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Bindi VE, Hao KA, Freeman DA, Olowofela BO, Moser MW, Farmer KW, Pazik M, Roach RP. Comparison of Pain Scores and Functional Outcomes of Patients Undergoing Arthroscopic Hip Labral Repair and Concomitant Capsular Repair or Plication Versus No Closure. Orthop J Sports Med 2024; 12:23259671241243303. [PMID: 38646603 PMCID: PMC11032060 DOI: 10.1177/23259671241243303] [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: 09/24/2023] [Accepted: 10/11/2023] [Indexed: 04/23/2024] Open
Abstract
Background The need for capsular closure during arthroscopic hip labral repair is debated. Purpose To compare pain and functional outcomes in patients undergoing arthroscopic hip labral repair with concomitant repair or plication of the capsule versus no closure. Study Design Cohort study. Methods Outcomes were compared between patients undergoing arthroscopic hip labral repair with concomitant repair or plication of the capsule versus no closure at up to 2 years postoperatively and with stratification by age and sex. Patients with lateral center-edge angle <20°, a history of instability, a history of prior arthroscopic surgery in the ipsilateral hip, or a history of labral debridement only were excluded. Subanalysis was performed between patients undergoing no capsular closure who were propensity score matched 1:1 with patients undergoing repair or plication based on age, sex, and preoperative Modified Harris Hip Score (MHHS). We compared patients who underwent T-capsulotomy with concomitant capsular closure matched 1:5 with patients who underwent an interportal capsulotomy with concomitant capsular repair based on age, sex, and preoperative MHHS. Results Patients undergoing capsular closure (n = 1069), compared with the no-closure group (n = 230), were more often female (68.6% vs 53.0%, respectively; P < .001), were younger (36.4 ± 13.3 vs 47.9 ± 14.7 years; P < .001), and had superior MHHS scores at 2 years postoperatively (85.8 ± 14.5 vs 81.8 ± 18.4, respectively; P = .020). In the matched analysis, no difference was found in outcome measures between patients in the capsular closure group (n = 215) and the no-closure group (n = 215) at any follow-up timepoint. No significant difference was seen between the 2 closure techniques at any follow-up timepoint. Patients with closure of the capsule achieved the minimal clinically important difference (MCID) and the patient acceptable symptom state (PASS) for the 1-year MHHS at a similar rate as those without closure (MCID, 50.3% vs 44.9%, P = .288; PASS, 56.8% vs 51.1%, P = .287, respectively). Patients with T-capsulotomy achieved the MCID and the PASS for the 1-year MHHS at a similar rate compared with those with interportal capsulotomy (MCID, 50.1% vs 44.9%, P = .531; PASS, 65.7% vs 61.2%, P = .518, respectively). Conclusion When sex, age, and preoperative MHHS were controlled, capsular closure and no capsular closure after arthroscopic hip labral repair were associated with similar pain and functional outcomes for patients up to 2 years postoperatively.
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Affiliation(s)
- Victoria E. Bindi
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Kevin A. Hao
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - David A. Freeman
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Michael W. Moser
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Kevin W. Farmer
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Marissa Pazik
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Ryan P. Roach
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
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Hones KM, Hao KA, Trammell AP, Wright JO, Wright TW, Vasilopoulos T, Schoch BS, King JJ. Clinical outcomes of anatomic vs. reverse total shoulder arthroplasty in primary osteoarthritis with preoperative external rotation weakness and an intact rotator cuff: a case-control study. J Shoulder Elbow Surg 2024; 33:e185-e197. [PMID: 37660887 DOI: 10.1016/j.jse.2023.07.039] [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: 05/06/2023] [Revised: 07/21/2023] [Accepted: 07/29/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) are well-established treatments for patients with primary osteoarthritis and an intact cuff. However, it is unclear whether aTSA or rTSA provides superior outcomes in patients with preoperative external rotation (ER) weakness. METHODS A retrospective review of a prospectively collected shoulder arthroplasty database was performed between 2007 and 2020. Patients were excluded for preoperative diagnoses of nerve injury, infection, tumor, or fracture. The analysis included 333 aTSAs and 155 rTSAs performed for primary cuff-intact osteoarthritis with 2-year minimum follow-up. Defining preoperative ER weakness as strength <3.3 kilograms (7.2 pounds), 3 cohorts were created and matched: (1) weak aTSAs (n = 74) vs. normal aTSAs (n = 74), (2) weak rTSAs (n = 38) vs. normal rTSAs (n = 38), and (3) weak rTSAs (n = 60) vs. weak aTSAs (n = 60). We compared range of motion, outcome scores, strength, complications, and revision rates at the latest follow-up. RESULTS Despite weak aTSAs having poorer preoperative strength in forward elevation and ER (P < .001), neither of these deficits persisted postoperatively compared with the normal cohort. Likewise, weak rTSAs had poorer preoperative strength in forward elevation and ER, overhead motion, and Constant, Shoulder Pain and Disability Index, and University of California, Los Angeles scores (P < .029). However, no statistically significant differences were found between preoperatively weak and normal rTSAs. When comparing weak aTSA vs. weak rTSA, no differences were found in preoperative and postoperative outcomes, proportion of patients achieving the minimal clinically important difference and substantial clinical benefit, and complication and rate of revision surgery. CONCLUSIONS In preoperatively weak patients with cuff-intact primary osteoarthritis, aTSA leads to similar postoperative strength, range of motion, and outcome scores compared with patients with normal preoperative strength, indicating that preoperative weakness does not preclude aTSA use. Furthermore, patients who were preoperatively weak in ER demonstrated improved postoperative rotational motion after undergoing aTSA and rTSA, with both groups achieving the minimal clinically important difference and substantial clinical benefit at similar rates.
