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Wang T, Guo J, Mi Y, Xiao Z, Yin B, Lu B, Deng H. States of contra-lateral rotator cuff - Based on bilateral shoulder ultrasound results of 401 patients. J Orthop Sci 2024; 29:964-968. [PMID: 37330353 DOI: 10.1016/j.jos.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/05/2023] [Accepted: 05/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND For patients with rotator cuff tear (RCT), the contra-lateral shoulders have higher risk of RCT than general population. It has been proved by several previous studies. The focus of this study is to obtain the data of contra-lateral rotator cuff tear in Chinese population, and to find the rules of contra-lateral rotator cuff tear through statistical analysis. METHODS From March 2016 to January 2020, patients who underwent shoulder arthroscopic surgery were included in the study, we conduct bilateral shoulder ultrasound before surgery, patients information collection include gender, age, occupation and whether received contra-lateral rotator cuff surgery within 1-3 years. The above information was statistically analyzed. RESULTS According to the inclusion and exclusion criteria, 401 patients were included. The incidence of contra-lateral rotator cuff tear was 24.3%, 5.58% of them underwent contra-lateral rotator cuff repair surgery within 3 years. The degree of contra-lateral rotator cuff tear was positively correlated with the degree of the primary side; Patients with full-thickness rotator cuff tear were more likely to have contra-lateral rotator cuff tear than patients with partial rotator cuff tear. For patients with supraspinatus tendon tear, the contra-lateral rotator cuff tear risk increases, For patients with subscapularis muscle tear, the contra-lateral rotator cuff tear risk doesn't increases. Contra-lateral rotator cuff tear is related to age, the risk of contra-lateral rotator cuff tear is higher in elderly patients. CONCLUSIONS The contra-lateral RCT data obtained in our study was 24.3%, significantly lower than that of previous studies. The reasons may include ethnic variation, lifestyle, and proportion of heavy physical labor. The condition of contra-lateral rotator cuff is closely related to affected side rotator cuff tear.
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Affiliation(s)
- Tianci Wang
- Department of Orthopaedic Trauma, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Jialiang Guo
- Department of Orthopaedic Trauma, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Yaru Mi
- Department of Ultrasonography, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Zeng Xiao
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bing Yin
- Department of Orthopaedic Trauma, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Bo Lu
- Department of Orthopaedic Trauma, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China.
| | - Heping Deng
- Department of Ultrasonography, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China.
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De Giorgi S, Ottaviani G, Bianchi FP, Delmedico M, Suma M, Moretti B. Single-row versus transosseous technique in the arthroscopic treatment of rotator cuff tears: a meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:31-38. [PMID: 37561195 PMCID: PMC10771355 DOI: 10.1007/s00590-023-03657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE This study aims to compare single-row suture-anchors (SA) versus transosseous arthroscopic (TO) technique in the treatment of patients with rotator cuff tears in terms of clinical structural outcomes at atleast 24 months of follow-up. METHODS The systematic review was performed according to "PRISMA guidelines" (Preferred Reporting Items for Systematic Reviews and Meta-analyses), in order to identify all the studies comparing clinical, both subjective and objective, outcomes with 24 months follow-up minimum in patients undergoing arthroscopic RC repair with the SR and TO technique. OVID-MEDLINE®, Cochrane, SCOPUS and PubMed were searched from January 2010 to October 2022 to identify relevant studies, using the following key words, that were combined together to achieve maximum search strategy sensitivity: "Rotator cuff tear" OR "repair" OR "shoulder" OR "reconstruction" OR "suture" OR "arthroscopic" OR "single-row" OR "transosseous". RESULTS Six papers were finally analyzed in this meta-analysis. The weighted mean difference on Constant scores and for ASES for studies considering suture-anchors (SA) group showed good outcomes. The weighted mean difference of Constant scores and of ASES for TO (transosseous) group showed good outcomes. The weighted mean difference of CONSTANT for TO versus SA groups showed no differences in the outcomes of SA and TO techniques for the repair of Rotator Cuff Tears at minimum 24 months follow-up. CONCLUSIONS The Arthroscopic transosseous rotator cuff repair technique and SA (suture-anchor) technique both lead to significant short-term improvement and satisfactory subjective outcome scores with low complication/failure rates. No differences were found in the final outcome between the two techniques.
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Affiliation(s)
- S De Giorgi
- Department of Translational Biomedicine and Neuroscience "DiBraiN", School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - G Ottaviani
- Department of Translational Biomedicine and Neuroscience "DiBraiN", School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - F P Bianchi
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - M Delmedico
- Department of Translational Biomedicine and Neuroscience "DiBraiN", School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - M Suma
- Department of Translational Biomedicine and Neuroscience "DiBraiN", School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - B Moretti
- Department of Translational Biomedicine and Neuroscience "DiBraiN", School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Umehara J, Ueda Y, Yagi M, Nojiri S, Tachibana T, Nobuhara K, Ichihashi N. Mechanical characteristic of supraspinatus muscle changes independent of its size and intramuscular fat in patient with rotator cuff repair. J Electromyogr Kinesiol 2023; 73:102831. [PMID: 37871509 DOI: 10.1016/j.jelekin.2023.102831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/23/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
PURPOSE This study aimed i) to investigate the mechanical, morphological, and compositional characteristics of the supraspinatus muscle after rotator cuff repair by using ultrasound shear wave elastography (SWE) and B-mode imaging, and ii) to determine whether the morphological or compositional characteristics are associated with the mechanical characteristic of the supraspinatus during contraction. METHODS Using SWE and B-mode imaging, active and passive shear moduli, muscle thickness, and echo intensity of the supraspinatus were measured from the repaired and contralateral control shoulders of 22 patients with rotator cuff repair. The shear modulus, muscle thickness, and echo intensity were compared between the repaired and control shoulders. The association between the active shear modulus and the other variables was determined. RESULTS While the active and passive shear moduli were lower in the repaired shoulder compared to the control, the muscle thickness and echo intensity did not vary between them. Interestingly, the passive shear modulus was positively correlated with the active shear modulus only in the control shoulder. CONCLUSION The mechanical characteristic of supraspinatus remains impaired, even without degenerative changes in the morphological and compositional characteristics after rotator cuff repair. Furthermore, the association between contractile and elastic characteristics in the supraspinatus was deteriorated in control shoulder.
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Affiliation(s)
- Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan.
