanchez Rangel
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Hunter Storaci
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA
| | - Jung Gi Min
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Zhen Wang
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Geoffrey D. Abrams
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA
| | - James Chang
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Paige M. Fox
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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23
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Prevalence, Natural History, and Nonoperative Treatment of Rotator Cuff Disease. OPER TECHN SPORT MED 2023. [DOI: 10.1016/j.otsm.2023.150978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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24
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Cha ED, Shultz K, Chan K, Choi J. Longitudinal efficacy of acellular dermal allograft following superior capsular reconstruction of irreparable rotator cuff tears. J Orthop 2022; 33:31-36. [PMID: 35801200 PMCID: PMC9253897 DOI: 10.1016/j.jor.2022.06.012] [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: 04/21/2022] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Superior capsular reconstruction (SCR) remains an option for irreparable rotator cuff tears, especially for active patients. While fascia lata grafts were first used with SCRs, acellular dermal allografts have demonstrated similar postoperative outcomes and complication rates. Few studies report long-term clinical outcomes following use of acellular dermal allografts. The aim of the current study is to evaluate long-term efficacy of allograft usage in SCR through patient reported clinical outcomes. Methods A retrospective review of patients undergoing SCR with use of dermal allografts from 2015 to 2021 was performed. Exclusion criteria included patients lost to follow up, revision or removal of graft, and inadequate follow up timepoints. Demographics and operative characteristics were collected. To evaluate efficacy of graft, numerical rating scale (NRS), American Shoulder and Elbow Score (ASES) were assessed postoperatively. Shoulder range of motion (ROM) was also evaluated by the 6-month postoperative timepoint. Improvement in NRS, ASES, and shoulder ROM from baseline values were evaluated using a t-test. Results The final cohort was 21 patients with two patients undergoing revision and removal of the graft. Mean follow up time was 36.9 months. No major postoperative complications were recorded. Mean preoperative NRS and ASES score was 5.7 and 38.4, which both significantly improved postoperatively (p < 0.001). Patients demonstrated improvements in forward flexion, abduction in 90° rotation, and external and internal rotation. Conclusion Use of acellular dermal grafts in SCR procedures for irreparable rotator cuff tears remains a viable long-term solution to restore shoulder function.
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Affiliation(s)
- Elliot D.K. Cha
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
| | | | - Kelley Chan
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Joseph Choi
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
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25
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Brock L, Hightower B, Moore T, Nees D, Heigle B, Shepard S, Kee M, Ottwell R, Hartwell M, Vassar M. Reporting of Patient-Reported Outcome Measures in Randomized Controlled Trials on Shoulder Rotator Cuff Injuries Is Suboptimal and Requires Standardization. Arthrosc Sports Med Rehabil 2022; 4:e1429-e1436. [PMID: 36033194 PMCID: PMC9402470 DOI: 10.1016/j.asmr.2022.04.032] [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: 12/19/2021] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Methods Results Conclusions Clinical Relevance
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Affiliation(s)
- Lydia Brock
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
- Address correspondence to Lydia Brock, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK 74107.
| | - Brooke Hightower
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Ty Moore
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Danya Nees
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Benjamin Heigle
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Samuel Shepard
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Micah Kee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Ryan Ottwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
- Department of Internal Medicine, University of Oklahoma, School of Community Medicine Tulsa, Oklahoma, U.S.A
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
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Wang H, Hu F, Lyu X, Jia H, Wang B, Liu F, Yang Y. Kinesiophobia could affect shoulder function after repair of rotator cuff tears. BMC Musculoskelet Disord 2022; 23:714. [PMID: 35883122 PMCID: PMC9316366 DOI: 10.1186/s12891-022-05679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Kinesiophobia (fear of movement) is a major limiting factor in the return to pre-injury sport level after surgery of rotator cuff tears. The study aims to gain insights into how kinesiophobia affects shoulder pain and function after the repair of full-thickness rotator cuff tears. Methods A prospective study was conducted to evaluate patients who underwent rotator cuff repair between January 2019 and December 2019 in our institution. The patients were divided into a trial group with a high kinesiophobia (Tampa Scale for Kinesiophobia [TSK], TSK > 37) and a control group with a low kinesiophobia (TSK ≤ 37). The indicators of interest included the Constant-Murley scores, numerical rating scale (NRS), visual analogue scale (VAS), Oxford Shoulder Score (OSS), and the American shoulder and elbow score (ASES), shoulder function and strength, and range of motion (ROM) at 3 days, 6 weeks, and 12 months after repair of full-thickness rotator cuff tears. Results In total, 49 patients who underwent repair of full-thickness rotator cuff tears were enrolled, which was divided into a trial group involving 26 patients (mean TSK 52.54) and a control group involving 23 patients (mean TSK 33.43). There were no statistically significant differences in basic information such as age, gender, and length of stay in the two groups. The preoperative and early postoperative functional scores and the Tampa Scale for Kinesiophobia were statistically significant differences between the two groups. However, long-term postoperative follow-up showed no statistically significant difference in ASES, and Constant-Murley scores, OSS, and VAS scores between the two groups as the kinesiophobia changed from positive to negative. Conclusion Degree of kinesiophobia reduced during post-operative rehabilitation of rotator cuff repair patients, but high kinesiophobia is still present in a large portion of the patients after rotator cuff repair. Patients after rotator cuff repair will benefit from early recognition and prevention of kinesiophobia.
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Affiliation(s)
- Huihui Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Fangning Hu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Xiaolong Lyu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Honglei Jia
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Bomin Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Yongliang Yang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
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27
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Hall A, Lee D, Campbell R, Palm J, Tucker B, Pepe M, Tjoumakaris F. The Shoulder Function “Tipping-Point” for Elective Rotator Cuff Repair: Demographic and Longitudinal Trends. JSES Int 2022; 6:828-832. [PMID: 36081700 PMCID: PMC9446187 DOI: 10.1016/j.jseint.2022.05.004] [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: 11/16/2022] Open
Abstract
Background A patient's decision to undergo an elective orthopedic procedure is largely based on their symptoms and functional limitations. This point where patients choose to undergo surgery is known as the “tipping point.” The primary aim of this study is to determine the relationship between demographic parameters and the tipping point for elective rotator cuff repair. The secondary aim is to investigate if the tipping point is associated with mental health. The tertiary aim is to determine if the tipping point changes over time. Methods Retrospective chart review was used to identify all patients who underwent primary arthroscopic rotator cuff repair between January 1, 2015, to January 1, 2020, with 1 of 3 board-certified orthopedic surgeons. Exclusion criteria included age <18 years, revision surgery, or incomplete datasets (American Shoulder and Elbow Surgeons [ASES], 12-item short form, demographic information, and surgical history). Preoperative ASES score was designated as the tipping point for an individual patient, with a lower score representing worse shoulder function and therefore a higher tipping point and vice versa. Demographic parameters (age, sex, body mass index [BMI], race, and insurance), hand dominance, and surgical history extracted from chart review were analyzed to determine associations with tipping point. Results A total of 2153 patients were identified from chart review, with 1731 included in the final analysis. The patients had a mean age of 58.6 ± 9.66 years and a mean BMI of 29.2 ± 6.02 kg/m2. There was no significant difference in mean preoperative ASES score by year for the duration of this study (2015-2019, P = .27). Worker's compensation patients had a significantly lower mean preoperative ASES score than patients with commercial or government insurance (P < .01). Spearman's rank correlations showed no relationship between ASES score and patient demographics (age, sex, BMI, race, and hand dominance) or between ASES and previous orthopedic surgery. Preoperative ASES showed a weakly positive correlation (ρ = 0.26) with 12-item short form mental component score. Multivariate linear regression showed male sex is predictive of a lower tipping point (P < .01), whereas higher BMI, African American race, and history of arthroplasty are predictive of a higher tipping point (P ≤ .02). Conclusion The tipping point was not demonstrated to change over time in our analysis. Male sex is predictive of a lower tipping point for arthroscopic rotator cuff repair, whereas elevated BMI, African American race, worker's compensation insurance, and prior arthroplasty are predictive of a higher tipping point. Also, better mental health function is associated with a lower tipping point.
