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Eng E, Mowers C, Sachdev D, Yerke-Hansen P, Jackson GR, Knapik DM, Sabesan VJ. ChatGPT-3.5 Responses Require Advanced Readability for the General Population and May Not Effectively Supplement Patient-Related Information Provided by the Treating Surgeon Regarding Common Questions About Rotator Cuff Repair. Arthroscopy 2024:S0749-8063(24)00369-4. [PMID: 38777000 DOI: 10.1016/j.arthro.2024.05.009] [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: 12/03/2023] [Revised: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To investigate the accuracy of ChatGPT's responses to frequently asked questions prior to rotator cuff repair surgery. METHODS The 10 most common frequently asked questions related to rotator cuff repair were compiled from 4 institution websites. Questions were then input into ChatGPT-3.5 in 1 session. The provided ChatGPT-3.5 responses were analyzed by 2 orthopaedic surgeons for reliability, quality, and readability using the Journal of the American Medical Association Benchmark criteria, the DISCERN score, and the Flesch-Kincaid Grade Level. RESULTS The Journal of the American Medical Association Benchmark criteria score was 0, indicating the absence of reliable source material citations. The mean Flesch-Kincaid Grade Level was 13.4 (range, 11.2-15.0). The mean DISCERN score was 43.4 (range, 36-51), indicating that the quality of the responses overall was considered fair. All responses cited making final decision-making to be made with the treating physician. CONCLUSIONS ChatGPT-3.5 provided substandard patient-related information in alignment with recommendations from the treating surgeon regarding common questions around rotator cuff repair surgery. Additionally, the responses lacked reliable source material citations, and the readability of the responses was relatively advanced with a complex language style. CLINICAL RELEVANCE The findings of this study suggest that ChatGPT-3.5 may not effectively supplement patient-related information in the context of recommendations provided by the treating surgeon prior to rotator cuff repair surgery.
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Affiliation(s)
- Emma Eng
- Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, Florida, U.S.A
| | - Colton Mowers
- Rush University Medical College, Chicago, Illinois, U.S.A
| | | | - Payton Yerke-Hansen
- Department of Orthopaedic Surgery, Louisiana State University Health-Shreveport, Shreveport, Louisiana, U.S.A
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A..
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, Missouri, U.S.A
| | - Vani J Sabesan
- HCA JFK/University of Miami Miller School of Medicine Orthopaedic Residency Program Palm Beach, Lake Worth, Florida, U.S.A
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Maggini E, Tedah Djemetio MD, Husband I, Paganelli L, Saccomanno MF, Milano G. Criteria, Timing, and Factors Associated With Return to Competitive Sport After Rotator Cuff Surgery. Sports Med Arthrosc Rev 2024; 32:22-32. [PMID: 38695500 DOI: 10.1097/jsa.0000000000000396] [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 pathology in competitive athletes is common and may produce chronic symptoms and joint disability, impairing sports participation and leading to premature retirement. Athletes are a high-functioning patient population with unique characteristics. Decision-making for return to sport is a complex and multifactorial process. Literature is sparse and does not provide precise guidelines to assist physicians to make the right decision. This review aimed to highlight factors affecting outcome, timing, and criteria for return to competitive sport after rotator cuff surgery to help physicians to clearly counsel athletes and make high-quality decisions for return to sport.