| | - Yasuyuki Ueda
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Faculty of Health Science, Takarazuka University of Medical and Healthcare, Takarazuka, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shusuke Nojiri
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Yoon TH, Kim SJ, Choi YR, Kang KT, Chun YM. Age, Tear Size, Extent of Retraction, and Fatty Infiltration Associated With a High Chance of a Similar Rotator Cuff Tear in the Contralateral Shoulder Regardless of Symptoms in Patients Undergoing Cuff Repair in the Index Shoulder. Arthroscopy 2023:S0749-8063(23)00174-3. [PMID: 36804457 DOI: 10.1016/j.arthro.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/26/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To investigate the prevalence of a contralateral rotator cuff tear (RCT) in patients with a symptomatic RCT requiring repair and to determine whether findings from magnetic resonance imaging (MRI) of the affected shoulder can predict the presence of a contralateral tear. METHODS Patients with atraumatic RCTs who had undergone arthroscopic repair between March 2019 and February 2021 were reviewed in this study. MRI of both shoulder joints was performed to evaluate the bilaterality of RCT. Demographic factors and MRI findings of index shoulders were assessed using logistic regression analysis to reveal any correlations with the presence of RCT in the contralateral shoulder. RESULTS A total of 428 patients were enrolled in this study. When the affected shoulders had a posterosuperior rotator cuff (PSRC) or subscapularis tear including either an isolated or combined tear, 63.6% and 67.8% had the same tears on the contralateral side, respectively. A contralateral-side tear was found in 74.6% (185/248) of symptomatic cases and 44.8% (65/145) of asymptomatic cases, which represents a significant difference (P < .001). Logistic regression analysis revealed that age ≥67.5 years, tear size ≥17 mm, Goutallier grade ≥1.5, and Patte grade ≥1.5 were found to be indicative of potential contralateral PSRC tears. By contrast, the presence of a subscapularis tear in the affected shoulder was the only significant risk factor in predicting a potential subscapularis tear in the contralateral shoulder. CONCLUSIONS Among patients with a symptomatic RCT requiring arthroscopic repair, 63.6% with a PSRC tear and 67.8% with a subscapularis tear in the affected shoulder were found to have a similar tear in the contralateral shoulder regardless of symptoms. Age, tear size, extent of retraction, fatty infiltration of PSRC tears, and the presence of subscapularis tears were identified as factors predictive of tears on the contralateral side. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Jae Kim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Tae Kang
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Sgroi M, Kranz ,M, Seitz AM, Ludwig M, Faschingbauer M, Zippelius T, Reichel H, Kappe T. Comparison of Knotless and Knotted Single-Anchor Repair for Ruptures of the Upper Subscapularis Tendon: Outcomes at 2-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221083591. [PMID: 35309232 PMCID: PMC8928393 DOI: 10.1177/23259671221083591] [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: 11/27/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Both knotted and knotless single-anchor repair techniques are used to repair transmural ruptures of the upper subscapularis (SSC) tendon. However, it is still unclear which technique provides better clinical and radiological results. Purpose/Hypothesis: To compare the clinical and magnetic resonance imaging (MRI) outcomes of knotless and knotted single-anchor repair techniques in patients with a transmural rupture of the upper SSC tendon at 2-year follow-up. It was hypothesized that the 2 techniques would not differ significantly in outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Forty patients with a transmural tear of the upper SSC tendon (grade 2 or 3 according to Fox and Romeo) were retrospectively enrolled. Depending on the repair technique, patients were assigned to either the knotless single-anchor or knotted single-anchor group. After a mean follow-up of 2.33 ± 0.43 years, patients were assessed by the ASES, WORC, OSS, CS, and SSV. A clinical examination that included the bear-hug, the lift-off, and the belly-press tests was performed, in which the force exerted by the subjects was measured. In addition, all patients underwent MRI of the affected shoulder to assess repair integrity, tendon width, fatty infiltration, signal-to-signal ratio of the upper and lower SSC muscle, and atrophy of the SSC muscle. Results: No significant difference was found between the 2 groups on any of the clinical scores [ASES (P = .272), WORC (P = .523), OSS (P = .401), CS (P = .328), SSV (P = .540)] or on the range-of-motion or force measurements. Apart from a higher signal-to-signal ratio of the lower SSC muscle in the knotless group (P = .017), no significant difference on imaging outcomes was found between the 2 groups. Conclusion: Both techniques can be used in surgical practice, as neither was found to be superior to the other in terms of clinical or imaging outcomes at 2-year follow-up.
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Affiliation(s)
- Mirco Sgroi
- Department for Orthopaedic Surgery, University of Ulm, RKU, Ulm, Germany
| | - , Marilena Kranz
- Department for Orthopaedic Surgery, University of Ulm, RKU, Ulm, Germany
| | - Andreas Martin Seitz
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Marius Ludwig
- Department for Orthopaedic Surgery, University of Ulm, RKU, Ulm, Germany
| | | | - Timo Zippelius
- Department for Orthopaedic Surgery, University of Ulm, RKU, Ulm, Germany
| | - Heiko Reichel
- Department for Orthopaedic Surgery, University of Ulm, RKU, Ulm, Germany
| | - Thomas Kappe
- Department for Orthopaedic Surgery, University of Ulm, RKU, Ulm, Germany
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Hong JP, Huang SW, Lee CH, Chen HC, Charoenpong P, Lin HW. Osteoporosis increases the risk of rotator cuff tears: a population-based cohort study. J Bone Miner Metab 2022; 40:348-356. [PMID: 35059890 DOI: 10.1007/s00774-021-01293-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Osteoporosis has been demonstrated to be a risk factor for rotator cuff retears after surgery; however, no studies have directly investigated the association between osteoporosis and the development of rotator cuff tears. To investigate whether osteoporosis is associated with an increased risk of rotator cuff tears. MATERIALS AND METHODS We conducted a population-based, matched-cohort study with a 7-year follow-uTwo matched cohorts (n = 3511 with osteoporosis and 17,555 without osteoporosis) were recruited from Taiwan's Longitudinal Health Insurance Dataset. Person-year data and incidence rates were evaluated. A multivariable Cox model was used to derive an adjusted hazard ratio (aHR) after controlling for age, sex, and various prespecified comorbidities. Age and sex were added in the model to test for interaction with osteoporosis. RESULTS Women constituted 88.5% of the cohorts. During follow-up of 17,067 and 100,501 person-years for the osteoporosis and nonosteoporosis cohorts, 166 and 89 rotator cuff tears occurred, respectively. The cumulative incidence of rotator cuff tears was significantly higher in the osteoporosis cohort than in the nonosteoporosis cohort (p < 0.001, log-rank). The Cox model revealed a 1.79-fold increase in rotator cuff tears in the osteoporosis cohort, with an aHR of 1.79 (95% confidence interval, 1.55-2.05). Effect modification of sex and age on rotator cuff tears was not found in patients with osteoporosis. CONCLUSION This population-based study supports the hypothesis that compared with individuals without osteoporosis, those with osteoporosis have a higher risk of developing rotator cuff tears.
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Affiliation(s)
- Jia-Pei Hong
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Hong Lee
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Department of Neurology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Prangthip Charoenpong
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Louisiana State University, Shreveport, LA, USA
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, 70 Linhsi Road, Shihlin, Taipei, 111, Taiwan.
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Liu G, Li W, Zhang L, Zhou C, Cong R. The role of vitamin D on rotator cuff tear with osteoporosis. Front Endocrinol (Lausanne) 2022; 13:1017835. [PMID: 36465653 PMCID: PMC9716320 DOI: 10.3389/fendo.2022.1017835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/24/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUNDS Osteoporosis (OP) is an important risk factor for rotator cuff tears (RCTs). However, the relationship and mechanism between rotator cuff injury and osteoporosis are unclear. Therefore, to investigate association between rotator cuff injury and osteoporosis, and find clinical characteristics, bone mineral density, bone metabolism markers, and nutrient levels in rotator cuff injury patients with or without osteoporosis. METHODS One hundred and four cases of patients (RCTs, n=32; RCTs-OP, n=72) who underwent rotator cuff injury and need arthroscopic rotator cuff repair between June 2021 and February 2022, along with the diagnosis of osteoporosis were identified from the dual-energy X-ray bone density screening(DXA). The outcome measure includes clinical characteristics, bone mineral density, bone metabolism markers, vitamins, and amino acids. Multivariable logistic regression analysis was applied to build a predicting model incorporating the feature selected in the least absolute shrinkage and selection operator regression model. Discrimination, calibration, and clinical usefulness of the predicting model were assessed using the C-index, calibration plot, and decision curve analysis. Internal validation was assessed using bootstrapping validation. RESULTS OP with RCTs has a lower level of in 25-vitD, osteocalcin (OCN), serum Ca2+, ornithine, diaminocaproic_acid but the high level of Vitamin_B12, PTH, Vitamin_D3,γ_aminobutyric_acid, Vitamin_C and Vitamin_E than RCTs patients without OP. Predictors contained in the prediction nomogram included lumber T score, femur T score, Niacin_B3, and vitamin D, reflecting the combined effect of vitamins on RCTs-related OP progression. The model has good discriminative ability with a C-index of 0.938(95% CI:-1.83-1.39) and good scaling ability. The high C-index value of 0.95 is still achievable with range validation. Analysis of decision curves showed that non-adherence is clinically useful when intervention decisions are at the 14% probability limit of non-adherence. CONCLUSION This study supports the hypothesis that lumber T score, femur T score, Niacin_B3, and Vitamin D are valuable prognostic biomarkers on RCTs related OP progression. WHAT IS KNOWN ABOUT THE SUBJECT It is found that vitamin D are valuable prognostic biomarkers, reflecting the combined effect of vitamins on RCTs related OP progression. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE These findings also highlight that nutrients condition such as vitamins and amino acids of patients provide a new understanding of the development of RCTs.