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Ponce-Fuentes F, Cuyul-Vásquez I, Bustos-Medina L, Fuentes J. Effects of pain neuroscience education and rehabilitation following arthroscopic rotator cuff repair. A randomized clinical trial. Physiother Theory Pract 2022:1-10. [PMID: 35412432 DOI: 10.1080/09593985.2022.2061394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the effectiveness of pain neuroscience education (PNE) versus biomedical education (BME) in a rehabilitation program following arthroscopic rotator cuff repair (ARCR) in patients with chronic shoulder pain. METHODS Twenty-nine patients who participated in a rehabilitation program were randomly assigned to either an experimental PNE group (N = 16) or a control BME group (N = 13). Measurements included pain intensity at rest and in movement, pain catastrophizing, kinesiophobia, disability and health-related quality of life (HRQoL). Outcomes were evaluated at baseline and at 4 and 8 weeks after the intervention. RESULTS A main effect for time was observed for: intensity of pain at rest (p < .01); pain with movement (p < .01); pain catastrophizing (p < .01); kinesiophobia (p < .01); disability (p < .01); and HRQoL (p < .01). No group interactions were significant for any variable, except for pain with movement, which favored the PNE group (p = .03). Large effect sizes (ranging from d = 0.79 to d = 2.65) were found for both interventions in all outcomes. CONCLUSION A rehabilitation program including either PNE or BME are equally effective in improving rest pain, pain catastrophizing, kinesiophobia, disability, and HRQoL in patients after ARCR, except for pain at movement in favor of the PNE group. The inclusion of PNE in the rehabilitation program appears to lead to clinically meaningful improvements in pain at rest in short term when treating patients with ARCR.
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Affiliation(s)
| | - Iván Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - Luis Bustos-Medina
- Gestión para la Salud (CIGES), Facultad de Medicina, Universidad de La FronteraDepartamento de Salud Pública, Centro de Investigación y , Temuco, Chile
| | - Jorge Fuentes
- Clinical Research Lab, Department of Physical Therapy, Catholic University of Maule, Talca, Chile.,Faculty of Rehab Medicine, University of Alberta, Edmonton,AB, Canada
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Wang Y, Xu Y, Peng Y, Liao S, Dai G, Li T. Acupuncture for Atraumatic Shoulder Conditions: Protocol for a Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:720551. [PMID: 35330586 PMCID: PMC8940297 DOI: 10.3389/fmed.2022.720551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Shoulder pain is one of the most common musculoskeletal disorders among adults and is caused by a variety of shoulder conditions. The popularity of different acupuncture methods in the nonsurgical treatment of shoulder pain has recently increased. However, evidence regarding the efficacy of acupuncture for shoulder pain is inconsistent, and there is a lack of supporting evidence regarding the overall efficacy of different acupuncture methods for shoulder pain. Methods and Analysis A systematic review will be conducted to assess the effectiveness of a wide range of acupuncture techniques for atraumatic shoulder conditions. The PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Ovid MEDLINE, Chinese Biomedical Literature, Chinese National Knowledge Infrastructure, Wanfang, and Chongqing VIP databases will be searched to identify eligible studies. Studies will be selected according to preset inclusion and exclusion criteria and relevant data will be extracted from the final included studies. The heterogeneity, risk of bias, publication bias and evidence quality of the studies will be assessed, and a subgroup analysis and sensitivity analysis will be performed. Systematic Review Registration PROSPERO registration number CRD42021249625.
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Affiliation(s)
- Yi Wang
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Yan Xu
- Experiment Teaching Center for Preclinical Medicine, Chengdu Medical College, Chengdu, China
| | - Yu Peng
- School of Sports Medicine and Health, Postgraduate School, Chengdu Sport Institute, Chengdu, China
| | - Shichuan Liao
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Guogang Dai
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Tao Li
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, Chengdu, China
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Better Short-Term Outcomes After Rotator Cuff Repair in Studies With Poorer Mean Shoulder Scores and Predominantly Small to Medium-Sized Tears at Baseline: A Systematic Review and Meta-analysis. Arthroscopy 2022; 38:967-979.e4. [PMID: 34450217 DOI: 10.1016/j.arthro.2021.08.019] [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: 04/07/2021] [Revised: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a meta-analysis to explore factors associated with clinical and structural short-term outcomes in randomized and nonrandomized prospective studies of rotator cuff repair. METHODS Medline, clinicaltrials.gov, and Mendeley were searched for literature published from January 2000 to December 2020 to identify randomized controlled trials (RCT) and nonrandomized prospective cohort studies (PCS) describing the outcome of surgical repair of full-thickness rotator cuff tears. Study quality was assessed by two independent reviewers. We calculated standardized mean difference (SMD) from baseline to follow-up in each trial arm, preferably at 12 months follow-up. Between-study heterogeneity of outcomes, small-study effects and rates of retear were assessed. Meta-regression was performed to estimate associations between prespecified variables and clinical and structural outcomes. RESULTS Outcomes in 64 RCT and 19 PCS trial arms were analyzed. Median age was 59 years. There was substantial between-study heterogeneity in clinical outcomes (SMD range: .42 to 6.44; I2 = 93% in RCT, 88% in PCS) and summary estimates were not calculated. On the basis of multivariate analysis, better clinical outcome was associated with lower (worse) mean outcome value at baseline, smaller tear size, and lower proportion of large-massive tears (R2 = 56 and 44%, respectively). Overall retear rate at median 13-month follow-up was 19.9% (interquartile range: 10-30). Higher mean age together with larger tear size and higher proportion of large-massive tears were associated with increased retear rates (R2 = 33% and 58%, respectively). Clinical outcome was not significantly related to rate of retear. CONCLUSIONS Studies with lower mean outcome values at baseline and predominantly small- to medium-sized tears reported better clinical outcomes. Studies with higher mean age and a predominance of large-massive tears had significantly increased retear rates, but retear rates were not associated with clinical outcome. LEVEL OF EVIDENCE Level II, meta-analysis of level I and II studies.
