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Baltassat A, Riffault L, Villatte G, Meyer N, Antoni M, Clavert P. History of mood and anxiety disorders affects return to work and return to sports after rotator cuff repair. Orthop Traumatol Surg Res 2024; 110:103854. [PMID: 38432470 DOI: 10.1016/j.otsr.2024.103854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION After rotator cuff repair (RCR), return to work and return to sports is affected by various psychosocial factors. The role of one of these factors - mood and anxiety disorders (MAD) - is still not clear. The primary objective of this study was to determine the influence of prior MAD on the return to work and return to sports after RCR. Our hypothesis was that patients with a history of MAD would take longer to return to work and to sports after RCR, and the rate of return would be lower, than for patients without MAD. MATERIALS AND METHODS This was a retrospective single-center study of patients who underwent arthroscopic RCR (distal supraspinatus tear). Patients who were employed and those who participated in sports before the surgery were included in the "working" and "sports" groups, respectively. The primary outcomes were the time to return to work and return to sports after surgery. The secondary outcomes were the ratio of patients returning to work and to sports at 3, 6 and 12 months; rate of return to same level of sports; need to change or stop working or sports. The effects of prior MAD on these various outcomes were determined using Bayesian multivariate analysis. RESULTS The "working" group consisted of 158 patients (of which 16.5% had MAD) and the "sports" group consisted of 118 patients (of which 17.8% had MAD). In those with a history of MAD, return to work was 21±11 weeks later and the return to sports was 17±8 weeks later than in those without MAD. There was a 98% probability that return to work or return to sports was delayed by at least 4 weeks in patients with history of MAD. The likelihood that patients with prior MAD who undergo RCR will completely abandon their sport was 2.8 times higher (OR=2.8 [1; 7.8]). CONCLUSION We found a negative influence of prior MAD on the return to work and return to sports after RCR. LEVEL OF EVIDENCE III; retrospective case-control study.
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Affiliation(s)
- Antoine Baltassat
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - Louis Riffault
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - Guillaume Villatte
- Service de chirurgie orthopédique et traumatologique, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Nicolas Meyer
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France; Pole de santé publique, secteur méthodologie et biostatistiques, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - Maxime Antoni
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France.
| | - Philippe Clavert
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France
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Coyle M, Jaggi A, Weatherburn L, DanielI H, Chester R. Post-operative rehabilitation following traumatic anterior shoulder dislocation: A systematic scoping review. Shoulder Elbow 2023; 15:554-565. [PMID: 37811389 PMCID: PMC10557935 DOI: 10.1177/17585732221089636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/23/2022] [Indexed: 10/10/2023]
Abstract
Background This systematic scoping review aimed to describe the content of post-operative rehabilitation programmes, and outcome measures selection following stabilisation surgery for traumatic anterior shoulder dislocation (TASD). Methods An electronic search of Medline, EMBASE, CINAHL and AMED was conducted (2000-2021). Any cohort or clinical trial of patients receiving post-operative TASD rehabilitation were included. Study selection, data extraction and quality appraisal were undertaken by two independent reviewers. Results Twelve studies including fourteen treatment programmes were eligible. Period of post-operative immobilisation ranged from 1 day to 6 weeks, with exercise introduced between 1 and 7 weeks. Strengthening exercises were introduced between 1 and 12 weeks. Two studies described "accelerated" rehabilitation programmes, differing in immobilisation period and exercise milestones. No increased recurrence was reported in professional footballers. Two studies compared rehabilitation programmes, one not randomised, the other 18 years old. There was variability in selected outcomes measures, with only 4 studies using a common measure. Discussion There is minimal evidence to guide post-operative rehabilitation, variability in immobilisation periods and when exercise is introduced. There is no consensus on the definition of accelerated rehabilitation, or outcome measure selection. Clinical consensus of standardised terminology and stages of rehabilitation is required prior to efficacy studies.