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Affiliation(s)
- Gejun Liu
- Department of Orthopedics, The Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Wenjun Li
- Department of Orthopedics, The Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Liyun Zhang
- Department of Medical Iconography, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Chao Zhou
- Department of Orthopaedics, Yinshanhu Hospital of Wuzhong District, Suzhou, China
- *Correspondence: Chao Zhou, ; Ruijun Cong,
| | - Ruijun Cong
- Department of Orthopedics, The Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
- *Correspondence: Chao Zhou, ; Ruijun Cong,
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Yanik EL, Keener JD, Lin SJ, Colditz GA, Wright RW, Evanoff BA, Jain NB, Saccone NL. Identification of a Novel Genetic Marker for Risk of Degenerative Rotator Cuff Disease Surgery in the UK Biobank. J Bone Joint Surg Am 2021; 103:1259-1267. [PMID: 33979311 PMCID: PMC8282705 DOI: 10.2106/jbjs.20.01474] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND While evidence indicates that familial predisposition influences the risk of developing degenerative rotator cuff disease (RCD), knowledge of specific genetic markers is limited. We conducted a genome-wide association study of RCD surgery using the UK Biobank, a prospective cohort of 500,000 people (40 to 69 years of age at enrollment) with genotype data. METHODS Cases with surgery for degenerative RCD were identified using linked hospital records. The cases were defined as an International Classification of Diseases, Tenth Revision (ICD-10) code of M75.1 determined by a trauma/orthopaedic specialist and surgery consistent with RCD treatment. Cases were excluded if a diagnosis of traumatic injury had been made during the same hospital visit. For each case, up to 5 controls matched by age, sex, and follow-up time were chosen from the UK Biobank. Analyses were limited to European-ancestry individuals who were not third-degree or closer relations. We used logistic regression to test for genetic association of 674,405 typed and >10 million imputed markers, after adjusting for age, sex, population principal components, and follow-up. RESULTS We identified 2,917 RCD surgery cases and 14,158 matched controls. We observed 1 genome-wide significant signal (p < 5 × 10-8) for a novel locus tagged by rs2237352 in the CREB5 gene on chromosome 7 (odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.11 to 1.24). The single-nucleotide polymorphism (SNP) rs2237352 was imputed with a high degree of confidence (info score = 0.9847) and is common, with a minor allele frequency of 47%. After expanding the control sample to include additional unmatched non-cases, rs2237352 and another SNP in the CREB5 gene, rs12700903, were genome-wide significant. We did not detect genome-wide significant signals at loci associated with RCD in previous studies. CONCLUSIONS We identified a novel association between a variant in the CREB5 gene and RCD surgery. Validation of this finding in studies with imaging data to confirm diagnoses will be an important next step. CLINICAL RELEVANCE Identification of genetic RCD susceptibility markers can guide understanding of biological processes in rotator cuff degeneration and help inform disease risk in the clinical setting. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Elizabeth L. Yanik
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Jay D. Keener
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Shiow J. Lin
- Department of Genetics, Washington University School of Medicine, St. Louis, MO
| | - Graham A. Colditz
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Rick W. Wright
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Bradley A. Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO
| | - Nitin B. Jain
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX
| | - Nancy L. Saccone
- Department of Genetics, Washington University School of Medicine, St. Louis, MO
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Porschke F, Loew M, Schnetzke M. Traumatische vs. degenerative Rotatorenmanschettenläsion. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00438-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Shepet KH, Liechti DJ, Kuhn JE. Nonoperative treatment of chronic, massive irreparable rotator cuff tears: a systematic review with synthesis of a standardized rehabilitation protocol. J Shoulder Elbow Surg 2021; 30:1431-1444. [PMID: 33276163 DOI: 10.1016/j.jse.2020.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE A massive, irreparable rotator cuff tear may cause significant pain and dysfunction. However, the efficacy of nonoperative treatment modalities in this subset of patients is not currently well known. Also, there is currently no gold standard nonoperative protocol to guide treatment. The goal of the present systematic review is to determine if there is any evidence to support the use of various nonoperative treatment modalities and synthesize a standardized nonoperative treatment protocol for the patient with a massive irreparable rotator cuff tear. METHODS A comprehensive review of the literature utilizing PRISMA guidelines was performed. Studies involving clinical outcomes of nonoperative treatment of massive, irreparable rotator cuff tears were included. Articles were reviewed by 2 reviewers to determine inclusion or exclusion based on established criteria. Selected articles were reviewed for results of clinical and functional outcomes. The studies were also reviewed to determine their level of evidence and potential sources of bias. A standardized nonoperative treatment protocol was developed by taking described elements of the protocols used in studies that demonstrated clinical improvement beyond the MCID for the outcome scores used by the authors. RESULTS A total of 10 studies met inclusion criteria for our studies. Of the included studies, 1 was Level III evidence and the remaining 9 were Level IV evidence. Multiple studies showed significant improvement exceeding the MCID for functional outcome scores following treatment. Also, several studies demonstrated significant improvements in strength and range of motion. The overall success of nonoperative treatment ranged from 32%-96%. The synthesized nonoperative treatment protocol is characterized by requiring some supervised physical therapy, often requiring 12 weeks or more, focusing on supine exercises with gradual progression to upright. Corticosteroid injections and nonsteroidal anti-inflammatory drugs may also be of benefit. CONCLUSION Despite low-quality evidence, nonoperative treatment has been shown to be efficacious for patients with chronic, massive, irreparable rotator cuff tears. Using these results, a synthesized rehabilitation program was developed to guide clinicians when treating patients with massive irreparable rotator cuff tears.
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Affiliation(s)
- Kevin H Shepet
- Bellin Health Titletown Sports Medicine and Orthopedics, Green Bay, WI, USA
| | - Daniel J Liechti
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - John E Kuhn
- Department of Orthopaedics, Vanderbilt University, Nashville, TN, USA.
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Wang C, Yang P, Zhang D, Jeon IH, Yu T, Zhang Y, Qi C. Bilateral single-staged arthroscopic rotator cuff repair is comparable to staged procedures: a retrospective follow up study of 2 years. BMC Musculoskelet Disord 2021; 22:409. [PMID: 33947360 PMCID: PMC8094466 DOI: 10.1186/s12891-021-04304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Bilateral rotator cuff tears are not uncommon and the timing of the surgical treatment of both shoulders is debated. In the present study, we aimed to compare the clinical outcomes of patients who underwent single-stage or staged bilateral arthroscopic rotator cuff repair. Methods From March 2013 to May 2018, a retrospective review on all patients who underwent bilateral arthroscopic rotator cuff repair at our department was performed. Patients were separated into 2 groups: single-stage and staged. The minimum follow-up period was 2 years. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, Constant-Murley (Constant) score, the range of motion (ROM) of the shoulder and the hospitalization costs were evaluated for comparison between the two groups before and after the operation. Differences between groups were assessed using t-tests and ANOVA. Results All 51 patients completed follow-up of 2 years, single stage (n = 24) and staged group (n = 27). There was no significant difference in the VAS, ASES, UCLA and Constant scores between the single-stage group and the staged group before the operation. Postoperative clinical scores were significantly improved in both groups (P < 0.05). All outcome scores were significantly different between the two groups at 6 months postoperatively, and the staged scored better than the single-stage (P < 0.05). At 12, 18, and 24 months after the operation, the outcome scores were not significantly different between the two groups. At follow-up, the ROM of the shoulder was not significantly different between the two groups. In the single-stage group, the outcome scores and ROM were similar for both shoulders and comparable to the staged group. We also found significant cost savings in the single-stage group (4440.89 ± 130.55 USD) compared to the staged group (5065.73 ± 254.76 USD) (p < 0.05). Conclusions Patients receiving single-stage or staged bilateral arthroscopic rotator cuff repair showed similarly good clinical outcomes at follow-ups longer than 6 months. Moreover, good outcomes were observed on both sides of the single-stage group.
