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Hill M, Allen C, Williamson TK, Martinez V, Vangeli S, Zaheer A, Kingery MT, Checketts JX. Top 50 most impactful publications on massive rotator cuff tears. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:20-32. [PMID: 38323204 PMCID: PMC10840572 DOI: 10.1016/j.xrrt.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background Bibliometric analysis is a useful tool for measuring the scholarly impact of a topic and its more and less heavily studied aspects. The purpose of this study is to use bibliometric analysis to comprehensively analyze the 50 articles with the highest citation indices in studies evaluating the treatment and outcomes of massive rotator cuff tears (mRCTs). Methods This cross-sectional study identified articles within the Scopus database published through December 2022. Keywords used were "massive rotator cuff tear." Articles were sorted in chronological order. The year published and number of citations were recorded. A citation index (CI) was calculated for each article by dividing the number of citations by number of years published [1 citation/1 year published (2021) = CI of 1]. Of these, the 50 articles with the highest CIs were carried forward for evaluation. Frequencies and distributions were assessed for data of each variable collected. Results These search methods produced 625 articles regarding mRCT research (ranging from January 1986 to December 2022). Four of the top 10 most impactful articles were published in the 2010s. The level of evidence (LOE) published with the greatest frequency was level of evidence 4 (41%). The journal Arthroscopy published the highest number within the top 50 (26%) followed by the Journal of Bone and Joint Surgery and the American Journal of Sports Medicine (20% each). Clinical studies composed 88% of the top 50. Case series (38%) predominated, while systematic reviews (20%) and randomized control trials (8%) were less prevalent. The majority of studies concentrated on the clinical outcomes of certain interventions (62%), mainly comparing multiple interventions. Conclusion Despite the relatively high prevalence of mRCTs (40% of all tears), this topic comprises only a small proportion of all rotator cuff research. This analysis has identified gaps within and limitations of the findings concerning mRCTs for researchers to propose research questions targeting understudied topics and influence the future treatment and outcomes of this clinically difficult diagnosis.
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Affiliation(s)
- Marcheta Hill
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Christian Allen
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Tyler K. Williamson
- Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Victor Martinez
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Sydney Vangeli
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Aroob Zaheer
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Matthew T. Kingery
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Jake X. Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
- St Francis Medical Center, Tulsa, OK, USA
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Brandariz R, Charbonnier C, Culebras Almeida A, Lädermann A, Cunningham G. The role of bone morphology of the greater tuberosity and lateral acromion on subacromial space during scaption: a three-dimensional dynamic simulation analysis. BMC Musculoskelet Disord 2023; 24:888. [PMID: 37968608 PMCID: PMC10647087 DOI: 10.1186/s12891-023-06957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The bone morphology of the greater tuberosity and lateral acromion plays a central role in subacromial impingement syndrome. The critical shoulder angle (CSA) and greater tuberosity angle (GTA) are two-dimensional measurement parameters that have been validated to evaluate it radiologically. These markers are, however, static and don't consider the dynamic effect of glenohumeral motion. OBJECTIVES This study aimed to better understand the biomechanics in subacromial impingement with a dynamic simulation based on a validated 3D biomechanical model coupling joint kinematics and 3D reconstructed computed tomography. STUDY DESIGN & METHODS Sixty-one patients were included in this study: a case group of 44 patients with degenerative rotator cuff tears involving only the supraspinatus, and a control group of 17 without a rotator cuff tear. Patients with previous surgeries, traumatic cuff tears, and cuff tear arthropathy were excluded. CSA, GTA, and impingement-free range of motion (IF-ROM) of the glenohumeral joint in scaption were calculated. Correlation tests were used to determine the relationship between ROM and CSA, GTA, and combined CSA and GTA values. RESULTS CSA and GTA were significantly higher in the rotator cuff tear group (p = 0.001 and < 0.001), while IF-ROM was significantly higher in the control group (p = 0.001). There was no overall correlation between CSA and GTA (R = 0.02, p = 0.8). Individual correlation between both angles with IF-ROM was negatively weak for CSA (R = -0.4, p < 0.001) and negatively moderate for GTA and IF-ROM (R = -0.5, p < 0.001). However, combining both angles resulted in a negatively high correlation with IF-ROM (R = -0.7, p < 0.001). CONCLUSION Subacromial space narrowing during scaption is highly correlated to the cumulative values of GTA and CSA. These findings suggest that the combined bony morphology of the lateral acromion and greater tuberosity plays an important role in subacromial impingement. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Caecilia Charbonnier
- Medical Research Department, Artanim Foundation, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alejandro Culebras Almeida
- Shoulder and Elbow Center La Colline, Geneva, Switzerland
- Department of Orthopaedics and Traumatology, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
| | - Alexandre Lädermann
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Gregory Cunningham
- Shoulder and Elbow Center La Colline, Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
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Lundeen M, Hurd JL, Hayes M, Hayes M, Facile TR, Furia JP, Maffulli N, Alt C, Alt EU, Schmitz C, Pearce DA. Management of partial-thickness rotator cuff tears with autologous adipose-derived regenerative cells is safe and more effective than injection of corticosteroid. Sci Rep 2023; 13:19348. [PMID: 37935850 PMCID: PMC10630470 DOI: 10.1038/s41598-023-46653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023] Open
Abstract
Symptomatic, partial-thickness rotator cuff tears (sPTRCT) are problematic. This study tested the hypothesis that management of sPTRCT with injection of fresh, uncultured, unmodified, autologous, adipose-derived regenerative cells (UA-ADRCs) is safe and more effective than injection of corticosteroid even in the long run. To this end, subjects who had completed a former randomized controlled trial were enrolled in the present study. At baseline these subjects had not responded to physical therapy treatments for at least 6 weeks, and were randomly assigned to receive respectively a single injection of UA-ADRCs (n = 11) or a single injection of methylprednisolone (n = 5). Efficacy was assessed using the ASES Total score, pain visual analogue scale (VAS), RAND Short Form-36 Health Survey and range of motion at 33.2 ± 1.0 (mean ± SD) and 40.6 ± 1.9 months post-treatment. Proton density, fat-saturated, T2-weighted MRI of the index shoulder was performed at both study visits. There were no greater risks connected with injection of UA-ADRCs than those connected with injection of corticosteroid. The subjects in the UA-ADRCs group showed statistically significantly higher mean ASES Total scores than the subjects in the corticosteroid group. The MRI scans at 6 months post-treatment allowed to "watch the UA-ADRCs at work".
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Affiliation(s)
- Mark Lundeen
- Sanford Orthopedics and Sports Medicine Fargo, Fargo, ND, USA
| | - Jason L Hurd
- Sanford Orthopedics and Sports Medicine Sioux Falls, Sioux Falls, SD, USA
| | | | | | | | - John P Furia
- SUN Orthopedics of Evangelical Community Hospital, Lewisburg, PA, USA
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, UK
- School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Keele University School of Medicine, Stoke on Trent, UK
| | - Christopher Alt
- InGeneron, Inc., Houston, TX, USA
- Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich, Germany
- Isar Klinikum, Munich, Germany
| | - Eckhard U Alt
- InGeneron, Inc., Houston, TX, USA
- Isar Klinikum, Munich, Germany
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
- Heart and Vascular Institute, Department of Medicine, Tulane University Health Science Center, New Orleans, LA, USA
| | - Christoph Schmitz
- Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich, Germany
| | - David A Pearce
- Sanford Health, Sioux Falls, SD, USA.
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA.
- Sanford Research, Sioux Falls, SD, USA.
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4
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Liu S, Liu JT, Chen L, Fan TY, Cui XJ, Cheng SD, Chen YJ, Shi Q, Xue CC, Li XF. Efficacy of five-step shoulder manipulation for rotator cuff-related shoulder pain: protocol for a multicenter randomized controlled trial. Trials 2023; 24:498. [PMID: 37550698 PMCID: PMC10405406 DOI: 10.1186/s13063-023-07540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Rotator cuff-related shoulder pain (RCRSP) is the most common cause of shoulder disorders. In China, manipulation has been used extensively for the treatment of patients with RCRSP. However, high-quality clinical evidence to support the therapeutic effect of manipulation is still limited. METHODS A multicenter, participant-, outcome assessor-, and data analyst-blinded, randomized, placebo-controlled trial will be conducted. A total of 280 participants with RCRSP will be recruited from three hospitals and randomly assigned to a five-step shoulder manipulation (FSM) group or a sham manipulation (SM) group. Each group will receive four weekly treatment sessions, with all participants performing exercises at home for 12 weeks. Assessments, namely the Constant-Murley score, visual analog scale, range of motion, and 36-Item Short Form Survey, will be made at baseline, 4, 12, 18, and 24 weeks. Adverse events during the study will also be recorded. DISCUSSION This is a pragmatic clinical trial to evaluate the efficacy and safety of FSM in patients with RCRSP. The findings of this study will provide worthy clinical evidence for manual therapy for RCRSP. TRIAL REGISTRATION China Registered Clinical Trial Registration Center ChiCTR2000037577. Registered on 29 August 2020.
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Affiliation(s)
- Shuang Liu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiangzhong Road, Shanghai, 200071 China
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, 725 Wanpingnan Road, Shanghai, 200032 China
| | - Jin-Tao Liu
- Suzhou Hospital of Traditional Chinese Medicine, 899 Wuzhongxi Road, Suzhou, 215009 Jiangsu China
| | - Lin Chen
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiangzhong Road, Shanghai, 200071 China
| | - Tian-You Fan
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiangzhong Road, Shanghai, 200071 China
| | - Xue-Jun Cui
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, 725 Wanpingnan Road, Shanghai, 200032 China
| | - Shao-Dan Cheng
- Shanghai GuangHua Hospital of Integrated Traditional Chinese and Western Medicine, 540 Xinhua Road, Shanghai, 200052 China
| | - Yan-Jiao Chen
- Shanghai Research Institute of Acupuncture and Meridian, YueYang Hospital of Integrated Traditional Chinese and Western Medicine, 650 Wanpingnan Road, Shanghai, 200030 China
| | - Qi Shi
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, 725 Wanpingnan Road, Shanghai, 200032 China
- Qi Shi’s Studio of Famous Chinese Medicine Physician, 274 Zhijiangzhong Road, Shanghai, 200032 China
| | - Chun-Chun Xue
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiangzhong Road, Shanghai, 200071 China
| | - Xiao-Feng Li
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiangzhong Road, Shanghai, 200071 China
- Qi Shi’s Studio of Famous Chinese Medicine Physician, 274 Zhijiangzhong Road, Shanghai, 200032 China
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Velasquez Garcia A, Ingala Martini L, Franco Abache A, Abdo G. Role of platelet-rich plasma in the treatment of rotator cuff tendinopathy. World J Orthop 2023; 14:505-515. [PMID: 37485430 PMCID: PMC10359750 DOI: 10.5312/wjo.v14.i7.505] [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: 01/31/2023] [Revised: 04/11/2023] [Accepted: 05/15/2023] [Indexed: 07/18/2023] Open
Abstract
Shoulder pain is a common musculoskeletal complaint, and rotator cuff (RC) pathologies are one of the main causes. The RC undergoes various tendinopathic and avascular changes during the aging process. Other degenerative changes affecting its healing potential make it an appealing target for biological agents. Platelet-rich plasma (PRP) has demonstrated the potential to deliver a high concentration of several growth factors and anti-inflammatory mediators, and its clinical use is mainly supported by experiments that demonstrated its positive effect on muscle, ligaments, and tendinous cells. This review aimed to specify the role of PRP and its future applications in RC tendinopathies based on the current clinical evidence. Due to the different characteristics and conflicting outcomes, clinicians should use PRP with moderate expectations until more consistent evidence is available. However, it is reasonable to consider PRP in patients with contraindications to corticosteroid injections or those with risk factors for inadequate healing. Its autologous origin makes it a safe treatment, and its characteristics make it a promising option for treating RC tendinopathy, but the efficacy has yet to be established.
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Affiliation(s)
| | - Liborio Ingala Martini
- Department of Orthopedic Surgery, Hospital IVSS Dr. Luis Ortega, Porlamar 6301, Venezuela
- Department of Orthopedic Surgery, Hospital Clinicas del Este, Los Robles 6301, Venezuela
| | - Andres Franco Abache
- Department of Orthopedic Surgery, Hospital de Especialidades Guayaquil MSP, Guayaquil 090101, Ecuador
| | - Glen Abdo
- Department of Graduate Medical Education, Internal Medicine Residence Program, New York Medical College at St. Mary’s and St. Clare’s, Passaic, NJ 07055, United States
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Three-Dimensional Kinematics during Shoulder Scaption in Asymptomatic and Symptomatic Subjects by Inertial Sensors: A Cross-Sectional Study. SENSORS 2022; 22:s22083081. [PMID: 35459065 PMCID: PMC9029881 DOI: 10.3390/s22083081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 02/04/2023]
Abstract
Shoulder kinematics is a measure of interest in the clinical setting for diagnosis, evaluating treatment, and quantifying possible changes. The aim was to compare shoulder scaption kinematics between symptomatic and asymptomatic subjects by inertial sensors. Methods: Scaption kinematics of 27 subjects with shoulder symptomatology and 16 asymptomatic subjects were evaluated using four inertial sensors placed on the humerus, scapula, forearm, and sternum. Mobility, velocity, and acceleration were obtained from each sensor and the vector norm was calculated from the three spatial axis (x,y,Z). Shoulder function was measured by Upper Limb Functional Index and Disabilities of the Arm, Shoulder, and Hand questionnaires. One way ANOVA was calculated to test differences between the two groups. Effect size was calculated by Cohen’s d with 95% coefficient Intervals. Pearson’s correlation analysis was performed between the vector norms humerus and scapula kinematics against DASH and ULFI results in symptomatic subjects. Results: The asymptomatic group showed higher kinematic values, especially in the humerus and forearm. Symptomatic subjects showed significantly lower values of mobility for scapular protraction-retraction (Cohen’s d 2.654 (1.819–3.489) and anteriorisation-posteriorisation (Cohen’s d 1.195 (0.527–1.863). Values were also lower in symptomatic subjects for velocity in all scapular planes of motion. Negative correlation showed that subjects with higher scores in ULFI or DASH had lower kinematics values. Conclusion: Asymptomatic subjects tend to present greater kinematics in terms of mobility, velocity, and linear acceleration of the upper limb, and lower humerus and scapula kinematics in symptomatic subjects is associated with lower levels of function.
