1
|
Savarese E, Aicale R, Torsiello E, Bernardini G, Maffulli N. Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38651602 DOI: 10.1002/ksa.12184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Management of massive rotator cuff tears (MRCTs) remains debated, and various arthroscopic and open techniques have been described for their management. Nevertheless, the optimal strategy remains unclear. The present study evaluated the clinical results in patients managed arthroscopically for MRCTs augmented with the long head biceps tendon (LHBT) at a minimum 1-year follow-up, considering different type of tears, demographic data and number of torn tendons. METHODS Patients treated in a secondary referral centre from January 2021 to April 2022 were enroled prospectively. Inclusion criteria were pain, inability to fully elevate the affected shoulder, irreparable tears and active and motivated patients. All patients were managed within 2 months from diagnosis in a single centre by the same surgeons. Preoperative shoulder radiographs and magnetic resonance imaging (MRI) were collected, and clinical assessment was also performed using the Numerical analogue scale (NAS), Constant score (CS) American Shoulder and Elbow Surgeons Shoulder Score (ASES). Tissue retraction and tendon fatty infiltration were evaluated using Patte and Fuchs scale, respectively. Clinical assessment was performed using the same scales at 3-6 months and 1-year follow-up. RESULTS A total of 55 patients (31 female and 24 male) with a mean age of 60 ± 7.1 years were enroled for a mean follow-up of 18.2 ± 4.3 months. The mean preoperative NAS was 7.8 ± 0.6, CS was 20.5 ± 7.6 and ASES was 22.6 ± 9.2, increasing, respectively, to 0.3 ± 0.6, 91.5 ± 6.9 and 94.2 ± 6.7. No adverse side effects (infection, rejection, allergy) were reported during the study period. All patients were evaluated after surgery at 3 and 6 months and 1 year with statistically significant improvement for each score at the first and last follow-up (p < 0.05). CONCLUSIONS The use of LHBT augmentation in patients with MRCTs in appropriately selected patients is safe and effective and can lead to pain relief and acceptable clinical outcomes. Furthermore, its use carries low donor site morbidity and is cost effective. Comparative studies, including randomised controlled trials, with other proposed techniques are needed to confirm these findings. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Eugenio Savarese
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, Taranto, Italy
| | - Rocco Aicale
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, Taranto, Italy
| | - Ernesto Torsiello
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Giulio Bernardini
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, Taranto, Italy
| | - Nicola Maffulli
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, UK
- School of Medicine, Institute of Science and Technology in Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Keele University, Stoke-on-Trent, UK
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, Roma, Italy
| |
Collapse
|
2
|
Wan RW, Luo ZW, Yang YM, Zhang HL, Chen JN, Chen SY, Shang XL. Long head of biceps tendon transposition for massive and irreparable rotator cuff tears: A systematic review and meta-analysis. World J Orthop 2023; 14:813-826. [DOI: 10.5312/wjo.v14.i11.813] [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: 08/16/2023] [Revised: 09/21/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Superior capsular reconstruction (SCR) with long head of biceps tendon (LHBT) transposition was developed to massive and irreparable rotator cuff tears (MIRCTs); however, the outcomes of this technique remain unclear.
AIM To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical outcomes after LHBT transposition for MIRCTs.
METHODS We performed a systematic electronic database search on PubMed, EMBASE, and Cochrane Library. Studies of SCR with LHBT transposition were included according to the inclusion and exclusion criteria. Biomechanical studies were assessed for main results and conclusions. Included clinical studies were evaluated for quality of methodology. Data including study characteristics, cohort demographics, and outcomes were extracted. A meta-analysis was conducted of the clinical outcomes.
RESULTS According to our inclusion and exclusion criteria, a total of six biomechanical studies were identified and reported an overall improvement in subacromial contact pressures and prevention of superior humeral migration without limiting range of motion (ROM) after LHBT transposition for MIRCTs. A total of five clinical studies were included in the meta-analysis of LHBT transposition outcomes, consisting of 253 patients. The results indicated that compared to other surgical methods for MIRCTs, LHBT transposition had advantages of more significant improvement in ROM (forward flexion mean difference [MD] = 6.54, 95% confidence interval [CI]: 3.07-10.01; external rotation [MD = 5.15, 95%CI: 1.59-8.17]; the acromiohumeral distance [AHD] [MD = 0.90, 95%CI: 0.21-1.59]) and reducing retear rate (odds ratio = 0.27, 95%CI: 0.15-0.48). No significant difference in American Shoulder and Elbow Surgeons score, visual analogue scale score, and University of California at Los Angles score was demonstrated between these two groups for MIRCTs.