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Affiliation(s)
- Martha Coyle
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Anju Jaggi
- Physiotherapy Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Lewis Weatherburn
- Physiotherapy Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Helena DanielI
- Physiotherapy Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Rachel Chester
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Sandler AB, Childs BR, Scanaliato JP, Dunn JC, Parnes N. SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis. Orthop J Sports Med 2022; 10:23259671221140364. [PMID: 36479458 PMCID: PMC9720817 DOI: 10.1177/23259671221140364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/15/2022] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The surgical management of type II superior labrum anterior and posterior (SLAP) tears in patients younger than 40 years is controversial, but growing evidence suggests comparable outcomes between primary SLAP repair and primary biceps tenodesis, with lower rates of reoperations after primary biceps tenodesis. Given the relatively similar patient-reported outcomes, cost-effectiveness analyses of direct and indirect costs associated with the two procedures propound a valuable comparative technique. HYPOTHESIS In this value-based comparison of SLAP repair versus biceps tenodesis, we hypothesized that biceps tenodesis would be more cost-effective than SLAP repair in patients younger than 40 years. STUDY DESIGN Economic and decision analysis; Level of evidence, 4. METHODS A 1-month Markov cycle was simulated to reflect 10 years of health outcomes. Health states were selected based on outcomes that are especially important in assessing indirect costs for a younger, active patient population: return-to-sport rates, which demonstrate a return to baseline function, and reoperation rates. Transition state probabilities were obtained through an index systematic review and meta-analysis comparing labral repair and biceps tenodesis for the treatment of type II SLAP lesions in patients younger than 40 years. Health state utility and cost values were obtained from accepted values denoted in existing literature. RESULTS Both primary SLAP repair and primary biceps tenodesis yielded an average expected 8.1 quality-adjusted life years over the 10-year period. The average cost (in 2021 US$) was $16,619 for biceps tenodesis and $19,388 for SLAP repair. CONCLUSION In a younger patient population, SLAP repair and biceps tenodesis had comparable quality-adjusted life years and utility in the treatment of type II SLAP tears; however, SLAP repair cost $19,388, while biceps tenodesis cost $16,619, reflecting a 14% cost savings with biceps tenodesis. These findings can be extrapolated to further establish the role for these procedures in treating SLAP tears.
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Affiliation(s)
- Alexis B. Sandler
- Department of Orthopaedics, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Benjamin R. Childs
- Department of Orthopaedics, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - John P. Scanaliato
- Department of Orthopaedics, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - John C. Dunn
- Department of Orthopaedics, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Nata Parnes
- Department of Orthopedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Department of Orthopedics, Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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Murphy GT, Lam PH, Murrell GAC. Is timing of superior labrum anterior to posterior (SLAP) repair important? A cohort study evaluating the effect of the duration of symptoms prior to surgery on the outcomes of patients who underwent type II SLAP repair. Shoulder Elbow 2022; 14:515-522. [PMID: 36199504 PMCID: PMC9527478 DOI: 10.1177/17585732211015825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 01/17/2023]
Abstract
Background The management of superior labrum anterior to posterior (SLAP) tears is somewhat controversial. It is unclear if the length of time between symptom onset and surgery affects SLAP repair outcomes. Methods Sixty-one SLAP repairs were retrospectively reviewed pre-operatively and post-operatively at 1, 6, 24 weeks, and > 2 years post-surgery. Patients were allocated to an 'early repair' or 'late repair' group based on time between symptom onset and surgery. Results Of the 61 patients, 22 patients had surgery within six months of symptom onset. Pre-operatively, 'late repair' patients played a higher level of sport than 'early repair' patients prior to injury. Post-operatively, both groups had similar outcomes up to six months, though at six months 'early repair' patients reported a higher level of work than 'late repair' patients (p = 0.01). At > 2 years after surgery, 'early repair' patients had reduced pain and difficulty with overhead activities (p = 0.002), less stiffness (p = 0.001) and were more satisfied than 'late repair' patients (p = 0.04). Conclusions Up to six months post-operatively, the time between symptom onset and surgery has limited effect on functional outcomes. However, at > 2 years after surgery, earlier repairs ( < 6 months) are interestingly associated with better functional outcomes. Further studies are required to determine if this is a causal relationship.
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Affiliation(s)
- Geoffrey T Murphy
- Orthopaedic Research Institute, University of New South Wales, Kogarah, Australia
| | - Patrick H Lam
- Orthopaedic Research Institute, University of New South Wales, Kogarah, Australia
| | - George AC Murrell
- Orthopaedic Research Institute, University of New South Wales, Kogarah, Australia
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Ekeberg OM, Pedersen SJ, Natvig B, Brox JI, Biringer EK, Endresen Reme S, Engebretsen KB, Joranger P, Mdala I, Juel NG. Making should er p ain simple in g eneral p ractice: implementing an evidence-based guideline for shoulder pain, protocol for a hybrid design stepped-wedge cluster randomised study (EASIER study). BMJ Open 2022; 12:e051656. [PMID: 34996788 PMCID: PMC8744118 DOI: 10.1136/bmjopen-2021-051656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Research suggests that current care for shoulder pain is not in line with the best available evidence. This project aims to assess the effectiveness, cost-effectiveness and the implementation of an evidence-based guideline for shoulder pain in general practice in Norway. METHODS AND ANALYSIS A stepped-wedge, cluster-randomised trial with a hybrid design assessing clinical effectiveness, cost-effectiveness and the effect of the implementation strategy of a guideline-based intervention in general practice. We will recruit at least 36 general practitioners (GPs) and randomise the time of cross-over from treatment as usual to the implemented intervention. The intervention includes an educational outreach visit to the GPs, a computerised decision tool for GPs and a self-management application for patients. We will measure outcomes at patient and GP levels using self-report questionnaires, focus group interviews and register based data. The primary outcome measure is the patient-reported Shoulder Pain and Disability Index measured at 12 weeks. Secondary outcomes include the EuroQol Quality of Life Measure (EQ5D-5L), direct and indirect costs, patient's global perceived effect of treatment outcome, Pain Self-Efficacy and Brief Illness Perception Questionnaire. We will evaluate the implementation process with focus on adherence to guideline treatment. We will do a cost-minimisation analysis based on direct and selected indirect costs and a cost-utility analysis based on EQ5D-5L. We will use mixed effect models to analyse primary and secondary outcomes. ETHICS AND DISSEMINATION Ethics approval was granted by the Regional Committee for Medical and Health Research Ethics-South East Norway (ref. no: 2019/104). Trial results will be submitted for publication in a peer-reviewed medical journal in accordance with Consolidated Standards of Reporting Trials. TRIAL REGISTRATION NUMBER NCT04806191.