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Affiliation(s)
- Keegan M Hones
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Amy P Trammell
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Terrie Vasilopoulos
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA; Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA.
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Turnbull LM, Hao KA, Srinivasan RC, Wright JO, Wright TW, Farmer KW, Vasilopoulos T, Struk AM, Schoch BS, King JJ. Does achieving clinically important thresholds after first shoulder arthroplasty predict similar outcomes of the contralateral shoulder? J Shoulder Elbow Surg 2024; 33:880-887. [PMID: 37690587 DOI: 10.1016/j.jse.2023.08.004] [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: 03/29/2023] [Revised: 07/30/2023] [Accepted: 08/06/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Patients are increasingly undergoing bilateral total shoulder arthroplasty (TSA). At present, it is unknown whether success after the first TSA is predictive of success after contralateral TSA. We aimed to determine whether exceeding clinically important thresholds of success after primary TSA predicts similar outcomes for subsequent contralateral TSA. METHODS We performed a retrospective review of a prospectively collected shoulder arthroplasty database for patients undergoing bilateral primary anatomic (aTSA) or reverse (rTSA) total shoulder arthroplasty since January 2000 with preoperative and 2- or 3-year clinical follow-up. Our primary outcome was whether exceeding clinically important thresholds in the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score for the first TSA was predictive of similar success of the contralateral TSA; thresholds for the ASES score were adopted from prior literature and included the minimal clinically important difference (MCID), the substantial clinical benefit (SCB), 30% of maximal possible improvement (MPI), and the patient acceptable symptomatic state (PASS). The PASS is defined as the highest level of symptom beyond which patients consider themselves well, which may be a better indicator of a patient's quality of life. To determine whether exceeding clinically important thresholds was independently predictive of similar success after second contralateral TSA, we performed multivariable logistic regression adjusted for age at second surgery, sex, BMI, and type of first and second TSA. RESULTS Of the 134 patients identified that underwent bilateral shoulder arthroplasty, 65 (49%) had bilateral rTSAs, 45 (34%) had bilateral aTSAs, 21 (16%) underwent aTSA/rTSA, and 3 (2%) underwent rTSA/aTSA. On multivariable logistic regression, exceeding clinically important thresholds after first TSA was not associated with greater odds of achieving thresholds after second TSA when success was evaluated by the MCID, SCB, and 30% MPI. In contrast, exceeding the PASS after first TSA was associated with 5.9 times greater odds (95% confidence interval 2.5-14.4, P < .001) of exceeding the PASS after second TSA. Overall, patients who exceeded the PASS after first TSA exceeded the PASS after second TSA at a higher rate (71% vs. 29%, P < .001); this difference persisted when stratified by type of prosthesis for first and second TSA. CONCLUSIONS Patients who achieve the ASES score PASS after first TSA have greater odds of achieving the PASS for the contralateral shoulder regardless of prostheses type.
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Affiliation(s)
- Lacie M Turnbull
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin W Farmer
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Terrie Vasilopoulos
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA; Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Aimee M Struk
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA.