CONCLUSION In general, SCR with LHBT transposition was a reliable and economical technique for treating MIRCTs, both in terms of biomechanical and clinical outcomes, with comparable clinical outcomes, improved ROM, AHD, and reduced the retear rates compared to conventional SCR and other established techniques. More high-quality randomized controlled studies on the long-term outcomes of SCR with LHBT transposition are required to further assess.
Collapse
Affiliation(s)
- Ren-Wen Wan
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhi-Wen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yi-Meng Yang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Han-Li Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jia-Ni Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shi-Yi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xi-Liang Shang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| |
Collapse
|
3
|
Anderson DE, Broun KG, Kundu P, Jing X, Tang X, Lu C, Kotelsky A, Mannava S, Lee W. PIEZO1 is downregulated in glenohumeral chondrocytes in early cuff tear arthropathy following a massive rotator cuff tear in a mouse model. Front Bioeng Biotechnol 2023; 11:1244975. [PMID: 37731766 PMCID: PMC10508846 DOI: 10.3389/fbioe.2023.1244975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction: A massive rotator cuff tear (RCT) leads to glenohumeral joint destabilization and characteristic degenerative changes, termed cuff tear arthropathy (CTA). Understanding the response of articular cartilage to a massive RCT will elucidate opportunities to promote homeostasis following restoration of joint biomechanics with rotator cuff repair. Mechanically activated calcium-permeating channels, in part, modulate the response of distal femoral chondrocytes in the knee against injurious loading and inflammation. The objective of this study was to investigate PIEZO1-mediated mechanotransduction of glenohumeral articular chondrocytes in the altered biomechanical environment following RCT to ultimately identify potential therapeutic targets to attenuate cartilage degeneration after rotator cuff repair. Methods: First, we quantified mechanical susceptibility of chondrocytes in mouse humeral head cartilage ex vivo with treatments of specific chemical agonists targeting PIEZO1 and TRPV4 channels. Second, using a massive RCT mouse model, chondrocytes were assessed for mechano-vulnerability, PIEZO1 expression, and calcium signaling activity 14-week post-injury, an early stage of CTA. Results: In native humeral head chondrocytes, chemical activation of PIEZO1 (Yoda1) significantly increased chondrocyte mechanical susceptibility against impact loads, while TRPV4 activation (GSK101) significantly decreased impact-induced chondrocyte death. A massive RCT caused morphologic and histologic changes to the glenohumeral joint with decreased sphericity and characteristic bone bruising of the posterior superior quadrant of the humeral head. At early CTA, chondrocytes in RCT limbs exhibit a significantly decreased functional expression of PIEZO1 compared with uninjured or sham controls. Discussion: In contrast to the hypothesis, PIEZO1 expression and activity is not increased, but rather downregulated, after massive RCT at the early stage of cuff tear arthropathy. These results may be secondary to the decreased axial loading after glenohumeral joint decoupling in RCT limbs.
