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Ye J, Wang Y, Zeng W, Li Y, Yao B, Wang S, Wu J, Hou J. Local Injection of Rapamycin-Loaded Pcl-Peg Nanoparticles for Enhanced Tendon Healing in Rotator Cuff Tears via Simultaneously Reducing Fatty Infiltration and Drug Toxicity. Adv Healthc Mater 2024; 13:e2300612. [PMID: 37931903 DOI: 10.1002/adhm.202300612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/20/2023] [Indexed: 11/08/2023]
Abstract
As a common cause of shoulder pain, rotator cuff tears (RCTs) are difficult to treat clinically because of their unsatisfactory prognosis due to the fatty infiltration caused by muscle-derived stem cells (MDSCs). Previous studies have found that rapamycin (RAPA) can inhibit fatty infiltration. However, systemic administration of RAPA may cause complications such as infection and nausea, while local administration of RAPA may lead to the cytotoxicity of tendon cells, affecting the healing of rotator cuffs. In this study, biocompatible and clinically approved polycaprolactone-polyethylene glycol (PCL-PEG) is formulated into an injectable nanoparticle for the sustained release of RAPA. The results indicate that the RAPA/PCL-PEG nanoparticles (NPs) can efficiently prolong the release of RAPA and significantly reduce the cytotoxicity of tendon cells caused by RAPA. The study of the fatty infiltration model in rats with delayed rotator cuff repair shows that weekly intraarticular injection of RAPA/PCL-PEG NPs can more effectively reduce the fatty infiltration and muscle atrophy of rat rotator cuffs and leads to better mechanical properties and gait improvements than a daily intraarticular injection of RAPA. These findings imply that local injection of RAPA/PCL-PEG NPs in the shoulder joints can be a potential clinical option for RCTs patients with fatty infiltration.
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Affiliation(s)
- Jichao Ye
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
| | - Yongbo Wang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
- Bioscience and Biomedical Engineering Thrust, The Hong Kong University of Science and Technology (Guangzhou), Nansha, Guangzhou, 511458, China
| | - Weike Zeng
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, China
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
| | - Yuxiang Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
| | - Bin Yao
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
| | - Siheng Wang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, P. R. China
| | - Jun Wu
- Bioscience and Biomedical Engineering Thrust, The Hong Kong University of Science and Technology (Guangzhou), Nansha, Guangzhou, 511458, China
- Division of Life Science, Hong Kong University of Science and Technology, Hong Kong, SAR, 999077, P. R. China
| | - Jingyi Hou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
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Song W, Guo X, Wang X, Yu J, Jiang W, Wei C, Zhao Y. A multi-center, single-blinded, randomized, parallel-group, superiority study to compare the efficacy of manipulation under anesthesia versus intra-articular steroid injection in the treatment of patients with frozen shoulder and a diagnosis of rotator cuff injury or tear by MRI: study protocol for a randomized controlled trial. Trials 2023; 24:765. [PMID: 38012777 PMCID: PMC10683184 DOI: 10.1186/s13063-023-07810-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Frozen shoulder (FS) is a common condition that can cause severe pain and limited range of motion in the shoulder joint. While intra-articular steroid injection has been shown to be an effective treatment for FS, manipulation under anesthesia (MUA) is an alternative treatment that has gained popularity in recent years. However, there is a lack of evidence regarding the effectiveness of MUA on FS patients with concomitant rotator cuff injury or tear. Though a few studies have shown that MUA is not associated with rotator cuff tears, and will not exacerbate the injury, more high-quality studies with bigger sample sizes are needed. Therefore, the aim of this multi-center, single-blinded, randomized, parallel-group, superiority study is to compare the efficacy of MUA versus intra-articular steroid injection in the treatment of FS patients with a diagnosis of rotator cuff injury or tear by MRI. METHODS A parallel, single-blinded, multi-center randomized controlled trial of 320 patients will be conducted at three hospitals of China. Eligible patients with frozen shoulder and rotator cuff injury or tear diagnosed by MRI will be randomly assigned to, in equal proportions, the manipulation under anesthesia group and the intra-articular steroid injection group via a central randomization system, undergoing a corresponding operation on day one and a sequent physical exercise for 14 days. The primary outcome is the comprehensive efficacy evaluation (total effective rate) and the change of Constant-Murley Score. Outcome assessors and data analysts will be blinded, and participants will be asked not to reveal their allocation to assessors. DISCUSSION This study aims to explore the superiority of manipulation under anesthesia in reducing pain and improving shoulder function in frozen shoulder patients accompanied with rotator cuff injury. To provide a scientific basis for the dissemination and application of manipulation under anesthesia, and a better knowledge for the role of MUA in the treatment of frozen shoulder accompanied with rotator cuff injury. TRIAL REGISTRATION Chictr.org.cn ChiCTR2200067122 . Registered on 27 December 2022. ChiCTR is a primary registry of the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) network and includes all items from the WHO Trial Registration data set in Trial registration.
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Affiliation(s)
- Wuwei Song
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoyu Guo
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang Wang
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Jiacheng Yu
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenyu Jiang
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen Wei
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuhao Zhao
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Yamaura K, Fujibayashi I, Kurosawa T, Mifune Y, Inui A, Ozaki T, Mitani M. Timing of retears after arthroscopic rotator cuff repair and associated factors: a retrospective analysis. J Shoulder Elbow Surg 2023; 32:1929-1936. [PMID: 36842463 DOI: 10.1016/j.jse.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/04/2023] [Accepted: 01/22/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Retear after arthroscopic rotator cuff repair (ARCR) remains a complication of important concern. Few reports have evaluated retear timing and its associated patient characteristics in large cohorts. This study aimed to investigate retear timing and patient characteristics and factors associated with this parameter. METHODS Of the 638 consecutive shoulders that underwent ARCR from August 2009 to November 2019, shoulders with retear complication within 1 year of surgery were included. Retears were defined as type IV or V of the Sugaya's classification, and magnetic resonance imaging was performed at 6 weeks, 3 months, 6 months, and 1 year after surgery. The distribution of patients with retears at the timing of retears was investigated. In addition, patients with retears were classified into the following two groups: early group with retears occurring at 6 weeks and 3 months postoperatively or late group with retears occurring between 6 months and 1 year postoperatively. Associated factors such as sex, age, tear size, pre and postoperative range of motion, surgical technique, and clinical outcome between the two groups were investigated. RESULTS The 41 shoulders with retears were divided into four groups: 1) within 6 weeks after surgery (n = 9, 22.0%), 2) 6 weeks-to 3 months after surgery (n = 19, 46.3%), 3) 3-6 months after surgery (n = 11, 26.8%), and 4) 6 months-1 year after surgery (n = 2, 4.9%). In addition, there were significantly larger retear sizes in the Sugaya's classification in the early group compared to the late group (P = .013), while there were significantly more males in the late group compared to the early group (P = .030). CONCLUSION The highest retear rate after ARCR was observed from 6 weeks to 3 months after surgery, with equivalent rates within 6 weeks and from 3 months to 6 months after surgery.