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Affiliation(s)
- Chen Wang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - Pu Yang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - Dongfang Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - In-Ho Jeon
- Department of Orthopedic Surgery, College of Medicine, Asan Medical Center, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Republic of Korea
| | - Tengbo Yu
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - Yingze Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China
| | - Chao Qi
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong , 266103, Qingdao, P.R. China.
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12
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Vogler T, Andreou D, Gosheger G, Kurpiers N, Velmans C, Ameziane Y, Schneider K, Rickert C, Liem D, Schorn D. Long-term outcome of arthroscopic debridement of massive irreparable rotator cuff tears. PLoS One 2020; 15:e0241277. [PMID: 33180802 PMCID: PMC7660551 DOI: 10.1371/journal.pone.0241277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives To evaluate the clinical and radiographic outcome of low-demand patients with massive rotator cuff tears undergoing arthroscopic debridement in mid- and long-term follow-up, as well as the rate of conversion to reverse shoulder arthroplasty. Methods We performed a retrospective analysis of 19 patients with a mean age at surgery of 68 years (range, 55–80 years) from a previously described consecutive cohort and after a mean follow up of 47 month (FU1) and 145 month (FU2). The functional outcome was evaluated with the VAS score, the American Shoulder and Elbow Surgeons (ASES) score, and the age- and gender-adjusted Constant (aCS) score. The radiographic outcome was classified according to the Hamada classification. Non-parametric analyses were carried out with the Mann-Whitney U for independent samples and the Wilcoxon signed-rank test for related samples. Results Five patients (26%) developed symptomatic cuff tear arthropathy and underwent reverse shoulder arthroplasty after a mean time of 63 months (range, 45–97 months). These patients were excluded from further analyses. The mean VAS score of the remaining 14 patients at FU1 was significantly lower compared to preoperatively (P = .041), while there were no significant differences between the VAS score at FU1 and FU2 (P = 1.0). The ASES score of the affected shoulder at FU1 was significantly higher compared to prior to surgery (P = .028), while there were no significant differences between the scores of the affected shoulder between FU1 and FU2 (P = .878). While the ASES score of the contralateral shoulder at FU1 was significantly higher than the score of the affected shoulder (P = .038), there were no significant differences in the ASES scores of the affected and the healthy shoulder at FU2 (P = .575). The evaluation of the aCS produced similar results. A progression of the Hamada grade was documented in 6 patients. Conclusions Arthroscopic debridement is a safe and valid option for low-demand middle-age or elderly patients with symptomatic massive rotator cuff tears, leading to a significant pain relief and significantly improved functional outcome at mid- and long-term follow up. However, about a quarter of the patients in our cohort had to undergo reverse shoulder arthroplasty due to symptomatic cuff tear arthropathy. Furthermore, some of the remaining patients continued to undergo radiographic progression. This might be due to the natural history of their disease and/or the surgical procedure, and the clinical relevance of this finding should be evaluated in further studies.
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Affiliation(s)
- Tim Vogler
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
- * E-mail:
| | - Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Georg Gosheger
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Nico Kurpiers
- Institute of Sports Science, University of Hildesheim, Hildesheim, Germany
| | - Clara Velmans
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Yacine Ameziane
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Kristian Schneider
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Carolin Rickert
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Dennis Liem
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Dominik Schorn
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
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13
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Yanik EL, Colditz GA, Wright RW, Saccone NL, Evanoff BA, Jain NB, Dale AM, Keener JD. Risk factors for surgery due to rotator cuff disease in a population-based cohort. Bone Joint J 2020; 102-B:352-359. [PMID: 32114822 DOI: 10.1302/0301-620x.102b3.bjj-2019-0875.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS Few risk factors for rotator cuff disease (RCD) and corresponding treatment have been firmly established. The aim of this study was to evaluate the relationship between numerous risk factors and the incidence of surgery for RCD in a large cohort. METHODS A population-based cohort of people aged between 40 and 69 years in the UK (the UK Biobank) was studied. People who underwent surgery for RCD were identified through a link with NHS inpatient records covering a mean of eight years after enrolment. Multivariate Cox proportional hazards regression was used to calculate hazard ratios (HRs) as estimates of associations with surgery for RCD accounting for confounders. The risk factors which were considered included age, sex, race, education, Townsend deprivation index, body mass index (BMI), occupational demands, and exposure to smoking. RESULTS Of the 421,894 people who were included, 47% were male. The mean age at the time of enrolment was 56 years (40 to 69). A total of 2,156 people were identified who underwent surgery for RCD. Each decade increase in age was associated with a 55% increase in the incidence of RCD surgery (95% confidence interval (CI) 46% to 64%). Male sex, non-white race, lower deprivation score, and higher BMI were significantly associated with a higher risk of surgery for RCD (all p < 0.050). Greater occupational physical demands were significantly associated with higher rates of RCD surgery (HR = 2.1, 1.8, and 1.4 for 'always', 'usually', and 'sometimes' doing heavy manual labour vs 'never', all p < 0.001). Former smokers had significantly higher rates of RCD surgery than those who had never smoked (HR 1.23 (95% CI 1.12 to 1.35), p < 0.001), while current smokers had similar rates to those who had never smoked (HR 0.94 (95% CI 0.80 to 1.11)). Among those who had never smoked, the risk of surgery was higher among those with more than one household member who smoked (HR 1.78 (95% CI 1.08 to 2.92)). The risk of RCD surgery was not significantly related to other measurements of secondhand smoking. CONCLUSION Many factors were independently associated with surgery for RCD, including older age, male sex, higher BMI, lower deprivation score, and higher occupational physical demands. Several of the risk factors which were identified are modifiable, suggesting that the healthcare burden of RCD might be reduced through the pursuit of public health goals, such as reducing obesity and modifying occupational demands. Cite this article: Bone Joint J 2020;102-B(3):352-359.