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Affiliation(s)
- Emanuele Maggini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia
| | - Mac Donald Tedah Djemetio
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia
| | - Isabella Husband
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia
| | - Luca Paganelli
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia
| | - Maristella F Saccomanno
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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3
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Yedulla NR, Mehta N, Bernstein DN, Cross AG, Elhage KG, Moutzouros V, Makhni EC. When Do Patients Achieve PROMIS Milestones After Rotator Cuff Repair? Orthop J Sports Med 2024; 12:23259671241231608. [PMID: 38510320 PMCID: PMC10953020 DOI: 10.1177/23259671241231608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 03/22/2024] Open
Abstract
Background Given the variability of the questions asked, the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) computer adaptive test (CAT) Version 2.0 item bank aids in the evaluation of rotator cuff repair (RCR) rehabilitation by determining when recovery milestones are possible based on the quality of patient responses at certain time points. Purpose To assess the time point at which patients with RCR were able to achieve specific functional milestones, determined as positive responses to the 5 most frequently asked items on the PROMIS UE CAT Version 2.0. Study Design Case series; Level of evidence, 4. Methods The postoperative PROMIS UE CAT Version 2.0 scores of patients who underwent RCR between February 16, 2017, and July 30, 2019, were reviewed with respect to individual PROMIS item, response, and timing of response. A functional milestone was considered achieved if the patient response was "without any difficulty" or "with a little difficulty" to any of the 5 most frequently asked PROMIS items. The percentage of patients in each monthlong postoperative interval who answered with either response was recorded. The logit generalized estimating equations method was used to analyze the association between milestone achievement for each PROMIS item and predictor variables (age, sex, body mass index, smoking status, race, ethnicity, and employment status). Results A total of 1131 responses from 371 patients were included. The majority of patients attained milestone achievement on 4 of the 5 most frequently asked PROMIS items at time points ranging from 1 to 5 months postoperatively: "Are you able to carry a shopping bag or briefcase?" (by 1 month), "Are you able to put on and take off a coat or jacket?" (by 3 months), "Are you able to pour liquid from a bottle into a glass?" (by 3 months), and "Are you able to carry a heavy object (over 10 pounds/5 kg)?" (by 5 months). For the item "Are you able to put on a shirt or blouse?", the majority of patients did not achieve the milestone by 1 year. Conclusion These findings support the application of PROMIS UE CAT Version 2.0 milestone achievement in the shared decision-making process and postoperative monitoring, as patients can use this information to determine when they can return to certain activities and providers can apply these standards to identify patients needing additional clinical support.
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Affiliation(s)
- Nikhil R. Yedulla
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Nabil Mehta
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - David N. Bernstein
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Austin G. Cross
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Kareem G. Elhage
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Vasilios Moutzouros
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Eric C. Makhni
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
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Porcellini G, Ziroglu N, De Santis E, Micheloni GM, Tarallo L, Giorgini A. Midterm Clinical Outcomes After Arthroscopic Rotator Cuff Repair in Olympic Volleyball Players: Return to Sports and Return to Performance. Orthop J Sports Med 2023; 11:23259671231186820. [PMID: 37655246 PMCID: PMC10467408 DOI: 10.1177/23259671231186820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/13/2023] [Indexed: 09/02/2023] Open
Abstract
Background The decision-making process and predicting the time to return to sport (RTS) and return to performance (RTP) after arthroscopic rotator cuff repair (ARCR) in elite volleyball players are difficult issues to address, even among experienced shoulder surgeons. Purpose/Hypothesis The purpose of the study was to evaluate the results in Olympic-level volleyball players treated with arthroscopic supraspinatus repair and to report the RTS and the RTP. It was hypothesized that these athletes had higher RTS and faster RTP. Study Design Case series; Level of evidence, 4. Methods This study included 17 elite volleyball athletes (11 male, 6 female; mean age, 26.2 years) who underwent ARCR for partial- and full-thickness supraspinatus tears that did not improve despite nonoperative treatment. The clinical results were evaluated at 12 months postoperatively. The authors compared the athletes' preoperative, 6-month, and 12-month Kerlan-Jobe Orthopaedic Clinic (KJOC) scores and the visual analog scale (VAS) for pain after competition and conducted 6- and 12-month isometric strength analyses. The athletes' RTS and RTP times were recorded. Results All tears were on the dominant side (15 right, 2 left), and 82% were partial tears (14 partial thickness, 3 full thickness). The mean time from the onset of symptoms to surgery was 11.3 ± 6.7 months. While the mean Kerlan-Jobe Orthopaedic Clinic score was 31 preoperatively, it was 89 after 6 months (P < .001 vs preoperative) and 96 after 12 months (P = .003 vs 6 months). The mean VAS for pain was 7.9 preoperatively, 0.4 at 6 months (P < .001 vs preoperative), and 0.1 at 12 months (P = .02 vs 6 months). All athletes were able to reach their preinjury level, with RTS at a mean of 6.9 months and RTP at a mean of 12.4 months. Conclusion ARCR appears to be an effective option for Olympic-level volleyball players who do not benefit from nonoperative treatment. All athletes returned to their preinjury level of sports. The surgeon and athlete can plan surgical decision-making and timing based on the mean RTS time of 6.9 months and mean RTP time of 12.4 months.