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Affiliation(s)
- Kohei Yamaura
- Department of Orthopaedic Surgery, Himeji St. Mary's Hospital, Himeji, Japan; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Isao Fujibayashi
- Department of Orthopaedic Surgery, Himeji St. Mary's Hospital, Himeji, Japan.
| | - Takashi Kurosawa
- Department of Orthopaedic Surgery, Himeji St. Mary's Hospital, Himeji, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takuma Ozaki
- Department of Orthopaedic Surgery, Himeji St. Mary's Hospital, Himeji, Japan
| | - Makoto Mitani
- Department of Orthopaedic Surgery, Himeji St. Mary's Hospital, Himeji, Japan
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Migliorini F, Maffulli N, Eschweiler J, Schenker H, Tingart M, Betsch M. Arthroscopic versus mini-open rotator cuff repair: A meta-analysis. Surgeon 2023; 21:e1-e12. [PMID: 34961701 DOI: 10.1016/j.surge.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 10/22/2021] [Accepted: 11/05/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND An all-arthroscopic rotator cuff repair (ASR) may result in less postoperative pain and better functional outcomes than the mini-open (MOR) approach. This meta-analysis provides an updated assessment of the current literature which compares the clinical outcomes of mini-open versus all arthroscopic rotator cuff repair techniques. MATERIAL AND METHODS The main online databases were accessed in October 2021. All the trials directly comparing primary ASR versus MOR for rotator cuff rupture were accessed. Studies concerning revision settings were not eligible, nor where those combining the surgical procedures with other adjuvants. RESULTS A total of 21 articles were retrieved. Data from 1644 procedures (ASR = 995, MOR = 649) were collected. The mean follow-up was 26.7 (6.0-56.4) months. Comparability was found between ASR and MOR groups at baseline with regards to age (P = 0.3), gender (P = 0.7) and mean duration of the follow-up (P = 0.7). No difference was found between ASR and MOR with regard to surgical duration (P = 0.05), Constant score (P = 0.2), University of California at Los Angeles Shoulder (P = 0.3), American Shoulder and Elbow Surgeons Shoulder (P = 0.5), VAS (P = 0.2), forward flexion (P = 0.3), abduction (P = 0.3), external rotation (P = 0.2), internal rotation (P = 0.7), re-tear (P = 0.9), adhesive capsulitis (P = 0.5). CONCLUSION Arthroscopic and mini-open rotator cuff repair result in similar clinical outcomes. Male gender and older age lead to greater rates of rotator cuff re-tears, while longer surgical duration was associated with a greater rate of adhesive capsulitis.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi 84081, SA, Italy; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England, UK; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, UK.
| | - Joerg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Hanno Schenker
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Markus Tingart
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of the University Heidelberg, Mannheim, Germany.
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Sex Is Associated with the Success or Failure of Manipulation Alone for Joint Stiffness Associated with Rotator Cuff Repair. J Clin Med 2022; 11:jcm11237192. [PMID: 36498766 PMCID: PMC9739455 DOI: 10.3390/jcm11237192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose: One-stage arthroscopic rotator cuff repair with manipulation has been recently performed for rotator cuff tears with shoulder stiffness, whereas some patients require capsular release due to severe stiffness that is difficult to treat with manipulation. The purpose of this study was to analyze patient backgrounds and related factors of success or failure of manipulation alone for the treatment of shoulder stiffness associated with rotator cuff tears. Methods: This study included 64 patients with rotator cuff tears and shoulder stiffness who underwent arthroscopic rotator cuff repair with manipulation alone or with manipulation and capsular release of the glenohumeral joint at our institution between January 2015 and September 2019. The patients were divided into two groups: those whose shoulder stiffness could be improved by manipulation alone (Manipulation group) and those whose stiffness could not be improved by manipulation alone and required capsular release (Capsular release addition group). Analysis was performed between the two groups regarding patient backgrounds and related factors, including rotator cuff tear morphology and range of motions pre- and postoperatively. Results: Exactly 45 patients and 19 patients were included in Manipulation group and Capsular release addition group, respectively. A comparison between the two groups showed that patient age (p = 0.0040), sex (p = 0.0005), and injury due to trauma (p = 0.0018) were significantly related to the success or failure of manipulation alone. Multivariate logistic regression analysis on these three factors showed that sex (odds ratio, 5.5; p = 0.048) was significantly associated with the success or failure of manipulation alone. In both groups, the passive ROM of all patients improved at the last postoperative follow-up compared to their pre-operative values (p < 0.001), except for internal rotation in the Capsular release addition group (p = 0.49). Conclusion: Young male patients who have shoulder stiffness associated with rotator cuff tears should be considered for arthroscopic capsular release rather than manipulation.
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Gatot C, Lie HM, Tijauw Tjoen DL. Human Dermal Allograft Patch Augmentation of Degenerate Rotator Cuff Tendon Using a Single Lateral-Row Technique. Arthrosc Tech 2022; 11:e2143-e2151. [PMID: 36632385 PMCID: PMC9826975 DOI: 10.1016/j.eats.2022.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
The role of biological augmentation in arthroscopic rotator cuff repair surgery has increased over the years. It has shown favorable healing rates and functional outcomes. Patch augmentation is commonly applied in repairs of massively retracted cuff tears, full-thickness tears, revision repair, or open cuff surgery. There is a paucity of literature on the use of patch augmentation when dealing with a chronic degenerate tendon associated with small-sized cuff tears. In recent years, the resorbable bioinductive bovine collagen implant has gained popularity for its application in partial-thickness tears via an isolated bioinductive repair fashion, without traditional rotator cuff repair. These bioinductive implants, albeit promising in their biological properties for tendon repair, lack structural strength and do not confer similar biomechanical advantages as human dermal allograft. We share our surgical technique for an arthroscopic patch augmentation involving human dermal allograft, using a single-lateral row surgical fixation, to address a degenerate cuff tendon with small-sized rotator cuff tear. We believe that our use of a human dermal patch augmentation conferred increased biomechanical advantage and reduced costs while delivering favorable outcomes for patients in our value-driven care.
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Affiliation(s)
- Cheryl Gatot
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore,Address correspondence to Cheryl Gatot, Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd., Academia, Level 4, Singapore 169856.
| | - Hannah Marian Lie
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Assessment of Acute Lesions of the Biceps Pulley in Patients with Traumatic Shoulder Dislocation Using MR Imaging. Diagnostics (Basel) 2022; 12:diagnostics12102345. [PMID: 36292035 PMCID: PMC9600602 DOI: 10.3390/diagnostics12102345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Shoulder dislocations represent common injuries and are often combined with rotator cuff tears and potentially damage to the biceps pulley. Purpose: To assess the occurrence and type of biceps pulley lesions in patients after traumatic anterior shoulder dislocation using 3T MRI. Methods: Thirty-three consecutive patients were enrolled between June 2021 and March 2022 (14 women, mean age 48.0 ± 19 years). All patients underwent MR imaging at 3 T within one week. Images were analyzed for the presence and type of pulley tears, subluxation/dislocation of the LHBT, rotator cuff lesions, joint effusion, labral lesions, and osseous defects. Results: Seventeen patients (52%) with traumatic anterior shoulder dislocation demonstrated biceps pulley lesions. Of those, eleven patients (33%) showed a combined tear of the sGHL and CHL. All seventeen patients with lesions of the biceps pulley showed associated partial tearing of the rotator cuff, whereas three patients showed an additional subluxation of the LHBT. Patients with pulley lesions after dislocations were significantly older than those without (mean age 52 ± 12 years vs. 44 ± 14 years, p = 0.023). Conclusion: Our results suggest an increased awareness for lesions of the biceps pulley in acute traumatic shoulder dislocation, particularly in patients over 45 years.