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Affiliation(s)
- Elizabeth L Yanik
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA; Assistant Professor, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Graham A Colditz
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nancy L Saccone
- Department of Genetics and Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bradley A Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nitin B Jain
- Department of Physical Medicine and Rehabilitation and Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ann Marie Dale
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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14
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Ashir A, Ma Y, Jerban S, Jang H, Wei Z, Le N, Du J, Chang EY. Rotator Cuff Tendon Assessment in Symptomatic and Control Groups Using Quantitative MRI. J Magn Reson Imaging 2020; 52:864-872. [PMID: 32129560 DOI: 10.1002/jmri.27115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Relatively weak correlations between patient symptoms and rotator cuff tendon (RCT) tearing have been reported; however, the relationship between symptoms and tendinosis has been less well-studied. PURPOSE/HYPOTHESIS To use quantitative MRI to assess the bilateral RCTs in shoulders of both patients with unilateral symptomatic tendinopathy and control subjects. We hypothesized that quantitative MRI measures would differ between symptomatic patients and controls. STUDY TYPE Prospective imaging study. POPULATION/SUBJECTS In all, 48 shoulders from 24 subjects (mean age, 32.8 years), including 14 patients with unilateral symptomatic tendinopathy and 10 asymptomatic controls. FIELD STRENGTH/SEQUENCE 3T/3D ultrashort echo time Cones sequence with magnetization transfer preparation (UTE-Cones-MT) and Carr-Purcell-Meiboom-Gill. ASSESSMENT Macromolecular fraction (MMF) and T2 relaxation were measured in four regions of the superior RCT, including all-segments, and lateral-third, bursal-sided, and articular-sided segments. The Western Ontario Rotator Cuff (WORC) index and visual analog scale were assessed. STATISTICAL TESTS Three shoulder groups were evaluated, including symptomatic shoulders, contralateral asymptomatic shoulders in patients, and asymptomatic controls. MMF and T2 values were compared between groups using a bootstrap-based comparison of means. RESULTS Significant differences were found in both MMF and T2 values between symptomatic and control RCTs when analyzing all-segments (P = 0.027 and P = 0.006, respectively) and articular-sided segments (both P = 0.001). Significant differences between asymptomatic RCTs in patients and control RCTs were also found, including MMF in all four anatomic regions analyzed (P = 0.024-0.044), as well as T2 in all-segments (P = 0.003), bursal-sided segments (P = 0.021), and articular-sided segments (P = 0.002). No significant differences in MMF (P = 0.420-0.950) or T2 (P = 0.380-0.910) were seen between ipsilateral symptomatic and contralateral asymptomatic RCTs in patients. DATA CONCLUSION Symptomatic RCTs showed significantly lower MMF values and higher T2 values compared with control RCTs. In patients with unilateral symptomatic tendinopathy, the contralateral shoulder can demonstrate asymptomatic tendinopathy, which can be quantified using MMF or T2 . EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2. J. Magn. Reson. Imaging 2020;52:864-872.
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Affiliation(s)
- Aria Ashir
- Department of Radiology, University of California, San Diego, California, USA.,Research Service, VA San Diego Healthcare System, San Diego, California, USA.,College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, California, USA
| | - Saeed Jerban
- Department of Radiology, University of California, San Diego, California, USA
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, California, USA
| | - Zhao Wei
- Department of Radiology, University of California, San Diego, California, USA
| | - Nicole Le
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, California, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, California, USA.,Research Service, VA San Diego Healthcare System, San Diego, California, USA
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15
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Schemitsch C, Chahal J, Vicente M, Nowak L, Flurin PH, Lambers Heerspink F, Henry P, Nauth A. Surgical repair versus conservative treatment and subacromial decompression for the treatment of rotator cuff tears. Bone Joint J 2019; 101-B:1100-1106. [DOI: 10.1302/0301-620x.101b9.bjj-2018-1591.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aims The purpose of this study was to compare the effectiveness of surgical repair to conservative treatment and subacromial decompression for the treatment of chronic/degenerative tears of the rotator cuff. Materials and Methods PubMed, Cochrane database, and Medline were searched for randomized controlled trials published until March 2018. Included studies were assessed for methodological quality, and data were extracted for statistical analysis. The systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results Six studies were included. Surgical repair resulted in a statistically significantly better Constant–Murley Score (CMS) at one year compared with conservative treatment (mean difference 6.15; p = 0.002) and subacromial decompression alone (mean difference 5.81; p = 0.0004). In the conservatively treated group, 11.9% of patients eventually crossed over to surgical repair. Conclusion The results of this review show that surgical repair results in significantly improved outcomes when compared with either conservative treatment or subacromial decompression alone for degenerative rotator cuff tears in older patients. However, the magnitude of the difference in outcomes between surgery and conservative treatment may be small and the ‘success rate’ of conservative treatment may be high, allowing surgeons to be judicious in choosing those patients who are most likely to benefit from surgery. Cite this article: Bone Joint J 2019;101-B:1100–1106.
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Affiliation(s)
- C. Schemitsch
- University of Toronto, St. Michael’s Hospital, Toronto, Canada
| | - J. Chahal
- Department of Surgery, University of Toronto, Toronto Western Hospital, Toronto, Canada
| | | | - L. Nowak
- University of Toronto, St. Michael’s Hospital, Toronto, Canada
| | - P-H. Flurin
- Bordeaux-Mérignac Sport Clinic, Mérignac, France
| | | | - P. Henry
- Department of Surgery, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - A. Nauth
- Department of Surgery, University of Toronto, St. Michael’s Hospital, Toronto, Canada
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16
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Abstract
Asymptomatic rotator cuff tears (RCTs) are prevalent in the general population; they are positively associated with age and are common in the contralateral shoulder of individuals who are being treated for shoulder pain or a symptomatic RCT. Asymptomatic RCTs are likely to become symptomatic over time, corresponding with decreased patient-reported function, strength, and range of motion. Previous studies have largely reported inconsistent findings regarding patient-reported outcomes, strength, range of motion, and kinematics in individuals with asymptomatic RCTs. Future research would benefit from characterizing any functional alteration that is associated with asymptomatic rotator cuff pathology, including determining whether such alterations are detrimental or compensatory and understanding the mechanism by which an asymptomatic RCT becomes symptomatic.
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Affiliation(s)
- Rebekah L Lawrence
- Department of Orthopaedic Surgery, Bone & Joint Center, Henry Ford Health System, Detroit, Michigan
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17
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Matsen FA, Whitson A, Jackins SE, Hsu JE. Significant improvement in patient self-assessed comfort and function at six weeks after the smooth and move procedure for shoulders with irreparable rotator cuff tears and retained active elevation. INTERNATIONAL ORTHOPAEDICS 2019; 43:1659-1667. [PMID: 30903255 DOI: 10.1007/s00264-019-04310-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND It has been documented that the smooth and move procedure-smoothing the proximal humeral surface while maintaining the coracoacromial arch-can provide clinically significant long-term improvement in function for patients having irreparable rotator cuff tears with retained active elevation. This study sought to demonstrate that clinically significant gains in comfort, function, and active motion can be realized as early as 6 weeks after this procedure. METHODS We conducted a prospective cohort study of the 6-week clinical outcomes for 48 patients enrolled prior to a smooth and move procedure for irreparable rotator cuff tears. Prior rotator cuff repair had been attempted in 28 (70%). RESULTS In 40 patients with preoperative and 6-week postoperative measurements, the Simple Shoulder Test scores improved from an average of 3.4 ± 2.8 preoperatively to 5.7 ± 3.5 at 6 weeks (p < 0.001), an improvement that exceeded the published values for the minimal clinically important difference (MCID). The clinical outcomes were not worse for the 18 shoulders with irreparable tears of both the supraspinatus and infraspinatus. In 30 patients with preoperative and 6-week postoperative objective measurements of active motion, the average abduction improved from 93(± 43) to 123(± 47)° (p = 0.005) and the average flexion improved from 102(± 46) to 126(± 44)° (p = 0.023). CONCLUSIONS In addition to its previously documented long-term effectiveness for shoulders with irreparable rotator cuff tears and retained active elevation, this study demonstrates that the smooth and move procedure provides clinically significant improvement as early as 6 weeks after surgery.