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7
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Classification of rotator cuff tears in ultrasound images using deep learning models. Med Biol Eng Comput 2022; 60:1269-1278. [PMID: 35043367 DOI: 10.1007/s11517-022-02502-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
Rotator cuff tears (RCTs) are one of the most common shoulder injuries, which are typically diagnosed using relatively expensive and time-consuming diagnostic imaging tests such as magnetic resonance imaging or computed tomography. Deep learning algorithms are increasingly used to analyze medical images, but they have not been used to identify RCTs with ultrasound images. The aim of this study is to develop an approach to automatically classify RCTs and provide visualization of tear location using ultrasound images and convolutional neural networks (CNNs). The proposed method was developed using transfer learning and fine-tuning with five pre-trained deep models (VGG19, InceptionV3, Xception, ResNet50, and DenseNet121). The Bayesian optimization method was also used to optimize hyperparameters of the CNN models. A total of 194 ultrasound images from Kosin University Gospel Hospital were used to train and test the CNN models by five-fold cross-validation. Among the five models, DenseNet121 demonstrated the best classification performance with 88.2% accuracy, 93.8% sensitivity, 83.6% specificity, and AUC score of 0.832. A gradient-weighted class activation mapping (Grad-CAM) highlighted the sensitive features in the learning process on ultrasound images. The proposed approach demonstrates the feasibility of using deep learning and ultrasound images to assist RCTs' diagnosis.
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Wang W, Kang H, Li H, Li J, Meng Y, Li P. Comparative efficacy of 5 suture configurations for arthroscopic rotator cuff tear repair: a network meta-analysis. J Orthop Surg Res 2021; 16:714. [PMID: 34895286 PMCID: PMC8665484 DOI: 10.1186/s13018-021-02847-y] [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: 08/26/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rotator cuff tear is one of the most common complaint with shoulder pain, disability, or dysfunction. So far, different arthroscopic techniques including single row (SR), double row (DR), modified Mason-Allen (MMA), suture bridge (SB) and transosseous (TO) have been identified to repair rotator cuff. However, no study has reported the comparative efficacy of these 5 suture configurations. The overall aim of this network meta-analysis was to analyze the clinical outcomes and healing rate with arthroscopy among SR, DR, MMA, SB and TO. METHODS A systematic literature was searched from PubMed, EBSCO-MEDLINE, Web of Science, google scholar and www.dayi100.com , and checked for the inclusion and exclusion standards. The network meta-analysis was conducted using Review Manager 5.3 and SATA 15.0 software. RESULTS Thirty-four studies were eligible for inclusion, including 15 randomized controlled trials, 17 retrospective and 2 prospective cohort studies, with total 3250 shoulders. Two individual reviewers evaluated the quality of the 34 studies, the score form 5 and 9 of 10 were attained according to the Newcastle-Ottawa Scale for the 17 retrospective and 2 prospective studies. There was no significant distinction for the Constant score among 5 groups in the 16 studies with 1381 shoulders. The treatment strategies were ranked as MMA, DR, SB, SR and TO. In ASES score, 14 studies included 1464 shoulders showed that no significant differences was showed among all 5 groups after surgery. Whereas the efficacy probability was TO, MMA, DR, SB and SR according to the cumulative ranking curve. The healing rate in 25 studies include 2023 shoulders was significant in both SR versus DR [risk ratio 0.45 with 95% credible interval (0.31, 0.65)], and SR versus SB [risk ratio 0.45 (95% credible interval 0.29, 0.69)], and no significant in the other comparison, the ranking probability was MMA, SB, DR, TO and SR. CONCLUSION Based on the clinical results, this network meta-analysis revealed that these 5 suture configurations shows no significant difference. Meanwhile, suture bridge may be the optimum treatment strategy which may improve the healing rate postoperatively, whereas the DR is a suboptimal option for arthroscopic rotator cuff repairs.
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Affiliation(s)
- Wei Wang
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Hui Kang
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Hongchuan Li
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Jian Li
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Yibin Meng
- Departments of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Peng Li
- Department of Hand Surgery, Honghui Hospital, Xi'an Jiaotong University, 76 Guo Road, Beilin South District, Xian City, 710054, Shanxi Province, China.
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Paul S, Yadav AK, Goyal T. Comparison of tear characteristics, outcome parameters and healing in traumatic and non-traumatic rotator cuff tear: a prospective cohort study. Musculoskelet Surg 2021; 106:433-440. [PMID: 34105053 DOI: 10.1007/s12306-021-00719-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 06/03/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Acute traumatic and chronic non-traumatic rotator cuff tears are etiologically distinguishable entities. However, prospective studies comparing tear characteristics and outcomes between these two types of tears are lacking. The purpose of this study was to compare the tear characteristics, clinical and functional outcomes, and tendon healing as assessed on magnetic resonance imaging (MRI), between traumatic and non-traumatic rotator cuff tears. METHODS MRI proven rotator cuff tears were allocated into two groups according to the history of injury: Group 1 included 28 patients with traumatic tears and group 2 included 33 patients of non-traumatic cuff tears. Both the groups were compared for preoperative tear characteristics (tear size, muscle atrophy, fatty degeneration), range of motion, strength of shoulder abduction and external rotation, functional outcomes, and tendon integrity on MRI, 2 years after the surgery. RESULTS Postoperative mean active range of abduction (p = 0.005), abduction strength (p = 0.013), external rotation strength (p = 0.027), University of California at Los Angeles score (p < 0.001), Constant score (p = 0.002), American Shoulder and Elbow Surgeons scores (p = 0.028) and visual analog scale for pain (p = 0.02) were significantly better in group 1 as compared to group 2. The postoperative structural integrity of the cuff on MRI was better in group 1 as compared to group 2, but the values did not reach statistical significance (p = 0.13). CONCLUSION Findings from this study suggest that traumatic tears affect younger patients and while having a larger tear size, they have lesser muscle atrophy, fatty degeneration, and tendon retraction. Functional outcomes are better after treatment of traumatic tears as compared to non-traumatic tears. Chronicity of the tear and tendon retraction negatively affected healing in traumatic cuff tears. Muscle atrophy was found to be associated with poorer healing in non-traumatic tears. However, tear size was not associated with healing. LEVEL OF EVIDENCE II, Prospective cohort study.
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Affiliation(s)
- S Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - A K Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - T Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
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Marathe A, Song B, Jayaram P. Microfragmented Adipose Tissue With Adjuvant Platelet-Rich Plasma Combination Therapy for Partial-Thickness Supraspinatus Tear. Cureus 2021; 13:e15583. [PMID: 34277204 PMCID: PMC8270056 DOI: 10.7759/cureus.15583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 01/08/2023] Open
Abstract
A 50-year-old male presented with acute, sharp, right shoulder pain. Ultrasound of the right shoulder revealed a partial thickness tear of the supraspinatus. After conservative management failed to provide any relief, he was treated with microfragmented adipose tissue (MFAT) injection followed by platelet-rich plasma (PRP) at 14 weeks. At the 28-week follow-up, he showed significant improvement in pain and mobility with a resolution of the tear on ultrasound. While PRP has been shown to confer some protection against retears, very few studies have investigated the efficacy of MFAT use in rotator cuff pathology. In this case, we used a combination of MFAT and PRP to successfully treat a partial thickness supraspinatus tear. These agents may function in a synergistic manner, with MFAT providing a cell scaffold and PRP modulating the cellular environment to optimize healing. Further studies are needed to better understand the mechanism of this treatment modality in treating similar conditions.
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Affiliation(s)
- Anuj Marathe
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, USA
| | - Bo Song
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, USA
| | - Prathap Jayaram
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, USA
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Niazi GE, Hassan MS, Elfawy DM. Ultrasound-guided injection of platelet-rich plasma (PRP) in rotator cuff tendinopathy: effect on patients’ symptoms and supraspinatus tendon thickness. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00221-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
Rotator cuff tendinopathy is considered a major cause of shoulder pain and disability that is increasing substantially with age affecting more than half of the general population by the age of 60 years. This study aims to assess the effect of ultrasound-guided injection of platelet-rich plasma on patient symptoms and supraspinatus tendon thickness in cases of rotator cuff tendinopathy.
Results
This was a single-arm interventional study conducted on 30 patients with age ranging between 27 and 54 years old. Following US-guided injection of PRP, patients were evaluated clinically using the Shoulder Pain and Disability Index (SPADI) scoring system and radiologically using ultrasonographic supraspinatus tendon thickness measurements at 4, 8, 12, and 24 weeks. Our study showed remarkably noticeable changes when comparing the pre-injection and post-injection SPADI scoring system. There is highly statistically significant pain and disability score and percentage improvement, yet on the other hand, the radiological improvement shows no statistically significant difference found between baseline tendon thickness and its follow-up at 4, 8, and 12 weeks while only there was a statistically significant decrease in tendon thickness found at 24 weeks with P value = 0.043.
Conclusions
The ultrasound-guided PRP injection for supraspinatus tendinopathy cases is a safe, cheap, and easily prepared outpatient procedure which showed competitive, promising, and well-proved results when compared to other modality outcomes such as conventional surgeries, arthroscopic procedures, and physiotherapy.
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12
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The Lateral Deltoid Originates From the Entire Lateral Wall of the Acromion: MRI and Histologic Cadaveric Analysis Regarding Vertical Lateral Acromioplasty. Arthrosc Sports Med Rehabil 2020; 2:e547-e552. [PMID: 33134993 PMCID: PMC7588629 DOI: 10.1016/j.asmr.2020.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/08/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose The aim of this study was to assess the nature of the middle deltoid muscle insertion onto the lateral acromion by macroscopic, MRI and histologic examination and to, therefore, assess the potential impact of a vertical lateral acromioplasty on the deltoid origin. Methods We assessed the acromial origin of the deltoid in 6 cadaver shoulders by macroscopic, MRI and histologic examination. The cadavers were scanned with T1 and proton density-weighted sequences. H&E- and Masson trichrome-stained histologic sections through the acromion were taken and visualized under polarized microscopy. Results The enthesis of the deltoid muscle consisted of dense birefringent bundles of collagen that blended with the bony endplate of the acromion at all points on its lateral wall. A prominent band of collagen was seen on both MRI and histologic slices, traversing the superior surface of the acromion. It was continuous with the deltoid origin and blended with the superficial fascia of the deltoid laterally. Conclusions The middle deltoid muscle occupies the entire lateral acromion. Clinical Relevance A high critical shoulder angle is associated with rotator cuff tears. A lateral acromioplasty resects the lateral acromion and aims to normalize the critical shoulder angle. However, a vertical lateral acromioplasty may release the middle deltoid origin from the lateral acromion. The superior band of collagen may anchor the middle deltoid to the superior acromion and prevent retraction.
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13
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Vora M, Sing DC, Curry EJ, Kamal RN, Li X. National Trends in the Surgical Treatment of Chronic Rotator Cuff Tear in Patients Without Arthritis. Orthopedics 2020; 43:e409-e414. [PMID: 32602925 DOI: 10.3928/01477447-20200619-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/28/2019] [Indexed: 02/03/2023]
Abstract
Both rotator cuff repair (RCR) and reverse total shoulder arthroplasty (RTSA) are effective treatment options for chronic large degenerative rotator cuff tear (RCT) in the elderly. The goal of this study was to evaluate national trends for surgical management of chronic RCT among patients without glenohumeral arthritis. The authors conducted a retrospective review from 2007 to 2015 using the PearlDiver database. The study included patients who had the International Classification of Diseases, Ninth Revision, diagnosis of chronic RCT without shoulder arthritis. Procedural codes from the Current Procedural Terminology and the International Classification of Diseases, Ninth Revision, were used to identify patients undergoing RCR or RTSA. Chi-square analysis assessed differences between the groups, and Cochran-Armitage trend tests were used to evaluate trends over time. Overall, 428,651 patients had chronic RCT without arthritis; 364,141 (84.9%) were treated nonoperatively, 53,566 (12.5%) underwent RCR, and 10,944 (2.6%) underwent RTSA. Patients who were 60 to 79 years old had the highest rate of surgical intervention (70.8% of all surgical patients), with 69.2% and 78.4% who underwent RCR and RTSA, respectively. A 3-fold increase in RTSA use was noted among patients 60 years and older vs patients younger than 60 years. Overall revision rates 2 years after RCR and RTSA among patients 60 to 79 years old were 13.0% and 3.7%, respectively. Revision rates after RCR remained constant over time (9.3% to 13.0%; P=.082), whereas revision rates after RTSA decreased significantly over time (12.1% to 2.2%; P=.016). Older patients were more likely to be treated nonoperatively compared with younger patients, but among those patients treated with RTSA, there was a 3-fold increase in the use of RTSA in patients older than 60 years compared with patients younger than 60 years. Further, the authors found that revision rates after RTSA decreased over time (from 12% to 2%), suggesting better implant design, improved knowledge of implant positioning, and increased surgical proficiency. [Orthopedics. 2020;43(5):e409-e414.].