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Grewal G, Polisetty T, Cannon D, Ardeljan A, Vakharia RM, Rodriguez HC, Levy JC. Alcohol Abuse, Morbid Obesity, Depression, Congestive Heart Failure, and Chronic Pulmonary Disease are Risk Factors for 90-Day Readmission After Arthroscopic Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2022; 4:e1683-e1691. [PMID: 36312727 PMCID: PMC9596891 DOI: 10.1016/j.asmr.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study was to report the rate and causes of 90-day readmissions after arthroscopic rotator cuff repair. Methods A retrospective query from January 2005 to March 2014 was performed using a nationwide administrative claims registry. Patients and complications were identified using International Classification of Disease, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes. Patients who underwent arthroscopic rotator cuff repair (RCR) and were readmitted within 90 days after their index procedure were identified. Patients not readmitted represented controls. Patients readmitted were stratified into separate cohorts depending on the primary cause of readmission, which included cardiac, endocrine, hematological, infectious, gastrointestinal, musculoskeletal (MSK), neoplastic, neurological or psychiatric, pulmonary, and renal. Risk factors assessed were comorbidities comprising the Elixhauser-Comorbidity Index (ECI). Primary outcomes analyzed and compared included cause for readmission, patient demographics, risk factors, in-hospital length of stay (LOS), and costs. Pearson’s chi-square was used to compare patient demographics, and multivariate binomial logistic regression was used to calculate odds ratios (OR) on patient-related risk factors for 90-day readmissions. Results 10,425 readmitted patients and 301,625 control patients were identified, representing a 90-day readmission rate of 3.5%. The causes of readmissions were primarily related to infectious diseases (15%), MSK (15%), and cardiac (14%) complications. The most common MSK readmissions were osteoarthrosis of the leg or shoulder (24.8%) and spinal spondylosis (8.4%). Multivariate binomial logistic regression analyses demonstrated patients with alcohol abuse (OR, 1.42; P < .0001), morbid obesity (OR, 1.38; P < .0001), depression (OR, 1.35; P < .0001), congestive heart failure (OR, 1.34; P < 0.0001), and chronic pulmonary disease (OR, 1.28; P < .0001) were at the greatest risk of readmissions after RCR. Conclusions Significant differences exist among patients readmitted, and those patients who do not require hospital readmission within 90 days following arthroscopic rotator cuff repairs. Readmissions are associated with significant patient comorbidities and were primarily related to medically based complications. Level of Evidence Level III, prognostic, retrospective cohort study.
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Muthu S, Mogulesh C, Viswanathan VK, Jeyaraman N, Pai SN, Jeyaraman M, Khanna M. Is cellular therapy beneficial in management of rotator cuff tears? Meta-analysis of comparative clinical studies. World J Meta-Anal 2022; 10:162-176. [DOI: 10.13105/wjma.v10.i3.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/02/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mesenchymal stromal cell (MSC)-based cellular therapy promotes type I collagen production, enhance mechanical strength of tissues, and enhance biology at the bone-tendon interface, which primarily explains their potential clinical utility in rotator cuff (RC) tears.
AIM To analyze the efficacy and safety of cellular therapy utilizing MSCs in the management of RC tears from clinical studies available in the literature.
METHODS We conducted independent and duplicate electronic database searches including PubMed, Embase, Reference Citation Anallysis, Web of Science, and Cochrane Library in August 2021 for studies analyzing the efficacy and safety of cellular therapy (CT) utilizing MSCs in the management of RC tears. Visual Analog Score (VAS) score for pain, American Shoulder and Elbow Surgeons (ASES) score, Disability of the Arm, Shoulder, and Hand score, Constant score, radiological assessment of healing, and complications such as retear rate and adverse events were the outcomes analyzed. Analysis was performed in R-platform using OpenMeta [Analyst] software.
RESULTS Six studies involving 238 patients were included for analysis. We noted a significant reduction in VAS score for pain at 3 mo (weighed mean difference [WMD] = -2.234, P < 0.001) and 6 mo (WMD = -3.078, P < 0.001) with the use of CT, which was not maintained at long-term follow-up (WMD = -0.749, P = 0.544). Concerning functional outcomes, utilization of CT produced a significant short-term improvement in the ASES score (WMD = 17.090, P < 0.001) and significant benefit in functional scores such as Constant score (WMD = 0.833, P = 0.760) at long-term follow-up. Moreover, we also observed significantly improved radiological tendon healing during the long-term follow-up (odds ratio [OR] = 3.252, P = 0.059). We also noted a significant reduction in the retear rate upon utilization of CT in RC tears both at short- (OR = 0.079, P = 0.032) and long-term (OR = 0.434, P = 0.027) follow-ups. We did not observe any significant increase in the adverse events directly related to cellular therapy, as compared with the control group (OR = 0.876, P = 0.869).
CONCLUSION Based on our comprehensive and critical review, we could observe that the utilization of CT in RC tear significantly reduced pain severity at 3 and 6 mo, improved short-term functional outcome, enhanced radiological tendon healing, and mitigated retear rates at both short- and long-term follow-ups. The literature also confirmed the relative safety of using MSC therapy in patients presenting with RC tears.
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Affiliation(s)
- Sathish Muthu
- Department of Orthopaedics, Government Medical College and Hospital, Dindigul 624001, Tamil Nadu, India
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201306, Uttar Pradesh, India
- Indian Stem Cell Study Group Association, Lucknow 226010, Uttar Pradesh, India
| | - Cheruku Mogulesh
- Indian Stem Cell Study Group Association, Lucknow 226010, Uttar Pradesh, India
- Department of Orthopaedic Rheuamtology, Dr Ram Manohar Lohiya National Law University, Lucknow 226010, Uttar Pradesh, India
| | | | - Naveen Jeyaraman
- Indian Stem Cell Study Group Association, Lucknow 226010, Uttar Pradesh, India
- Department of Orthopaedic Rheuamtology, Dr Ram Manohar Lohiya National Law University, Lucknow 226010, Uttar Pradesh, India
- Department of Orthopaedics, Atlas Hospitals (The Tamil Nadu Dr MGR Medical University), Tiruchirappalli 620002, Tamil Nadu, India
| | - Satvik N Pai
- Department of Orthopaedics, Sri Ramachandra Medical College and Research Institute, Chennai 600116, Tamil Nadu, India
| | - Madhan Jeyaraman
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201306, Uttar Pradesh, India
- Indian Stem Cell Study Group Association, Lucknow 226010, Uttar Pradesh, India
- Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600095, Tamil Nadu, India
- Department of Orthopaedics, South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045, United States
| | - Manish Khanna
- Indian Stem Cell Study Group Association, Lucknow 226010, Uttar Pradesh, India
- Department of Orthopaedics, South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045, United States
- Department of Orthopaedics, Autonomous State Medical College, Ayodhya 224135, Uttar Pradesh, India
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Patients with Dual Shoulder-Spine Disease: Does Operative Order Affect Clinical Outcomes? World Neurosurg 2022; 164:e1269-e1280. [PMID: 35697230 DOI: 10.1016/j.wneu.2022.06.006] [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: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE 1) To analyze the effect of operative sequence (anterior cervical discectomy and fusion [ACDF] first or rotator cuff repair [RCR] first) on surgical outcomes after both procedures for patients with dual shoulder-spine injuries and 2) to determine how operative sequence affects patient-reported outcome measures (PROMs) after surgery. METHODS Patients >18 years of age who underwent primary ACDF and primary RCR at our institution were retrospectively identified. Only patients with overlapping symptoms before the first procedure were included. Patients were divided into 2 cohorts (ACDF first or RCR first). Patient demographics, surgical characteristics, surgical outcomes, and PROMs were compared between groups. Multivariate linear regression models were developed to determine if operative order was predictive of improvements in PROM scores at the 1-year postoperative point after the second procedure. Alpha was set at P < 0.05. RESULTS Of the 85 patients included, 44 patients (51.8%) underwent ACDF first, whereas 41 patients (48.2%) underwent RCR first. There were no significant differences in the rate of 90-day readmission, spine reoperations, and rotator cuff reoperations between groups (all, P > 0.05). Multivariate linear regression showed that undergoing an ACDF first was not a significant predictor of Δ Mental Component Score of the Short-Form 12 (β = -2.78; P = 0.626) and Δ Physical Component Score of the Short-Form 12 (β = 7.74; P = 0.077) at the 1-year postoperative point after the second procedure. CONCLUSIONS For patients with dual shoulder-spine injuries who are appropriate surgical candidates, undergoing ACDF first compared with RCR first does not result in significant differences in clinical surgical or patient-reported outcomes.