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Santiago M, Gonçalves F, Martins J, Lopes T, Carvalho JL. Ultrasound-Guided Injection of a Tendon-Compatible Hyaluronic Acid Preparation for the Management of Partial Thickness Rotator Cuff Tear: A Case Report. Cureus 2022; 14:e20900. [PMID: 35145804 PMCID: PMC8809445 DOI: 10.7759/cureus.20900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/05/2022] Open
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Comparative Analysis of Real-Time Dynamic Ultrasound and Magnetic Resonance Imaging in the Diagnosis of Rotator Cuff Tear Injury. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:2107693. [PMID: 34887929 PMCID: PMC8651368 DOI: 10.1155/2021/2107693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
Objective To explore the value of real-time dynamic ultrasound and magnetic resonance imaging (MRI) in the diagnosis of rotator cuff injury. Methods From January 2020 to June 2021, the clinical data of 55 patients with rotator cuff injury were collected. All patients were examined by real-time dynamic ultrasound and MRI at the same time within two weeks before surgery, which was confirmed by arthroscopy. The value of real-time dynamic ultrasound, MRI, and the real-time dynamic ultrasound combined with MRI in the diagnosis of rotator cuff injury was evaluated. Results Among the 55 patients with rotator cuff injury, real-time dynamic ultrasound showed full-thickness rotator cuff tear in 12 patients (21.82%), including type I in 2 patients (3.64%), type II in 6 patients (10.91%), and type III in 4 patients (7.27%), and partial rotator cuff tear in 31 patients (56.36%), including type IV in 16 patients (29.00%), type V in 5 patients (9.09%), and type VI in 10 patients (18.18%). MRI showed full-thickness rotator cuff tear in 12 patients (21.82%), including type I in 2 patients (3.64%), type II in 6 patients (10.91%), and type III in 4 patients (7.27%), and partial rotator cuff tear in 37 patients (67.27%), including type IV in 20 patients (36.36%), type V in 7 patients (12.73%), and type VI in 10 patients (18.18%). The combined examination showed full-thickness rotator cuff tear in 12 patients (21.82%), including type I in 2 patients (3.64%), type II in 6 patients (10.91%), and type III in 4 patients (7.27%), and partial rotator cuff tear in 39 cases (70.91%), including type IV in 21 cases (38.12%), type V in 7 patients (12.73%), and type VI in 12 patients (21.82%). The diagnostic accuracy of real-time dynamic ultrasound in complete tearing, partial tearing and the overall accuracy were 92.31%, 73.81% and 78.18%, respectively. The diagnostic accuracy of complete tear, partial tear and the overall accuracy of MRI were 92.31%, 88.00% and 89.09%, respectively. The diagnostic accuracy of complete tear and partial tear and overall accuracy in the real-time dynamic ultrasound combined with MRI were 92.31%, 95.24%, and 94.55%, respectively. The diagnostic accuracy and overall diagnostic accuracy of the combined examination of partial tears were higher than those of the real-time dynamic ultrasound and MRI examinations alone. Conclusion Real-time dynamic ultrasound and MRI have high application value in the diagnosis of rotator cuff injury, and the combined diagnosis is conducive to improving the diagnostic accuracy of patients with partial tear.
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Hodgetts C, Walker B. Epidemiology, common diagnoses, treatments and prognosis of shoulder pain: A narrative review. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Singh H, Isak I, Cregar WM, Higgins JD, Vadhera AS, Perry AK, Nicholson GP, Cole BJ, Verma NN. Retrospective Analysis of Patients Undergoing Arthroscopic Rotator Cuff Repair at a Single Institution Yields a 0.11% Postoperative Infection Rate. Arthrosc Sports Med Rehabil 2021; 3:e1853-e1856. [PMID: 34977640 PMCID: PMC8689265 DOI: 10.1016/j.asmr.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To establish an infection rate following primary arthroscopic rotator cuff repair (ARCR) from a single institutional database and to ascertain whether there is a relationship between the use of preoperative corticosteroid injection (CSI) and the risk of postoperative infection. Methods All medical records at a single institution were retrospectively reviewed to identify patients who had undergone arthroscopic repair from January 2016 to December 2018. Patient charts were reviewed for CSI treatment within 6 months of surgery, superficial or deep infection within 2 months postoperatively, and specific treatment of the infection. Patient characteristics were summarized by descriptive statistics using means with standard deviations for continuous variables and frequencies with percentages for categorical variables. A χ2 correlation analysis was performed to determine the association between receiving an injection and having an infection. Results A total of 1773 patients were included for analysis with an average age of 59.24 ± 9.4 years. The overall infection rate was 0.11% (2/1773 patients). Both patients were treated with oral antibiotics. Of the included patients, 616 had a preoperative CSI within 6 months of their surgery, and 102 injections were administered within 1 month of surgery. None of these patients had a postoperative infection. A χ2 correlation analysis showed a negligible relationship between preoperative injections and postoperative infection (φ = 0.02, χ2 = 0.84). Conclusions Through this single-institution, large cohort retrospective review, we found an overall 0.11% rate of postoperative infection following primary arthroscopic RCR. In addition, we found no correlation between the use of preoperative CSI ahead of elective ARCR at any time point and risk of developing a postoperative infection. Infection is uncommon following ARCR, and preoperative steroid injection did not increase infection risk in our study population. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Nikhil N. Verma
- Address correspondence to Nikhil N. Verma, M.D., Midwest Orthopaedics at Rush, 1611 W Harrison St., Chicago, IL 60661.
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Atik OŞ. Does conservative treatment must be the first choice in elderly patients with degenerative rotator cuff tears? Jt Dis Relat Surg 2021; 32:567-568. [PMID: 34842085 PMCID: PMC8650657 DOI: 10.52312/jdrs.2021.57901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/18/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- O Şahap Atik
- Turkish Joint Diseases Foundation, Mustafa Kemal Mah., Dumlupınar Bul., 274/2, C2 Blok, Ofis 5, 06900 Çankaya, Ankara, Türkiye.