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14
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Lin CL, Chen YW, Lin LF, Chen CP, Liou TH, Huang SW. Accuracy of the Critical Shoulder Angle for Predicting Rotator Cuff Tears in Patients With Nontraumatic Shoulder Pain. Orthop J Sports Med 2020; 8:2325967120918995. [PMID: 32478116 PMCID: PMC7232055 DOI: 10.1177/2325967120918995] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background: The critical shoulder angle (CSA) is the angle between the superior and
inferior bony margins of the glenoid and the most lateral border of the
acromion. Although studies have reported that the CSA is associated with
rotator cuff tears (RCTs), few studies have examined the accuracy of the CSA
for predicting RCTs in patients with shoulder pain. Purpose: To investigate the accuracy of the CSA for predicting RCTs among patients
with nontraumatic shoulder pain. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Data were retrospectively collected from 301 patients who had RCTs and
underwent arthroscopic rotator cuff repair between January 2014 and December
2018 (RCT group). During that same period, we also included 300 patients
with shoulder pain but without RCTs, confirmed through ultrasound (non-RCT
group). Baseline demographic data, the CSA, and the acromion index (AI) were
compared using an independent t test. Categorical variables
were analyzed using the chi-square test. Receiver operating characteristic
(ROC) curve analysis was performed to investigate the accuracy of the CSA
and AI for predicting RCTs, and the optimal cutoff point was determined
using the Youden index. Multiple stepwise and binary logistic regressions
were used to determine the predictors of RCTs. Results: A total of 301 patients (123 males, 178 females) and 300 patients (116 males,
184 females) were included in the RCT and non-RCT groups, respectively. The
RCT group had a higher CSA (P < .001) than the non-RCT
group. The area under the ROC curve (AUC) was 70.5% (P <
.001) for the CSA, but there was no significance for the AI, with an AUC of
47.7% for predicting RCTs in patients. Stepwise logistic regression revealed
the CSA as an independent predictor of RCTs, with an adjusted odds ratio of
1.295 (95% CI, 1.019-1.571; P = .006). For patients with a
CSA greater than 37.52°, binary logistic regression revealed an adjusted
odds ratio of 3.92 (95% CI, 2.79-5.51; P < .001) for the
presence of an RCT. Conclusion: The CSA was an objective assessment tool to identify patients with shoulder
pain who may have RCTs. Our study indicated that the CSA predicted RCTs more
accurately than did the AI for patients with shoulder pain.
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Affiliation(s)
- Che-Li Lin
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Orthopedics, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Wen Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Cho-Pang Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan City, Taiwan
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15
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Hurd JL, Facile TR, Weiss J, Hayes M, Hayes M, Furia JP, Maffulli N, Winnier GE, Alt C, Schmitz C, Alt EU, Lundeen M. Safety and efficacy of treating symptomatic, partial-thickness rotator cuff tears with fresh, uncultured, unmodified, autologous adipose-derived regenerative cells (UA-ADRCs) isolated at the point of care: a prospective, randomized, controlled first-in-human pilot study. J Orthop Surg Res 2020; 15:122. [PMID: 32238172 PMCID: PMC7110715 DOI: 10.1186/s13018-020-01631-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background This study tested the hypothesis that treatment of symptomatic, partial-thickness rotator cuff tears (sPTRCT) with fresh, uncultured, unmodified, autologous adipose-derived regenerative cells (UA-ADRCs) isolated from lipoaspirate at the point of care is safe and more effective than corticosteroid injection. Methods Subjects aged between 30 and 75 years with sPTRCT who did not respond to physical therapy treatments for at least 6 weeks were randomly assigned to receive a single injection of an average 11.4 × 106 UA-ADRCs (in 5 mL liquid; mean cell viability: 88%) (n = 11; modified intention-to-treat (mITT) population) or a single injection of 80 mg of methylprednisolone (40 mg/mL; 2 mL) plus 3 mL of 0.25% bupivacaine (n = 5; mITT population), respectively. Safety and efficacy were assessed using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), RAND Short Form-36 Health Survey, and pain visual analogue scale (VAS) at baseline (BL) as well as 3 weeks (W3), W6, W9, W12, W24, W32, W40, and W52 post treatment. Fat-saturated T2-weighted magnetic resonance imaging of the shoulder was performed at BL as well as at W24 and W52 post treatment. Results No severe adverse events related to the injection of UA-ADRCs were observed in the 12 months post treatment. The risks connected with treatment of sPTRCT with UA-ADRCs were not greater than those connected with treatment of sPTRCT with corticosteroid injection. However, one subject in the corticosteroid group developed a full rotator cuff tear during the course of this pilot study. Despite the small number of subjects in this pilot study, those in the UA-ADRCs group showed statistically significantly higher mean ASES total scores at W24 and W52 post treatment than those in the corticosteroid group (p < 0.05). Discussion This pilot study suggests that the use of UA-ADRCs in subjects with sPTRCT is safe and leads to improved shoulder function without adverse effects. To verify the results of this initial safety and feasibility pilot study in a larger patient population, a randomized controlled trial on 246 patients suffering from sPTRCT is currently ongoing. Trial registration Clinicaltrials.gov ID NCT02918136. Registered September 28, 2016, https://clinicaltrials.gov/ct2/show/NCT02918136. Level of evidence Level I; prospective, randomized, controlled trial.
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Affiliation(s)
- Jason L Hurd
- Sanford Orthopedics & Sports Medicine Sioux Falls, 1210 W. 18th St., Suite G01, Sioux Falls, SD, 57104, USA.
| | | | | | | | | | - John P Furia
- SUN Orthopedics of Evangelical Community Hospital, Lewisburg, PA, USA
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, UK.,School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Keele University School of Medicine, Stoke on Trent, UK
| | | | | | - Christoph Schmitz
- Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Eckhard U Alt
- Sanford Health, Sioux Falls, SD, USA.,InGeneron, Inc., Houston, TX, USA.,Isar Klinikum, Munich, Germany
| | - Mark Lundeen
- Sanford Orthopedics & Sports Medicine Fargo, Fargo, ND, USA
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16
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Relationship between calcific tendinopathy and rotator cuff tear on shoulder magnetic resonance imaging: case-controlled comparison. Pol J Radiol 2020; 85:e8-e13. [PMID: 32180848 PMCID: PMC7064010 DOI: 10.5114/pjr.2020.92709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/02/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose To determine the frequency of rotator cuff tear on the shoulder magnetic resonance imaging (MRI) of patients with rotator cuff calcific tendinopathy and the relationship between rotator cuff tear and calcific tendinopathy. Material and methods In this retrospective case control study, 137 patients with calcific tendinopathy and 137 control group patients without calcific tendinopathy with shoulder pain, whose age, sex, and shoulder laterality values were matched, were compared in terms of rotator cuff tears on their shoulder MRI images. Results The frequency of rotator cuff tear was found to be significantly higher in the control group (37.2%) compared to the calcific tendinopathy group (23.4%) (p < 0.01). Partial thickness was 81.3% in the calcific tendinopathy group and 70.6% in the control group, and no significant difference was observed between the two groups in terms of the size of the rotator cuff tear (p > 0.05). In the calcific tendinopathy group, there was no significant relationship between the localisation of calcification and the rotator cuff tear, and only in 4.4% of the participants were calcification and tear at the same location on the same tendon (p > 0.05, r = 0.04). Conclusions The patients with calcific tendinopathy, who had been admitted with shoulder pain, did not demonstrate an increased risk of rotator cuff tear based on their MRI compared to patients with shoulder pain without calcific tendinopathy. No significant relationship was determined between calcific tendinopathy and rotator cuff tear.
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17
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Roldán-Jiménez C, Cuadros-Romero M, Bennett P, McPhail S, Kerr GK, Cuesta-Vargas AI, Martin-Martin J. Assessment of abduction motion in patients with rotator cuff tears: an analysis based on inertial sensors. BMC Musculoskelet Disord 2019; 20:597. [PMID: 31830985 PMCID: PMC6909443 DOI: 10.1186/s12891-019-2987-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 12/03/2019] [Indexed: 01/10/2023] Open
Abstract
Background Reduced range of motion in the shoulder can be a source of functional limitation. The use of inertial sensors to quantify movement in addition to more common clinical assessments of the shoulder may allow clinicians to understand that they are potentially unnoticed by visual identification. The aim of this study was to generate an explanatory model for shoulder abduction based on data from inertial sensors. Method A cross-sectional study was carried out to generate an explanatory model of shoulder abduction based on data from inertial sensors. Shoulder abduction of thirteen older adults suffering from shoulder dysfunction was recorded with two inertial sensors placed on the humerus and scapula. Movement variables (maximum angular mobility, angular peak of velocity, peak of acceleration) were used to explain the functionality of the upper limb assessed using the Upper Limb Functional Index (ULFI). The abduction movement of the shoulder was explained by six variables related to the mobility of the shoulder joint complex. A multivariate analysis of variance (MANOVA) was used to explain the results obtained on the functionality of the upper limb. Results The MANOVA model based on angular mobility explained 69% of the variance of the ULFI value (r-squared = 0.69). The most relevant variables were the abduction-adduction of the humerus and the medial/lateral rotation of the scapula. Conclusions The method used in the present study reveals the potential importance of the analysis of the scapular and humeral movements for comprehensive evaluation of the upper limb. Further research should include a wider sample and may seek to use this assessment technique in a range of potential clinical applications.
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Affiliation(s)
- Cristina Roldán-Jiménez
- Department of Psychiatry and Physiotherapy, University of Malaga, Faculty of Health Sciences, Arquitecto Francisco Peñalosa 3, Campus de Teatinos, 29071, Málaga, Spain.,Clinimetric Group F-14 Biomedical Research Institute of Malaga, (IBIMA), Málaga, Spain
| | - Miguel Cuadros-Romero
- Unit of Upper Limb Orthopedic Surgery of Hospital at University of Malaga, Málaga, Spain
| | - Paul Bennett
- Institute of Health & Biomedical Innovation, Faculty of Health, Queensland University Technology, Brisbane, Australia
| | - Steven McPhail
- Institute of Health & Biomedical Innovation, Faculty of Health, Queensland University Technology, Brisbane, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Graham K Kerr
- Institute of Health & Biomedical Innovation, Faculty of Health, Queensland University Technology, Brisbane, Australia
| | - Antonio I Cuesta-Vargas
- Department of Psychiatry and Physiotherapy, University of Malaga, Faculty of Health Sciences, Arquitecto Francisco Peñalosa 3, Campus de Teatinos, 29071, Málaga, Spain. .,Clinimetric Group F-14 Biomedical Research Institute of Malaga, (IBIMA), Málaga, Spain. .,Institute of Health & Biomedical Innovation, Faculty of Health, Queensland University Technology, Brisbane, Australia.
| | - Jaime Martin-Martin
- Clinimetric Group F-14 Biomedical Research Institute of Malaga, (IBIMA), Málaga, Spain.,Department of Human Anatomy, Legal Medicine and History of Science. Legal Medicine Area, University of Malaga, Faculty of Medicine, Malaga, Spain
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18
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Kim SJ, Yeo SM, Noh SJ, Ha CW, Lee BC, Lee HS, Kim SJ. Effect of platelet-rich plasma on the degenerative rotator cuff tendinopathy according to the compositions. J Orthop Surg Res 2019; 14:408. [PMID: 31791360 PMCID: PMC6889570 DOI: 10.1186/s13018-019-1406-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022] Open
Abstract
Background There are controversies about platelet-rich plasma (PRP) as an established treatment option for rotator cuff (RC) tendinopathy. The purpose of the study was to find the relation of cellular component with clinical efficacy in RC tendinopathy and to find the composition of PRP in treating RC tendinopathy. Methods A total 30 patients were recruited and divided into PRP and control groups. In the PRP group, 2 ml of PRP solution was injected to the hypoechoic lesion of degenerative supraspinatus via 22-gauge syringe with peppering technique. Patients in the control group were taught rotator cuff strengthening exercises. American Shoulder and Elbow Surgeons (ASES), Constant-Murley score, and numeric rating scale (NRS) were measured before, 6 weeks after, 12 weeks after, and 24 weeks after the procedure. PRP compositions were analyzed using the 1 ml of PRP solution. Results Linear regression analysis showed no significant difference of ASES and Constant-Murley scores between the groups at 6 weeks (P = 0.582 and 0.258) and at 12 weeks (P = 0.969 and 0.795) but showed a significant difference at 24 weeks (P = 0.050 and 0.048). Independent t test showed significant group difference of NRS at 6 weeks (P = 0.031) but not at 12 and 24 weeks (P = 0.147 and 0.935). 5.19 pg/ml in IL-1β and 61.79 μg/ml in TGF-β1 were acquired as cutoff values to predict meaningful improvement. The PRP subgroup above IL-1β or TGF-β1 cutoff value showed significant differences in all clinical outcomes compared with the exercise group while the PRP subgroup below the cutoff value showed no significant differences in linear regression analysis. Conclusions Our study can help to find the optimal PRP condition and to enhance the effect of PRP on RC tendinopathy. Trial registration All the patients were registered in our Institutional Ethics Committee (approval number 2014-05-009).