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Hartnett DA, Milner JD, DeFroda SF. The Weekend Warrior: Common Shoulder and Elbow Injuries in the Recreational Athlete. Am J Med 2022; 135:297-301. [PMID: 34508699 DOI: 10.1016/j.amjmed.2021.08.015] [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: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/01/2022]
Abstract
"Weekend warriors" are recreational athletes who compress their physical activity into 1-2 weekly exercise sessions. These individuals are generally older than the conventionally discussed athlete, and can live otherwise sedentary lifestyles that contribute to limited opportunities for regular exercise. The combination of high-energy physical activity with relative deconditioning, as well as older age and a potential history of competitive athletic play, can predispose these weekend warriors to a plethora of sports injuries. The shoulder and elbow are dynamically involved in a multitude of common recreational sports, such as baseball, softball, tennis, golf, and volleyball, and forms of casual exercise, such as swimming or climbing. A lack of proper conditioning and supplemental training in weekend warriors, particularly in comparison to elite athletes in these respective sports, can contribute to the development of both acute and chronic conditions of the shoulder and elbow. Inconsistency in physical activity can minimize the prominence of symptoms, leading patients to delayed presentations with injuries that severely impact their ability to engage in their exercise of choice, and therefore remain active at all. This narrative review aims to present the etiology, presentation, and management of common shoulder and elbow injuries that may afflict this patient population. Prevention strategies will also be discussed.
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Affiliation(s)
- Davis A Hartnett
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI.
| | - John D Milner
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia
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12
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Naz S, Sibha SD. A rotator cuff injury affecting the prognosis of a patient with myofascial pain. INDIAN JOURNAL OF PAIN 2022. [DOI: 10.4103/ijpn.ijpn_51_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Comparison of the Separate and Combined Effects of Physiotherapy Treatment and Corticosteroid Injection on the Range of Motion and Pain in Nontraumatic Rotator Cuff Tear: A Randomized Controlled Trial. Adv Orthop 2021; 2021:6789453. [PMID: 34733561 PMCID: PMC8560293 DOI: 10.1155/2021/6789453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/30/2021] [Accepted: 10/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgical treatment and conservative treatment is the options to improve pain, function, and range of motion following rotator cuff tear. In this study, we aimed to compare the effects of physiotherapy and corticosteroid injections on the function, pain, and range of motion in patients with full-thickness rotator cuff tearing separately and simultaneously. METHODS A total of 96 patients were randomly assigned to the study and divided into 3 groups of 32 patients. DASH questionnaire and VAS criterion were completed by all three groups, and the range of motions of all groups was measured by a goniometer. Then, the first group underwent 12 sessions of physiotherapy twice a week for 6 weeks; the second group received 80 mg of methylprednisolone and 1 ml of lidocaine 2% in two stages, 21 days apart; and the third group received 80 mg of methylprednisolone and 1 ml of lidocaine 2%, and after 2 days, 6 sessions of physiotherapy twice a week for 3 weeks were prescribed. In the end, the questionnaire was filled out by the patient, and the range of emotions was assessed with a goniometer. RESULTS More than 80% of patients in each group were female. There was no significant difference between the gender and age distribution of the groups. The mean age in physiotherapy, steroid, and physiotherapy + steroid groups was 51.78 ± 7.37, 52.37 ± 6.61, and 50.87 ± 5.65, respectively. The combination of physiotherapy + steroid intervention was more effective in reducing VAS and DASH scores than physiotherapy or steroid injection alone. Goniometric findings showed that treatments that included the steroid injection approach (steroid injection and steroid + physiotherapy) had a more dramatic effect on improving the patients' range of motion than physiotherapy alone. CONCLUSIONS Among the conservative approaches of treating full-thickness rotator cuff tear, a combination of steroid injection and physiotherapy is more effective significantly in comparison with either treatment alone. This trial is registered with IRCT20200102045987N1.
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Thepsoparn M, Thanphraisan P, Tanpowpong T, Itthipanichpong T. Comparison of a Platelet-Rich Plasma Injection and a Conventional Steroid Injection for Pain Relief and Functional Improvement of Partial Supraspinatus Tears. Orthop J Sports Med 2021; 9:23259671211024937. [PMID: 34485587 PMCID: PMC8414632 DOI: 10.1177/23259671211024937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background Partial supraspinatus tendon tears have frequently been treated using a subacromial corticosteroid injection or surgery. The clinical use of a platelet-rich plasma (PRP) injection is an alternative treatment method for the condition, despite the paucity of evidence of its efficacy. Purpose To compare pain relief, functional improvement, and complications after an intratendinous PRP injection versus a subacromial corticosteroid injection for partial supraspinatus tears. Study Design Randomized controlled trial; Level of evidence, 1. Methods A total of 32 patients with partial supraspinatus tears were randomly assigned to receive a leukocyte-poor PRP (LP-PRP) injection or a corticosteroid injection. One patient withdrew from the PRP group, leaving 15 patients in the PRP group and 16 patients in the corticosteroid group. The ultrasound-guided procedures were performed by a single experienced pain physician. Pain relief and functional improvement were evaluated using the visual analog scale (VAS) and the Oxford Shoulder Score (OSS), respectively. Treatment efficacy and complications were documented, and the 2 groups were compared at 1- and 6-month follow-up. Results There were no differences in VAS and OSS scores between the PRP and corticosteroid groups at 1-month follow-up. However, the PRP group had better scores than the corticosteroid group had on both the VAS and OSS at 6-month follow-up (VAS: 14.5 ± 15.4 vs 37.5 ± 24.9, respectively; OSS: 16.2 ± 3.9 vs 25.0 ± 10.2, respectively; P < .01 for both). Both groups showed significant improvement in VAS and OSS scores from before treatment to 1-month follow-up (mean difference, 35.67 and 11.47 points, respectively, for the PRP group; mean difference, 29.69 and 11.13 points, respectively, for the corticosteroid group; P < .01 for all). The VAS and OSS scores did not change significantly at 6-month follow-up in the corticosteroid group; however, the PRP group showed continued improvement in both VAS and OSS scores between 1- and 6-month follow-up (mean difference, 15.87 and 7.40 points, respectively; P < .01 for both). There were no complications in either group. Conclusion An injection using either a corticosteroid or LP-PRP resulted in a similar reduction in pain and improvement in function at 1 month in patients with a partial supraspinatus tear. However, PRP showed superior benefits over the corticosteroid at 6-month follow-up.