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA.
| | - Anastasia Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA
| | - Sarah E Jackins
- Department of Rehabilitation, University of Washington, 1959 NE Pacific St., Box 354745, Seattle, WA, 98195, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA
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18
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Jenssen KK, Lundgreen K, Madsen JE, Kvakestad R, Dimmen S. Prognostic Factors for Functional Outcome After Rotator Cuff Repair: A Prospective Cohort Study With 2-Year Follow-up. Am J Sports Med 2018; 46:3463-3470. [PMID: 30383411 DOI: 10.1177/0363546518803331] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although shoulder function is reported to be generally good after rotator cuff repair, limited knowledge exists regarding which prognostic factors predict functional outcomes. PURPOSE To identify pre- and perioperative predictors of functional outcomes after arthroscopic rotator cuff repair. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A cohort of 733 consecutive patients treated with rotator cuff repair between 2010 and 2014 in a single orthopaedics unit was included. Data were collected prospectively and included pre- and perioperative variables. Univariate and multivariable linear regression analyses were used to predict shoulder function at 2-year follow-up, as measured by the Western Ontario Rotator Cuff Index (WORC). RESULTS In total, 647 (88%) patients were followed for 25 ± 5 months (mean ± SD; range, 17-66 months). In the multivariable regression model, the adjusted R2 was 0.360, indicating that 36% of the variation in the WORC at final follow-up could be explained by this statistical model. The multivariable linear regression analysis revealed that the strongest positive independent predictors of shoulder function at 2 years were preoperative WORC and Constant-Murley score in the contralateral shoulder. The model also indicated that activities of daily living, age, subacromial decompression, and biceps surgery had independent positive associations with better shoulder function at 2 years. In addition, previous surgery in the ipsilateral or contralateral shoulder, smoking, partial rotator cuff repair, preoperative pain, and atrophy in the infraspinatus were all independent factors negatively associated with shoulder function after 2 years. The overall healing rate of complete repairs per magnetic resonance imaging was 80%. CONCLUSION The most important finding of the present study was that the strongest prognostic factors for better WORC at 2-year follow-up were better preoperative WORC and Constant-Murley score in the contralateral shoulder. Although not all the prognostic factors identified in this study are modifiable, they can still be useful for guiding patients in shared decision making with the surgeon. This cohort study shows that if selection of patients is performed properly, it is possible to obtain a successful outcome.
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19
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Kuffler DP. Differing efficacies of autologous platelet-rich plasma treatment in reducing pain following rotator-cuff injury in a single patient. J Pain Res 2018; 11:2239-2245. [PMID: 30349350 PMCID: PMC6186771 DOI: 10.2147/jpr.s169647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rotator-cuff tears (RCTs) are typically associated with chronic pain. The most common treatment for reducing pain is the injection of cortisone into the injury site. An alternative and increasingly used technique is the injection of autologous platelet-rich plasma (PRP). A limitation of cortisone is its pain relief is short-lived, while PRP has the limitation of providing pain relief to only about 50% of patients, making its efficacy questioned, although when it is effective, its efficacy is longer than cortisone. Little is known about what accounts for these limitations. This paper presents results from a patient with RCTs causing excruciating pain who received an injection of PRP into that shoulder resulting in complete pain elimination that was ongoing at 2 years and 2 months. When 7-month severe posttrauma pain associated with the RCT developed in the contralateral shoulder, PRP prepared the same way and injected by the same person who performed the first injection provided no pain relief. However, a subsequent single cortisone injection resulted in complete pain elimination, which was ongoing at >15 months. These observations indicate that PRP can have inconsistent effects in reducing pain, not only between patients but also within the same patient. Further, although the pain relief induced by cortisone is normally not long-lasting, when given following a PRP injection, it can induce complete pain relief lasting >15 months. This paper discusses possible reasons for the variability in PRP efficacy on pain relief and addresses the possibility that when administered together, PRP and cortisone may act in a complementary manner, leading to significantly greater and longer-lasting pain relief.
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Affiliation(s)
- Damien P Kuffler
- Institute of Neurobiology, Medical Sciences Campus, University of Puerto Rico, San Juan 00901, Puerto Rico,
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20
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Ranebo MC, Björnsson Hallgren HC, Norlin R, Adolfsson LE. Long-term clinical and radiographic outcome of rotator cuff repair with a synthetic interposition graft: a consecutive case series with 17 to 20 years of follow-up. J Shoulder Elbow Surg 2018; 27:1622-1628. [PMID: 29731397 DOI: 10.1016/j.jse.2018.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/15/2018] [Accepted: 03/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment options for irreparable cuff tears include synthetic interposition grafts, but whether such grafts can maintain acceptable shoulder function and prevent cuff tear arthropathy in the long-term is unknown. METHOD This was a retrospective case series of 13 consecutive patients treated with a synthetic interposition graft made of Dacron (DuPont, Wilmington, DE, USA). Patients were examined with bilateral ultrasonography, bilateral x-ray imaging, Constant-Murley score, and Western Ontario Rotator Cuff score. RESULTS After a mean of 18 years (range, 17-20 years), 1 patient had died, and 12 were available for x-ray imaging and 10 also for ultrasonography and clinical scores. Cuff tear arthropathy (Hamada grade ≥2) had developed in 9 of 12 (75%; 95% confidence interval, 43%-95%), including 3 patients operated on with arthroplasty in the follow-up period. The mean absolute Constant-Murley score was 46 (standard deviation, 26), and the mean Western Ontario Rotator Cuff score was 59 (standard deviation, 20). In 7 of 10 patients (70%) with available ultrasonography, the graft was interpreted as not intact. All patients had a contralateral full-thickness tear, and 7 of 12 patients (58 %; 95% confidence interval, 28%-85%) had contralateral cuff tear arthropathy. The number of patients with cuff tear arthropathy was not significantly different between the shoulder repaired with a Dacron graft and the contralateral shoulder (P = .667). CONCLUSION These results indicate that a synthetic interposition graft with screw fixation could not prevent cuff tear arthropathy and preserve cuff integrity in a long-term perspective.
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Affiliation(s)
- Mats C Ranebo
- Department of Orthopedics, Kalmar County Hospital, Kalmar, Sweden; Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | | | - Rolf Norlin
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Lars E Adolfsson
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Orthopedics, Linköping University Hospital, Linköping, Sweden
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21
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Ranebo MC, Björnsson Hallgren HC, Adolfsson LE. Patients with a long-standing cuff tear in one shoulder have high rates of contralateral cuff tears: a study of patients with arthroscopically verified cuff tears 22 years ago. J Shoulder Elbow Surg 2018; 27:e68-e74. [PMID: 29249548 DOI: 10.1016/j.jse.2017.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of contralateral full-thickness cuff tears (FTTs) and cuff tear arthropathy (CTA) is presumed to be higher in patients with long-standing cuff tears than in those with newly diagnosed tears, but data are currently lacking. METHODS Sixty-one patients with 38 partial and 23 full-thickness tears of 1 shoulder at arthroscopy were examined with bilateral radiographs, ultrasound, and the Constant-Murley score at a mean of 22 years (range, 21-25 years) after arthroscopy. RESULTS The overall rate of full-thickness tears in the contralateral shoulder was 50.8%. In patients with a full-thickness tear and CTA (Hamada grade ≥2) in the index shoulder at follow-up, 18 of 20 (90%) had a contralateral full-thickness tear and 4 of 20 (20%) had CTA. In patients with a partial tear in the index shoulder at follow-up, 3 of 22 (13.6%) had a contralateral full-thickness tear and none had CTA. CTA changes were more common in patients with FTT and a previous acromioplasty (P < .001). The correlation between shoulders was 0.72 for the number of tendons with FTT (P <.001), 0.31 for the Hamada grade (P = .016), and 0.65 for the absolute Constant-Murley score (P <.001). The number of tendons with a full-thickness tear at follow-up was a risk factor (odds ratio, 3.28; 95% confidence interval, 1.67-6.44; P <.001) for a contralateral full-thickness tear. Patients with a partial or full-thickness tear in the contralateral shoulder had pain in 39.2% of cases. CONCLUSION Patients with long-standing cuff tears have high rates of contralateral cuff tears. The severity of the condition is strongly correlated between the shoulders. Patients with full-thickness tears and a previous acromioplasty have a significantly higher frequency of CTA than patients with cuff tears who had not undergone a previous acromioplasty.