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Affiliation(s)
- Giuseppe Porcellini
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Nezih Ziroglu
- Department of Orthopedics and Traumatology, Acibadem University, Acibadem Atakent Hospital, Kucukcekmece/Istanbul, Turkey
| | | | - Gian Mario Micheloni
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Luigi Tarallo
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Andrea Giorgini
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
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Alben MG, Gambhir N, Papalia AG, Bostrom N, Larose G, Virk MS, Rokito AS. Return to Sport after Arthroscopic Rotator Cuff Repair of Full-Thickness Rotator Cuff Tears: A Systematic Review. Clin J Sport Med 2023; 33:00042752-990000000-00094. [PMID: 36853904 DOI: 10.1097/jsm.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/24/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Perform a systematic literature review regarding return to sport (RTS) outcomes after arthroscopic rotator cuff repair (aRCR) for full-thickness rotator cuff tears (FTRCTs). DATA SOURCES Systematic review of all articles in PubMed, Medline, and Excerpta Medica Database (EMBASE) was conducted in April 2022 using a combination of keywords: "rotator cuff repair," "RCR," "complete," "full-thickness," "tear," "RCT," "injury," "shoulder," "arthroscopic," "return to sport," "RTS," "sport," "return to play," and "athlete." Cohorts were included from all articles reporting RTS after aRCR for FTRCTs. Studies that were non-English, failed to distinguish between partial and FTRCT outcomes, or treated FTRCTs by open RCR, mini-open RCR, debridement, or nonsurgical management were excluded. Abstracted data included study design, surgical techniques, concomitant procedures, demographics, FTRCT type and size, patient-reported outcomes, type of sport, competition level, time to return, and reasons for failing to RTS. MAIN RESULTS 11 studies were reviewed, with inclusion of 463 patients (385 athletes; mean age 47.9). RTS varied considerably in rate and timing, with 50.0% to 100% of patients returning on average between 4.8 to 14 months. In addition, 31 patients returned to a higher level of sport, 107 returned to or near preinjury level, and 36 returned to a lower level of competition or failed to RTS entirely. CONCLUSIONS The ability for athletes to RTS after aRCR for FTRCTs is likely multifactorial, demonstrating high variability in return rates and time to RTS. Given the paucity of available literature, future studies are warranted to provide a more definitive consensus.
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Affiliation(s)
- Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
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Kholinne E, Singjie LC, Marsetio AF, Kwak JM, Jeon IH. Return to physical activities after arthroscopic rotator cuff repair: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03490-5. [PMID: 36792854 DOI: 10.1007/s00590-023-03490-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Rotator cuff tear is one of the most common disorders in orthopedic surgery. When conservative treatment fails, arthroscopic rotator cuff repair has become the most common procedure to achieve a functional shoulder. HYPOTHESIS/PURPOSE The articles on return to activities following arthroscopic rotator cuff repair have not been collectively analyzed and investigated. We aimed to review systematically and perform a meta-analysis of studies on the return to activities which consist of the return to work, return to sports, and return to daily activities following arthroscopic rotator cuff repair. STUDY DESIGN Systematic Review and Meta-Analysis. METHODS Articles regarding return to activities were systematically searched using databases of PubMed, MEDLINE via EBSCO, ScienceDirect, and ProQuest. The review was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guideline. The study protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews. Studies with a level of evidence 1-4 that examined the rate of return to activities after arthroscopic rotator cuff repair were included and analyzed. RESULTS Fifteen studies published between 2005 and 2021 were included, with 1065 patients (644 male and 421 female). The patient populations are workers and athletes. The meta-analysis on the combined effect of a return to activities using the random-effects model was 88.5% (83.8% on return to work, 88.2% on return to sport, and 97.3% on return to daily activities). The mean duration for return to activities is 6.59 months. CONCLUSION As much as 88.5% of patients were able to return to activities after arthroscopic rotator cuff repair with a mean duration of 6.59 months. Preoperative factors (gender, workload, chronicity, tear size, and cholesterol level) may contribute to the rate and duration of return to activities.
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Affiliation(s)
- Erica Kholinne
- Department of Orthopedic Surgery, St. Carous Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
| | | | | | - Jae-Man Kwak
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.