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Affiliation(s)
- Sang Jun Kim
- Seoul Jun Rehabilitation Research Center, Seoul Jun Rehabilitation Medical Center, Nambusoonhwanro, 2606, Seoul, 06737, South Korea.
| | - Seung Mi Yeo
- Department of Physical and Rehabilitation Medicine, Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Soo Jin Noh
- Department of Physical and Rehabilitation Medicine, Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Chul-Won Ha
- Department of Orthopaedic Surgery, Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Byung Chan Lee
- Department of Physical and Rehabilitation Medicine, Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Hyo Sun Lee
- Department of Physical and Rehabilitation Medicine, Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Sun Jeong Kim
- Department of Physical and Rehabilitation Medicine, Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
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19
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Gniesmer S, Brehm R, Hoffmann A, de Cassan D, Menzel H, Hoheisel AL, Glasmacher B, Willbold E, Reifenrath J, Wellmann M, Ludwig N, Tavassol F, Zimmerer R, Gellrich NC, Kampmann A. In vivo analysis of vascularization and biocompatibility of electrospun polycaprolactone fibre mats in the rat femur chamber. J Tissue Eng Regen Med 2019; 13:1190-1202. [PMID: 31025510 PMCID: PMC6771623 DOI: 10.1002/term.2868] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022]
Abstract
In orthopaedic medicine, connective tissues are often affected by traumatic or degenerative injuries, and surgical intervention is required. Rotator cuff tears are a common cause of shoulder pain and disability among adults. The development of graft materials for bridging the gap between tendon and bone after chronic rotator cuff tears is essentially required. The limiting factor for the clinical success of a tissue engineering construct is a fast and complete vascularization of the construct. Otherwise, immigrating cells are not able to survive for a longer period of time, resulting in the failure of the graft material. The femur chamber allows the observation of microhaemodynamic parameters inside implants located in close vicinity to the femur in repeated measurements in vivo. We compared a porous polymer patch (a commercially available porous polyurethane‐based scaffold from Biomerix™) with electrospun polycaprolactone (PCL) fibre mats and chitosan (CS)‐graft‐PCL modified electrospun PCL (CS‐g‐PCL) fibre mats in vivo. By means of intravital fluorescence microscopy, microhaemodynamic parameters were analysed repetitively over 20 days at intervals of 3 to 4 days. CS‐g‐PCL modified fibre mats showed a significantly increased vascularization at Day 10 compared with Day 6 and at Day 14 compared with the porous polymer patch and the unmodified PCL fibre mats at the same day. These results could be verified by histology. In conclusion, a clear improvement in terms of vascularization and biocompatibility is achieved by graft‐copolymer modification compared with the unmodified material.
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Affiliation(s)
- Sarah Gniesmer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.,NIFE-Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
| | - Ralph Brehm
- Institute for Anatomy, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Andrea Hoffmann
- NIFE-Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany.,Department of Orthopedic Surgery, Laboratory for Biomechanics and Biomaterials, Graded Implants and Regenerative Strategies, Hannover Medical School, Hannover, Germany
| | - Dominik de Cassan
- Institute for Technical Chemistry, University of Technology, Braunschweig, Germany
| | - Henning Menzel
- Institute for Technical Chemistry, University of Technology, Braunschweig, Germany
| | - Anna-Lena Hoheisel
- NIFE-Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany.,Institute for Multiphase Processes, Leibniz University of Hannover, Hannover, Germany
| | - Birgit Glasmacher
- NIFE-Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany.,Institute for Multiphase Processes, Leibniz University of Hannover, Hannover, Germany
| | - Elmar Willbold
- NIFE-Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany.,Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Janin Reifenrath
- NIFE-Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany.,Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Mathias Wellmann
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Nils Ludwig
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Frank Tavassol
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Ruediger Zimmerer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Andreas Kampmann
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.,NIFE-Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
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20
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Huang SW, Lin CL, Lin LF, Huang CC, Liou TH, Lin HW. Autoimmune Connective Tissue Diseases and the Risk of Rotator Cuff Repair Surgery: A Population-Based Retrospective Cohort Study. BMJ Open 2019; 9:e023848. [PMID: 30808669 PMCID: PMC6398915 DOI: 10.1136/bmjopen-2018-023848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Autoimmune connective tissue diseases (ACTDs) commonly involve the shoulder joint; however, clinical epidemiological studies investigating their association with tendons are scant. Rotator cuff (RC) tears can cause shoulder disability, and surgical intervention is usually required. The study investigated RC repair surgery risk in ACTD patients. The effect of anti-inflammatory medication on RC repair surgery risk was also investigated. METHODS We conducted a retrospective cohort study with a 7-year longitudinal follow-up period. Patients with systemic lupus erythematosus, systemic sclerosis, sicca syndrome, dermatomyositis and polymyositis diagnoses between 2004 and 2008 were enrolled. The control cohort comprised age- and sex-matched controls. The HR and adjusted HR (aHR) were estimated for the risk of RC surgery between ACTD and control cohorts after adjustment for confounders. Furthermore, the effects of steroid and non-steroidal anti-inflammatory drug (NSAID) use on the HR and aHR of RC surgery risk were analysed. RESULTS We enrolled 5019 ACTD patients and 25 095 controls in the ACTD and control cohorts, respectively. RC surgery incidence was 49 and 24 per 100 000 person-years in the ACTD and control cohorts, respectively. In the ACTD cohort, the crude HR for RC surgery was 2.08 (95% CI , 1.08 to 4.02, p<0.05), and the aHR was 1.97 (95% CI, 1.01 to 3.82, p<0.05). The ACTD patients who used NSAIDs had an aHR of 3.13 (95% CI, 1.21 to 8.07, p<0.05) compared with the controls, but the ACTD patients who used steroids did not have a significantly higher aHR than the controls. CONCLUSIONS ACTD patients had an increased risk of RC repair surgery. However, no difference was found in RC surgery risk when steroids were used compared with the control cohort. This could indicate that inflammation control may be a strategy for managing subsequent RC lesions.
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Affiliation(s)
- Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Che-Li Lin
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Institute of Gerontology and Health Management, Taipei Medical University, Taipei, Taiwan
| | - Chi-Chang Huang
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Patients with Rheumatoid Arthritis Were Associated with a Risk of Rotator Cuff Diseases. J Clin Med 2019; 8:jcm8020129. [PMID: 30678235 PMCID: PMC6406446 DOI: 10.3390/jcm8020129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 11/17/2022] Open
Abstract
Rheumatoid arthritis (RA) commonly causes inflammation in the joints and periarticular structures. The association between RA and rotator cuff (RC) has been reported; however, epidemiological studies on RA and RC tendons are scant. Therefore, we investigated RC disease (RCD) risk and analyzed the effects of RA medication, steroids, and methotrexate, on the risk of RCD for patients with RA. We conducted a retrospective cohort study with a 6-year longitudinal follow-up in Taiwan. Patients who received RA diagnoses between 2004 and 2008 were enrolled in the study cohort. The non-RA control cohort comprised age- and sex-matched controls. Propensity score matching was used for other comorbidities and treatments. The hazard ratios (HRs) and adjusted HRs (aHRs) were estimated after confounders were adjusted for. Effects of steroid and methotrexate use on RCD risk were also analyzed. We enrolled 4521 RA patients (study cohort) and 22,605 matched controls. RCD incidence was 145 and 91 per 100,000 person-years in the RA and control cohorts, respectively. In the RA cohort, the crude HR for RCD was 1.62 (95% confidence interval (CI), 1.41–1.86, p < 0.001), and the aHR was 1.56 (95% CI, 1.36–1.79, p < 0.001). The methotrexate nonusers exhibited an aHR (vs. controls) of 1.61 (95% CI, 1.40–1.85, p < 0.001), but the methotrexate users did not have a significantly higher aHR than the controls. The steroid nonusers had an aHR (vs. controls) of 1.69 (95% CI, 1.46–1.96, p < 0.001), but the aHR of the steroid users was not significantly higher than the control aHR. Patients with RA had a higher risk for RCD compared with the non-RA control cohort. Steroids or methotrexate use significantly reduces the risk of RCD occurrence in patients with RA. Treatment for RCD symptoms and controlling inflammatory process are important to ensure high-quality care for patients with RA.
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Pepe M, Kocadal O, Gunes Z, Calisal E, Aksahin E, Aktekin CN. Subacromial space volume in patients with rotator cuff tear: The effect of surgical repair. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:419-422. [PMID: 30268741 PMCID: PMC6318497 DOI: 10.1016/j.aott.2018.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/12/2018] [Accepted: 08/29/2018] [Indexed: 11/28/2022]
Abstract
Objective The aim of this study was to evaluate the effect of the rotator cuff tear repair on subacromial space volume. Methods We retrospectively identified 21 eligible patients (5 males and 16 females; mean age: 56.4 (range; 46–71) years) who had shoulder arthroscopy for unilateral full-thickness small to medium rotator cuff tear and normal controlateral shoulder joint. The mean follow-up time was 16.1 (range; 12–25) months. Preoperative and postoperative 1 year bilateral shoulder MRIs and Constant scores were reviewed. Subacromial volume was calculated by using Osirix software. Pre-, postoperative and healthy side (contralateral control group) subacromial volumes were recorded. Paired sample and t-tests were used to compare the pre- and postoperative groups. Independent sample t-tests were used to compare the healthy and pre- and postoperative groups. The correlation between the changes in the subacromial volume and the shoulder Constant score were analyzed using Pearson correlation analyses. Results The mean subacromial volume of the preoperative group was 2.95 cm3 (range; 1.53–4.23) and the postoperative group was 3.59 cm3 (range; 2.12–4.84). The volume increase was statistically significant (p < 0.05). The mean subacromial volume of the control group was 3.93 cm3 (range; 2.77–5.03), and the difference between the preoperative group and the control group was statistically significant. There was no significant difference found between the postoperative group and the control group (p = 0.156). There was no significant correlation found between the volume and the constant score changes (r = 0.170, p = 0.515). Conclusion The subacromial space volume significantly decreases in full-thickness rotator cuff tears smaller than 3 cm and the surgical repair increases the subacromial volume significantly. Level of evidence Level IV; Diagnostic Study.
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Affiliation(s)
- Murad Pepe
- Department of Orthopaedics and Traumatology, University of Amasya, Amasya, Turkey.