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Freeman DA, Hao KA, Hones KM, Olowofela BO, Parrish R, Damrow D, King JJ, Farmer KW, Pazik M, Roach RP. Pain scores and functional outcomes of patients with shoulder labral repair using all-suture anchors versus conventional anchors. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1509-1515. [PMID: 38265743 DOI: 10.1007/s00590-023-03820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
HYPOTHESIS/PURPOSE The purpose of this study was to compare PROMs in patients undergoing anterior glenoid labral repair using all-suture versus conventional anchors. We hypothesized PROMs would be similar between groups. METHODS We performed a retrospective review of the Arthrex Global Surgical Outcomes System (SOS) database, querying patients who underwent arthroscopic glenoid labral repair between 01/01/2015 and 12/31/2020. Patients aged 18-100, who had isolated glenoid labrum repair with at least 12-month follow-up were included. The visual analog pain scale (VAS), Western Ontario Shoulder Instability Index, Veteran's RAND 12-items health survey, single assessment numeric evaluation and the American Shoulder and Elbow Surgeons score (ASES) were compared preoperatively, 3 months, 6 months, 1 year and 2 years postoperatively in patients who received all-suture anchors versus conventional anchors in the setting of anterior glenoid labrum repair. Our primary aim was comparison of PROMs between patients receiving all-suture versus conventional suture anchors. Secondarily, a sub-analysis was performed comparing outcomes based on anchor utilization for patients with noted anterior instability. RESULTS We evaluated 566 patients, 54 patients receiving all-suture anchors and 512 patients receiving conventional anchors. At two-year follow-up there was no significant difference between the two groups in PROMs. In a sub-analysis of isolated anterior labrum repair, there was an improvement in ASES (P = 0.034) and VAS (P = 0.039) with the all-suture anchor at two-year follow-up. CONCLUSIONS All-suture anchors provide similar or superior pain and functional outcome scores up to 2 years postoperatively compared to conventional anchors. CLINICAL RELEVANCE As all-suture anchors gain popularity among surgeons, this is the largest scale study to date validating their use in the setting of glenoid labrum repair. Institutional Review Board (IRB): IRB202102550.
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Affiliation(s)
- David A Freeman
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Keegan M Hones
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | | | - Ryan Parrish
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Derek Damrow
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Kevin W Farmer
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Marissa Pazik
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Roach P Roach
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA.
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Bedi A, Bishop J, Keener J, Lansdown DA, Levy O, MacDonald P, Maffulli N, Oh JH, Sabesan VJ, Sanchez-Sotelo J, Williams RJ, Feeley BT. Rotator cuff tears. Nat Rev Dis Primers 2024; 10:8. [PMID: 38332156 DOI: 10.1038/s41572-024-00492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
Rotator cuff tears are the most common upper extremity condition seen by primary care and orthopaedic surgeons, with a spectrum ranging from tendinopathy to full-thickness tears with arthritic change. Some tears are traumatic, but most rotator cuff problems are degenerative. Not all tears are symptomatic and not all progress, and many patients in whom tears become more extensive do not experience symptom worsening. Hence, a standard algorithm for managing patients is challenging. The pathophysiology of rotator cuff tears is complex and encompasses an interplay between the tendon, bone and muscle. Rotator cuff tears begin as degenerative changes within the tendon, with matrix disorganization and inflammatory changes. Subsequently, tears progress to partial-thickness and then full-thickness tears. Muscle quality, as evidenced by the overall size of the muscle and intramuscular fatty infiltration, also influences symptoms, tear progression and the outcomes of surgery. Treatment depends primarily on symptoms, with non-operative management sufficient for most patients with rotator cuff problems. Modern arthroscopic repair techniques have improved recovery, but outcomes are still limited by a lack of understanding of how to improve tendon to bone healing in many patients.
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Affiliation(s)
- Asheesh Bedi
- Department of Orthopedic Surgery, University of Chicago, Chicago, IL, USA
- NorthShore Health System, Chicago, IL, USA
| | - Julie Bishop
- Department of Orthopedic Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jay Keener
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Drew A Lansdown
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Peter MacDonald
- Department of Surgery, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Vani J Sabesan
- HCA Florida JFK Orthopaedic Surgery Residency Program, Atlantis Orthopedics, Atlantis, FL, USA
| | | | - Riley J Williams
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Brian T Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA.