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Wang L, Kang Y, Jin H, Wang M, Wei Y, Gao H, Shi D, Yu S, Xie G, Jiang J, Zhao J. Relationship between the progression of posterosuperior rotator cuff tear size and shoulder abduction function: A cadaveric study via dynamic shoulder simulator. Front Bioeng Biotechnol 2022; 10:858488. [PMID: 36237220 PMCID: PMC9551239 DOI: 10.3389/fbioe.2022.858488] [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: 01/20/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Posterosuperior rotator cuff tear (PSRCT) is one of the most common shoulder disorders in elderly people’s daily life; however, the biomechanical relationship between PSRCT and shoulder abduction function is still controversial. In this study, a total of twelve freshly frozen cadaveric shoulders were included and tested in five conditions: intact rotator cuff, 1/3 PSRCT, 2/3 PSRCT, entire PSRCT, and global RCT. In each condition, extra load (0%, 45%, and 90% failure load) was sequentially added to the distal humerus, and the function of the remaining rotator cuff was mainly evaluated via the middle deltoid force (MDF) required for abduction. It is found that the peak MDF is required for abduction did not differ among the three PSRCT conditions (1/3 PSRCT: 29.30 ± 5.03 N, p = 0.96; 2/3 PSRCT: 29.13 ± 9.09 N, p = 0.98; entire PSRCT: 28.85 ± 7.12 N, p = 0.90) and the intact condition (29.18 ± 4.99 N). However, the peak MDF significantly differed between the global RCT (76.27 ± 4.94 N, p < 0.01) and all PSRCT and intact conditions. Under 45% failure load, the MDF of the entire PSRCT and global tear conditions were significantly increased compared with another status. With the 90% failure load, only the 1/3 PSRCT condition maintained the same shoulder function as the intact rotator cuff. These biomechanical testing jointly suggested that the weight-bearing ability of the shoulder significantly decreased as PSRCT progressed.
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Affiliation(s)
- Liren Wang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhao Kang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haocheng Jin
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingqi Wang
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Basic Medical Science, Fudan University, Shanghai, China
| | - Yiyao Wei
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Basic Medical Science, Fudan University, Shanghai, China
| | - Haihan Gao
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dingyi Shi
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Suiran Yu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Regenerative Sports Medicine Lab of the Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People’ Hospital, Shanghai, China
- *Correspondence: Jia Jiang, ; Jinzhong Zhao,
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Regenerative Sports Medicine Lab of the Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People’ Hospital, Shanghai, China
- *Correspondence: Jia Jiang, ; Jinzhong Zhao,
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Bravi M, Fossati C, Giombini A, Macaluso A, Lazzoli JK, Santacaterina F, Bressi F, Vorini F, Campi S, Papalia R, Pigozzi F. Criteria for Return-to-Play (RTP) after Rotator Cuff Surgery: A Systematic Review of Literature. J Clin Med 2022; 11:jcm11082244. [PMID: 35456339 PMCID: PMC9024603 DOI: 10.3390/jcm11082244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
This systematic review of the literature aimed to highlight which criteria are described in the literature to define when a patient, after rotator cuff repair (RCR), is ready for return-to-play (RTP), which includes return to unrestricted activities, return to work, leisure, and sport activities. An online systematic search on the US National Library of Medicine (PubMed/MEDLINE), SCOPUS, Web of Science (WOS), and the Cochrane Database of Systematic Reviews, was performed with no data limit until December 2021. A total of 24 studies that reported at least one criterion after RCR were included. Nine criteria were identified and among these, the most reported criterion was the time from surgery, which was used by 78% of the studies; time from surgery was used as the only criterion by 54% of the studies, and in combination with other criteria, in 24% of the studies. Strength and ROM were the most reported criteria after time (25%). These results are in line with a previous systematic review that aimed to identify RTP criteria after surgical shoulder stabilization and with a recent scoping review that investigated RTP criteria among athletes after RCR and anterior shoulder stabilization. Compared to this latest scoping review, our study adds the methodological strength of being conducted according to the Prisma guidelines; furthermore, our study included both athletes and non-athletes to provide a comprehensive view of the criteria used after RCR; moreover, ten additional recent manuscripts were examined with respect to the scoping review.
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Affiliation(s)
- Marco Bravi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico, 00128 Rome, Italy; (M.B.); (F.S.); (F.B.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
- Correspondence:
| | - Arrigo Giombini
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
| | - José Kawazoe Lazzoli
- Biomedical Institute, Medical School, Fluminense Federal University, Niterói 24220-008, Brazil;
| | - Fabio Santacaterina
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico, 00128 Rome, Italy; (M.B.); (F.S.); (F.B.)
| | - Federica Bressi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico, 00128 Rome, Italy; (M.B.); (F.S.); (F.B.)
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, 00128 Rome, Italy; (F.V.); (S.C.); (R.P.)
| | - Stefano Campi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, 00128 Rome, Italy; (F.V.); (S.C.); (R.P.)
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, 00128 Rome, Italy; (F.V.); (S.C.); (R.P.)