| | - Onur Kocadal
- Department of Orthopaedics and Traumatology, University of Yeditepe, Istanbul, Turkey
| | - Zafer Gunes
- Department of Orthopaedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Emre Calisal
- Department of Orthopaedics and Traumatology, University of Amasya, Amasya, Turkey
| | - Ertugrul Aksahin
- Orthopaedics and Traumatology, Medical Park Hospital, Ankara, Turkey
| | - Cem Nuri Aktekin
- Department of Orthopaedics and Traumatology, Ankara Yildirim Beyazit University, Ankara, Turkey
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Lai J, Gagnier JJ. The Effect of Lipid Disorders on the Risk of Rotator Cuff Disease: A Systematic Review and Meta-Analysis. JB JS Open Access 2018; 3:e0018. [PMID: 30533592 PMCID: PMC6242326 DOI: 10.2106/jbjs.oa.18.00018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Rotator cuff disease has a high prevalence and is associated with shoulder pain and disability. Dyslipidemia might be an intrinsic factor related to the development of the disease as it might increase tendon stiffness and result in tendon problems. The purposes of the present study were (1) to systematically review the association between lipid disorders and the risk of rotator cuff disease and (2) to provide physicians with guidance to prevent rotator cuff disease. Methods Six databases were searched through July 6, 2016: MEDLINE, Embase, CINAHL, Web of Science, SPORTDiscus, and the Cochrane Central Register of Controlled Trials. Eligible studies were assessed for risk of bias and strength of evidence. Meta-analysis was performed for the effect of dyslipidemia on the presence of rotator cuff disease, with the effect being expressed as an odds ratio. The overall effect was estimated, and heterogeneity across studies was expressed with the I2 statistic. We used standard and contour-enhanced funnel plots as well as the Begg and Egger tests to check for publication bias. Results Three cross-sectional studies, 1 cohort study, and 3 case-control studies involving 505,852 participants were selected, with 6 of these studies being eligible for meta-analysis. The main-effect meta-analysis yielded a pooled odds ratio of 2.17 (95% confidence interval, 1.46 to 3.23; p < 0.001; I2 = 82.4%), indicating a higher rate of rotator cuff disease in patients with dyslipidemia. The sensitivity analysis was not different from the main-effect analysis. Contour-enhanced funnel plots revealed the possibility of publication bias or other small-study effects. Conclusions We found that dyslipidemia was associated with high occurrence of rotator cuff disease. We recommend that physicians examine tendon conditions if their patients have severe dyslipidemia. Level of Evidence Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jianyu Lai
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Park HB, Gwark JY, Im JH, Jung J, Na JB, Yoon CH. Factors Associated with Atraumatic Posterosuperior Rotator Cuff Tears. J Bone Joint Surg Am 2018; 100:1397-1405. [PMID: 30106821 PMCID: PMC6133217 DOI: 10.2106/jbjs.16.01592] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Certain metabolic factors have been proposed as risk factors for a posterosuperior rotator cuff tear. Although metabolic syndrome is of increasing concern in industrialized societies, little information exists regarding its association with posterosuperior rotator cuff tears. The purpose of this study was to determine the risk factors for an atraumatic posterosuperior rotator cuff tear, including metabolic factors and metabolic syndrome. METHODS This study involved 634 subjects (634 shoulders) drawn from a cohort of rural residents. Posterosuperior rotator cuff tear diagnoses were based on magnetic resonance imaging (MRI) findings. Logistic regression analysis was used to determine the odds ratios (ORs) and 95% confidence intervals (CIs) for various demographic, physical, and social factors, including age, sex, dominant-side involvement, body mass index (BMI), and participation in manual labor; the comorbidities of diabetes, hypertension, dyslipidemia, thyroid dysfunction, ipsilateral carpal tunnel syndrome, and metabolic syndrome; and the serum metabolic parameters of serum lipid profile, glycosylated hemoglobin A1c, and level of thyroid hormone. Two multivariable analyses were performed: the first excluded metabolic syndrome while including diabetes, hypertension, BMI, and hypo-high-density lipoproteinemia (hypo-HDLemia), and the second included metabolic syndrome while excluding the formerly included variables. RESULTS Age, BMI, waist circumference, dominant-side involvement, manual labor, diabetes, hypertension, metabolic syndrome, ipsilateral carpel tunnel syndrome, HDL (high-density lipoprotein), and hypo-HDLemia were significantly associated with posterosuperior rotator cuff tears in univariate analyses (p ≤ 0.035). In the first multivariable analysis, age (OR. 1.86 [95% CI, 1.47 to 2.35]), BMI (OR, 1.09 [95% CI, 1.02 to 1.18]), dominant-side involvement (OR, 2.04 [95% CI, 1.38 to 3.01]), manual labor (OR, 9.48 [95% CI, 5.13 to 17.51]), diabetes (OR, 3.38 [95% CI, 1.98 to 5.77]), and hypo-HDLemia (OR, 2.07 [95% CI, 1.30 to 3.29]) were significantly associated with posterosuperior rotator cuff tears (p ≤ 0.019). In the second multivariable analysis, age (OR, 1.85 [95% CI, 1.48 to 2.31]), dominant-side involvement (OR, 1.83 [95% CI, 1.26 to 2.67]), manual labor (OR, 7.71 [95% CI, 4.33 to 13.73]), and metabolic syndrome (OR, 1.98 [95% CI, 1.35 to 2.91]) were significantly associated with posterosuperior rotator cuff tears (p ≤ 0.002). CONCLUSIONS The metabolic factors of diabetes, BMI, hypo-HDLemia, and metabolic syndrome were significant independent factors associated with the development of posterosuperior rotator cuff tears. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hyung Bin Park
- Departments of Orthopaedic Surgery (H.B.P., J.-Y.G., and J.-H.I.) and Internal Medicine (J.J.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea,E-mail address for H.B. Park:
| | - Ji-Yong Gwark
- Departments of Orthopaedic Surgery (H.B.P., J.-Y.G., and J.-H.I.) and Internal Medicine (J.J.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jin-Hyung Im
- Departments of Orthopaedic Surgery (H.B.P., J.-Y.G., and J.-H.I.) and Internal Medicine (J.J.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jaehoon Jung
- Departments of Orthopaedic Surgery (H.B.P., J.-Y.G., and J.-H.I.) and Internal Medicine (J.J.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae-Boem Na
- Departments of Radiology (J.-B.N.) and Rehabilitation Medicine (C.H.Y.), Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Chul Ho Yoon
- Departments of Radiology (J.-B.N.) and Rehabilitation Medicine (C.H.Y.), Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
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25
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Jeanfavre M, Husted S, Leff G. EXERCISE THERAPY IN THE NON-OPERATIVE TREATMENT OF FULL-THICKNESS ROTATOR CUFF TEARS: A SYSTEMATIC REVIEW. Int J Sports Phys Ther 2018; 13:335-378. [PMID: 30038823 PMCID: PMC6044593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Although commonly prescribed, the evidence to support exercises therapy (ET) and conservative management for the treatment of full-thickness rotator cuff tears (FTT) is equivocal. PURPOSE The purpose of this systematic review of the literature was to determine the current level of evidence available for ET in the treatment of FTT and to provide a formal Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group of recommendation. METHODS Five databases were systematically searched to evaluate the effectiveness of ET for FTT. Inclusion criteria: experimental or observational studies of adults clinically diagnosed with FTT, or massive, or inoperable tears that contained a treatment group that received ET for FTT. Exclusion criteria included: history of surgical repair, concurrent significant trauma, neurological impairment, and level V studies. Articles were assessed for quality, the level of evidence (I - V) and GRADE of recommendation (A to F) was determined. Data extraction included: demographics, specific interventions, and outcomes. RESULTS One thousand, five-hundred and sixty-nine unique citations were identified, 35 studies were included: nine randomized controlled studies, six cohort studies, 15 case series and five case reports. There were 2010 shoulders in 1913 subjects with an average age of 64.2 years, 54% males, 73% of tears were > 1 cm and 37% were classified as massive. Based on studies that reported, >58% of tears were > 1 year and 73% were atraumatic. Of the non-operatively treated cohorts that reported the respective outcomes: 78% improved in pain (9/10 cohorts that reported statistically significant differences [stat-sig] p<0.05), 81% improved in ROM (14/14 cohorts that reported, met stat-sig), 85% improved in strength (7/8 cohorts that reported, met stat-sig), 84% improved in functional outcomes (17/17 cohorts that reported, met stat-sig). Dissatisfied outcomes occurred in 15% of patients, who then transitioned to surgery. CONCLUSION The current literature indicates GRADE B recommendation (moderate strength) to support the use of ET in the management of FTT. There is further need for well-designed randomized controlled trials. LEVEL OF EVIDENCE 2a.
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Affiliation(s)
| | - Sean Husted
- Advanced Physical Therapy, Thousand Oaks, CA, USA
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26
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Fouda MB, Thankam FG, Dilisio MF, Agrawal DK. Alterations in tendon microenvironment in response to mechanical load: potential molecular targets for treatment strategies. Am J Transl Res 2017; 9:4341-4360. [PMID: 29118899 PMCID: PMC5666046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
Rotator cuff (RC) tendons could beinflicted in many ways with an eventual outcome of pain, weakness and disability, which represent a large burden on health care cost. However, optimal healing, either conservatively or with surgical intervention, remains an issue that needs further investigation. Disorders of the RC tendons may result from external factors like trauma, or internal factors through physiologic and metabolic derangement. Most RC tendon disorders may be asymptomatic and may result from an over-activity of the inflicted shoulder and its tendons. Such tendon disorders are poorly diagnosed since patients do not seek medical attention until pain or weakness ensue. Immunological and biochemical events in RC disorders due to mechanical intolerance have not been investigated. Generally, the mechanical load drives normal physiological properties of the tendon. But, mechanical overload/burden exerts stress on tenocytes, and disrupts the tendon microenvironment by triggering a multitude of signaling pathways leading to extracellular matrix remodeling, disorganization, alteration in collagen composition and apoptosis. These events result in weak tendon which is highly susceptible to rupture or tear. In this article, we critically reviewed the intrinsic signaling pathways that are excessively triggered by continuous mechanical load and the counteracting physiological responses and associated derangements. The elucidation of the molecular events underlying mechanical stress-induced symptomatic/asymptomatic tendinopathy could provide information on potential target sites for translational application in the management of rotator cuff disorders.
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Affiliation(s)
- Mohamed B Fouda
- Department of Clinical & Translational Science, Creighton University School of MedicineOmaha 68178, NE, USA
| | - Finosh G Thankam
- Department of Clinical & Translational Science, Creighton University School of MedicineOmaha 68178, NE, USA
| | - Matthew F Dilisio
- Department of Clinical & Translational Science, Creighton University School of MedicineOmaha 68178, NE, USA
- Department of Orthopedic Surgery, Creighton University School of MedicineOmaha 68178, NE, USA
| | - Devendra K Agrawal
- Department of Clinical & Translational Science, Creighton University School of MedicineOmaha 68178, NE, USA
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Gallorini M, Berardi AC, Berardocco M, Gissi C, Maffulli N, Cataldi A, Oliva F. Hyaluronic acid increases tendon derived cell viability and proliferation in vitro: comparative study of two different hyaluronic acid preparations by molecular weight. Muscles Ligaments Tendons J 2017; 7:208-214. [PMID: 29264330 DOI: 10.11138/mltj/2017.7.2.208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Hyaluronic Acid (HA) has been already approved by Food and Drug Administration (FDA) for osteoarthritis (OA), while its use in the treatment of tendinopathy is still debated. The aim of this study was to evaluate the effects of two different HA on human rotator cuff tendon derived cells in terms of cell viability, proliferation and apoptosis. Methods An in vitro model was developed on human tendon derived cells from rotator cuff tears to study the effects of two different HA preparations: Sinovial HL® (High-Low molecular weight) (MW: 80-100 kDa) and KDa Sinovial Forte SF (MW: 800-1200), at various concentrations. Tendon derived cells morphology was evaluated after 0, 7 and 14 d of culture. Viability and proliferation were analyzed after 0, 24, and 48 h of culture and apoptosis occurrence was assessed after 24 h of culture. Results All the HAPs tested here increased viability and proliferation, in a dose-dependent manner and they reduced apoptosis at early stages (24 h) compared to control cells (without HAPs). Conclusions HAPs enhanced viability and proliferation and counteracted apoptosis in tendon derived cells.
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Affiliation(s)
| | - Anna C Berardi
- UOC of Immunohaematology and Transfusion Medicine, Laboratory of Stem Cells, Spirito Santo Hospital, Pescara, Italy
| | - Martina Berardocco
- UOC of Immunohaematology and Transfusion Medicine, Laboratory of Stem Cells, Spirito Santo Hospital, Pescara, Italy
| | - Clarissa Gissi
- UOC of Immunohaematology and Transfusion Medicine, Laboratory of Stem Cells, Spirito Santo Hospital, Pescara, Italy
| | - Nicola Maffulli
- Head of Department of Orthopaedics and Traumatology, Azienda Ospedaliera San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
| | - Amelia Cataldi
- Department of Pharmacy, University G. d'Annunzio, Chieti, Italy
| | - Francesco Oliva
- Department of Orthopedics and Traumatology, University of Rome "Tor Vergata" School of Medicine, Rome, Italy
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Giardella A, Ascione F, Mocchi M, Berlusconi M, Romano AM, Oliva F, Maradei L. Reverse total shoulder versus angular stable plate treatment for proximal humeral fractures in over 65 years old patients. Muscles Ligaments Tendons J 2017; 7:271-278. [PMID: 29264338 DOI: 10.11138/mltj/2017.7.2.271] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Treatment for displaced proximal humeral fractures is still under debate. Poor rotator cuff status and non-union of the tubercles in elderly patients has caused reversed total shoulder prosthesis growing popularity and showed promising results, even in comparison to angular stable plates fixation.The purpose of this study is to report clinical and radiological results of proximal humerus fractures treated with rTSA or ORIF in elderly. Materials and methods The study has investigated retrospectively a consecutive series of 73 patients over 65 years old (range 65-91) with proximal humeral three- and four- parts fractures, operated from January 2009 to June 2014 with a reversed total shoulder prosthetic replacement or open reduction and internal fixation using an angular stable plate, with at least 1 year follow-up. Participants are admitted in our hospital with a displaced proximal humeral fracture according to AO-OTA type 11-B2 or 11-C2.The primary outcomes are active ROM and shoulder function (Constant score). Secondary outcomes have been patient self-assessment form (Simple shoulder test) and radiographical details. Follow-up takes place at the moment of clinical observation with rx control. Results We analyzed a group of 23 patients treated by plate and screws and 21 patients treated by rTSA with these average results. ORIF: Flexion 112.8°, Abduction 99.6°, External rotation at 90° 47.4°, modal Internal rotation hand at Sacroiliac joint, Constant Score 52.9 and Simple Shoulder Test 8.0. RSA: Flexion 133.3°, Abduction 101.4°, External rotation at 90° of abduction 35.5°, modal Internal rotation hand at waist (L3), Constant Score 65.9 and Simple Shoulder Test 9.2. No nerve injuries were reported. No cases of pseudoarthrosis or plate fractures. No arthroplasty implant loosening, infection or dislocation was documented and revision required. Conclusion Our study shows good clinical outcomes and fewer complications in both treatment options. Better clinical and daily living results are reported in RSA compared with ORIF, confirming that rTSA is one of the best treatment in proximal humeral fractures in the elderly patients, which rotator cuff status frequently is poor and degenerating. The few radiological complications do not seem to have influence on active ROM and Constant Score, both the first and the second group of patients. Level of evidence Level IV, Case Series, Surgical.