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Kukkonen J, Ryösä A, Joukainen A, Lehtinen J, Kauko T, Mattila K, Äärimaa V. Operative versus conservative treatment of small, nontraumatic supraspinatus tears in patients older than 55 years: over 5-year follow-up of a randomized controlled trial. J Shoulder Elbow Surg 2021; 30:2455-2464. [PMID: 33774172 DOI: 10.1016/j.jse.2021.03.133] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/28/2021] [Accepted: 03/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Nontraumatic rotator cuff tear is a common shoulder problem that can be treated either conservatively or operatively. In the previous publications of the 1- and 2-year results of this trial, we found no significant between-group clinical differences. The aim of this study was to investigate the differences in mid-term clinical and radiologic outcomes in patients older than 55 years. MATERIALS AND METHODS One hundred eighty shoulders with symptomatic, nontraumatic supraspinatus tears were randomly assigned to 1 of the 3 cumulatively designed treatment groups: physiotherapy (group 1); acromioplasty and physiotherapy (group 2); and rotator cuff repair, acromioplasty, and physiotherapy (group 3). The change in the Constant score was the primary outcome measure. The secondary outcome measures were the change in the visual analog scale score for pain and patient satisfaction. Radiologic analysis included evaluation of glenohumeral osteoarthritis (OA) and rotator cuff tear arthropathy (CTA). RESULTS A total of 150 shoulders (mean age, 71 years) were available for analysis after a mean follow-up period of 6.2 years. The mean sagittal tear size of the supraspinatus tendon tear at baseline was 10 mm in all groups (P = .33). During follow-up, 8 shoulders in group 1 and 2 shoulders in group 2 crossed over to rotator cuff repair. The mean baseline Constant score was 57.1, 58.2, and 58.7 in groups 1, 2, and 3, respectively (P = .85). There were no significant differences (P = .84) in the mean change in the Constant score: 18.5 in group 1, 17.9 in group 2, and 20.0 in group 3. There were no statistically significant differences in the change in the visual analog scale pain score (P = .74) and patient satisfaction (P = .83). At follow-up, there were no statistically significant differences in the mean progression of glenohumeral OA (P = .538) or CTA (P = .485) among the groups. However, the mean progression of glenohumeral OA from baseline to follow-up was statistically significant in the trial population (P = .0045). CONCLUSIONS On the basis of this study, operative treatment is no better than conservative treatment regarding small, nontraumatic, single-tendon supraspinatus tears in patients older than 55 years. Operative treatment does not protect against degeneration of the glenohumeral joint or CTA. Conservative treatment is a reasonable option for the primary initial treatment of these tears.
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Affiliation(s)
- Juha Kukkonen
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland.
| | - Anssi Ryösä
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Joukainen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Janne Lehtinen
- Orthopaedic Unit, Tays Hatanpää Hospital, Tampere, Finland
| | - Tommi Kauko
- Auria Clinical Informatics, Turku University Hospital, Turku, Finland
| | - Kimmo Mattila
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Äärimaa
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
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Hajivandi S, Dachek A, Salimi A, Mamaghani HJ, Mirghaderi SP, Dehghani J, Borazjani R, Babaniamansour A, Sarallah R, Javanshir S, Salimi M. Comparison of the Separate and Combined Effects of Physiotherapy Treatment and Corticosteroid Injection on the Range of Motion and Pain in Nontraumatic Rotator Cuff Tear: A Randomized Controlled Trial. Adv Orthop 2021; 2021:6789453. [PMID: 34733561 PMCID: PMC8560293 DOI: 10.1155/2021/6789453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/30/2021] [Accepted: 10/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgical treatment and conservative treatment is the options to improve pain, function, and range of motion following rotator cuff tear. In this study, we aimed to compare the effects of physiotherapy and corticosteroid injections on the function, pain, and range of motion in patients with full-thickness rotator cuff tearing separately and simultaneously. METHODS A total of 96 patients were randomly assigned to the study and divided into 3 groups of 32 patients. DASH questionnaire and VAS criterion were completed by all three groups, and the range of motions of all groups was measured by a goniometer. Then, the first group underwent 12 sessions of physiotherapy twice a week for 6 weeks; the second group received 80 mg of methylprednisolone and 1 ml of lidocaine 2% in two stages, 21 days apart; and the third group received 80 mg of methylprednisolone and 1 ml of lidocaine 2%, and after 2 days, 6 sessions of physiotherapy twice a week for 3 weeks were prescribed. In the end, the questionnaire was filled out by the patient, and the range of emotions was assessed with a goniometer. RESULTS More than 80% of patients in each group were female. There was no significant difference between the gender and age distribution of the groups. The mean age in physiotherapy, steroid, and physiotherapy + steroid groups was 51.78 ± 7.37, 52.37 ± 6.61, and 50.87 ± 5.65, respectively. The combination of physiotherapy + steroid intervention was more effective in reducing VAS and DASH scores than physiotherapy or steroid injection alone. Goniometric findings showed that treatments that included the steroid injection approach (steroid injection and steroid + physiotherapy) had a more dramatic effect on improving the patients' range of motion than physiotherapy alone. CONCLUSIONS Among the conservative approaches of treating full-thickness rotator cuff tear, a combination of steroid injection and physiotherapy is more effective significantly in comparison with either treatment alone. This trial is registered with IRCT20200102045987N1.
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Affiliation(s)
- Shaahin Hajivandi
- Department of Orthopedic Surgery, Dezful University of Medical Sciences, Dezful, Iran
| | - Atousa Dachek
- Student Research Committee, Dezful University of Medical Sciences, Dezful, Iran
| | - Amirhossein Salimi
- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hesan Jelodari Mamaghani
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Peyman Mirghaderi
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Dehghani
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roham Borazjani
- Trauma Research Center, Shahid Rajaee (Emtiaz) Ttauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirmohammad Babaniamansour
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Rojin Sarallah
- Islamic Azad University Medical Branch of Tehran, Tehran, Iran
| | - Salar Javanshir
- Islamic Azad University Medical Branch of Tehran, Tehran, Iran
| | - Maryam Salimi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Alt E, Rothoerl R, Hoppert M, Frank HG, Wuerfel T, Alt C, Schmitz C. First immunohistochemical evidence of human tendon repair following stem cell injection: A case report and review of literature. World J Stem Cells 2021; 13:944-970. [PMID: 34367486 PMCID: PMC8316863 DOI: 10.4252/wjsc.v13.i7.944] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/29/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Current clinical treatment options for symptomatic, partial-thickness rotator cuff tear (sPTRCT) offer only limited potential for true tissue healing and improvement of clinical results. In animal models, injections of adult stem cells isolated from adipose tissue into tendon injuries evidenced histological regeneration of tendon tissue. However, it is unclear whether such beneficial effects could also be observed in a human tendon treated with fresh, uncultured, autologous, adipose derived regenerative cells (UA-ADRCs). A specific challenge in this regard is that UA-ADRCs cannot be labeled and, thus, not unequivocally identified in the host tissue. Therefore, histological regeneration of injured human tendons after injection of UA-ADRCs must be assessed using comprehensive, immunohistochemical and microscopic analysis of biopsies taken from the treated tendon a few weeks after injection of UA-ADRCs.