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Affiliation(s)
- Ole Marius Ekeberg
- Department of Research and innovation, Helse Fonna HF, Haugesund, Norway
| | | | - Bård Natvig
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
- Medical Faculty, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | - Kaia Beck Engebretsen
- Department of Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Pål Joranger
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Ibrahimu Mdala
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Niels Gunnar Juel
- Department of General Practice, University of Oslo, Oslo, Norway
- Department of Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
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Skare Ø, Brox JS, Schrøder CP, Brox JI. Responsiveness of five shoulder outcome measures at follow-ups from 3 to 24 months. BMC Musculoskelet Disord 2021; 22:606. [PMID: 34225701 PMCID: PMC8259445 DOI: 10.1186/s12891-021-04483-3] [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: 03/05/2021] [Accepted: 06/15/2021] [Indexed: 11/15/2022] Open
Abstract
Background To assess responsiveness of five outcome measures at four different follow-ups in patients with SLAP II lesions of the shoulder. Methods 119 patients with symptoms and signs, MRI arthrography and arthroscopic findings were included. The Western Ontario Shoulder Instability Index (WOSI), Oxford Instability Shoulder Score (OISS), EuroQol (EQ-5D3L), Rowe Score and Constant-Murley Score (CMS) were assessed at baseline, 3, 6, 12 and 24 months. The analysis contains both anchor-based and distribution-based methods, and hypothesis testing. Results Confidence intervals for ROC cut-off values, representing MID, for OISS, CMS and EQ-5D3L crossed zero at 3 months. Cut-off values were stable between 6- and 24-months follow-up. At 24-months ROC cut-off values (95% CI) were: Rowe 18 (13 to 24); WOSI 331 (289 to 442); OISS 9 (5 to 14); CMS 11 (9 to 15) and EQ-5D3L 0.123 (0.035 to 0.222). MID95%limit estimates were substantially higher than ROC cut-off values and MIDMEAN at all follow-ups for all instruments. The reliable change proportion (RCP) values in the improved group were highest for WOSI and the Rowe Score (ranging from 68 to 87%) and significantly lower for CMS. EQ-5D3L had the lowest values (13 to 16%). We found a moderate correlation between mean change scores of the outcome measures and the anchor, except for the EQ-5D3L. Conclusions In patients with SLAP II-lesions the patient reported OISS and WOSI and the clinical Rowe score had best responsiveness. Our results suggest that 3 months follow-up is too early for outcome evaluation.
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Affiliation(s)
- Øystein Skare
- Surgical Department, Lovisenberg Diaconal Hospital, Oslo, Norway. .,Orthopedic Department, Lovisenberg Diaconal Hospital, Lovisenberggt 17, 0440, Oslo, Norway.
| | | | | | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Medical Faculty, University of Oslo, Oslo, Norway
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LeVasseur MR, Mancini MR, Hawthorne BC, Romeo AA, Calvo E, Mazzocca AD. SLAP tears and return to sport and work: current concepts. J ISAKOS 2021; 6:204-211. [PMID: 34272296 DOI: 10.1136/jisakos-2020-000537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 01/02/2023]
Abstract
Superior labrum, anterior and posterior (SLAP) lesions are common and identified in up to 26% of shoulder arthroscopies, with the greatest risk factor appearing to be overhead sporting activities. Symptomatic patients are treated with physical therapy and activity modification. However, after the failure of non-operative measures or when activity modification is precluded by athletic demands, SLAP tears have been managed with debridement, repair, biceps tenodesis or biceps tenotomy. Recently, there have been noticeable trends in the operative management of SLAP lesions with older patients receiving biceps tenodesis and younger patients undergoing SLAP repair, largely with suture anchors. For overhead athletes, particularly baseball players, SLAP lesions remain a difficult pathology to manage secondary to concomitant pathologies and unpredictable rates of return to play. As a consequence, the most appropriate surgical option in elite throwers is controversial. The objective of this current concepts review is to discuss the anatomy, mechanism of injury, presentation, diagnosis and treatment options of SLAP lesions and to present current literature on outcomes affecting return to sport and work.
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Affiliation(s)
- Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Benjamin C Hawthorne
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Anthony A Romeo
- Musculoskeletal Institute, DuPage Medical Group, Downers Grove, Illinois, USA
| | - Emilio Calvo
- Department of Orthopaedic Surgery, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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