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Affiliation(s)
- Antonio Giardella
- Unità Operativa di Chirurgia Mini-Invasiva, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Francesco Ascione
- Unità Operativa di Chirurgia Mini-Invasiva, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Mattia Mocchi
- Unìtà Operativa di Traumatologia II, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Marco Berlusconi
- Unìtà Operativa di Traumatologia II, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Alfonso Maria Romano
- Unità Operativa di Chirurgia Mini-Invasiva, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Leonardo Maradei
- Unità Operativa di Chirurgia Mini-Invasiva, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
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Jo CH, Shin WH, Park JW, Shin JS, Kim JE. Degree of tendon degeneration and stage of rotator cuff disease. Knee Surg Sports Traumatol Arthrosc 2017; 25:2100-2108. [PMID: 27896393 DOI: 10.1007/s00167-016-4376-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 11/07/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE While tendon degeneration has been known to be an important cause of rotator cuff disease, few studies have objectively proven the association of tendon degeneration and rotator cuff disease. The purpose of this study was to investigate changes of tendon degeneration with respect to the stage of rotator cuff disease. METHODS A total of 48 patients were included in the study: 12 with tendinopathy, 12 with a partial-thickness tear (pRCT), 12 with a full-thickness tear (fRCT), and 12 as the control. A full-thickness supraspinatus tendon sample was harvested en bloc from the middle portion between the lateral edge and the musculotendinous junction of the tendon using a biopsy punch with a diameter of 3 mm. Harvested samples were evaluated using a semi-quantitative grading scale with 7 parameters after haematoxylin and eosin staining. RESULTS There was no significant difference in age, gender, symptom duration, and Kellgren-Lawrence grade between the groups except for the global fatty degeneration index. All of the seven parameters were significantly different between the groups and could be categorized as follows: early responders (fibre structure and arrangement), gradual responder (rounding of the nuclei), after-tear responders (cellularity, vascularity, and stainability), and late responder (hyalinization). The total degeneration scores were not significantly different between the control (6.08 ± 1.16) and tendinopathy (6.67 ± 1.83) (n.s.). However, the score of pRCT group (10.42 ± 1.31) was greater than that of tendinopathy (P < 0.001), and so was the score of fRCT (12.33 ± 1.15) than that of pRCT (p = 0.009). CONCLUSION This study showed that the degeneration of supraspinatus tendon increases as the stage of rotator cuff disease progresses from tendinopathy to pRCT, and then to fRCT. The degree of degeneration of tendinopathy was not different from that of normal but aged tendons, and significant tendon degeneration began from the stage of pRCT. The clinical relevance of the study is that strategies and goals of the treatment for rotator cuff disease should be specific to its stage, in order to prevent disease progression for tendinopathy and pRCT, as well to restore the structural integrity for fRCT. LEVEL OF EVIDENCE Diagnostic, Level I.
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Affiliation(s)
- Chris Hyunchul Jo
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-Gu, Seoul, 07061, Korea.
| | - Won Hyoung Shin
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-Gu, Seoul, 07061, Korea
| | - Ji Wan Park
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-Gu, Seoul, 07061, Korea
| | - Ji Sun Shin
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-Gu, Seoul, 07061, Korea
| | - Ji Eun Kim
- Department of Pathology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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30
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Martini LI, Via AG, Fossati C, Randelli F, Randelli P, Cucchi D. Single Platelet-Rich Plasma Injection for Early Stage of Osteoarthritis of the Knee. JOINTS 2017; 5:2-6. [PMID: 29114622 PMCID: PMC5672849 DOI: 10.1055/s-0037-1601405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose
The purpose of this study was to determine the safety efficacy and outcomes of platelet-rich plasma (PRP) intra-articular injections for early stages of knee osteoarthritis (OA).
Methods
Twenty-five patients affected by grade I and II knee primary OA according to the Kellgren–Lawrence scale received a single intra-articular PRP injection. Patients were prospectively evaluated for 6 months. Visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee injury and Osteoarthritis Outcome Score (KOOS) scoring scales were used to evaluate clinical outcomes. Wilcoxon signed rank test was used to evaluate significance of improvement of WOMAC, KOOS, and VAS scores.
Results
Twenty-one patients completed 6-months follow-up. The median WOMAC score improved from 29.1 points (range: 17.4–60.4; standard deviation [SD] = 13.0) at baseline to 42.41 (range: 24.3–71.2; SD = 12.5) at final follow-up. Improvements in median KOOS and VAS score have been also found, from 37.49 points and 64.2 mm before injection to 59.71 points and 42.8 mm, respectively. All these improvements were statistically significant (
p
< 0.05). No adverse reactions have been observed.
Conclusion
Treating knee OA with PRP injection is safe. A single dose of PRP seems to be effective in managing pain and improving quality of life in patients with low-grade knee OA.
Level of Evidence
Level IV, therapeutic case series.
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31
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Giotis D, Aryaei A, Vasilakakos T, Paschos NK. Effectiveness of Biologic Factors in Shoulder Disorders. Open Orthop J 2017; 11:163-182. [PMID: 28400884 PMCID: PMC5366381 DOI: 10.2174/1874325001711010163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 12/17/2022] Open
Abstract
Background: Shoulder pathology can cause significant pain, discomfort, and loss of function that all interfere with activities of daily living and may lead to poor quality of life. Primary osteoarthritis and rotator cuff diseases with its sequalae are the main culprits. Management of shoulder disorders using biological factors gained an increasing interest over the last years. This interest reveals the need of effective treatments for shoulder degenerative disorders, and highlights the importance of a comprehensive and detailed understanding of the rapidly increasing knowledge in the field. Methods: This study will describe most of the available biology-based strategies that have been recently developed, focusing on their effectiveness in animal and clinical studies. Results: Data from in vitro work will also be briefly presented; in order to further elucidate newly acquired knowledge regarding mechanisms of tissue degeneration and repair that would probably drive translational work in the next decade. The role of platelet rich-plasma, growth factors, stem cells and other alternative treatments will be described in an evidence-based approach, in an attempt to provide guidelines for their clinical application. Finally, certain challenges that biologic treatments face today will be described as an initiative for future strategies. Conclusion: The application of different growth factors and mesenchymal stem cells appears as promising approaches for enhancing biologic repair. However, data from clinical studies are still limited, and future studies need to improve understanding of the repair process in cellular and molecular level and evaluate the effectiveness of biologic factors in the management of shoulder disorders.
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Affiliation(s)
- Dimitrios Giotis
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Ashkan Aryaei
- Department of Biomedical Engineering, University of California, Davis, USA
| | - Theofanis Vasilakakos
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Nikolaos K Paschos
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece; Department of Biomedical Engineering, University of California, Davis, USA
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Kim JM, Kim MW, Do HJ. Influence of Hyperlipidemia on the Treatment of Supraspinatus Tendinopathy With or Without Tear. Ann Rehabil Med 2016; 40:463-9. [PMID: 27446783 PMCID: PMC4951365 DOI: 10.5535/arm.2016.40.3.463] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 10/05/2015] [Indexed: 12/16/2022] Open
Abstract
Objective To investigate the influence of hyperlipidemia on the treatment of supraspinatus tendinopathy, with or without tear. Methods We retrospectively reviewed the data of patients with shoulder pain and patients with supraspinatus tendinopathy, with or without tear, were included in the study. Exclusion criteria were prior shoulder surgery, prior steroid injection, neurological diseases that could lead to shoulder pain, and use of lipid-lowering medication. According to the serum lipid profiles, patients were assigned to either the hyperlipidemia or non-hyperlipidemia group. By analyzing the numeric rating scale (NRS) before treatment, and at 2 weeks and 8 weeks after treatment, we compared the difference in treatment effect between the two groups. Results No significant baseline difference was found among the two groups for age, gender, body mass index, duration of pain, side of pain, range of motion of affected shoulder, or physical examination. On the repeated-measures analysis of variance, NRS scores significantly decreased with time for both groups (p<0.001). When analyzing the effect of time between the subjects factor, there was significant difference in the treatment effect between the two groups (p<0.001), namely NRS was less decreased in the hyperlipidemia group. Conclusion We found that hyperlipidemia may be an adversely affecting factor in the treatment of supraspinatus tendinopathy with or without tear.
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Affiliation(s)
- Jae-Min Kim
- Department of Rehabilitation, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Min-Wook Kim
- Department of Rehabilitation, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hyun-Jung Do
- Department of Rehabilitation, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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Abdul-Wahab TA, Betancourt JP, Hassan F, Thani SA, Choueiri H, Jain NB, Malanga GA, Murrell WD, Prasad A, Verborgt O. Initial treatment of complete rotator cuff tear and transition to surgical treatment: systematic review of the evidence. Muscles Ligaments Tendons J 2016; 6:35-47. [PMID: 27331030 DOI: 10.11138/mltj/2016.6.1.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND rotator cuff tear affects many people. Natural history, and evidence for non-operative treatment remains limited. Our objective is to assess evidence available for the efficacy and morbidity of commonly used systemic medications, physiotherapy, and injections alongside evaluating any negative long-term effects. METHODS a systematic search was performed of PubMed, Cochrane, EMBASE and CINAHL dates (1 January 1960 - 1 December 2014), search terms: 'rotator cuff tear', 'natural history', 'atraumatic', 'injection', 'physiotherapy' or 'physical therapy', 'injection', 'corticosteroid', 'PRP', 'MSC', risk of conservative treatment', and 'surgical indication'. RESULTS eleven studies were included. The mean Coleman Methodology Score modified for conservative therapy is 69.21 (range 88-44) (SD 12.31). This included 2 RCTs, 7 prospective, and 2 retrospective studies. Evidence suggests it is safe to monitor symptomatic rotator cuff tears, as tear size and symptoms are not correlated with pain, function, and/or ultimate outcome. CONCLUSIONS complete rotator cuff tears may be effectively treated with injections, exercise in the short and intermediate terms respectively. Negative effect of corticosteroids on rotator cuff tissue has not been demonstrated. Timing to end conservative treatment is unknown, but likely indicated when a patient demonstrates increased weakness and loss of function not recoverable by physiotherapy.
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Affiliation(s)
| | | | - Fadi Hassan
- Hull York Medical School, North Yorkshire, UK
| | - Saeed Al Thani
- Orthocure Medical Center, United Arab Emirates University, Dubai, United Arab Emirates
| | | | - Nitin B Jain
- Vanderbilt University School of Medicine, Nashville, USA
| | - Gerard A Malanga
- Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, USA
| | - William D Murrell
- Department of Orthopaedic Sports Medicine, Dr. Humeira Badsha Medical Center, Dubai, United Arab Emirates, and Department of Orthopaedics, Rehabilitation, and Pediatry, Ft. Belvoir Community Hospital, Ft. Belvoir, Virginia, USA
| | - Anil Prasad
- Osteopathic Health Centre, Dubai, United Arab Emirates
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Edwards P, Ebert J, Joss B, Bhabra G, Ackland T, Wang A. EXERCISE REHABILITATION IN THE NON-OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS: A REVIEW OF THE LITERATURE. Int J Sports Phys Ther 2016; 11:279-301. [PMID: 27104061 PMCID: PMC4827371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
UNLABELLED The incidence of rotator cuff tears increases with age, with full-thickness rotator cuff tears present in approximately 25% of individuals in their sixties, and more than 50% of those in their eighties. While surgery is considered an effective treatment, recurrent tears at the insertion site are common, especially with degenerative tears, which are frequent in the older population. More recently, there has been increasing interest in exercise rehabilitation and physical therapy as a means to manage partial and full thickness tears of the rotator cuff by addressing weakness and functional deficits. Recent studies have suggested that patients opting for physical therapy have demonstrated high satisfaction, an improvement in function, and success in avoiding surgery. When considering the increasing rate of shoulder surgery and the associated economic and social burden rotator cuff surgery places on both the patient and the health care system, non-surgical management such as physical therapy and exercise may, in selected cases, be a treatment alternative to surgical repair. The purpose of this clinical commentary is to provide an overview of rotator cuff pathology and pathogenesis, and to present an evidence-based case for the role of conservative rehabilitation in the management of rotator cuff injuries. LEVEL OF EVIDENCE Level 5.