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
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9
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Retear bigger than preoperative tear size would lead to treatment failure after rotator cuff repair. J Shoulder Elbow Surg 2022; 31:310-317. [PMID: 34411721 DOI: 10.1016/j.jse.2021.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/05/2021] [Accepted: 07/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to (1) define treatment failure using the referred patient acceptable symptomatic state (PASS) values for pain visual analog scale (PVAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Single Assessment Numeric Evaluation (SANE) clinical scores and (2) identify the factors that lead to patient dissatisfaction after arthroscopic rotator cuff repair (ARCR). METHODS We analyzed the arthroscopic rotator cuff surgery registry data from January 2015 to December 2016. Patients were followed for ≥2 years and categorized as dissatisfied or satisfied based on our own definition of treatment failure at 2 years postoperatively. For defining treatment failure, the referred PASS values for the PVAS, ASES, and SANE scores were used. Patients who failed to attain the PASS value for the PVAS, ASES, or SANE score were categorized into the dissatisfied group. Pre- and postoperative imaging and basic demographic data were compared between groups. Univariable and multivariable logistic regression analyses were performed to identify the factors affecting patient satisfaction at 2 years after rotator cuff repair. RESULTS Of 117 patients, 30 (25.6%) were defined as the dissatisfied group (mean follow-up period, 37.5 months). Seventeen patients (14.5%) had confirmed retear on follow-up magnetic resonance imaging. In the univariate analysis, sex significantly differed between the groups (female, satisfied vs. dissatisfied groups: 39 [44.8%] vs. 22 [73.3%]; P = .010). Retear alone did not affect patient satisfaction in the univariate analysis (P = .11). Progressed retear size featured a significantly higher risk of patient dissatisfaction (P = .024; odds ratio 6.430, 95% confidence interval 1.270-32.541) in the multivariable analysis using symptom duration, sex, preoperative ASES score, preoperative tear size, retear, and progressed retear size as variables. Moreover, female sex had an increased odds for dissatisfaction (odds ratio 4.646, 95% confidence interval 1.590-13.578; P = .005). CONCLUSION Two years after ARCR, most patients (74.4%) reported satisfaction with their outcomes. However, satisfaction levels can be altered by female sex or progressed retear size compared with the preoperative state.
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10
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Leider M, Campbell R, Qadiri Q, Pastore L, Tjoumakaris F. Lost to follow-up: does it matter after arthroscopic rotator cuff repair (a matched cohort analysis of functional outcomes). JSES Int 2021; 6:275-278. [PMID: 35252926 PMCID: PMC8888167 DOI: 10.1016/j.jseint.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Loss to follow-up after surgery is problematic in that it is thought to lead to poorer outcomes. There is little research on the long-term outcomes of people who have been lost to follow-up vs. patients who attended all follow-up appointments. Rotator cuff repair is unique in that the postoperative course is lengthy, and the rehabilitation program is typically tightly supervised. Therefore, the aim of this investigation is to determine whether there is any long-term difference in functional outcomes after arthroscopic rotator cuff repair between patients who are noncompliant with follow-up appointments vs. those who are compliant with all follow-up. Methods A database query was carried out which identified 782 patients who underwent arthroscopic rotator cuff repair at our institution during 2016. Patients were separated into 2 cohorts based on whether they were compliant with all follow-up appointments. Demographic variables such as age and sex were compiled along with objective details from surgery such as size of tear, number of anchors, and other pathologies treated. Patients who were lost to follow-up were contacted by phone to answer survey questions. A matching control group of patients who attended all follow-up appointments was identified based on demographics and surgery details using propensity score matching. The control group was then contacted by phone to answer survey questions. Statistical results were reported as P values. Minimum follow-up was set at 2 years. Results The nonsatisfactory follow-up cohort consisted of 44 people (average follow-up: 30 months), with the satisfactory follow-up cohort consisting of 57 people (average follow-up: 42 months). There was no statistical difference between groups in sex, age, American Shoulder and Elbow Surgeons scores, Single Assessment of Numeric Evaluation scores, number of anchors, number of tears, additional surgical procedures, and patient satisfaction with the surgery and the surgeon. Of the reasons patients gave for why they did not attend follow-up appointments, 25.0% felt fine or returned to work, 22.7% did not know why, 15.9% reported travel distance, 13.6% of patients gave other explanations, 11.4% reported unrelated medical issues, and 11.4% were unaware they missed any appointments. Conclusion This study demonstrated that there is no difference in the outcomes of patients who attended all follow-up appointments vs. patients who prematurely discontinued follow-up after arthroscopic rotator cuff repair. Better communication with patients in the postoperative period may help to improve follow-up after arthroscopic rotator cuff repair.
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Affiliation(s)
| | | | | | | | - Fotios Tjoumakaris
- Corresponding author: Fotios Tjoumakaris, MD, 2500 English Creek Ave., Bldg. 1300, Egg Harbor Township, NJ 08234, USA.