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Clinker C, Smith KM, Ishikawa H, Joyce C, Tashjian RZ, Chalmers PN. Three-month Delay in Rotator Cuff Repair: 2-year Follow-up. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202401000-00009. [PMID: 38252563 PMCID: PMC10805414 DOI: 10.5435/jaaosglobal-d-23-00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION This study examined 2-year outcomes of patients who underwent delayed rotator cuff repair (RCR) compared with those who underwent RCR without delay. METHODS In this prospective comparative study, two groups were formed: (1) patients planning RCR during a 6-week elective surgery ban and (2) patients undergoing RCR at least 6 weeks after the ban. The Simple Shoulder Test, American Shoulder and Elbow Surgeon score, and visual analog scale for pain were collected preoperatively and at 2 years postoperatively. Magnetic resonance imaging assessed healing 6 months postoperatively. RESULTS With a 93.3% 2-year follow-up (13/15 delay group, 15/15 control), there was an 87-day difference in presentation to surgery (P = 0.001), with no significant preoperative demographic or tear characteristic differences between groups. Intraoperatively, there were no differences between groups in repair characteristics. Preoperative versus postoperative differences in American Shoulder and Elbow Surgeon score (P < 0.001), visual analog scale (P < 0.001), and Simple Shoulder Test scores (P < 0.001) were significant but not between groups (P = 0.650, 0.586, 0.525). On MRI, 58% in the delay group and 85% in the control group had healed (P = 0.202). DISCUSSION Although a 3-month delay showed no statistically significant effect on outcomes, the delay group had an approximately 27% higher failure rate. Thus, although a 3-month period of nonsurgical treatment before RCR may be reasonable, larger studies are warranted for definitive conclusions.
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Affiliation(s)
- Christopher Clinker
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Mr. Clinker, Dr. Ishikawa, Dr. Joyce, Dr. Tashjian, Dr. Chalmers); Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Dr. Smith)
| | - Karch M. Smith
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Mr. Clinker, Dr. Ishikawa, Dr. Joyce, Dr. Tashjian, Dr. Chalmers); Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Dr. Smith)
| | - Hiroaki Ishikawa
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Mr. Clinker, Dr. Ishikawa, Dr. Joyce, Dr. Tashjian, Dr. Chalmers); Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Dr. Smith)
| | - Christopher Joyce
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Mr. Clinker, Dr. Ishikawa, Dr. Joyce, Dr. Tashjian, Dr. Chalmers); Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Dr. Smith)
| | - Robert Z. Tashjian
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Mr. Clinker, Dr. Ishikawa, Dr. Joyce, Dr. Tashjian, Dr. Chalmers); Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Dr. Smith)
| | - Peter N. Chalmers
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Mr. Clinker, Dr. Ishikawa, Dr. Joyce, Dr. Tashjian, Dr. Chalmers); Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Dr. Smith)
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Trammell AP, Hao KA, Hones KM, Wright JO, Wright TW, Vasilopoulos T, Schoch BS, King JJ. Clinical outcomes of anatomical versus reverse total shoulder arthroplasty in patients with primary osteoarthritis, an intact rotator cuff, and limited forward elevation. Bone Joint J 2023; 105-B:1303-1313. [PMID: 38037676 DOI: 10.1302/0301-620x.105b12.bjj-2023-0496.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Aims Both anatomical and reverse total shoulder arthroplasty (aTSA and rTSA) provide functional improvements. A reported benefit of aTSA is better range of motion (ROM). However, it is not clear which procedure provides better outcomes in patients with limited foward elevation (FE). The aim of this study was to compare the outcome of aTSA and rTSA in patients with glenohumeral osteoarthritis (OA), an intact rotator cuff, and limited FE. Methods This was a retrospective review of a single institution's prospectively collected shoulder arthroplasty database for TSAs undertaken between 2007 and 2020. A total of 344 aTSAs and 163 rTSAs, which were performed in patients with OA and an intact rotator cuff with a minimum follow-up of two years, were included. Using the definition of preoperative stiffness as passive FE ≤ 105°, three cohorts were matched 1:1 by age, sex, and follow-up: stiff aTSAs (85) to non-stiff aTSAs (85); stiff rTSAs (74) to non-stiff rTSAs (74); and stiff rTSAs (64) to stiff aTSAs (64). We the compared ROMs, outcome scores, and complication and revision rates. Results Compared with non-stiff aTSAs, stiff aTSAs had poorer passive FE and active external rotation (ER), whereas there were no significant postoperative differences between stiff rTSAs and non-stiff rTSAs. There were no significant differences in preoperative function when comparing stiff aTSAs with stiff rTSAs. However, stiff rTSAs had significantly greater postoperative active and passive FE (p = 0.001 and 0.004, respectively), and active abduction (p = 0.001) compared with stiff aTSAs. The outcome scores were significantly more favourable in stiff rTSAs for the Shoulder Pain and Disability Index, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, University of California, Los Angeles score, and the Constant score, compared with stiff aTSAs. When comparing the proportion of stiff aTSAs versus stiff rTSAs that exceeded the minimal clinically important difference and substantial clinical benefit, stiff rTSAs achieved both at greater rates for all measurements except active ER. The complication rate did not significantly differ between stiff aTSAs and stiff rTSAs, but there was a significantly higher rate of revision surgery in stiff aTSAs (p = 0.007). Conclusion Postoperative overhead ROM, outcome scores, and rates of revision surgery favour the use of a rTSA rather than aTSA in patients with glenohumeral OA, an intact rotator cuff and limited FE, with similar rotational ROM in these two groups.