Collapse
Affiliation(s)
- Devon E. Anderson
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, United States
- Department of Orthopaedics and Physical Performance, University of Rochester, Rochester, NY, United States
| | - Katherine G. Broun
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Paromita Kundu
- Department of Physiology and Pharmacology, University of Rochester, Rochester, NY, United States
| | - Xingyu Jing
- Department of Physiology and Pharmacology, University of Rochester, Rochester, NY, United States
| | - Xiang Tang
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Christopher Lu
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Alexander Kotelsky
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, United States
| | - Sandeep Mannava
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, United States
- Department of Orthopaedics and Physical Performance, University of Rochester, Rochester, NY, United States
| | - Whasil Lee
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, United States
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
- Department of Physiology and Pharmacology, University of Rochester, Rochester, NY, United States
| |
Collapse
|
4
|
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]
|
5
|
Jeong JH, Yoon EJ, Kim BS, Ji JH. Biceps-incorporating rotator cuff repair with footprint medialization in large-to-massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2022; 30:2113-2122. [PMID: 34988632 DOI: 10.1007/s00167-021-06829-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE In large-to-massive rotator cuff tears (MRCTs), incorporating the long head of the biceps tendon (LHBT) with arthroscopic partial rotator cuff and margin convergence can improve clinical outcomes and preserve the acromio-humeral interval (AHI) during mid-term follow-up. The purpose of this study was to evaluate mid-term clinical and radiological outcomes of arthroscopic biceps-incorporating rotator cuff repair with partial release of the LHBT and footprint medialization through the Neviaser portal in MRCTs. METHODS This study enrolled 107 patients (38 males and 69 females, mean age: 64.9 ± 8.6 years) with MRCTs. A novel arthroscopic biceps-incorporating repair was performed by footprint medialization, with a partially released biceps tendon covering central defects. Clinical outcomes such as pain VAS, KSS, ASES, UCLA, SST and CS scores and ROM were evaluated at a mean follow-up time of 35 months (range 12-132 months). Serial radiographs with a mean postoperative MRI follow-up duration of 33 months were used to evaluate AHI, tendon integrity, fatty infiltration (FI) and muscle hypotrophy. RESULTS Postoperative pain VAS, KSS, ASES, UCLA, SST, and CS scores and ROM (except external rotation) were improved significantly. AHI also improved significantly from 8.6 to 9.3 mm. According to Sugaya's classification, type I, II, III, IV, or V healing status was found in 30 (28.0%), 29 (27.1%), 26 (24.3%), 14 (13.1%), and 8 (7.5%) patients, respectively. The retear rate was 22 (20.6%). CONCLUSIONS Novel biceps-incorporating cuff repair with footprint medialization yielded satisfactory outcomes in MRCT patients at the 3-year follow-up. A partially released, repaired biceps tendon provided superior stability with preserved AHI similar to that of anterior cable reconstruction. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Jin Hwa Jeong
- Joint Center, Department of Orthopedic Surgery, Shinsegae Seoul Hospital, 841, Gyeongin-ro, Yeongdeungpo-gu, Seoul, 07305, Republic of Korea
| | - Eun Ji Yoon
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea
| | - Bo Seoung Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea.
| |
Collapse
|
6
|
Misir A, Uzun E, Kizkapan TB, Ozcamdalli M, Sekban H, Guney A. Factors associated with the development of early- to mid-term cuff-tear arthropathy following arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2021; 30:1572-1580. [PMID: 33038498 DOI: 10.1016/j.jse.2020.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have specifically evaluated the development of cuff-tear arthropathy (CTA) after a rotator cuff repair in the postoperative early to mid-term. This study aimed to identify the factors associated with the development of CTA, to evaluate the effect of arthropathy on functional outcomes, and to evaluate the incidence of CTA 3-10 years after an arthroscopic rotator cuff repair. METHODS A total of 312 patients who underwent an arthroscopic repair of a large or massive full-thickness rotator cuff tear with a minimum follow-up of 3 years were retrospectively divided into 2 groups for analysis: those with postrepair CTA (arthritic glenohumeral changes due to rotator cuff insufficiency) and those without. CTA was assessed using the Seebauer and modified Hamada-Fukuda classification systems. Pre-, intra-, and postoperative patient characteristics; characteristics of the rotator cuff tear; clinical and radiological parameters; and pre- and postoperative functional scores were compared. RESULTS The rate of development of CTA was 11.5% (36 of 312 patients, 13 centric and 23 eccentric arthropathy). CTA was more frequently associated with the poor integrity of the supraspinatus tendon after repair (P < .001) and massive tears (P = .006). Postoperative pseudoparalysis (P < .001), symptomatic retear (P < .001), tear size (P = .026), critical shoulder angle (P = .001), preoperative acromiohumeral interval (P = .046), and the humeral head superior migration (P = .001) were found to be associated with the development of CTA. However, only postoperative pseudoparalysis was found to be an independent risk factor (P < .001, odds ratio: 2.965). Patients with postrepair CTA had significantly worse functional outcome scores. CONCLUSION The postoperative development of pseudoparalysis may be a marker of CTA in the future and that closer follow-up may be necessary.