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Affiliation(s)
- Marvin Thepsoparn
- Pain Management Research Unit, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Phark Thanphraisan
- Pain Management Research Unit, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanathep Tanpowpong
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thun Itthipanichpong
- Pain Management Research Unit, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Zabrzyński J, Huri G, Gagat M, Łapaj Ł, Yataganbaba A, Szwedowski D, Askin M, Paczesny Ł. The Impact of Smoking on Clinical Results Following the Rotator Cuff and Biceps Tendon Complex Arthroscopic Surgery. J Clin Med 2021; 10:599. [PMID: 33562734 PMCID: PMC7915659 DOI: 10.3390/jcm10040599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 12/18/2022] Open
Abstract
The purpose of this study was to investigate the association of smoking and functional outcomes after arthroscopic treatment of complex shoulder injuries: rotator cuff tears (RCTs) with biceps tendon (LHBT) tears. This retrospective case-control study has been conducted on a cohort of patients who underwent shoulder arthroscopy between 2015 and 2017 due to complex injury treatment. The outcomes were assessed using the American Shoulder and Elbow Surgeons Score (ASES), the University of California at Los Angeles (UCLA) Shoulder Score, need for non-steroid anti-inflammatory drugs (NSAIDs) consumption and the visual analog scale (VAS). Complications and changes in smoking status were also noted. A cohort of 59 patients underwent shoulder arthroscopy, due to complex LHBT pathology and RCTs, and were enrolled in the final follow-up examination; with mean duration of 26.03 months. According to smoking status, 27 of patients were classified as smokers, and the remaining 32 were non-smokers. In the examined cohort, 36 patients underwent the LHBT tenotomy and 23 tenodesis. We observed a relationship between smoking status and distribution of various RCTs (p < 0.0001). The mean postoperative ASES and UCLA scores were 80.81 and 30.18 in the smoker's group and 84.06 and 30.93 in the non-smoker's group, respectively. There were no statistically significant differences in pre/postoperative ASES and postoperative UCLA scores between smokers and non-smokers (p > 0.05). The VAS was significantly lower in the non-smokers' group (p = 0.0021). Multi-tendon injuries of the shoulder are a serious challenge for surgeons, and to obtain an excellent functional outcome, we need to limit the negative risk factors, including smoking. Furthermore, there is a significant association between smoking and the occurrence of massive rotator cuff tears, and the pain level measured by the VAS. Simultaneous surgical treatment of RC and LHBT lesions in the smoker population allowed us to obtain the functional outcomes approximated to non-smokers in the long-term follow-up. Of course, we cannot assert that smoking is the real cause of all complications, however, we may assume that this is a very important, negative factor in shoulder arthroscopy.
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Affiliation(s)
- Jan Zabrzyński
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, 61-701 Poznan, Poland;
- Department of Orthopaedics, Orvit Clinic, Citomed Healthcare Center, 87-100 Torun, Poland;
- Department of Pathology, Faculty of Medicine, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland
| | - Gazi Huri
- Orthopaedics and Traumatology Department, Hacettepe Universitesi, Ankara 06-532, Turkey; (G.H.); (A.Y.); (M.A.)
| | - Maciej Gagat
- Department of Histology and Embryology, Faculty of Medicine, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland;
| | - Łukasz Łapaj
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, 61-701 Poznan, Poland;
| | - Alper Yataganbaba
- Orthopaedics and Traumatology Department, Hacettepe Universitesi, Ankara 06-532, Turkey; (G.H.); (A.Y.); (M.A.)
| | - Dawid Szwedowski
- Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, 20-133 Milan, Italy;
| | - Mehmet Askin
- Orthopaedics and Traumatology Department, Hacettepe Universitesi, Ankara 06-532, Turkey; (G.H.); (A.Y.); (M.A.)
| | - Łukasz Paczesny
- Department of Orthopaedics, Orvit Clinic, Citomed Healthcare Center, 87-100 Torun, Poland;
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17
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Dakkak A, Krill MK, Krill ML, Nwachukwu B, McCormick F. Evidence-Based Physical Examination for the Diagnosis of Subscapularis Tears: A Systematic Review. Sports Health 2020; 13:78-84. [PMID: 32822265 DOI: 10.1177/1941738120936232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT There is a renewed interest in diagnosing and treating subscapularis tears, but there is a paucity of clinical guidance to optimize diagnostic decision-making. OBJECTIVE To perform a literature review to evaluate advanced maneuvers and special tests in the diagnosis of subscapularis tears and create a diagnostic algorithm for subscapularis pathology. DATA SOURCES PubMed, MEDLINE, Ovid, and Cochrane Reviews databases. STUDY SELECTION Inclusion criteria consisted of level 1 and 2 studies published in peer-reviewed scientific journals that focused on physical examination. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION Individual test characteristics (bear hug, belly press, lift-off, Napoleon, and internal rotation lag sign) were combined in series and in parallel to maximize clinical sensitivity and specificity for any special test evaluated in at least 2 studies. A secondary analysis utilized subjective pretest probabilities to create a clinical decision tree algorithm and provide posttest probabilities. RESULTS A total of 3174 studies were identified, and 5 studies met inclusion criteria. The special test combination of the bear hug and belly press demonstrated the highest positive likelihood ratio (18.29). Overall, 3 special test combinations in series demonstrated a significant impact on posttest probabilities. With parallel testing, the combination of bear hug and belly press had the highest sensitivity (84%) and lowest calculated negative likelihood ratio (0.21). CONCLUSION The combined application of the bear hug and belly press physical examination maneuvers is an optimal combination for evaluating subscapularis pathology. Positive findings using this test combination in series with a likely pretest probability yield a 96% posttest probability; whereas, negative findings tested in parallel with an unlikely pretest probability yield a 12% posttest probability.
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Affiliation(s)
- Andrew Dakkak
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Michael K Krill
- Division of Neurorehabilitation, Department of Neurology, Washington University in St Louis, St Louis, Missouri
| | - Matthew L Krill
- Jameson Crane Sports Medicine Institute, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Benedict Nwachukwu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Frank McCormick
- Department of Orthopedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Sports Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Mocini F, Monteleone AS, Piazza P, Cardona V, Vismara V, Messinese P, Campana V, Sircana G, Maccauro G, Saccomanno MF. The role of adipose derived stem cells in the treatment of rotator cuff tears: from basic science to clinical application. Orthop Rev (Pavia) 2020; 12:8682. [PMID: 32913610 PMCID: PMC7459379 DOI: 10.4081/or.2020.8682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022] Open
Abstract
Over the last decade, regenerative medicine has become increasingly popular throughout the scientific community. The poor healing capacity at the tendon-bone interface makes the rotator cuff an appealing target for biologic agents. Adipose derived stem cells are mesenchymal cells with the capacity for self-renewal and multipotential differentiation. They have been recently proposed, both in isolation and as adjuvants to existing surgical therapies, for the treatment of rotator cuff tears. Several studies have been carried out in this research field, starting from the biological characteristics of adipose derived stem cells, their preparation and culture, up to the application in the experimental field on animal models and on humans. The purpose of this study was to provide a state of the art about the current basic science and clinical literature for the effectiveness of adipose derived stem cells in the treatment of rotator cuff tears.