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Affiliation(s)
- Peter Edwards
- School of Sport Science, Exercise and Health, the University of Western Australia, Perth, Australia
| | - Jay Ebert
- School of Sport Science, Exercise and Health, the University of Western Australia, Perth, Australia
| | - Brendan Joss
- School of Sport Science, Exercise and Health, the University of Western Australia, Perth, Australia
| | - Gev Bhabra
- St. John of God Hospital, Subiaco, Western Australia, Perth, Australia
| | - Tim Ackland
- School of Sport Science, Exercise and Health, the University of Western Australia, Perth, Australia
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Gilotra MN, Shorofsky MJ, Stein JA, Murthi AM. Healing of rotator cuff tendons using botulinum toxin A and immobilization in a rat model. BMC Musculoskelet Disord 2016; 17:127. [PMID: 26979873 PMCID: PMC4791755 DOI: 10.1186/s12891-016-0978-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/08/2016] [Indexed: 01/08/2023] Open
Abstract
Background We evaluated effects of botulinum toxin A (Botox) and cast immobilization on tendon healing in a rat model. Injection of Botox into rat supraspinatus was hypothesized to reduce muscle active force and improved healing. Methods Eighty-four supraspinatus tendons were surgically transected and repaired in 42 Sprague-Dawley rats (transosseous technique). After repair, supraspinatus muscle was injected with saline or Botox (3 or 6 U/kg). Half the shoulders were cast-immobilized for the entire postoperative period; half were allowed free cage activity. Histology was examined at 2, 4, 8, and 12 weeks. A healing zone cross-sectional area was measured, and biomechanical testing of repair strength and tendon viscoelastic properties was conducted at 4 and 12 weeks. Results Botox alone and cast immobilization alone exhibited increased ultimate load compared with controls (saline injection, no immobilization) at 4 weeks. No difference in ultimate load occurred between Botox-only and cast-only groups. At 12 weeks, the Botox (6 U/kg) plus cast immobilization group was significantly weakest (p < 0.05). A trend was shown toward decreased healing zone cross-sectional areas in casted groups. Conclusions Supraspinatus Botox injection after rotator cuff repair might help protect the repair. However, cast immobilization plus Botox administration is harmful to rotator cuff healing in a rat tendon model.
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Affiliation(s)
- Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Michael J Shorofsky
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jason A Stein
- Department of Orthopaedics and Sports Medicine, MedStar Union Memorial Hospital, Baltimore, MD, 21218, USA
| | - Anand M Murthi
- Department of Orthopaedics and Sports Medicine, MedStar Union Memorial Hospital, Baltimore, MD, 21218, USA
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Osti L, Buda M, Buono AD, Osti R, Massari L. Clinical evidence in the treatment of rotator cuff tears with hyaluronic acid. Muscles Ligaments Tendons J 2016; 5:270-5. [PMID: 26958534 DOI: 10.11138/mltj/2015.5.4.270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE the aim of this quantitative review is to document potential benefit and adverse effects of hyaluronic acid (HA) injection into the shoulder with rotator cuff tears. METHODS a systematic literature search was performed in english PubMed, Medline, Ovid, Google Scholar and Embase databases using the combined key words "hyaluronic acid", "rotator cuff tear", "hyaluronate", "shoulder", "viscosupplementation", with no limit regarding the year of publication. Articles were included if they reported data on clinical and functional outcomes, complications in series of patients who had undergone HA injection for management of rotator cuff tears. Two Authors screened the selected articles for title, abstract and full text in accordance with predefined inclusion and exclusion criteria. The papers were accurately analyzed focusing on objective rating scores reported. RESULTS a total of 11 studies, prospective, 7 were randomized were included by full text. A total of 1102 patients were evaluated clinically after different HA injection compare with corticosteroid injection, physically therapies, saline solution injection and control groups. The use of HA in patients with rotator cuff tears improve VAS and functional score in all trials that we have analyzed. CONCLUSION intra-articular injection with HA is effective in reducing pain and improving function in shoulder with rotator cuff tears and without severe adverse reaction. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Leonardo Osti
- Unit of Arthroscopy and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - Matteo Buda
- Department of Orthopaedic and Traumatology, University of Ferrara, Italy
| | - Angelo Del Buono
- Department of Orthopaedic and Trauma Surgery Hospital Sant'Anna, Como, Italy
| | - Raffaella Osti
- Department of Orthopaedic and Traumatology, University of Ferrara, Italy
| | - Leo Massari
- Department of Orthopaedic and Traumatology, University of Ferrara, Italy
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Lenz CG, Wieser K, Lajtai G, Meyer DC. Arthroscopic suture retrievers and shuttles: a biomechanical investigation of the force required for tendon penetration and defect size. BMC Musculoskelet Disord 2015; 16:357. [PMID: 26577997 PMCID: PMC4650195 DOI: 10.1186/s12891-015-0794-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 10/29/2015] [Indexed: 11/24/2022] Open
Abstract
Background To compare instruments designed for arthroscopic suture handling during arthroscopic rotator cuff repair, to assess the force needed to penetrate the tendon, and to evaluate the residual defect size. Methods Twenty-one instruments were each tested ten times on thawed sheep infraspinatus tendons. The force needed to pierce the tendon with each instrument was measured using a custom setup. Bone wax plates were used to make the perforation marks visible and to quantify the lesions each instrument created. Results The force to pierce a tendon had a range of 5.6–18.5 N/mm. Within the group of suture retrievers, the angled instruments required in average 85 % higher forces than straight instruments. The lesion area had a range of 2–7 mm2. Suture retrievers produced significantly larger lesion sizes compared with suture shuttles. Conclusion For the identical task of passing a suture through a tendon, differences exist regarding the ease of tendon penetration and potential damage to the tendon for different tools. The design, function, and resulting lesion size may be relevant and important for surgical handling and to avoid excess structural damage to the tendon. These results suggest that choosing the most appropriate tools for arthroscopic suture stitching influences the ease of handling and final integrity of the tissue. Level of evidence Mechanical evaluation of surgical devices. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0794-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher G Lenz
- Orthopaedic Department, Balgrist Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
| | - Karl Wieser
- Orthopaedic Department, Balgrist Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
| | - Georg Lajtai
- Orthopaedic Department, Private Hospital Maria Hilf, Klagenfurt, Austria.
| | - Dominik C Meyer
- Orthopaedic Department, Balgrist Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
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Osti L, Berardocco M, di Giacomo V, Di Bernardo G, Oliva F, Berardi AC. Hyaluronic acid increases tendon derived cell viability and collagen type I expression in vitro: Comparative study of four different Hyaluronic acid preparations by molecular weight. BMC Musculoskelet Disord 2015; 16:284. [PMID: 26444018 PMCID: PMC4596363 DOI: 10.1186/s12891-015-0735-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/24/2015] [Indexed: 01/25/2023] Open
Abstract
Background Hyaluronic Acid (HA) has been already approved by Food and Drug Administration (FDA) for osteoarthritis (OA), while its use in the treatment of tendinopathy is still debated. The aim of this study was to evaluate in human rotator cuff tendon derived cells the effects of four different HA on cell viability, proliferation, apoptosis and the expression of collagen type I and collagen type III. Methods An in vitro model was developed on human tendon derived cells from rotator cuff tears to study the effects of four different HA preparations (Ps) (sodium hyaluronate MW: 500-730 KDa - Hyalgan®, 1000 kDa Artrosulfur HA®, 1600 KDa Hyalubrix® and 2200 KDa Synolis-VA®) at various concentrations. Tendon derived cells morphology were evaluated after 0, 7 and 14 d of culture. Viability, proliferation, apoptosis were evaluated after 0, 24 and 48 h of culture. The expression and deposition of collagen type I and collagen type III were evaluated after 1, 7 and 14 d of culture. Results All HAPs tested increased viability and proliferation, in dose dependent manner. HAPs already reduce apoptosis at 24 h compared to control cells (without HAPs). Furthermore, HAPs stimulated the synthesis of collagen type I in a dose dependent fashion over 14 d, without increase in collagen type III; moreover, in the presence of Synolis-VA® the expression and deposition of collagen type I was significantly higher as compare with the other HAPs. Conclusions HAPs enhanced viability, proliferation and expression of collagen type I in tendon derived cells.
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Affiliation(s)
- Leonardo Osti
- Unit of Arthoscopy and Sports Trauma Surgery, Hesperia Hospital, Modena, Italy.
| | - Martina Berardocco
- U.O.C. of Immunohaematology and Transfusion Medicine, Laboratory of Stem Cells, Spirito Santo Hospital, via Fonte Romana 8, 65125, Pescara, Italy.
| | | | - Graziella Di Bernardo
- U.O.C. of Immunohaematology and Transfusion Medicine, Santo Spirito Hospital, Pescara, Italy.
| | - Francesco Oliva
- Department of Orthopedics and Traumatology, University of Rome "Tor Vergata" School of Medicine, Rome, Italy.
| | - Anna C Berardi
- U.O.C. of Immunohaematology and Transfusion Medicine, Laboratory of Stem Cells, Spirito Santo Hospital, via Fonte Romana 8, 65125, Pescara, Italy.
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Luan T, Liu X, Easley JT, Ravishankar B, Puttlitz C, Feeley BT. Muscle atrophy and fatty infiltration after an acute rotator cuff repair in a sheep model. Muscles Ligaments Tendons J 2015; 5:106-112. [PMID: 26261789 PMCID: PMC4496009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION rotator cuff tears (RCTs) are the most common tendon injury seen in orthopedic patients. Muscle atrophy and fatty infiltration of the muscle are crucial factors that dictate the outcome following rotator cuff surgery. Though less studied in humans, rotator cuff muscle fibrosis has been seen in animal models as well and may influence outcomes as well. The purpose of this study was to determine if the rotator cuff would develop muscle changes even in the setting of an acute repair in a sheep model. We hypothesized that fatty infiltration and fibrosis would be present even after an acute repair six months after initial surgery. METHODS twelve female adult sheep underwent an acute rotator cuff tear and immediate repair on the right shoulder. The left shoulder served as a control and did not undergo a tear or a repair. Six months following acute rotator cuff repairs, sheep muscles were harvested to study atrophy, fatty infiltration, and fibrosis by histological analysis, western blotting, and reverse transcription polymerase chain reaction (RT-PCR). RESULTS the repair group demonstrated an increase expression of muscle atrophy, fatty infiltration, and fibrosis related genes. Significantly increased adipocytes, muscle fatty infiltration, and collagen deposition was observed in rotator cuff muscles in the tendon repair group compared to the control group. CONCLUSIONS rotator cuff muscle undergoes degradation changes including fatty infiltration and fibrosis even after the tendons are repair immediately after rupture. LEVEL OF EVIDENCE Basic Science Study.
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Affiliation(s)
- Tammy Luan
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Xuhui Liu
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, United States
| | | | - Bharat Ravishankar
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, United States
| | | | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, United States
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Yi A, Avramis IA, Argintar EH, White ER, Villacis DC, Hatch III GFR. Subacromial volume and rotator cuff tears: Does an association exist? Indian J Orthop 2015; 49:300-3. [PMID: 26015629 PMCID: PMC4443411 DOI: 10.4103/0019-5413.156201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rotator cuff pathology occurs commonly and its cause is likely multifocal in origin. The development and progression of rotator cuff injury, especially in relation to extrinsic shoulder compression, remain unclear. Traditionally, certain acromial morphologies have been thought to contribute to rotator cuff injury by physically decreasing the subacromial space. The relationship between subacromial space volume and rotator cuff tears (RCT) has, however, never been experimentally confirmed. In this study, we retrospectively compared a control patient population to patients with partial or complete RCTs in an attempt to quantify the relationship between subacromial volume and tear type. MATERIALS AND METHODS We retrospectively identified a total of 46 eligible patients who each had shoulder magnetic resonance imaging (MRI) performed from January to December of 2008. These patients were stratified into control, partial RCT, and full-thickness RCT groups. Subacromial volume was estimated for each patient by averaging five sequential MRI measurements of subacromial cross-sectional areas. These volumes were compared between control and experimental groups using the Student's t-test. RESULTS With the numbers available, there was no statistically significant difference in subacromial volume measured between: the control group and patients diagnosed partial RCT (P > 0.339), the control group and patients with complete RCTs (P > 0.431). CONCLUSION We conclude that subacromial volumes cannot be reliably used to predict RCT type.
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Affiliation(s)
- Anthony Yi
- Department of Orthopedic Surgery, University of Southern California, Los Angeles, California, USA,Address for correspondence: Mr. Anthony Yi, 1200 N. State Street, GNH 3900, Los Angeles, CA 90033, California, USA. E-mail:
| | - Ioannis A Avramis
- Department of Orthopedic Surgery, University of Southern California, Los Angeles, California, USA
| | - Evan H Argintar
- Department of Orthopedic Surgery, University of Southern California, Los Angeles, California, USA
| | - Eric R White
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Diego C Villacis
- Department of Orthopedic Surgery, University of Southern California, Los Angeles, California, USA
| | - George F Rick Hatch III
- Department of Orthopedic Surgery, University of Southern California, Los Angeles, California, USA
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Oliva F, Osti L, Padulo J, Maffulli N. Epidemiology of the rotator cuff tears: a new incidence related to thyroid disease. Muscles Ligaments Tendons J 2014. [PMID: 25489548 DOI: 10.11138/mltj/2014.4.3.309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND in the last years the incidence of rotator cuff tears increased and one main cause still waiting to be clarified. Receptors for thyroid hormones in rotator cuff tendons suggest possible effects on tendons metabolism and status. We undertook a retrospective, observational cohort study of 441 patients who underwent arthroscopic and mini-open repair for non traumatic degenerative rotator cuff tears. METHODS all the patients, predominantly females (63%), were interview to assess the relationship (frequency for class age "20 yrs" and factor analysis) between lesions of the rotator cuff with the following variables: gender, thyroid disease, smoker, taking medications for diabetes, hypertension or high cholesterol; presence of associated conditions (diabetes, hypertension, hypercholesterolemia). RESULTS thyroid disease is highly frequently (until 63% for 60<80 yrs) in females group independent to the age. Conversely, males showed a high frequency for smoker 37<62% until 80 yrs and 50% hypercholesterolemia over 80 yrs for the clinical variable studied. CONCLUSIONS this is the first clinical report that shown a relationship between thyroid pathologies and non-traumatic rotator cuff tear as increased risk factors.