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Affiliation(s)
- Amy P Trammell
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Keegan M Hones
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Terrie Vasilopoulos
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
- Department of Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Joseph J King
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
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Prevalence, Natural History, and Nonoperative Treatment of Rotator Cuff Disease. OPER TECHN SPORT MED 2023. [DOI: 10.1016/j.otsm.2023.150978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Gillinov SM, Varady NH, Abraham PF, Meek WM, Eberlin CT, Small KM, Martin SD. Supraspinatus pathology on MRI is associated with degree of weakness on dynamic clinical strength testing. Skeletal Radiol 2022; 51:1967-1974. [PMID: 35380235 DOI: 10.1007/s00256-022-04049-x] [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: 02/10/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze shoulder strength and function in patients presenting with possible supraspinatus pathology and to ascertain if these clinical findings are associated with severity of supraspinatus pathology on MRI. MATERIALS AND METHODS In total, 171 patients with presumptive rotator cuff pathology and with preserved strength on standard rotator cuff examination were prospectively recruited. Patients were subjected to bilateral shoulder strength testing employing dynamometry; this included isometric strength testing at 90° of abduction, followed by eccentric assessment of isotonic strength from full abduction through the full range of motion until the arm rested at the patient's side. We calculated absolute strength and symptomatic-to-asymptomatic arm (S/A) strength ratios. On subsequent shoulder MRI, supraspinatus pathology was designated into one of seven categories. The association between strength measurements and MRI findings was analyzed. RESULTS Increasing lesion severity on MRI was associated with both decreasing absolute strength (no tear [59.9 N] to full-thickness tear [44.2 N]; P = 0.036) and decreasing S/A strength ratios during isotonic testing (no tear [91.9%] to full-thickness tear [65.3%]; P = 0.022). In contrast, there were no significant relationships between imaging severity and absolute strength or S/A strength ratios on isometric testing. CONCLUSION Severity of supraspinatus pathology on MRI was associated with dynamic clinical function. These results validate the clinical correlation between MRI designations of supraspinatus pathology and function and suggest the need for future work to investigate utility of dynamic (versus isometric) rotator cuff physical examination maneuvers.
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Affiliation(s)
- Stephen M Gillinov
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Paul F Abraham
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Wendy M Meek
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Christopher T Eberlin
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Kirstin M Small
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott D Martin
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
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Harada N, Ishitani E, Gotoh M, Shiba N. The clinical outcomes of infraspinatus rotational transfer for irreparable posterosuperior rotator cuff tears: a preliminary report. Clin Shoulder Elb 2022; 25:195-201. [PMID: 35791682 PMCID: PMC9471820 DOI: 10.5397/cise.2021.00731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background This study aimed to examine the preliminary clinical results of the infraspinatus rotational transfer procedure for irreparable posterosuperior rotator cuff tears. Methods This study included 34 patients (mean age, 68.4 years). Their mean tear width and length measurements were 50.9 mm and 50.6 mm, respectively. The functional outcomes, including physician-determined and patient-reported scores, were evaluated before and at 1 year after surgery. The structural outcomes determined using the magnetic resonance imaging examination results were also assessed. Results The clinical scores significantly improved after surgery compared with the scores before surgery: the Constant-Murley score (53.3±21.1 to 76.8±10.5), University of California at Los Angeles Shoulder score (15.6±3.6 to 27.8±6.7), American Shoulder and Elbow Surgeons Shoulder score (51.8±18.3 to 89.1±13.5), and WORC score (925.0±436.8 to 480.3±373.2) (all p<0.001). Postoperative re-tears were noted in two patients (5.9%). Conclusions One year postoperatively, the patient’s clinical scores significantly improved, with a re-tear rate of 5.9%.