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Affiliation(s)
- Fabrizio Mocini
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | | | - Piero Piazza
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Valentina Cardona
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Valeria Vismara
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Piermarco Messinese
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Vincenzo Campana
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Giuseppe Sircana
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Giulio Maccauro
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
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Abstract
Each year increasing numbers of people participate in a wider variety of athletic endeavors. Unlike previous generations, many patients remain in these activities later into their lives, some well beyond retirement. As the population ages and their activities continue, they are subject to injury of various forms affecting all aspects of their bodies.
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Affiliation(s)
| | - Christina Lin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
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20
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Maalouly J, Tawk A, Aouad D, Nour HA, Saidy E, Abboud G, El Rassi G. Is there an association between glenoid parameters and rotator cuff tears and the influence of gender: A retrospective study on a Middle Eastern population. Int J Surg Case Rep 2020; 68:74-82. [PMID: 32120282 PMCID: PMC7052435 DOI: 10.1016/j.ijscr.2020.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE This study aims to investigate the presence of any differences between the normal population and patients with rotator cuff tears in term of glenoid morphological parameters. METHOD For the purpose of this study, 82 shoulder MRIs were evaluated. The individuals included in this study were divided into the patient group (cuff tear group, n = 41) and the control group (control group, n = 41) with respect to the inclusion and exclusion criteria. For the statistical analysis, SPSS software was used. RESULTS Statistically significant difference was found between the patient group and the control group in terms of Glenoid Version Angle (GVA), Glenoid Axial Width (GAW), Glenoid Axial Depth (GAD), Glenoid Coronal Depth (GCD), and the Glenoid Inclination Angle (GIA). Age was found to have a positive linear correlation with the glenoid coronal height. Moreover, statistically significant difference was found between the males and females, between males with cuff tears and control males, and females with cuff tears and control females in terms of glenoid parameters. When gender was a covariate, statistically significant differences in glenoid parameters was still present between cuff tears patients and individuals with control shoulders. CONCLUSION The results attained in this study are suggest that the GVA, GAW, GAD, GCD, and GIA in rotator cuff tear patients are different than those found in control patients. These measurements may be helpful in reaching the diagnosis in cases where the clinical diagnosis is equivocal. Moreover, these measurements may be helpful in planning tears management. The influence of gender on glenoid parameters and subsequent impact on shoulder pathology may help to better understand the biomechanism of rotator cuff tears and reach an individualized management for better patient care.
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Affiliation(s)
- Joseph Maalouly
- St Georges University Medical Center Lebanon, Beirut, Achrafieh, St Georges Street, Lebanon.
| | - Antonios Tawk
- St Georges University Medical Center Lebanon, Beirut, Achrafieh, St Georges Street, Lebanon.
| | - Dany Aouad
- St Georges University Medical Center Lebanon, Beirut, Achrafieh, St Georges Street, Lebanon.
| | - Hicham Abdel Nour
- St Georges University Medical Center Lebanon, Beirut, Achrafieh, St Georges Street, Lebanon.
| | - Elias Saidy
- St Georges University Medical Center Lebanon, Beirut, Achrafieh, St Georges Street, Lebanon.
| | - Ghadi Abboud
- St Georges University Medical Center Lebanon, Beirut, Achrafieh, St Georges Street, Lebanon.
| | - Georges El Rassi
- St Georges University Medical Center Lebanon, Beirut, Achrafieh, St Georges Street, Lebanon.
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21
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Abraham AC, Shah SA, Golman M, Song L, Li X, Kurtaliaj I, Akbar M, Millar NL, Abu-Amer Y, Galatz LM, Thomopoulos S. Targeting the NF-κB signaling pathway in chronic tendon disease. Sci Transl Med 2020; 11:11/481/eaav4319. [PMID: 30814338 DOI: 10.1126/scitranslmed.aav4319] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/31/2019] [Indexed: 01/20/2023]
Abstract
Tendon disorders represent the most common musculoskeletal complaint for which patients seek medical attention; inflammation drives tendon degeneration before tearing and impairs healing after repair. Clinical evidence has implicated the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway as a correlate of pain-free return to function after surgical repair. However, it is currently unknown whether this response is a reaction to or a driver of pathology. Therefore, we aimed to understand the clinically relevant involvement of the NF-κB pathway in tendinopathy, to determine its potential causative roles in tendon degeneration, and to test its potential as a therapeutic candidate. Transcriptional profiling of early rotator cuff tendinopathy identified increases in NF-κB signaling, including increased expression of the regulatory serine kinase subunit IKKβ, which plays an essential role in inflammation. Using cre-mediated overexpression of IKKβ in tendon fibroblasts, we observed degeneration of mouse rotator cuff tendons and the adjacent humeral head. These changes were associated with increases in proinflammatory cytokines and innate immune cells within the joint. Conversely, genetic deletion of IKKβ in tendon fibroblasts partially protected mice from chronic overuse-induced tendinopathy. Furthermore, conditional knockout of IKKβ improved outcomes after surgical repair, whereas overexpression impaired tendon healing. Accordingly, targeting of the IKKβ/NF-κB pathway in tendon stromal cells may offer previously unidentified therapeutic approaches in the management of human tendon disorders.
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Affiliation(s)
- Adam C Abraham
- Department of Orthopedic Surgery, Columbia University, 650 W 168th St, New York, NY 10032, USA
| | - Shivam A Shah
- Department of Biomedical Engineering, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Mikhail Golman
- Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Ave, New York, NY 10027, USA
| | - Lee Song
- Department of Orthopedic Surgery, Columbia University, 650 W 168th St, New York, NY 10032, USA
| | - Xiaoning Li
- Department of Orthopedic Surgery, Columbia University, 650 W 168th St, New York, NY 10032, USA
| | - Iden Kurtaliaj
- Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Ave, New York, NY 10027, USA
| | - Moeed Akbar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Ave., Glasgow, Scotland G12 8TA, UK
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Ave., Glasgow, Scotland G12 8TA, UK
| | - Yousef Abu-Amer
- Departments of Orthopedic Surgery and Cell Biology and Physiology, Washington University in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA.,Shriners Hospital for Children, 4400 Clayton Ave, St. Louis, MO 63110, USA
| | - Leesa M Galatz
- Department of Orthopedic Surgery, Mount Sinai, 5 E 98th St., New York, NY 10029, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, 650 W 168th St, New York, NY 10032, USA. .,Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Ave, New York, NY 10027, USA
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22
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The role of biologic agents in the management of common shoulder pathologies: current state and future directions. J Shoulder Elbow Surg 2019; 28:2041-2052. [PMID: 31585784 DOI: 10.1016/j.jse.2019.07.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 07/28/2019] [Indexed: 02/01/2023]
Abstract
The field of orthopedic surgery has seen a rapid increase in the use of various biologic agents for the treatment of common musculoskeletal injuries. Most biologic agents attempt to harness or mimic naturally occurring growth factors, cytokines, and anti-inflammatory mediators to improve tissue healing and recovery. The most commonly used biologic agents are platelet-rich plasma and cells derived from bone marrow aspirate and adipose tissue. These agents have become increasingly popular despite a relative dearth of clinical data to support their use. Much confusion exists among patients and physicians in determining the role of these agents in treating common shoulder pathologies, such as glenohumeral osteoarthritis, rotator cuff tears, and tendinopathy. This article reviews the basic science and clinical evidence for the most commonly used biologic agents in the management of common shoulder pathology.