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Affiliation(s)
- Mats C Ranebo
- Department of Orthopedics, Kalmar County Hospital, Kalmar, Sweden; Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
| | | | - Lars E Adolfsson
- Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Orthopedics, Linkoping University Hospital, Linköping, Sweden
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Valencia AP, Iyer SR, Spangenburg EE, Gilotra MN, Lovering RM. Impaired contractile function of the supraspinatus in the acute period following a rotator cuff tear. BMC Musculoskelet Disord 2017; 18:436. [PMID: 29121906 PMCID: PMC5679320 DOI: 10.1186/s12891-017-1789-5] [Citation(s) in RCA: 8] [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: 06/16/2017] [Accepted: 10/26/2017] [Indexed: 01/16/2023] Open
Abstract
Background Rotator cuff (RTC) tears are a common clinical problem resulting in adverse changes to the muscle, but there is limited information comparing histopathology to contractile function. This study assessed supraspinatus force and susceptibility to injury in the rat model of RTC tear, and compared these functional changes to histopathology of the muscle. Methods Unilateral RTC tears were induced in male rats via tenotomy of the supraspinatus and infraspinatus. Maximal tetanic force and susceptibility to injury of the supraspinatus muscle were measured in vivo at day 2 and day 15 after tenotomy. Supraspinatus muscles were weighed and harvested for histologic analysis of the neuromuscular junction (NMJ), intramuscular lipid, and collagen. Results Tenotomy resulted in eventual atrophy and weakness. Despite no loss in muscle mass at day 2 there was a 30% reduction in contractile force, and a decrease in NMJ continuity and size. Reduced force persisted at day 15, a time point when muscle atrophy was evident but NMJ morphology was restored. At day 15, torn muscles had decreased collagen-packing density and were also more susceptible to contraction-induced injury. Conclusion Muscle size and histopathology are not direct indicators of overall RTC contractile health. Changes in NMJ morphology and collagen organization were associated with changes in contractile function and thus may play a role in response to injury. Although our findings are limited to the acute phase after a RTC tear, the most salient finding is that RTC tenotomy results in increased susceptibility to injury of the supraspinatus.
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Affiliation(s)
- Ana P Valencia
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Rm 540, 100 Penn St., Baltimore, MD, 21201, USA.,Department of Kinesiology, University of Maryland School of Public Health, College Park, USA
| | - Shama R Iyer
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Rm 540, 100 Penn St., Baltimore, MD, 21201, USA
| | - Espen E Spangenburg
- Department of Physiology, East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Rm 540, 100 Penn St., Baltimore, MD, 21201, USA
| | - Richard M Lovering
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Rm 540, 100 Penn St., Baltimore, MD, 21201, USA.
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23
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Meroni R, Piscitelli D, Valerio S, Boria P, Perin C, De Vito G, Cornaggia CM, Cerri CG. Ultrasonography of the shoulder: asymptomatic findings from working-age women in the general population. J Phys Ther Sci 2017; 29:1219-1223. [PMID: 28744052 PMCID: PMC5509596 DOI: 10.1589/jpts.29.1219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/27/2017] [Indexed: 12/19/2022] Open
Abstract
[Purpose] The aim of this study was to estimate the prevalence of abnormal shoulder
ultrasonographic findings in a sample of asymptomatic women. [Subjects and Methods] A
secondary analysis of a cross-sectional study was performed. We recruited 305 women (aged
18–56 years). All the subjects had a structured interview screening for self-reported
symptoms and underwent a shoulder ultrasonographic examination, in which both shoulders
were examined. The radiologist was blinded to the clinical history of the participants.
All detectable shoulder abnormalities were collected. [Results] Of the subjects, 228
(74.75%) were asymptomatic at both shoulders, and 456 asymptomatic shoulders were
analyzed. Lack of uniformity (supraspinatus, infraspinatus, subscapularis, and biceps
brachii long head) was found in 28 shoulders (6.14%), 19 (4.17%) on the dominant side and
9 (1.97%) on the non-dominant side. Tendinosis (supraspinatus, infraspinatus,
subscapularis, and biceps brachii long head) was found in 19 shoulders (5.32%), 12 (2.63%)
on the dominant side and 7 (1.53%) on the non-dominant side. Calcification and other
abnormal findings were reported. [Conclusion] The most common abnormalities were
calcifications within the rotator-cuff tendons and humeral head geodes; other degenerative
findings were less common.
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Affiliation(s)
- Roberto Meroni
- School of Medicine and Surgery, University of Milano Bicocca, Italy
| | | | | | - Paola Boria
- Occupational Medicine, Private Practice, Italy
| | - Cecilia Perin
- School of Medicine and Surgery, University of Milano Bicocca, Italy
| | - Giovanni De Vito
- School of Medicine and Surgery, University of Milano Bicocca, Italy
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Vrouva S, Batistaki C, Koutsioumpa E, Kostopoulos D, Stamoulis E, Kostopanagiotou G. The Greek version of Shoulder Pain and Disability Index (SPADI): translation, cultural adaptation, and validation in patients with rotator cuff tear. J Orthop Traumatol 2016; 17:315-326. [PMID: 27623841 PMCID: PMC5071243 DOI: 10.1007/s10195-016-0425-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/02/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study aimed to translate and culturally adapt a Greek version of the Shoulder Pain and Disability Index (SPADI) questionnaire and to validate its usage in Greek patients. MATERIALS AND METHODS A forward and backward translation was performed, and the final version of the Greek questionnaire was administered to 134 outpatients (mean age 47.4 ± 14.5) with rotator cuff tear under conservative treatment. The questionnaire was re-administered 2-5 days later to assess test-retest reliability. Patients completed the Greek SPADI, the Greek version of the Quick DASH (Disability of the Arm, Shoulder and Hand Questionnaire) and the EuroQoL EQ-5D. 102 of the 134 questionnaires were considered valid. RESULTS The internal consistencies of the SPADI total and its subscales measured with Cronbach's alpha coefficient were high (0.932 for SPADI-Total, 0.899 for SPADI-Disability, 0.905 for SPADI-Pain). Intraclass correlation coefficients showed excellent test-retest reliability (0.899 for Disability, 0.902 for Pain, and 0.929 for total SPADI). A significantly high positive correlation was found between the SPADI total score and its subscales, and Quick DASH for Pain and Disability. Significant correlations were also found between SPADI scales and EQ-5D variables. There was a moderate positive correlation with the variables "self-reliance" (r = 0.66), "common activities" (r = 0.58), and "pain/discomfort" (r = 0.49), and a weaker correlation with the "mobility" variable (r = 0.20). Factor analysis (PAF method) revealed a bidimensional formation of the SPADI. Eight items (five pain/three disability) weighted the first factor by >0.5, and five disability items weighted the second factor. CONCLUSIONS The Greek SPADI represents a valid and reliable tool for measuring pain and disability in patients with painful shoulder disorders. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- S Vrouva
- 2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Str, Athens, 12462, Greece
- Department of Physical Therapy, 401 Army General Hospital of Athens, Athens, Greece
| | - C Batistaki
- 2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Str, Athens, 12462, Greece.