CASE SUMMARY A 66-year-old patient suffered from sPTRCT affecting the right supraspinatus and infraspinatus tendon, caused by a bicycle accident. On day 18 post injury [day 16 post magnetic resonance imaging (MRI) examination] approximately 100 g of abdominal adipose tissue was harvested by liposuction, from which approximately 75 × 106 UA-ADRCs were isolated within 2 h. Then, UA-ADRCs were injected (controlled by biplanar X-ray imaging) adjacent to the injured supraspinatus tendon immediately after isolation. Despite fast clinical recovery, a follow-up MRI examination 2.5 mo post treatment indicated the need for open revision of the injured infraspinatus tendon, which had not been treated with UA-ADRCs. During this operation, a biopsy was taken from the supraspinatus tendon at the position of the injury. A comprehensive, immunohistochemical and microscopic analysis of the biopsy (comprising 13 antibodies) was indicative of newly formed tendon tissue.
CONCLUSION Injection of UA-ADRCs can result in regeneration of injured human tendons by formation of new tendon tissue.
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Affiliation(s)
- Eckhard Alt
- Chairman of the Board, Isarklinikum Munich, Munich 80331, Germany
| | - Ralf Rothoerl
- Department of Spine Surgery, Isarklinikum Munich, Munich 80331, Germany
| | - Matthias Hoppert
- Department for Orthopedics and Trauma Surgery, Isarklinikum Munich, Munich 80331, Germany
| | - Hans-Georg Frank
- Chair of Neuroanatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich 80336, Germany
| | - Tobias Wuerfel
- Chair of Neuroanatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich 80336, Germany
| | - Christopher Alt
- Director of Science and Research, InGeneron GmbH, Munich 80331, Germany
| | - Christoph Schmitz
- Chair of Neuroanatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich 80336, Germany
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Zhang C, Wu J, Li X, Wang Z, Lu WW, Wong TM. Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair. Front Bioeng Biotechnol 2021; 9:657584. [PMID: 34178957 PMCID: PMC8226184 DOI: 10.3389/fbioe.2021.657584] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Rotator cuff tear is one of the most common shoulder problems encountered by orthopedic surgeons. Due to the slow healing process and high retear rate, rotator cuff tear has distressed millions of people all around the world every year, especially for the elderly and active athletes. This disease significantly impairs patients' motor ability and reduces their quality of life. Besides conservative treatment, open and arthroscopic surgery contributes a lot to accelerate the healing process of rotator cuff tear. Currently, there are many emerging novel treatment methods to promote rotator cuff repair. A variety of biological stimulus has been utilized in clinical practice. Among them, platelet-rich plasma, growth factors, stem cells, and exosomes are the most popular biologics in laboratory research and clinical trials. This review will focus on the biologics of bioaugmentation methods for rotator cuff repair and tendon healing, including platelet-rich plasma, growth factors, exosomes and stem cells, etc. Relevant studies are summarized in this review and future research perspectives are introduced.
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Affiliation(s)
- Cheng Zhang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jun Wu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiang Li
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zejin Wang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Weijia William Lu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Center for Human Tissues and Organs Degeneration, Shenzhen Institutes of Advanced Technology (CAS), Shenzhen, China
| | - Tak-Man Wong
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Cederqvist S, Flinkkilä T, Sormaala M, Ylinen J, Kautiainen H, Irmola T, Lehtokangas H, Liukkonen J, Pamilo K, Ridanpää T, Sirniö K, Leppilahti J, Kiviranta I, Paloneva J. Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation. Ann Rheum Dis 2021; 80:796-802. [PMID: 33272959 PMCID: PMC8142425 DOI: 10.1136/annrheumdis-2020-219099] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression and non-surgical treatments provide equivalent results in RCD without a full-thickness tendon lesion. However, the importance of surgery for full-thickness tendon tears remains unclear. METHODS In a pragmatic, randomised, controlled trial, 417 patients with subacromial pain underwent 3-month initial rehabilitation and MRI arthrography (MRA) for the diagnosis of RCD. Of these, 190 shoulders remained symptomatic and were randomised to non-surgical or surgical treatments. The primary outcomes were the mean changes in the Visual Analogue Scale for pain and the Constant Murley Score for shoulder function at the 2-year follow-up. RESULTS At the 2-year follow-up, both non-surgical and surgical treatments for RCD reduced pain and improved shoulder function. The scores differed between groups by 4 (95% CI -3 to 10, p=0.25) for pain and 3.4 (95% CI -0.4 to 7.1, p=0.077) for function. Among patients with full-thickness ruptures, the reduction in pain (13, 95% CI 5 to 22, p=0.002) and improvement in function (7.0, 95% CI 1.8 to 12.2, p=0.008) favoured surgery. CONCLUSIONS Non-surgical and surgical treatments for RCD provided equivalent improvements in pain and function. Therefore, we recommend non-surgical treatment as the primary choice for patients with RCD. However, surgery yielded superior improvement in pain and function for full-thickness rotator cuff rupture. Therefore, rotator cuff repair may be suggested after failed non-surgical treatment. TRIAL REGISTRATION DETAILS ClinicalTrials.gov, NCT00695981 and NCT00637013.
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Affiliation(s)
- Sanna Cederqvist
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Tapio Flinkkilä
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Markus Sormaala
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Hannu Kautiainen
- Research Center, Folkhälsan, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Tero Irmola
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Heidi Lehtokangas
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juho Liukkonen
- Department of Emergency Medicine, Central Finland Central Hospital, Jyväskylä, Finland
| | - Konsta Pamilo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Tero Ridanpää
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Kai Sirniö
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Juhana Leppilahti
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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A. Hamid MS, Sazlina SG. Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis. PLoS One 2021; 16:e0251111. [PMID: 33970936 PMCID: PMC8109792 DOI: 10.1371/journal.pone.0251111] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/20/2021] [Indexed: 01/01/2023] Open
Abstract
Shoulder rotator cuff tendinopathy is a common debilitating condition that affects a person daily function and the quality of life. Despite its frequent occurrence, the best treatment is still inconclusive. This review assessed the clinical effect of platelet-rich plasma injection for rotator cuff tendinopathy. A systematic literature search was conducted using CINAHL, Medline, SCOPUS, SPORTSDiscus and Web of Science databases to retrieve articles published in peer-reviewed journals until December 2020. Randomised controlled trials (RCTs), which compared clinical effects of PRP injection to the usual care among adults diagnosed with rotator cuff conditions were reviewed. The main outcomes of interest were changes in shoulder pain symptoms and shoulder functions. All variables were analysed using random effects meta-analyses. Eight RCTs were reviewed in this study. The risk of bias for randomization was low for 6 RCTs, one study had unclear risk and the other was a high risk. Studies vary on the PRP techniques including preparation and injections. Moreover, the control intervention also differs. Four studies compared PRP with normal saline injection while in the remaining 4 RCTs the control intervention were rehabilitation program and dry needling. Meta-analysis of selected studies showed that PRP injection was safe and effective intervention for long-term pain control and shoulder function in patients with RC disorders.