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11
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Finger L, Dunn R, Hughes J, Lesniak B, Lin A. Clinical outcomes secondary to time to surgery for atraumatic rotator cuff tears. J Shoulder Elbow Surg 2022; 31:S18-S24. [PMID: 35085601 DOI: 10.1016/j.jse.2021.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The time from symptom onset to surgery has been shown to impact functional outcomes after repair of traumatic rotator cuff tears (RCTs), but this temporal relationship has not yet been evaluated in patients with atraumatic, degenerative cuff tears. Furthermore, it has been shown that over time, atraumatic cuff tears tend to enlarge and become more symptomatic, retracted, and atrophic-factors that have been shown to decrease success rates after repair. The aim of this study was to evaluate the relationship between the time from symptom onset to surgery and postoperative outcomes in patients with atraumatic RCTs. METHODS We performed a retrospective cohort study of patients with degenerative, atraumatic RCTs who underwent surgery performed by 2 fellowship-trained shoulder surgeons and had at least 12 months of postoperative follow-up. These patients were divided into 2 cohorts based on the duration between symptom onset and surgery: early (<12 months) and delayed (≥12 months). The primary outcome measures included reoperation rate and failure of repair. Secondary outcomes included clinical measures of strength and range of motion and patient-reported outcome measures consisting of the Subjective Shoulder Value, visual analog scale for pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment, and Brophy-Marx Activity Scale at last follow-up. RESULTS Of the 143 patients who met the inclusion criteria, 78 (54.5%) underwent surgery within 1 year of symptom onset whereas 65 (45.5%) underwent surgery after at least 1 year. There were no differences between groups regarding demographic or tear characteristics. At final follow-up, there were no differences between the early- and late-surgery groups regarding retear rate (12% vs. 9%, P = .65), reoperation rate (5% vs. 3%, P = .54), postoperative range of motion in any plane (P > .05), strength in external rotation and internal rotation, visual analog scale pain score, or Subjective Shoulder Value. A greater proportion of the early group (61%) than the late group (46%) experienced improvement in supraspinatus strength of ≥1 grade on manual muscle testing (P = .02) and post hoc analysis. CONCLUSION Despite our knowledge of the natural history of chronic, atraumatic RCTs, delaying surgical treatment for 1 year or more does not appear to significantly impact postoperative outcomes. Thus, it is reasonable for physicians to recommend either conservative or surgical treatment depending on patient-specific factors and expectations.
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Affiliation(s)
- Logan Finger
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robin Dunn
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Jonathan Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bryson Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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12
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Abstract
Background Although nonoperative treatment is effective for degenerative rotator cuff tears (RCTs), it remains unclear whether the delay created by a trial of nonoperative treatment negatively influences the outcome of a subsequent surgical repair. In March 2020, the COVID-19 pandemic resulted in an involuntary delay in the surgical treatment of rotator cuff disease, creating a natural experiment. The purpose of this study was to evaluate the outcomes and healing of patients who underwent delayed surgical treatment of chronic degenerative RCTs as compared with the nondelayed surgical treatment of RCTs. Methods This was a prospective study of two groups: patients planned to undergo arthroscopic rotator cuff repair between March 16, 2020 and May 1, 2020-the end of the ban on elective surgery-and patients who underwent rotator cuff repair starting six weeks after the ban on elective surgery had been lifted. Preoperatively and at six months postoperatively, we collected the Simple Shoulder Test, the American Shoulder and Elbow Surgeons (ASES) score, and the visual analog scale for pain. We also obtained magnetic resonance imaging (MRI) at six months postoperatively. A power analysis was conducted, and assuming a mean ± standard deviation ASES score of 93.1 ± 13.9 points and a minimum clinically important difference in the ASES score of 27.1 points, 7 patients per group (14 patients in total) would be necessary to have 90% chance of finding a difference. Results We included 15 patients within each group and obtained 100% follow-up at six months. In the delay group, the mean ± standard deviation delay was 63 ± 24 days. There were no significant preoperative differences between groups in demographics or tear characteristics. Intraoperatively, there were no differences between groups in repair characteristics. Using a repeated-measures analysis of variance, there were significant preoperative vs. postoperative differences in ASES scores (P < .001), visual analog scale scores (P < .001), and Simple Shoulder Test scores (P < .001), but no differences between groups (P = .910, .519, and 0.852, respectively). On MRI, within the delay group, 58% had healed, whereas within the control group, 85% had healed (P = .202). Conclusion COVID-19 caused a two-month delay in the operative treatment of RCTs. This delay did not significantly alter patient-reported outcomes. This delay resulted in a 27% difference in MRI healing rates, which was not statistically significant in this small study. Larger studies should be conducted as our results suggest that a delay in treatment may negatively impact healing rates.