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11
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Zhou ML, Haley CC. The Team Physician: Return to Play Considerations and Outcomes. Sports Med Arthrosc Rev 2021; 29:e65-e70. [PMID: 34730118 DOI: 10.1097/jsa.0000000000000323] [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: 11/25/2022]
Abstract
Successful rehabilitation of sports-related orthopedic injuries remains a challenge for both orthopedic surgeons and their patients. Team physicians are tasked with the complex problem of minimizing time away from competition, while simultaneously mitigating the risk of reinjury. Varying levels of expectation and demand between recreational and competitive athletes coupled with the already complex nature of sports-related injuries present a multifactorial challenge for the even the most experienced physicians. In the realm of sports medicine, timing of return to sport has become a controversial yet ubiquitous criterion by which treatment outcomes are measured. While accelerated rehabilitation may be desired in many cases, surgeons must also recognize the identifiable risk factors for potential reinjury. With these principles in mind, we present a summary of the available literature on data pertaining to return to sport, with coverage of injuries commonly seen within an orthopedic sports medicine practice.
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Affiliation(s)
- Maj Liang Zhou
- Keller Army Hospital, United States Military Academy, West Point, NY
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12
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Panattoni N, Longo UG, De Salvatore S, Castaneda NSC, Risi Ambrogioni L, Piredda M, De Marinis MG, Denaro V. The influence of psychosocial factors on patient-reported outcome measures in rotator cuff tears pre- and post-surgery: a systematic review. Qual Life Res 2021; 31:91-116. [PMID: 34216351 DOI: 10.1007/s11136-021-02921-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE Recent research shows that major levels of psychological distress correlate with higher pain and reduced function in patients with shoulder and rotator cuff pathology. A systematic review updating a review published in 2016 was conducted to determine the degree of consistency and the strength of association between psychosocial factors and patient-reported outcomes (PROMs) in patients with rotator cuff repair (RCR) with new high-quality literature. METHODS The bibliographic searches were conducted from May to June 2020 within the following databases: MEDLINE/PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Web of Science. The articles included should discuss the association between psychosocial factors and outcomes in patients with documented or diagnosed rotator cuff tears through clinical and/or radiological examination. The Methodological Index for Non-Randomized Studies (MINORS) tool was used to assess the methodological quality. RESULTS Fifteen articles were included. Negative psychosocial factors were found consistently associated with worse function and disability in the pre- and post-operative period. In particular, psychosocial factors regarding emotional or mental health were associated with a weak to a substantial degree with preoperative and postoperative function/disability and pain intensity in patients undergoing RCR. CONCLUSION In patients undergoing repair of the rotator cuff tear, there was a correlation between poor psychological function before surgery and worsening post-surgical outcomes, such as persistence of postoperative pain intensity and worse levels of function/disability.
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Affiliation(s)
- Nicolò Panattoni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133, Rome, Italy
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13
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Shoulder outcome scoring systems have substantial ceiling effects 2 years after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2021; 29:2070-2076. [PMID: 32440715 DOI: 10.1007/s00167-020-06036-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Previous studies show no difference in clinical outcomes between patients with healed and structurally failed rotator cuff repairs. The objective of this study was to assess ceiling effects when reporting surgical outcomes of arthroscopic rotator cuff repair using four of the currently most popular clinical shoulder outcome scoring systems. METHODS Ninety-two patients who underwent arthroscopic rotator cuff repair were examined. The simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) shoulder rating scale, and Constant-Murley shoulder score were completed 2 years postoperatively. Demographic data of the subjects were analysed using descriptive statistics. The ceiling effects in the outcome data assessed for each scale were estimated based on two previously reported definitions. RESULTS The number of patients with the maximum possible score was 31 (33.7%) with the SST, 26 (28.3%) with the ASES score, 28 (30.4%) with the UCLA scale, and 18 (19.6%) with the Constant-Murley score. The standardised distance of the outcome data assessed by the SST, ASES score, UCLA scale, and Constant-Murley scores were 0.92, 0.97, 0.96, and 1.18, respectively. CONCLUSION The SST, ASES score, and UCLA scale evaluated at 2 years postoperatively have substantial ceiling effects showing that the proportion of patients with the maximum possible score is > 20%, and the standardised distance is < 1.0. Researchers should be aware of possible biases due to ceiling effects when interpreting the results of studies investigating the surgical outcomes of arthroscopic rotator cuff repair. It could increase the likelihood of a type II error. LEVEL OF EVIDENCE IV.