Collapse
Affiliation(s)
- Abdulhamit Misir
- Department of Orthopaedics and Traumatology, Health Sciences University, Gaziosmanpasa Training and Research Hospital, Gaziosmanpasa, Istanbul, Turkey.
| | - Erdal Uzun
- Department of Orthopaedics and Traumatology, Erciyes University School of Medicine, Melikgazi, Kayseri, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopaedics and Traumatology, Bursa Cekirge State Hospital, Osmangazi, Bursa, Turkey
| | - Mustafa Ozcamdalli
- Department of Orthopaedics and Traumatology, Ahi Evran University School of Medicine, Kirsehir Merkez, Kirsehir, Turkey
| | - Hazim Sekban
- Department of Orthopaedics and Traumatology, Health Sciences University, Kayseri City Hospital, Kocasinan, Kayseri, Turkey
| | - Ahmet Guney
- Department of Orthopaedics and Traumatology, Erciyes University School of Medicine, Melikgazi, Kayseri, Turkey
| |
Collapse
|
7
|
Sayampanathan AA, Silva AN, Hwee Chye AT. Rotator Cuff Repairs With and Without Acromioplasties Yield Similar Clinical Outcomes: A Meta-analysis and Systematic Review. Arthroscopy 2021; 37:1950-1957. [PMID: 33515738 DOI: 10.1016/j.arthro.2021.01.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE This meta-analysis reviews the current literature comparing the patient-reported outcome measures of patients who underwent rotator cuff repairs with and without acromioplasties. METHOD A comprehensive literature search was performed using PubMed, EMBASE, and Scopus databases, obtaining 1,456 studies for the review. After the filtering process, 8 studies remained for our meta-analysis, of which 7 were prospective trials. From the included studies, the postoperative outcomes of 3,034 shoulders were studied. Data were analyzed using Mantel-Haenszel statistics and random-effect models where appropriate. RESULTS Our meta-analysis revealed that there was no significant difference in American Shoulder and Elbow Surgeons scores (standardized mean difference [SMD], 0.09; 95% confidence interval [CI], -0.10 to 0.28; I2 = 9%; P = .36), University of California at Los Angeles scores (SMD, 0.17; 95% CI, -0.07 to 0.40; I2 = 0%; P = .17), and rate of further surgery (odds ratio, 0.49; 95% CI, 0.04 to 5.66; I2 = 59%; P = .57) between the acromioplasty and nonacromioplasty groups. There was a statistical difference in the Constant score (SMD, 0.25; 95% CI, 0.02 to 0.48; I2 = 0%; P = .03) of both groups. However, with the Constant score having an SMD of only 0.25, the difference in Constant score was not clinically significant. CONCLUSIONS There were no clinically significant differences in postoperative functional scores and pain scores for patients who underwent rotator cuff repairs with and without acromioplasties. LEVEL OF EVIDENCE Level II, meta-analysis of Level I and II studies.