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23
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Jain NB, Ayers GD, Fan R, Kuhn JE, Warner JJ, Baumgarten KM, Matzkin E, Higgins LD. Comparative Effectiveness of Operative Versus Nonoperative Treatment for Rotator Cuff Tears: A Propensity Score Analysis From the ROW Cohort. Am J Sports Med 2019; 47:3065-3072. [PMID: 31518155 PMCID: PMC7325686 DOI: 10.1177/0363546519873840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The evidence to support operative versus nonoperative treatment for rotator cuff tears is sparse and inconclusive. PURPOSE To assess pain and functional outcomes in patients undergoing operative and nonoperative treatments for rotator cuff tears. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS From March 2011 to February 2015, a multicenter cohort of patients with rotator cuff tears undergoing operative and nonoperative treatments was recruited. Patients completed a detailed history questionnaire, the Shoulder Pain and Disability Index (SPADI), and the American Shoulder and Elbow Surgeons (ASES) standardized form and underwent magnetic resonance imaging. In addition to baseline assessments, patients received follow-up questionnaires at 3, 6, 12, and 18 months. Propensity score weighting was used to balance differences in characteristics of the operative and nonoperative groups. RESULTS Adjusted for propensity scores, the operative (n = 50) and nonoperative (n = 77) groups had similar characteristics, as evidenced by the small standardized mean differences between the groups. Adjusted mean differences in the SPADI and ASES scores between the operative and nonoperative groups were -22.0 points (95% CI, -32.1 to -11.8) and -22.2 points (95% CI, -32.8 to -11.6) at 18 months, respectively. The operative group had a significantly higher proportion of patients who showed ≥30% (P = .002) and ≥50% (P < .0001) improvement in SPADI and ASES scores as compared with the nonoperative group. CONCLUSION In this prospective cohort study, patients undergoing operative treatment had significantly better pain and functional outcomes as compared with patients undergoing nonoperative treatment for rotator cuff tears. Differences between the 2 groups in SPADI and ASES scores at the 6- to 18-month time points met the minimal clinically important difference (depending on the threshold used). A large randomized controlled trial is needed to answer this question more definitively.
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Affiliation(s)
- Nitin B. Jain
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Gregory D. Ayers
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Run Fan
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - John E. Kuhn
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Jon J.P. Warner
- Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Ardeljan A, Palmer J, Drawbert H, Ardeljan A, Vakharia RM, Roche MW. Partial thickness rotator cuff tears: Patient demographics and surgical trends within a large insurance database. J Orthop 2019; 17:158-161. [PMID: 31879497 DOI: 10.1016/j.jor.2019.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/13/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Partial thickness rotator cuff tears (PTRCT) are a common injury reported in 13-32% of the population, yet most of the current literature focuses on full thickness rotator cuff tears. Therefore, the purpose of this study was to analyze trends among patients with PTRCT including: (1) demographics; (2) comorbidities; (3) cost of care; (4) setting of initial diagnosis; and (5) change in incidence of PTRCT or surgical approach over time. Methods A Medicare patient-population consisting of 44 million lives was retrospectively analyzed from 2007 to 2017 using International Classification of Disease, 9th Revision (ICD-9) codes. Patients were identified for PTRCT using ICD-9 code: 726.13. The query yielded a total of 44,978 patients all of which had been previously diagnosed with PTRCT. Primary trends analyzed included: demographics, comorbidities, cost of care, initial setting of diagnosis, and change in incidence of PTRCT or surgical approach over time. Results PTRCTs and surgical repair of PTRCTs were most common in patients ages 65 to 69 and least common in patients who were 85 and older. Incidence of PTRCT was greater in females (54.12%) than males (45.88%). Comorbidities found within the population included hypertension, hyperlipidemia, diabetes mellitus, tobacco use, obesity, rheumatoid arthritis, and osteoarthritis of the shoulder. The average cost per episode of care totaled $9,923.26. PTRCTs were most commonly diagnosed in patients who resided in assisted living facilities (n = 27,106), making up 60% of the patient population. Reported incidence of PTRCT has increased substantially along with the surgical repair of PTRCT. Conclusion Reported cases of PTRCT and its surgical repair have both increased substantially over time. Approximately 11.70% of patients with PTRCT undergo either open or arthroscopic procedure as a means of surgical repair. With the growing popularity of arthroscopic procedures for rotator cuff repair, further investigation should be performed to analyze trends and risk factors for PTRCT, a seemingly underrepresented orthopedic condition.
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Affiliation(s)
- Andrew Ardeljan
- Holy Cross Hospital, Orthopedic Research Institute, 5597 North Dixie Highway, Ft. Lauderdale, FL, 33308, USA
| | - Joseph Palmer
- Broward General Medical Center, Department of Orthopedic Surgery, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA
| | - Hans Drawbert
- Florida International University, Herbert Wertheim College of Medicine, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Amalia Ardeljan
- Holy Cross Hospital, Orthopedic Research Institute, 5597 North Dixie Highway, Ft. Lauderdale, FL, 33308, USA
| | - Rushabh M Vakharia
- Holy Cross Hospital, Orthopedic Research Institute, 5597 North Dixie Highway, Ft. Lauderdale, FL, 33308, USA
| | - Martin W Roche
- Holy Cross Hospital, Orthopedic Research Institute, 5597 North Dixie Highway, Ft. Lauderdale, FL, 33308, USA
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Jain NB, Ayers GD, Koudelková H, Archer KR, Dickinson R, Richardson B, Derryberry M, Kuhn JE. Operative vs Nonoperative Treatment for Atraumatic Rotator Cuff Tears: A Trial Protocol for the Arthroscopic Rotator Cuff Pragmatic Randomized Clinical Trial. JAMA Netw Open 2019; 2:e199050. [PMID: 31397866 PMCID: PMC6692688 DOI: 10.1001/jamanetworkopen.2019.9050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Rotator cuff disorders remain the most common cause of shoulder pain and are among the most common reasons for patients to seek care in primary and specialty settings. Although operative and nonoperative treatments are offered to patients with atraumatic rotator cuff tears, there is a lack of evidence to support operative vs nonoperative treatment. This paucity of evidence has been highlighted by several professional agencies and experts. OBJECTIVE To perform a pragmatic randomized clinical trial, the Arthroscopic Rotator Cuff trial, comparing pain and functional outcomes in patients undergoing operative vs nonoperative treatment for atraumatic rotator cuff tears, and assessing heterogeneity of treatment effects by age and tear size. DESIGN, SETTING, AND PARTICIPANTS Trial protocol of the Arthroscopic Rotator Cuff trial. This pragmatic randomized clinical trial of an estimated 700 patients is adequately powered to accomplish its aims with 488 patients. Primary analysis will be conducted on an intent-to-treat population in the context of a mixed model. The multicenter trial started recruitment in 2018 with a 1-year follow-up duration. Patients aged 50 years or older to younger than 85 years with magnetic resonance imaging-confirmed atraumatic rotator cuff tears that are suitable for either operative or nonoperative treatment will be enrolled. Block randomization will be performed and stratified by site, age, and tear size. INTERVENTION Nonoperative treatment consists of an approximately 3-month standardized physical therapy program, whereas operative treatment consists of rotator cuff surgery followed by approximately 4 months of postoperative rehabilitation. MAIN OUTCOMES AND MEASURES The primary outcome is patient-reported Shoulder Pain and Disability Index score, and the secondary outcome is American Shoulder and Elbow Surgeons Standardized Shoulder Form score measured at 1 year of follow-up. DISCUSSION The Arthroscopic Rotator Cuff trial is ongoing, and 12 sites with more than 40 physicians are currently recruiting patients. Although there is variation by site, as of May 2, 2019, 13% of all patients screened (787 of 6293) were eligible for the trial, and 9% of eligible patients (74 of 787) were recruited. Results of this study may help patients, clinicians, and policy makers assess the comparative effectiveness of operative vs nonoperative treatment for atraumatic rotator cuff tears. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03295994.