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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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15
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Wang C, Yang P, Zhang D, Jeon IH, Yu T, Zhang Y, Qi C. Bilateral single-staged arthroscopic rotator cuff repair is comparable to staged procedures: a retrospective follow up study of 2 years. BMC Musculoskelet Disord 2021; 22:409. [PMID: 33947360 PMCID: PMC8094466 DOI: 10.1186/s12891-021-04304-7] [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: 01/06/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Bilateral rotator cuff tears are not uncommon and the timing of the surgical treatment of both shoulders is debated. In the present study, we aimed to compare the clinical outcomes of patients who underwent single-stage or staged bilateral arthroscopic rotator cuff repair. Methods From March 2013 to May 2018, a retrospective review on all patients who underwent bilateral arthroscopic rotator cuff repair at our department was performed. Patients were separated into 2 groups: single-stage and staged. The minimum follow-up period was 2 years. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, Constant-Murley (Constant) score, the range of motion (ROM) of the shoulder and the hospitalization costs were evaluated for comparison between the two groups before and after the operation. Differences between groups were assessed using t-tests and ANOVA. Results All 51 patients completed follow-up of 2 years, single stage (n = 24) and staged group (n = 27). There was no significant difference in the VAS, ASES, UCLA and Constant scores between the single-stage group and the staged group before the operation. Postoperative clinical scores were significantly improved in both groups (P < 0.05). All outcome scores were significantly different between the two groups at 6 months postoperatively, and the staged scored better than the single-stage (P < 0.05). At 12, 18, and 24 months after the operation, the outcome scores were not significantly different between the two groups. At follow-up, the ROM of the shoulder was not significantly different between the two groups. In the single-stage group, the outcome scores and ROM were similar for both shoulders and comparable to the staged group. We also found significant cost savings in the single-stage group (4440.89 ± 130.55 USD) compared to the staged group (5065.73 ± 254.76 USD) (p < 0.05). Conclusions Patients receiving single-stage or staged bilateral arthroscopic rotator cuff repair showed similarly good clinical outcomes at follow-ups longer than 6 months. Moreover, good outcomes were observed on both sides of the single-stage group.
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Affiliation(s)
- Chen Wang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - Pu Yang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - Dongfang Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - In-Ho Jeon
- Department of Orthopedic Surgery, College of Medicine, Asan Medical Center, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Republic of Korea
| | - Tengbo Yu
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - Yingze Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - Chao Qi
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China.
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16
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Improvements in sexual function following arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2021; 30:652-657. [PMID: 32650068 DOI: 10.1016/j.jse.2020.06.017] [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: 05/04/2020] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Three-fourths of Americans are sexually active, and studies show a correlation between sexual activity and good health. Rotator cuff tears and subsequent repairs can cause significant disruption in daily living including sexual activity. Orthopedic surgeons rarely discuss sexual activity with patients. Therefore, patients have little information about expectations, restrictions, and return to sexual activity. The primary goal of this study was to evaluate patient improvement in sexual activity following arthroscopic rotator cuff repair and evaluate factors that affect sexual activity. METHODS An anonymous 20-item multiple-choice survey was sent to patients > 6 months after arthroscopic rotator cuff repair performed by 7 fellowship-trained orthopedic shoulder and elbow surgeons between March 2018 and May 2019. The survey assessed preoperative and postoperative sexual activity and included questions regarding frequency, pain, positioning, and postoperative injury. RESULTS A total of 88 patients met the inclusion criteria and completed the survey. Preoperatively, 65% of patients admitted that their shoulder interfered with the quality and/or frequency of their sexual activity, most commonly secondary to an inability to bear weight on the affected arm (31%). Postoperatively, the majority of patients (79%) found it easier to engage in sexual activity, with 35% of patients attributing this to less pain. At 6 weeks postoperatively, 72% of patients returned to sexual activity. The overall trend demonstrated a statistically significant (P < .001) increase in sexual activity frequency as one progressed from his or her operative date. It is interesting to note that 31% of patients removed their sling to engage in sexual activity after surgery, with 7% admitting to aggravating their shoulder or causing significant pain. CONCLUSION Prior to arthroscopic rotator cuff repair, most patients experience limitations in the quality and/or frequency of their sexual activity secondary to their shoulder. Following surgery, the majority of patients will more easily engage in sexual activity by 6 weeks, with increasing frequency as time progresses from surgery. Many patients are noncompliant with sling wear during sexual activity, and 7% will aggravate their shoulder.