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Affiliation(s)
| | - Shariff Ghazali Sazlina
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail:
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Brindisino F, De Santis A, Rossettini G, Pellicciari L, Filipponi M, Rollo G, Gibson J. Post-surgery rehabilitation following rotator cuff repair. A survey of current (2020) Italian clinical practice. Disabil Rehabil 2021; 44:4689-4699. [PMID: 33945358 DOI: 10.1080/09638288.2021.1916628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS To analyse the clinical practice of Italian physiotherapists within the framework of postoperative rehabilitation of rotator cuff (RC) surgery patients, and to compare it with similar studies carried out in other countries. METHODS A web-based, voluntary, cross-sectional survey with 27 closed multiple-choice questions was developed and submitted to Italian-based physiotherapists in order to assess their clinical practice. RESULTS Data from 1160 questionnaires were then analysed. Thirty-five percent of respondents (n = 413/1160) reported that they commence passive range of motion from the first postoperative week, while 49.2% (n = 571/1160) start during the second or third week. The majority of respondents (n = 603/1160, 52.0%) introduce active mobilisation between the fourth and the sixth week after surgery and 41.1% (n = 477/1160) introduce overhead movements between the fourth and the sixth week after surgery. DISCUSSION AND CONCLUSIONS When managing the postoperative rehabilitation of RC surgery patients, Italian physiotherapists' practice is congruent with the guidelines published by American Society of Shoulder and Elbow Therapists (ASSET) and also with other UK surveys. However, while Italian physiotherapists manage immobilisation periods, active and passive mobilisation and the return to sport activities, according to evidence-based best practice guidelines, there is less consistency with respect to physical exercise, patient follow-up and referral.IMPLICATIONS FOR REHABILITATIONItalian physiotherapists' practice with patients following rotator cuff (RC) repair complies with evidence-based practice guidelines regarding immobilisation periods, passive and active mobilisation, and return to sport activities.There is less consistency between reported/declared practice and available evidence concerning physical exercise, patient follow-up, and referral.Physiotherapist with Orthopaedic Manipulative Physical Therapy (OMPT) training is more aligned with the current literature compared to physiotherapists without specific training, in terms of managing rehabilitation programmes, period of immobilisation and therapeutic exercise.More careful adherence to the international guidelines is recommended, in order to manage patients following RC repair in accordance with the evidence and to achieve the best possible outcomes.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.,Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Andrea De Santis
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.,Poliambulatorio Physiofit, Borgo Podgora, Italy
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,School of Physiotherapy, University of Verona, Verona, Italy
| | | | - Marco Filipponi
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Jo Gibson
- Department of Physiotherapy, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK.,The School of Health Sciences, University of Liverpool, Liverpool, UK
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43
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Abdelwahab A, Ahuja N, Iyengar KP, Jain VK, Bakti N, Singh B. Traumatic rotator cuff tears - Current concepts in diagnosis and management. J Clin Orthop Trauma 2021; 18:51-55. [PMID: 33996448 PMCID: PMC8093455 DOI: 10.1016/j.jcot.2021.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 12/26/2022] Open
Abstract
Rotator cuff tears represent one of common shoulder pathologies presenting over a wide spectrum of age groups and varying presentation. Typically, rotator cuff tears occur more frequently in elderly than in younger patients, following a chronic or acute-on-chronic course and usually secondary to due to tendon degeneration. Though there has been a considerable debate in the literature of the terms "acute" and "traumatic" used in the classification of rotator cuff tears, there appears to be consensus about the need for early diagnosis to facilitate prompt surgical treatment and the improve patient outcome. Significant differences in rotator cuff tears between those occurring in younger and older patients could be due to mechanism of injury, presentation, severity of the tear, biological healing potential and rehabilitation. Acute traumatic rotator cuff tears especially in younger age group represent a distinct entity from other patterns of rotator cuff tears. Consequently, a high index of suspicion, focused clinical examination, complementary imaging is a pre-requisite for an early diagnosis and effective management. We analyze the biomechanical consequences of acute rotator cuff tears along with characteristic mechanism of injury and spectrum of tendon involvement. The evolving concepts in the diagnosis and management of these distinct injuries are discussed with review of current literature.
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Affiliation(s)
| | - Neeraj Ahuja
- Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | | | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
| | - Nik Bakti
- East Kent Hospitals University Foundation Trust, William Harvey Hospital, TN24 0LZ, UK
| | - Bijayendra Singh
- Canterbury Christ Church University, Medway NHS Foundation Trust, Kent, ME7 5NY, UK
- Corresponding author.
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44
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Drummond Junior M, Ayinon C, Rodosky M, Vyas D, Lesniak B, Lin A. Predictive factors for failure of conservative management in the treatment of calcific tendinitis of the shoulder. JSES Int 2021; 5:469-473. [PMID: 34136856 PMCID: PMC8178619 DOI: 10.1016/j.jseint.2021.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Calcific tendinitis of the shoulder is a painful condition characterized by the presence of calcium deposits within the tendons of the rotator cuff (RTC). When conservative management fails, arthroscopic surgery for removal of the calcium may be considered. Surgical removal is often followed by RTC repair to address the resulting tendon defect. This study was performed to assess predictive factors for failure of conservative management and to characterize the rate of RTC repair in the setting of calcific tendinitis. We hypothesize that larger calcific lesion would have a higher likelihood to fail conservative treatment. Methods A retrospective review of patients who were diagnosed with calcific tendinitis at our institution between 2009 and 2019 was performed. Demographics, comorbidities, pain score (visual analog scale), American Shoulder and Elbow Surgeons score, range of motion, and patient-reported quality of life measures were recorded and analyzed. All patients underwent a radiograph and magnetic resonance imaging. Size of the calcific lesion was measured based on its largest diameter on magnetic resonance imaging. Statistical analysis included chi-square test, independent t-test, and analysis of variance. Results Two hundred thirty-nine patients were identified in the study period; 127 (53.1%) were women. The mean age was 54 years, and body mass index was 29.2 with a mean follow-up of 6 months. One hundred and sixty had an intact RTC (67.2%) and 78 had a partial RTC tear (32.8%). Ninety-three of 239 (38.9%) patients failed conservative treatment after an average of 4.4 months, necessitating surgical management. Among patients who underwent surgery, the majority of patients (77 of 93 [82.8%]) required a concomitant RTC repair. Subanalysis demonstrates that calcific lesions >1 cm was significantly associated with failure of conservative treatment (odds ratio = 2.86, 95% confidence interval 1.25-6.29, P < .05). All patients who underwent surgery demonstrated significant improvements in pain scores (6.3 to 2.3 visual analog scale), American Shoulder and Elbow Surgeons score (47.9 to 90.49), forward flexion (133° to 146.8°), and external rotation (49.2° to 57.6°) (P < .05) postoperatively. Conclusion Patients with calcific lesions >1 cm had a 2.8× increased likelihood to undergo operative treatment in the setting of calcific tendinitis of the shoulder. Most patients who undergo surgical management for removal of the calcific deposit required a concomitant RTC repair and had significant improvements in shoulder pain and function. This information can be helpful to guide orthopedic surgeons on preoperative planning and discussion when treating calcific tendinitis of the shoulder.