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13
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Cleland TL, Wilson R, Kim C, Jain NB. What's New in Orthopaedic Rehabilitation. J Bone Joint Surg Am 2020; 102:1923-1929. [PMID: 32947594 DOI: 10.2106/jbjs.20.01406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Travis L Cleland
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio
| | - Richard Wilson
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio
| | - Chong Kim
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio
| | - Nitin B Jain
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
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14
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Abraham PF, Nazal MR, Varady NH, Gillinov SM, Quinlan NJ, Alpaugh K, Martin SD. The new dynamic isotonic manipulation examination (DIME) is a highly sensitive secondary screening tool for supraspinatus full-thickness tears. J Shoulder Elbow Surg 2020; 29:2213-2220. [PMID: 32650076 DOI: 10.1016/j.jse.2020.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/13/2020] [Accepted: 06/22/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Traditional shoulder physical examination (PE) tests have suboptimal sensitivity for detection of supraspinatus full-thickness tears (FTTs). Therefore, clinicians may continue to suspect FTTs in some patients with negative rotator cuff PE tests and turn to magnetic resonance imaging (MRI) for definitive diagnosis. Consequently, there is a need for a secondary screening test that can accurately rule out FTTs in these patients to better inform clinicians which patients should undergo MRI. The purpose of this study was to assess the ability of 2 new dynamic PE tests to detect supraspinatus pathology in patients for whom traditional static PE tests failed to detect pathology. METHODS We prospectively enrolled 171 patients with suspected rotator cuff pathology with negative findings on traditional rotator cuff PE, who underwent 2 new dynamic PE tests: first, measurement of angle at which the patient first reports pain on unopposed active abduction and, second, the dynamic isotonic manipulation examination (DIME). Patients then underwent shoulder magnetic resonance arthrogram. Data from the new PE maneuvers were compared with outcomes collected from magnetic resonance arthrogram reports. RESULTS Pain during DIME testing had a sensitivity of 96.3% and 92.6% and a negative predictive value of 96.2% and 94.9% in the coronal and scapular planes, respectively. DIME strength ≤86.0 N had a sensitivity of 100% and 96.3% and a negative predictive value of 100% and 95.7% in the coronal and scapular planes, respectively. Pain at ≤90° on unopposed active abduction in the coronal plane had a specificity of 100% and a positive predictive value of 100% for supraspinatus pathology of any kind (ie, tendinopathy, "fraying," or tearing). CONCLUSION DIME is highly sensitive for supraspinatus FTTs in patients with negative traditional rotator cuff PE tests for whom there is still high clinical suspicion of FTTs. Thus, this test is an excellent secondary screening tool for supraspinatus FTTs in patients for whom clinicians suspect rotator cuff pathology despite negative traditional static PE tests. Given its high sensitivity, a negative DIME test rules out supraspinatus FTT well in these patients, and can therefore better inform clinicians which patients should undergo MRI. In addition, the angle at which patients first report pain on unopposed active shoulder abduction is highly specific for supraspinatus pathology.
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Affiliation(s)
- Paul F Abraham
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA.
| | - Mark R Nazal
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen M Gillinov
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
| | - Noah J Quinlan
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kyle Alpaugh
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, MA, USA
| | - Scott D Martin
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
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Guan J, Geng WQ, Li Y, Liu GY, Ding LB, Liu YJ, Xue W, Wang H, Zheng XF. Decreased Synovial Fluid Biomarkers Levels Are Associated with Rehabilitation of Function and Pain in Rotator Cuff Tear Patients Following Electroacupuncture Therapy. Med Sci Monit 2020; 26:e923240. [PMID: 32915775 PMCID: PMC7507797 DOI: 10.12659/msm.923240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background The aim of this study was to assess inflammatory cytokines levels in synovial fluid (SF) before and after electroacupuncture (EA) treatment and to explore whether these biomarkers are associated with function of rotator cuff tear (RCT) patients. Material/Methods We recruited 54 patients with RCT and separated them into an EA group and a control group. The SF biomarker levels were detected at baseline and at 6-week and 6-month follow-up. The symptomatic severity was evaluated by visual analog scale (VAS), Constant-Murley score, and American Shoulder and Elbow Surgeons score (ASES). We also investigated the correlation between symptomatic severity and biomarker levels in SF of the shoulder joint. Results The reductions in VAS and improved functional score (ASES and Constant-Murley score) were significantly different between the 2 groups, and SF biomarker concentrations were significantly lower in the EA group. IL-1β levels were significantly negatively correlated with Constant-Murley score (r=−0.73, P=0.04) and ASES score (r=−0.59, P<0.001) and positively correlated with VAS scores (r=0.81, P=0.004). IL-6 levels were significantly negatively correlated with Constant-Murley score (r=−0.67, P=0.03) and positively correlated with VAS score (r=0.7, P=0.01). MMP-1 levels were significantly negatively correlated with ASES score (r=−0.57, P<0.001). Conclusions The biomarkers in SF were directly associated with shoulder pain and shoulder function in rotator cuff tear. EA, as a safe and effective conservative therapy, obviously decreased the level of inflammatory cytokines in RCT patients, accompanied by a reduction in shoulder pain and improved function.