Collapse
Affiliation(s)
| | - Amila Nirmal Silva
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | |
Collapse
|
8
|
Abraham PF, Nazal MR, Varady NH, Gillinov SM, Quinlan NJ, Alpaugh K, Martin SD. The new dynamic isotonic manipulation examination (DIME) is a highly sensitive secondary screening tool for supraspinatus full-thickness tears. J Shoulder Elbow Surg 2020; 29:2213-2220. [PMID: 32650076 DOI: 10.1016/j.jse.2020.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/13/2020] [Accepted: 06/22/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Traditional shoulder physical examination (PE) tests have suboptimal sensitivity for detection of supraspinatus full-thickness tears (FTTs). Therefore, clinicians may continue to suspect FTTs in some patients with negative rotator cuff PE tests and turn to magnetic resonance imaging (MRI) for definitive diagnosis. Consequently, there is a need for a secondary screening test that can accurately rule out FTTs in these patients to better inform clinicians which patients should undergo MRI. The purpose of this study was to assess the ability of 2 new dynamic PE tests to detect supraspinatus pathology in patients for whom traditional static PE tests failed to detect pathology. METHODS We prospectively enrolled 171 patients with suspected rotator cuff pathology with negative findings on traditional rotator cuff PE, who underwent 2 new dynamic PE tests: first, measurement of angle at which the patient first reports pain on unopposed active abduction and, second, the dynamic isotonic manipulation examination (DIME). Patients then underwent shoulder magnetic resonance arthrogram. Data from the new PE maneuvers were compared with outcomes collected from magnetic resonance arthrogram reports. RESULTS Pain during DIME testing had a sensitivity of 96.3% and 92.6% and a negative predictive value of 96.2% and 94.9% in the coronal and scapular planes, respectively. DIME strength ≤86.0 N had a sensitivity of 100% and 96.3% and a negative predictive value of 100% and 95.7% in the coronal and scapular planes, respectively. Pain at ≤90° on unopposed active abduction in the coronal plane had a specificity of 100% and a positive predictive value of 100% for supraspinatus pathology of any kind (ie, tendinopathy, "fraying," or tearing). CONCLUSION DIME is highly sensitive for supraspinatus FTTs in patients with negative traditional rotator cuff PE tests for whom there is still high clinical suspicion of FTTs. Thus, this test is an excellent secondary screening tool for supraspinatus FTTs in patients for whom clinicians suspect rotator cuff pathology despite negative traditional static PE tests. Given its high sensitivity, a negative DIME test rules out supraspinatus FTT well in these patients, and can therefore better inform clinicians which patients should undergo MRI. In addition, the angle at which patients first report pain on unopposed active shoulder abduction is highly specific for supraspinatus pathology.
Collapse
Affiliation(s)
- Paul F Abraham
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA.
| | - Mark R Nazal
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen M Gillinov
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
| | - Noah J Quinlan
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kyle Alpaugh
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, MA, USA
| | - Scott D Martin
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
9
|
Schumaier AP, Bedeir YH, Dines JS, Kenter K, Gulotta LV, Dines DM, Grawe BM. Quantifying the Impact of Patient-Specific Factors and Disease Severity on Clinical Decision Making in Cuff Tear Arthropathy: A Case-Based Survey. HSS J 2019; 15:276-285. [PMID: 31624484 PMCID: PMC6778159 DOI: 10.1007/s11420-019-09695-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rotator cuff tears are a common cause of disability. Some patients with massive and irreparable tears can develop cuff tear arthropathy (CTA), which makes management more challenging. QUESTIONS/PURPOSES We sought to examine how orthopedists determine treatment for patients with CTA. Specifically, we investigated (1) the effect of patient age, symptoms, activity level, range of motion, and radiographic findings on the decision making of shoulder specialists and (2) the observer reliability of the Seebauer and Hamada grading systems. METHODS Five shoulder surgeons were each sent 108 simulated patient cases. Each simulated patient had a different combination of factors, including patient age, symptoms, activity level, range of motion, and radiographs. Responders graded the radiographs and chose a treatment (non-operative, arthroscopic, hemiarthroplasty, or reverse total shoulder arthroplasty). Spearman's correlations and χ 2 tests were used to assess the relationship between factors and treatments. Sub-analysis was performed on surgical cases. An intra-class correlation (ICC) was used to assess observer agreement. RESULTS The significant Spearman's correlations were symptoms (0.45), Hamada grade (0.38), patient age (0.34), and Seebauer type (0.29). In sub-analysis of operative cases, the significant correlations were Hamada grade (0.56), patient age (0.51), Seebauer type (0.46), activity level (-0.13). The χ 2 analysis was significant for all factors except activity level. The inter- and intraobserver reliabilities were, respectively, Seebauer type (0.59 and 0.63) and Hamada grade (0.58 and 0.65). Interobserver reliability for patient management was 0.44. CONCLUSION When evaluating CTA, patient symptoms, radiographic grade, and patient age are the factors most strongly associated with the decision making of shoulder specialists. Additionally, the Seebauer and Hamada classifications had similar reliability and clinical utility. However, there was only fair agreement regarding treatment, which indicates that CTA management remains controversial.