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Affiliation(s)
- Mauricio Drummond Junior
- Department of Orthopaedic Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Caroline Ayinon
- Department of Orthopaedic Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mark Rodosky
- Department of Orthopaedic Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Dharmesh Vyas
- Department of Orthopaedic Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bryson Lesniak
- Department of Orthopaedic Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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45
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Moorthy V, Chen JY, Lee M, Ang BFH, Lie DTT. The UCLA Shoulder Score Is a Better Predictor of Treatment Success Than the Constant and Oxford Shoulder Scores After Arthroscopic Rotator Cuff Repair: A 2-Year Follow-Up Study. Arthrosc Sports Med Rehabil 2021; 3:e485-e490. [PMID: 34027459 PMCID: PMC8129435 DOI: 10.1016/j.asmr.2020.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of this study was to determine the correlation between functional outcome scores and treatment success after arthroscopic rotator cuff repair. Methods We conducted a retrospective cohort study of patients who underwent unilateral rotator cuff repair at a tertiary hospital between 2010 and 2015. University of California at Los Angeles Shoulder Score (UCLASS), Constant Shoulder Score (CSS), and Oxford Shoulder Score (OSS) were measured before and at 6, 12, and 24 months after surgery. Patients were divided into 2 groups at each follow-up: (1) those with successful treatment and (2) those with unsuccessful treatment. Treatment success was defined as simultaneous fulfilment of 3 criteria: clinically significant improvement in pain, expectations for surgery met, and patient satisfied with surgery. Results A total of 214 subjects met the inclusion criteria. UCLASS was a consistent significant predictor of treatment success at 6 months (odds ratio [OR] 1.192, P = .005, 95% confidence interval [CI] 1.054-1.348), 12 months (OR 1.274, P < .001, 95% CI 1.153-1.406), and 24 months (OR 1.266, P < .001, 95% CI 1.162-1.380). Lower preoperative CSS was significant in predicting treatment success at 6 months (OR 0.952, P = .001, 95% CI 0.926-0.979), while larger tear size was significant in predicting treatment success at 24 months (OR 1.773, P = .043, 95% CI 1.019-3.083). Conclusion UCLASS is a better tool for predicting treatment success than CSS and OSS in patients undergoing arthroscopic rotator cuff repair, up to a minimum of 24 months’ follow-up. A holistic assessment of shoulder function, taking into account both subjective and objective evaluation of function, as well as patient-reported satisfaction, is important in determining treatment success after arthroscopic rotator cuff repair. Level of Evidence III, retrospective comparative study.
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Affiliation(s)
- Vikaesh Moorthy
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | | | - Merrill Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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46
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Merlet MC, Guinet V, Rousseau T, van Rooij F, Saffarini M, Dujardin F, Courage O. Arthroscopic Side-to-Side Repair of Massive Rotator Cuff Tears Maintains Adequate Functional Improvement at 12 to 14 Years' Follow-up. Am J Sports Med 2021; 49:298-304. [PMID: 33523752 DOI: 10.1177/0363546520985224] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff tears are common shoulder injuries that often cause pain and loss of function. Nonanatomic side-to-side techniques facilitate repair by minimizing tensions within tendons to improve healing and optimize the thickness of sutured tissues. PURPOSE/HYPOTHESIS The purpose was to evaluate long-term clinical and radiographic outcomes of arthroscopic side-to-side repair of massive rotator cuff tears (mRCTs). The hypothesis was that, at a minimum follow-up of 12 years, arthroscopic side-to-side repair maintains clinically important improvements. STUDY DESIGN Case series; Level of evidence, 4. METHODS The authors reviewed records of all patients who underwent arthroscopic repair of mRCTs over 2 consecutive years. A total of 30 adult patients met the eligibility criteria and underwent side-to-side repair. Patients were evaluated clinically using the Constant score (CS) and ultrasound to assess retears at 3 timepoints after surgery: 2 to 4 years, 5 to 7 years, and 12 to 14 years. RESULTS At first follow-up (3.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 13 retears (43%). At second follow-up (6.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 2 new retears (total 50%). At final follow-up (13.0 ± 0.7 years), only 21 patients had clinical assessment (1 died and 8 could not be reached), and only 19 patients had ultrasound assessment, which revealed 6 new retears (total 79%). Both absolute CS and age-/sex-adjusted CS improved significantly from baseline values at first follow-up (73.5 and 96.6, respectively), and remained stable at second follow-up (69.0 and 91.9, respectively), and final follow-up (64.4 and 87.0, respectively). Compared to shoulders with intact repairs, those with retears tended to have lower absolute CS at all follow-up visits, although differences were not statistically significant. CONCLUSION Patients with mRCTs maintain satisfactory clinical scores at 12 to 14 years after arthroscopic side-to-side repair despite a high incidence of retears. Repair is a safe and effective treatment for mRCTs, providing a less invasive and less complex alternative to reverse shoulder arthroplasty and tendon transfer procedures.
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Affiliation(s)
- Marie Caroline Merlet
- Ramsay Sante, Hopital Prive de l'Estuaire, Le Havre, France.,Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
| | - Virginie Guinet
- Ramsay Sante, Hopital Prive de l'Estuaire, Le Havre, France.,Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
| | - Thomas Rousseau
- Ramsay Sante, Hopital Prive de l'Estuaire, Le Havre, France.,Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
| | | | | | - Franck Dujardin
- Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
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47
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Zheng X, Tang K. [Research progress of treatment for massive rotator cuff tears]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:8-13. [PMID: 33448192 DOI: 10.7507/1002-1892.202004056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the research progress of treatment for massive rotator cuff tears. Methods The domestic and foreign literature about the treatment of massive rotator cuff tears was reviewed. The methods and effectiveness were extensively summarized. Results The treatment of massive rotator cuff tears still needs long-term research to promote its continuous improvement. The main goal of treatment is to relieve the symptoms and improve the shoulder joint function. With the development of arthroscopic technique, arthroscopic repair of rotator cuff tears has become a mature surgical protocol. Among these techniques, superior capsule reconstruction and patch augmentation for massive rotator cuff tears acquire more attention in recent years. As for rotator cuff arthropathy, reverse shoulder arthroplasty is considered to be a final choice. Conclusion Surgical treatment is the main choice for massive rotator cuff tears. Patients' age and muscle condition should be taken into consideration to decide the surgical technique.