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Affiliation(s)
- Jian Guan
- Department of Orthopedic Surgery, Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - Wei-Qiang Geng
- Department of Orthopedic Surgery, No. 980 Hospital, Joint Logistics Support Force People's Liberation Army (PLA), Handan Campus of Bethune International Hospital, Handan, Hebei, China (mainland)
| | - Yao Li
- Department of Orthopedic Surgery, Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - Guang-Yuan Liu
- Department of Orthopedic Surgery, Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - Luo-Bin Ding
- Department of Orthopedic Surgery, Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - You-Jie Liu
- Department of Orthopedic Surgery and Sports Medicine Center, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (mainland)
| | - Wei Xue
- Department of Orthopedics, Handan Central Hospital, Handan, Hebei, China (mainland)
| | - Huajun Wang
- Department of Orthopedic Surgery and Sports Medicine Center, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (mainland)
| | - Xiao-Fei Zheng
- Department of Orthopedic Surgery and Sports Medicine Center, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (mainland)
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16
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Song A, DeClercq J, Ayers GD, Higgins LD, Kuhn JE, Baumgarten KM, Matzkin E, Jain NB. Comparative Time to Improvement in Nonoperative and Operative Treatment of Rotator Cuff Tears. J Bone Joint Surg Am 2020; 102:1142-1150. [PMID: 32618921 PMCID: PMC7508291 DOI: 10.2106/jbjs.19.01112] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Comparative time to recovery after operative and nonoperative treatment for rotator cuff tears is an important consideration for patients. Hence, we compared the time to achieve clinically meaningful reduction in shoulder pain and function after treatment. METHODS From February 2011 to June 2015, a multicenter cohort of patients with rotator cuff tears undergoing operative or nonoperative treatment was recruited. After propensity score weighting, the Kaplan-Meier method was used to estimate the time to achieve a minimal clinically important difference (MCID), >30% reduction, and >50% reduction in the Shoulder Pain and Disability Index (SPADI) and the American Shoulder and Elbow Surgeons (ASES) scores. (In our analysis, both ASES and SPADI were coded such that a lower number corresponded to a better outcome; thus, the word "reduction" was used to indicate improvement in both ASES and SPADI scores.) A 2-stage test was conducted to detect a difference between the 2 groups. RESULTS In this cohort, 96 patients underwent nonoperative treatment and 73 patients underwent a surgical procedure. The surgical treatment group and the nonoperative treatment group were significantly different with respect to SPADI and ASES scores (p < 0.05). The maximum difference between groups in achievement of the MCID for the SPADI scores was at 3.25 months, favoring the nonoperative treatment group. The probability to achieve the MCID was 0.06 (95% confidence interval [CI], 0.00 to 0.12) for the surgical treatment group compared with 0.40 (95% CI, 0.29 to 0.50) for the nonoperative treatment group. The surgical treatment group had a greater probability of achieving >50% reduction in SPADI scores at 15.49 months (0.20 [95% CI, 0.12 to 0.29] for the surgical treatment group compared with 0.04 [95% CI, 0.00 to 0.09] for the nonoperative treatment group). The surgical treatment group had a greater probability of achieving >50% reduction in ASES scores at 24.74 months (0.96 [95% CI, 0.84 to 0.99] for the surgical treatment group compared with 0.66 [95% CI, 0.53 to 0.75] for the nonoperative treatment group). The differences for >30% reduction in SPADI and ASES scores and the MCID for ASES scores were not significant. CONCLUSIONS Patients undergoing nonoperative treatment had significantly better outcomes in the initial follow-up period compared with patients undergoing a surgical procedure, but this trend reversed in the longer term. These data can be used to inform expectations for nonoperative and operative treatments for rotator cuff tears. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Amos Song
- Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joshua DeClercq
- Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory D. Ayers
- Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - John E. Kuhn
- Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nitin B. Jain
- Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee,Email address for N.B. Jain:
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