Collapse
Affiliation(s)
- Adam P. Schumaier
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH USA
| | - Yehia H. Bedeir
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH USA
| | | | - Keith Kenter
- Western Michigan University Homer Stryker MD School of Medicine, Department of Orthopaedic Surgery, Kalamazoo, MI USA
| | | | | | - Brian M. Grawe
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH USA
| |
Collapse
|
10
|
Comprehensive Review of Provocative and Instability Physical Examination Tests of the Shoulder. J Am Acad Orthop Surg 2019; 27:395-404. [PMID: 30383578 DOI: 10.5435/jaaos-d-17-00637] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A detailed physical examination of the shoulder is crucial in creating a diagnosis in patients who present with shoulder pain. Tests of the cervical spine, scapula, and rotator cuff muscles have already been evaluated in a previous article. This article assesses provocative and instability examination tests of the shoulder. Descriptions on how the tests are performed and their diagnostic accuracy are presented.
Collapse
|
11
|
Zingman A, Li H, Sundem L, DeHority B, Geary M, Fussel T, Mooney R, Zuscik M, Elfar J. Shoulder arthritis secondary to rotator cuff tear: A reproducible murine model and histopathologic scoring system. J Orthop Res 2017; 35:506-514. [PMID: 27500994 PMCID: PMC5837043 DOI: 10.1002/jor.23383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/26/2016] [Indexed: 02/04/2023]
Abstract
Untreated rotator cuff tears can progress to a distinct form of shoulder arthritis, and the mechanism of this progression is poorly understood. Biomechanical, molecular and genetic factors may be at play, and a reliable animal model is needed to enable further research. The purpose of this study was to create a reproducible model of posttraumatic shoulder arthritis in the mouse, and to develop a scoring system for this model to enable future research on interventions, the role of various gene products, and the development of therapies to alter the natural course of the disease. Forty-five mice underwent operative ligation of the rotator cuff tendons and were followed for 45 weeks following surgery, with free cage activity post-operatively. Mice were sacrificed at various intervals from 2 to 45 weeks post-injury and histopathologic scoring was developed and tested by blinded reviewers using both quantitative computational analysis of coronal sections of the shoulder joint and semi-quantitative grading. The scoring system revealed a progressive, time-dependent set of tissue changes in the shoulder joint with features similar to human cuff tear arthropathy including acetabularization of the acromion and femoralization of the humeral head. This model establishes that osteoarthritis of the shoulder is distinct from osteoarthritis of the knee or hip, with different stages of degeneration and unique histopathologic features. Using the novel grading procedure and quantitative assessments presented here, future research using this model will enable investigators to test established and novel therapies and evaluate the role of inflammatory factors and gene products in shoulder arthritis. This study provides a reproducible mouse model of shoulder arthritis following isolated injury to the rotator cuff which elucidates characteristics of cuff tear arthropathy and provides a scoring system and venue for future research. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:506-514, 2017.
Collapse
Affiliation(s)
- Alissa Zingman
- Johns Hopkins Hospital, Bloomberg School of Public Health, Baltimore, Maryland
| | - Hiayan Li
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
| | - Leigh Sundem
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Becca DeHority
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Michael Geary
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Theron Fussel
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
| | - Robert Mooney
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
| | - Michael Zuscik
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
| | - John Elfar
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY,Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
12
|
A Critical Review on Prosthetic Features Available for Reversed Total Shoulder Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3256931. [PMID: 28105417 PMCID: PMC5220426 DOI: 10.1155/2016/3256931] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/24/2016] [Accepted: 11/27/2016] [Indexed: 12/31/2022]
Abstract
Reversed total shoulder arthroplasty is a popular treatment in rotator cuff arthropathy and in displaced proximal humeral fractures in elderly. In 2016, 29 models of commercially available designs express this popularity. This study describes all the different design parameters available on the market. Prosthetic differences are found for the baseplate, glenosphere, polyethylene, and humeral component and these differences need to be weighed out carefully for each patient knowing that a gain in one mechanical parameter can balance the loss of another. Patient specific implants may help in the future.
Collapse
|