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Affiliation(s)
- Xiaolong Zheng
- Department of Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - Kanglai Tang
- Department of Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
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48
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Longo UG, Risi Ambrogioni L, Candela V, Berton A, Carnevale A, Schena E, Denaro V. Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis. BMC Musculoskelet Disord 2021; 22:50. [PMID: 33419401 PMCID: PMC7796609 DOI: 10.1186/s12891-020-03872-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/14/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study aims to compare conservative versus surgical management for patients with full-thickness RC tear in terms of clinical and structural outcomes at 1 and 2 years of follow-up. METHODS A comprehensive search of CENTRAL, MEDLINE, EMBASE, CINAHL, Google Scholar and reference lists of retrieved articles was performed since the inception of each database until August 2020. According to the Cochrane Handbook for Systematic Reviews of Interventions, two independent authors screened all suitable studies for the inclusion, extracted data and assessed risk of bias. Only randomised controlled trials comparing conservative and surgical management of full-thickness RC tear in adults were included. The primary outcome measure was the effectiveness of each treatment in terms of Constant-Murley score (CMS) and VAS pain score at different time points. The secondary outcome was the integrity of the repaired tendon evaluated on postoperative MRI at different time points. The GRADE guidelines were used to assess the critical appraisal status and quality of evidence. RESULTS A total of six articles met the inclusion criteria. The average value of CMS score at 12 months of follow-up was 77.6 ± 14.4 in the surgery group and 72.8 ± 16.5 in the conservative group, without statistically significant differences between the groups. Similar results were demonstrated at 24 months of follow-up. The mean of VAS pain score at 12 months of follow-up was 1.4 ± 1.6 in the surgery group and 2.4 ± 1.9 in the conservative group. Quantitative synthesis showed better results in favour of the surgical group in terms of VAS pain score one year after surgery (- 1.08, 95% CI - 1.58 to - 0.58; P < 0.001). CONCLUSIONS At a 2-year follow-up, shoulder function evaluated in terms of CMS was not significantly improved. Further high-quality level-I randomised controlled trials at longer term follow-up are needed to evaluate whether surgical and conservative treatment provide comparable long-term results.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedics and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
| | - Laura Risi Ambrogioni
- Department of Orthopaedics and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Vincenzo Candela
- Department of Orthopaedics and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedics and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Arianna Carnevale
- Department of Orthopaedics and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedics and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
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Littlewood C, Wade J, Butler-Walley S, Lewis M, Beard D, Rangan A, Bhabra G, Kalogrianitis S, Kelly C, Mehta S, Singh HP, Smith M, Tambe A, Tyler J, Foster NE. Protocol for a multi-site pilot and feasibility randomised controlled trial: Surgery versus PhysiothErapist-leD exercise for traumatic tears of the rotator cuff (the SPeEDy study). Pilot Feasibility Stud 2021; 7:17. [PMID: 33413664 PMCID: PMC7788278 DOI: 10.1186/s40814-020-00714-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Clinically, a distinction is made between types of rotator cuff tear, traumatic and non-traumatic, and this sub-classification currently informs the treatment pathway. It is currently recommended that patients with traumatic rotator cuff tears are fast tracked for surgical opinion. However, there is uncertainty about the most clinically and cost-effective intervention for patients with traumatic rotator cuff tears and further research is required. SPeEDy will assess the feasibility of a fully powered, multi-centre randomised controlled trial (RCT) to test the hypothesis that, compared to surgical repair (and usual post-operative rehabilitation), a programme of physiotherapist-led exercise is not clinically inferior, but is more cost-effective for patients with traumatic rotator cuff tears. METHODS SPeEDy is a two-arm, multi-centre pilot and feasibility RCT with integrated Quintet Recruitment Intervention (QRI) and further qualitative investigation of patient experience. A total of 76 patients with traumatic rotator cuff tears will be recruited from approximately eight UK NHS hospitals and randomly allocated to either surgical repair and usual post-operative rehabilitation or a programme of physiotherapist-led exercise. The QRI is a mixed-methods approach that includes data collection and analysis of screening logs, audio recordings of recruitment consultations, interviews with patients and clinicians involved in recruitment, and review of study documentation as a basis for developing action plans to address identified difficulties whilst recruitment to the RCT is underway. A further sample of patient participants will be purposively sampled from both intervention groups and interviewed to explore reasons for initial participation, treatment acceptability, reasons for non-completion of treatment, where relevant, and any reasons for treatment crossover. DISCUSSION Research to date suggests that there is uncertainty regarding the most clinically and cost-effective interventions for patients with traumatic rotator cuff tears. There is a clear need for a high-quality, fully powered, RCT to better inform clinical practice. Prior to this, we first need to undertake a pilot and feasibility RCT to address current uncertainties about recruitment, retention and number of and reasons for treatment crossover. TRIAL REGISTRATION ClinicalTrials.gov ( NCT04027205 ) - Registered on 19 July 2019. Available via.
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Affiliation(s)
- Chris Littlewood
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK.
- Department of Health Professions, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK.
| | - Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephanie Butler-Walley
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Martyn Lewis
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Amar Rangan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Gev Bhabra
- University Hospitals Coventry & Warwickshire, Coventry, UK
| | - Socrates Kalogrianitis
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Cormac Kelly
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Saurabh Mehta
- Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke, UK
| | - Harvinder Pal Singh
- Leicester Shoulder Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Matthew Smith
- The Liverpool Upper Limb Unit, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Amol Tambe
- Derby Shoulder Unit, University Hospitals Derby & Burton NHS Foundation Trust, Derby, UK
| | - James Tyler
- Airedale General Hospital, Airedale NHS Foundation Trust, Keighley, UK
| | - Nadine E Foster
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK
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50
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Corrado B, Bonini I, Alessio Chirico V, Rosano N, Gisonni P. Use of injectable collagen in partial-thickness tears of the supraspinatus tendon: a case report. Oxf Med Case Reports 2020; 2020:omaa103. [PMID: 33269086 PMCID: PMC7685015 DOI: 10.1093/omcr/omaa103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/08/2020] [Accepted: 09/21/2020] [Indexed: 11/13/2022] Open
Abstract
Management of partial-thickness rotator cuff tears is actually controversial. We treated a patient with a partial-thickness tear of the supraspinatus tendon by a series of four type I porcine collagen ultrasound-guided injections, at weekly intervals. At the same time the patient underwent physical therapy, consisting of motor re-education and proprioceptive exercises. The patient was assessed before the treatment and up to 18 months after the last injection by the Constant-Murley score, the Disability of Arm, Shoulder and Hand questionnaire and ultrasonography. Shoulder pain and functional limitation progressively improved and they almost completely disappeared at the last follow-up. Ultrasonography showed a gradual healing of the partial-thickness tear and a regeneration of the tendon structure. This is the first study on ultrasound-guided injections of type I porcine collagen for the treatment of partial-thickness rotator cuff tears. Future research should confirm the excellent result achieved in this case report.
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Affiliation(s)
- Bruno Corrado
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy
| | - Ilenia Bonini
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy
| | | | - Nicola Rosano
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy
| | - Pietro Gisonni
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy
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