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Affiliation(s)
- Francesco Oliva
- Department of Orthopaedic and Traumatology, University of Rome "Tor Vergata", School of Medicine, Rome, Italy
| | - Leonardo Osti
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - Johnny Padulo
- University eCampus, Novedrate, Italy ; National Centre of Medicine and Science in Sports (CNMSS), Tunis, Tunisia
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine Queen Mary University of London Barts and The London School of Medicine and Dentistry, Mile End Hospital London, UK ; Head of Department of Physical and Rehabilitation Medicine, University of Salerno, Italy
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Sakamoto Y, Kido A, Inoue K, Sakurai G, Hashiuchi T, Munemoto M, Tanaka Y. In vivo microstructural analysis of the humeral greater tuberosity in patients with rotator cuff tears using multidetector row computed tomography. BMC Musculoskelet Disord 2014; 15:351. [PMID: 25336022 PMCID: PMC4216346 DOI: 10.1186/1471-2474-15-351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In arthroscopic surgery, the suture anchor technique has become popular for rotator cuff repair. Preoperative evaluation of the bone microstructure is of utmost importance because, especially in elderly patients, osteoporotic changes may cause anchor pullout, which results in failure of rotator cuff repair. Many groups have reported humeral microstructural analysis; however, most studies were experiments using porcine specimens or human cadavers. In this study, we used multidetector row computed tomography to successfully perform in vivo evaluation of the bone microstructure of the humeral greater tuberosity in patients with rotator cuff tears. METHODS Ten patients were examined. Regions of interest were defined in six quadrants of the greater tuberosity (medial, lateral, and far lateral rows of the anterior and posterior areas). The local bone mineral density and the trabecular microstructural parameters, including the mean bone volume to total volume (BV/TV), trabecular thickness, trabecular separation, and structure model index (SMI), were measured using bone analysis software. RESULTS The BV/TV of the posteromedial region was highest and the SMI of the posteromedial region was lowest. These findings suggest that the bone quality of the posteromedial portion is the highest within the greater tuberosity. CONCLUSION Because the bone quality may be correlated with the pullout strength of suture anchors, our method can help to understand the individual and regional variance in bone quality and may lead to the creation of personalized surgical protocols.
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Affiliation(s)
- Yoshihiro Sakamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8521, Japan.
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Berardi AC, Oliva F, Berardocco M, la Rovere M, Accorsi P, Maffulli N. Thyroid hormones increase collagen I and cartilage oligomeric matrix protein (COMP) expression in vitro human tenocytes. Muscles Ligaments Tendons J 2014; 4:285-291. [PMID: 25489544 PMCID: PMC4241417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND we previously demonstrated the presence of high levels of thyroid hormones (THs) receptors isoforms in healthy tendons, their protective action during tenocyte apoptosis, and the capability to enhance tenocyte proliferation in vitro. In the present study we tested the ability of THs to influence ECM protein tenocyte secretion in an in vitro system. METHODS primary tenocyte-like cells were cultivated for 1, 7 and 14 days in the presence of T3 or T4 individually or in combination with ascorbic acid (AA). RESULTS THs (T3 or T4) in synergism with AA increase significantly the total collagen production after 14 days. THs in synergism with AA increase significantly the expression of collagen I,biglycan and COMP, after some days. CONCLUSION THs play a role on the extra cellular matrix of tendons, enhancing in vitro the production of several proteins such as collagen I, biglycan and COMP. THs receptors are active on human tenocytes, and can play a role in tendon ailments.
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Affiliation(s)
- Anna C. Berardi
- UOC Immunohematology and Transfusion Medicine Laboratories, Laboratory of Stem Cells, Spirito Santo Hospital, Pescara, Italy
| | - Francesco Oliva
- Department of Orthopedics and Traumatology, University of Rome “Tor Vergata”, School of Medicine, Rome, Italy
| | - Martina Berardocco
- UOC Immunohematology and Transfusion Medicine Laboratories, Laboratory of Stem Cells, Spirito Santo Hospital, Pescara, Italy
| | - Marina la Rovere
- UOC Immunohematology and Transfusion Medicine Laboratories, Laboratory of Stem Cells, Spirito Santo Hospital, Pescara, Italy
| | - Patrizia Accorsi
- UOC Immunohematology and Transfusion Medicine Laboratories, Spirito Santo Hospital, Pescara, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; and Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Institute of Health Sciences Education, Centre for Sports and Exercise, London, UK
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Tawfik AM, El-Morsy A, Badran MA. Rotator cuff disorders: How to write a surgically relevant magnetic resonance imaging report? World J Radiol 2014; 6:274-283. [PMID: 24976930 PMCID: PMC4072814 DOI: 10.4329/wjr.v6.i6.274] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/07/2014] [Accepted: 05/14/2014] [Indexed: 02/06/2023] Open
Abstract
Evaluation of rotator cuff is a common indication for magnetic resonance imaging (MRI) scanning of the shoulder. Conventional MRI is the most commonly used technique, while magnetic resonance (MR) arthrography is reserved for certain cases. Rotator cuff disorders are thought to be caused by a combination of internal and external mechanisms. A well-structured MRI report should comment on the relevant anatomic structures including the acromial type and orientation, the presence of os acromiale, acromio-clavicular degenerative spurs and fluid in the subacromial subdeltoid bursa. In addition, specific injuries of the rotator cuff tendons and the condition of the long head of biceps should be accurately reported. The size and extent of tendon tears, tendon retraction and fatty degeneration or atrophy of the muscles are all essential components of a surgically relevant MRI report.
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Gu X, Cheng B, Sun J, Tao K. Arthroscopic evaluation for omalgia patients undergoing the clavicular hook plate fixation of distal clavicle fractures. J Orthop Surg Res 2014; 9:46. [PMID: 24917508 PMCID: PMC4084496 DOI: 10.1186/1749-799x-9-46] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 05/26/2014] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study is to investigate the anatomic changes in the shoulder joints responsible for omalgia after the clavicular hook plate fixation under arthroscope. Methods Arthroscopic examination was carried out for 12 omalgia patients who underwent clavicular hook plate fixation due to distal clavicle fractures. Functional outcome of shoulder was measured by the Japanese Orthopaedic Association (JOA) score before and after the withdrawal of the fixation plate. Results The rotator cuff compression by the clavicular hook was arthroscopically observed in 11 of the 12 cases. The JOA scores of the shoulder were significantly improved at 1 month after the withdrawal of the fixation plate (pain, 28 ± 2.4 vs. 15 ± 5.2; function, 19.2 ± 1.0 vs. 11.7 ± 1.9; range of movements, 26.8 ± 2.6 vs. 14.8 ± 3.4) compared with before. Conclusions The impingement of the hook to the rotator cuff may be the main cause for the omalgia. The appropriate hook and plate that fit to the curve of the clavicle as well as the acromion are necessary to decrease the severity of omalgia.
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Affiliation(s)
| | - Biao Cheng
- Department of Orthopaedic, Shanghai Tenth People's Hospital, Tongji University, No, 301 Middle Yanchang Road, Zhabei District, Shanghai 20072, China.
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Sicuri C, Porcellini G, Merolla G. Robotics in shoulder rehabilitation. Muscles Ligaments Tendons J 2014; 4:207-213. [PMID: 25332937 PMCID: PMC4187609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In the last few decades, several researches have been conducted in the field of robotic rehabilitation to meet the intensive, repetitive and task-oriented training, with the goal to recover the motor function. Up to now, robotic rehabilitation studies of the upper extremity have generally focused on stroke survivors leaving less explored the field of orthopaedic shoulder rehabilitation. In this review we analyse the present status of robotic technologies, in order to understand which are the current indications and which may be the future perspective for their application in both neurological and orthopaedic shoulder rehabilitation.
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Affiliation(s)
- Chiara Sicuri
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Italy
| | | | - Giovanni Merolla
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Italy
- Biomechanics Laboratory “Marco Simoncelli”, D. Cervesi Hospital, Cattolica, Italy
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Weinreb JH, Sheth C, Apostolakos J, McCarthy MB, Barden B, Cote MP, Mazzocca AD. Tendon structure, disease, and imaging. Muscles Ligaments Tendons J 2014; 4:66-73. [PMID: 24932450 PMCID: PMC4049653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Tendon imaging plays a critical role in evaluating tendon diseases and injuries including mechanical, degenerative, and overuse disease, inflammatory enthesitis, as well as partial and full thickness tears. Ultrasound and magnetic resonance imaging (MRI), each with unique benefits and limitations, are commonly utilized to assist in diagnosing these diseases and conditions. This review delineates important structural properties of tendon and biochemical changes occurring in tendon pathology. This review also examines commonly injured tendons including tendons of the elbow, tendons of the rotator cuff of the shoulder, hip abductor tendons, patellar tendons, and the Achilles tendon to help clinicians better recognize tendon disease. Finally, this paper introduces several emerging imaging techniques including T2 mapping, ultra-short echo time MRI, and sonoelastography as ways in which tendon imaging and evaluation may be improved.
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Affiliation(s)
| | | | | | | | | | | | - Augustus D. Mazzocca
- Corresponding author: Augustus D. Mazzocca, Department of Orthopaedic Surgery, UCONN Health Center, Farmington, CT 06034, USA, E-mail:
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Van Kampen C, Arnoczky S, Parks P, Hackett E, Ruehlman D, Turner A, Schlegel T. Tissue-engineered augmentation of a rotator cuff tendon using a reconstituted collagen scaffold: a histological evaluation in sheep. Muscles Ligaments Tendons J 2013; 3:229-235. [PMID: 24367785 PMCID: PMC3838334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
To determine if an absorbable collagen scaffold of high porosity would allow rapid tissue in-growth and permit the functional maturation and alignment of tendon-like tissue, scaffolds were sutured to the superficial surface of the infraspinatus tendons of adult sheep. Histology demonstrated complete ingrowth with fibrovascular tissue by 6 weeks and by 12 weeks the scaffold had induced the formation of a layer of dense, regularly-oriented collagenous tissue which significantly increased the thickness of the native tendon. This new tissue was well-integrated into the host tissues at both the bone interface and along the length of the tendon. At 26 weeks the scaffold was completely absorbed leaving a stable layer of mature tendon-like tissue over the surface of the host tendon which was still present at 52 weeks. The use of a reconstituted collagen scaffold consistently increased the thickness of a rotator cuff tendon by inducing the formation of a well-integrated and mature tendon-like tissue.
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Affiliation(s)
| | - Steven Arnoczky
- Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Patrick Parks
- Histopathometrics, LLC, Mendota Heights, Minnesota, USA
| | - Eileen Hackett
- Small Ruminant Comparative Orthopedic Laboratory, Department of Clinical Sciences, Colorado State University, Ft. Collins, Colorado, USA
| | - Dana Ruehlman
- Small Ruminant Comparative Orthopedic Laboratory, Department of Clinical Sciences, Colorado State University, Ft. Collins, Colorado, USA
| | - Anthony Turner
- Small Ruminant Comparative Orthopedic Laboratory, Department of Clinical Sciences, Colorado State University, Ft. Collins, Colorado, USA
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McFarland EG, Maffulli N, Del Buono A, Murrell GAC, Garzon-Muvdi J, Petersen SA. Impingement is not impingement: the case for calling it "Rotator Cuff Disease". Muscles Ligaments Tendons J 2013; 3:196-200. [PMID: 24367779 PMCID: PMC3838328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Historically, many causes have been proposed for rotator cuff conditions. The most prevalent theory is that the rotator cuff tendons, especially the supraspinatus, make contact with the acromion and coracoacromial ligament, resulting in pain and eventual tearing of the tendon. However, more recent evidence suggests that this concept does not explain the changes in rotator cuff tendons with age. The role of acromioplasty and coracoacromial ligament release in the treatment of rotator cuff disease has become questioned. Evidence now suggests that tendinopathy associated with aging may be a predominant factor in the development of rotator cuff degeneration. We propose that the overwhelming evidence favors factors other than "impingement" as the major cause of rotator cuff disease and that a paradigm shift in the way the development of rotator cuff pathology is conceptualized allows for a more comprehensive approach to the care of the patient with rotator cuff disease.
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Affiliation(s)
- Edward G. McFarland
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore MD, USA
| | - Nicola Maffulli
- Department of Physical and Rehabilitation Medicine, University of Salerno School of Medicine and Surgery, Salerno, Italy. Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK
| | - Angelo Del Buono
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Italy
| | - George A. C. Murrell
- Orthopaedic Research Institute, University of South Wales, The St George Hospital, Sydney, Australia
| | - Juan Garzon-Muvdi
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore MD, USA
| | - Steve A. Petersen
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore MD, USA
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