| | - E Koutsioumpa
- Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - D Kostopoulos
- 1st Department of Orthopedics, 401 Army General Hospital of Athens, Athens, Greece
| | - E Stamoulis
- Department of Radiology, 401 Army General Hospital of Athens, Athens, Greece
| | - G Kostopanagiotou
- 2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Str, Athens, 12462, Greece
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Cherchi L, Ciornohac JF, Godet J, Clavert P, Kempf JF. Critical shoulder angle: Measurement reproducibility and correlation with rotator cuff tendon tears. Orthop Traumatol Surg Res 2016; 102:559-62. [PMID: 27238292 DOI: 10.1016/j.otsr.2016.03.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 02/28/2016] [Accepted: 03/21/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Associations have been reported linking rotator cuff tears (RCTs) to both greater lateral extension of the acromion and greater inclination of the glenoid cavity. These two factors combined can be assessed using a recently introduced parameter, the critical shoulder angle (CSA). The primary objective of this study was to confirm the association linking a high CSA value to RCTs, and the secondary objective was to assess the reproducibility of CSA measurement using a goniometer. HYPOTHESIS The null hypothesis was that the CSA value in a group of patients with RCTs was not significantly different from that in patients with anterior shoulder instability and a Bankart lesion, taken as the general population for this study. METHODS After a power estimation, we retrospectively included 28 patients with a mean age of 55.5 years who had surgery for RCTs and 27 patients with a mean age of 27.2 years who underwent anterior labral repair. Two surgeons used a goniometer to measure the CSA in each patient. Reproducibility was assessed based on Bland-Altman plots and Pearson's correlation coefficient. RESULTS The mean CSA was significantly higher (P=0.02) in the RCT group (36.4°±4.4°; range: 30°-46°) than in the labral-repair group (33.3°±3.8°; range: 25°-41°). Intra-observer reproducibility was 96.7% and inter-observer reproducibility was 95.5%. CONCLUSION Our results support previously published evidence that the CSA is significantly greater in patients with RCTs. Thus, an anatomical difference seems to exist between patients with RCTs and the general population. The CSA measured on a standard radiograph using a goniometer provides a reproducible assessment of this anatomical difference. LEVEL OF EVIDENCE IV, case-control epidemiological study with a power estimation.
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Affiliation(s)
- L Cherchi
- Service de chirurgie de l'épaule et du coude, Centre de chirurgie orthopédique et de la main, CHRU de Strasbourg, avenue Baumann, 76400 Illkirch-Graffenstaden, France.
| | - J F Ciornohac
- Service de chirurgie de l'épaule et du coude, Centre de chirurgie orthopédique et de la main, CHRU de Strasbourg, avenue Baumann, 76400 Illkirch-Graffenstaden, France
| | - J Godet
- Département de santé publique, secteur biostatistiques et méthodologie, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France
| | - P Clavert
- Service de chirurgie de l'épaule et du coude, Centre de chirurgie orthopédique et de la main, CHRU de Strasbourg, avenue Baumann, 76400 Illkirch-Graffenstaden, France; Fédération de médecine translationnelle, FMTS, faculté de médecine de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | - J-F Kempf
- Service de chirurgie de l'épaule et du coude, Centre de chirurgie orthopédique et de la main, CHRU de Strasbourg, avenue Baumann, 76400 Illkirch-Graffenstaden, France; Fédération de médecine translationnelle, FMTS, faculté de médecine de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France
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The Incidence of Subsequent Surgery After Outpatient Arthroscopic Rotator Cuff Repair. Arthroscopy 2016; 32:1531-41. [PMID: 27039214 DOI: 10.1016/j.arthro.2016.01.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/13/2015] [Accepted: 01/15/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To quantify the incidence and risk factors associated with subsequent shoulder procedures in individuals undergoing outpatient arthroscopic rotator cuff repair (ARCR). METHODS We examined the New York Statewide Planning and Research Cooperative Systems outpatient database from 2003 through 2014 to identify patients undergoing isolated ARCR with or without concomitant acromioplasty. Patients were longitudinally followed up for a minimum of 2 years to determine the incidence of subsequent ipsilateral shoulder surgery. The impact of age, sex, insurance, concomitant acromioplasty, and tobacco use on reoperation was explored. RESULTS Between 2003 and 2012, 30,430 patients underwent isolated ARCR. The mean age was 56.6 ± 11.5 years, and 55.1% were male patients. A total of 1,826 patients (6.0%) underwent subsequent ipsilateral outpatient shoulder surgery a mean of 24.3 ± 27.1 months after the initial ARCR. Of patients who underwent repeat surgery, 57.3% underwent a revision cuff repair. Patients who underwent additional outpatient shoulder surgery were significantly younger (53.7 ± 10.9 years v 56.8 ± 11.5 years, P < .001). Tobacco use was associated with an increased rate of subsequent surgery (7.3% v 5.9%, P = .044) and accelerated time to reoperation (16.9 months v 24.7 months, P < .001). Independent risk factors for subsequent ipsilateral surgery after initial ARCR were presence of a Workers' Compensation claim (odds ratio, 2.11; 95% confidence interval, 1.89-2.36; P < .001) and initial ARCR without acromioplasty (odds ratio, 1.20; 95% confidence interval, 1.09-1.34; P < .001). CONCLUSIONS We identified a 6.0% incidence of repeat ipsilateral surgery after isolated ARCR. Although reasons for reoperation are likely multifactorial, younger age, Workers' Compensation claim, and absence of acromioplasty at the time of initial ARCR remained independent predictors of subsequent outpatient procedures, whereas a history of tobacco use was associated with accelerated time to subsequent surgery. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Vidt ME, Santago AC, Tuohy CJ, Poehling GG, Freehill MT, Kraft RA, Marsh AP, Hegedus EJ, Miller ME, Saul KR. Assessments of Fatty Infiltration and Muscle Atrophy From a Single Magnetic Resonance Image Slice Are Not Predictive of 3-Dimensional Measurements. Arthroscopy 2016; 32:128-39. [PMID: 26391648 PMCID: PMC4706774 DOI: 10.1016/j.arthro.2015.06.035] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 06/16/2015] [Accepted: 06/19/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To (1) determine whether standard clinical muscle fatty infiltration and atrophy assessment techniques using a single image slice for patients with a rotator cuff tear (RCT) are correlated with 3-dimensional measures in older individuals (60+ years) and (2) to determine whether age-associated changes to muscle morphology and strength are compounded by an RCT. METHODS Twenty older individuals were studied: 10 with an RCT of the supraspinatus (5 men and 5 women) and 10 matched controls. Clinical imaging assessments (Goutallier and Fuchs scores and cross-sectional area ratio) were performed for participants with RCTs. Three-dimensional measurements of rotator cuff muscle and fat tissues were obtained for all participants using magnetic resonance imaging (MRI). Isometric joint moment was measured at the shoulder. RESULTS There were no significant associations between single-image assessments and 3-dimensional measurements of fatty infiltration for the supraspinatus and infraspinatus muscles. Compared with controls, participants with RCTs had significantly increased percentages of fatty infiltration for each rotator cuff muscle (all P ≤ .023); reduced whole muscle volume for the supraspinatus, infraspinatus, and subscapularis muscles (all P ≤ .038); and reduced fat-free muscle volume for the supraspinatus, infraspinatus, and subscapularis muscles (all P ≤ .027). Only the teres minor (P = .017) fatty infiltration volume was significantly greater for participants with RCTs. Adduction, flexion, and external rotation strength (all P ≤ .021) were significantly reduced for participants with RCTs, and muscle volume was a significant predictor of strength for all comparisons. CONCLUSIONS Clinical scores using a single image slice do not represent 3-dimensional muscle measurements. Efficient methods are needed to more effectively capture 3-dimensional information for clinical applications. Participants with RCTs had increased fatty infiltration percentages that were likely driven by muscle atrophy rather than increased fat volume. The significant association of muscle volume with strength production suggests that treatments to preserve muscle volume should be pursued for older patients with RCTs. LEVEL OF EVIDENCE Level II, diagnostic study, with development of diagnostic criteria on the basis of consecutive patients with universally applied reference gold standard.
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Affiliation(s)
- Meghan E. Vidt
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Anthony C. Santago
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA,Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
| | - Christopher J. Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gary G. Poehling
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael T. Freehill
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Robert A. Kraft
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Anthony P. Marsh
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA,Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Eric J. Hegedus
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Michael E. Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katherine R. Saul
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
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28
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Sambandam SN, Khanna V, Gul A, Mounasamy V. Rotator cuff tears: An evidence based approach. World J Orthop 2015; 6:902-918. [PMID: 26716086 PMCID: PMC4686437 DOI: 10.5312/wjo.v6.i11.902] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/04/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, cost-effective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.
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