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Chen Y, Jiang F, Li H, Chen S, Qiao Y, Li Y, Hua Y, Chen J, Ge Y. Retears and Concomitant Functional Impairments After Rotator Cuff Repair: Shoulder Activity as a Risk Factor. Am J Sports Med 2020; 48:931-938. [PMID: 32040348 DOI: 10.1177/0363546519900897] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most patients return successfully to shoulder involving sports or activity after rotator cuff repairs. It has not been decided yet whether postoperative participation in shoulder activity adds to the risk of retear. PURPOSE/HYPOTHESIS The purpose was to verify whether patients who participate in shoulder activities after rotator cuff repair have a higher risk of structural failure than nonactive patients and to investigate the relationship between postoperative shoulder function and tendon integrity in active and nonactive patients. The hypotheses were that (1) active patients have a higher retear rate than nonactive patients and (2) structural failure is associated with worse functional outcomes in active patients. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A cohort study was performed using 145 patients who underwent arthroscopic rotator cuff repair from 2015 to 2017. Functional assessments and magnetic resonance imaging were performed at least 24 months postoperatively. Shoulder activities since 6 months after surgery were rated in 4 categories (sports, job, activities of daily life, and weight of general lifting) as sedentary, light, moderate, or strenuous. The activity level of each patient was defined by the highest rated category. Patients who were involved in light, moderate, and strenuous activity were identified as active for the present study, and the rest were defined as sedentary. The proportion of retears between groups and the functional conditions between retorn and intact tendons were compared. RESULTS A total of 48 patients were enrolled in the active group, and 97 were enrolled in the sedentary group. The active group demonstrated a significantly higher retear rate than the sedentary group (27.1% vs 11.3%, respectively; P = .016; risk ratio, 2.39 [95% CI, 1.16-4.93]). In the active group, patients with retears showed higher visual analog scale scores for pain, decreased abduction strength, and lower shoulder functional scores (American Shoulder and Elbow Surgeons score, Fudan University Shoulder Score, and Constant-Murley score) than those with healed tendons, whereas in the sedentary group, functional outcomes were generally similar across patients with and without retears. CONCLUSION Shoulder activity after the early postoperative period was associated with a high risk of retears in patients who underwent rotator cuff repair. A correlation between inhibited function and structural failure was detected but only in active patients, while sedentary patients with retears retained functional improvements similar to those with intact tendons.
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Affiliation(s)
- Yuzhou Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Fangyi Jiang
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yang Qiao
- Department of Radiology, Huashan Hospital, Shanghai, China
| | - Yunxia Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yunshen Ge
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
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Kim HJ, Kee YM, Kim JY, Rhee YG. Safe time frame of staged bilateral arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2019; 28:1707-1715. [PMID: 31053388 DOI: 10.1016/j.jse.2019.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have assessed the outcomes of staged bilateral arthroscopic rotator cuff repair (ARCR). This study aimed to determine the influencing factors related to the outcomes of patients who underwent staged bilateral ARCR and to verify an optimal interval for performing the second rotator cuff repair in staged bilateral ARCR. METHODS We analyzed 166 shoulders that underwent staged bilateral ARCR. The average interval between the first- and second-side surgical procedures was 21.9 ± 19.7 months. The minimum follow-up period was 2 years. RESULTS Clinical outcomes and retear rates were not significantly different according to the order of surgical procedures, sex, arm dominance, age, and tear size (P > .05 for all). The cutoff value for the optimal interval between the first and second surgical procedures for the University of California, Los Angeles score and American Shoulder and Elbow Surgeons score was 9 months, with the area under the curve equal to 0.815 (P < .001) for the University of California, Los Angeles score and 0.806 (P < .001) for the American Shoulder and Elbow Surgeons score. The group with an interval of 9 months or less between the first- and second-side surgical procedures showed significantly inferior clinical outcomes and a higher retear rate (35%) compared with the group with an interval greater than 9 months (retear rate, 10%) (P < .05). CONCLUSION Staged bilateral ARCR resulted in significant improvements in clinical outcomes regardless of the order of surgical procedures, sex, arm dominance, age, and tear size. To optimize clinical outcomes of staged bilateral ARCR, second-side surgery should be delayed until 9 months after the first-side surgical procedure.
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Affiliation(s)
- Hwan Jin Kim
- Department of Orthopaedic Surgery, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Young Moon Kee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Youn Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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CORR Insights®: When Do Patients Return to Previous Daily Activity After Arthroscopic Rotator Cuff Repair? Clin Orthop Relat Res 2019; 477:414-415. [PMID: 30516657 PMCID: PMC6370088 DOI: 10.1097/corr.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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