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Affiliation(s)
- Nitin B. Jain
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory D. Ayers
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Helen Koudelková
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristin R. Archer
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca Dickinson
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brian Richardson
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - John E. Kuhn
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
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Ackley JF, Kolosky M, Gurin D, Hampton R, Masin R, Krahe D. Cryopreserved amniotic membrane and umbilical cord particulate matrix for partial rotator cuff tears: A case series. Medicine (Baltimore) 2019; 98:e16569. [PMID: 31348285 PMCID: PMC6709267 DOI: 10.1097/md.0000000000016569] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Amniotic membrane (AM) and umbilical cord (UC) are well known to have anti-inflammatory properties and have been shown to promote healing in various orthopedic indications. This study investigated whether intra-articular injection of AM/UC particulate matrix promotes healing of partial rotator cuff tears (RCTs).A case series was performed on 10 patients that received injection of 50 mg AM/UC for partial RCTs that were refractory to conservative treatment. Outcomes included Penn Shoulder Score (PSS) questionnaire, range of motion examination, and magnetic resonance imaging (MRI) analysis before and at 6 months. Final MRI analysis was performed by a musculoskeletal radiologist in a blinded fashion.Average PSS score (out of 100) increased from 46.8 ± 23.7 at baseline to 82.0 ± 19.1 at 6 months. The average PSS sub-scores of pain, satisfaction, and function increased 78.4%, 37.1%, and 82.3% from baseline, respectively. The subject's range of motion was 77.9% at baseline and increased to 99.9% at 6-months. Follow-up MRI scans did not demonstrate any significant change in RCT size. No adverse events were noted.This small case series provides preliminary data for use of cryopreserved AM/UC particulate matrix in patients with refractory partial RCTs.
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Affiliation(s)
- J Freeland Ackley
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
- Southwest Sports Medicine, Waco, TX
| | | | - Danielle Gurin
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
| | - Robert Hampton
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
| | - Richard Masin
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
| | - David Krahe
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
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Lamas JR, García-Fernández C, Tornero-Esteban P, Lópiz Y, Rodriguez-Rodriguez L, Ortega L, Fernández-Gutiérrez B, Marco F. Adverse effects of xenogenic scaffolding in the context of a randomized double-blind placebo-controlled study for repairing full-thickness rotator cuff tears. Trials 2019; 20:387. [PMID: 31262366 PMCID: PMC6604436 DOI: 10.1186/s13063-019-3504-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 06/10/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The purpose of the study was to compare the safety and efficacy of autologous mesenchymal stem cells (MSCs) embedded in a xenogenic scaffold for repairing the supraspinatus tendon. METHODS This was a randomized, double-blind and placebo-controlled trial evaluating patients with full-thickness rotator cuff tears (Eudra-CT, 2007-007630-19). Effectiveness was evaluated using the Constant score and a visual analogue pain scale (VAS). Constant score has four domains including pain (15 possible points), activities of daily living (20 possible points), mobility (40 possible points), and strength (25 possible points). Scores range from 0 points (most disability) to 100 points (least disability). The structural integrity of the repaired tendon was assessed by magnetic resonance imaging (MRI) according to Patte and Thomazeau classification criteria. The primary study end point was an improvement in the Constant score by 20 points at one year compared to initial assessment. RESULTS The trial was stopped due to adverse effects observed in both groups. Only thirteen patients were included and analyzed. The Constant questionnaire showed a significant improvement in the MSC treatment group compared with the preoperative data (p = 0.0073). Secondary outcome measures were similar in both groups. CONCLUSIONS Our study showed preliminary inconclusive clinical outcomes in the patients treated with MSCs. Adverse events revealed the need for further approaches using scaffolds of a different nature or perhaps no scaffolds, in the context of small joints. TRIAL REGISTRATION Eudra-CT, 2007-007630-19 . Registered on 30 January 2008. LEVEL OF EVIDENCE A Level 1 of evidence treatment study.
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Affiliation(s)
- José Ramón Lamas
- UGC de Reumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain
| | - Carlos García-Fernández
- UGC de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pilar Tornero-Esteban
- UGC de Reumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain
| | - Yaiza Lópiz
- UGC de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Luis Rodriguez-Rodriguez
- UGC de Reumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain
| | - Luis Ortega
- Servicio de Anatomía Patológica Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Benjamín Fernández-Gutiérrez
- UGC de Reumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain.
| | - Fernando Marco
- UGC de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Khatri C, Ahmed I, Parsons H, Smith NA, Lawrence TM, Modi CS, Drew SJ, Bhabra G, Parsons NR, Underwood M, Metcalfe AJ. The Natural History of Full-Thickness Rotator Cuff Tears in Randomized Controlled Trials: A Systematic Review and Meta-analysis. Am J Sports Med 2019; 47:1734-1743. [PMID: 29963905 DOI: 10.1177/0363546518780694] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff tears are the most common tendon injury in the adult population, resulting in substantial morbidity. The optimum management for these patients is not known. PURPOSE To assess the overall treatment response to all interventions in full-thickness rotator cuff tears among patients enrolled in randomized clinical trials. STUDY DESIGN Systematic review and meta-analysis. METHODS Randomized controlled trials (RCTs) were identified from a systematic search of Medline, Embase, CINHAL, and the Cochrane Central Register of Controlled Trials. Patients were aged ≥18 years with a full-thickness rotator cuff tear. The primary outcome measure was change in Constant shoulder score from baseline to 52 weeks. A meta-analysis to assess treatment response was calculated via the standardized mean change in scores. RESULTS A total of 57 RCTs were included. The pooled standardized mean change as compared with baseline was 1.42 (95% CI, 0.80-2.04) at 3 months, 2.73 (95% CI, 1.06-4.40) at 6 months, and 3.18 (95% CI, 1.64-4.71) at 12 months. Graphic plots of treatment response demonstrated a sustained improvement in outcomes in nonoperative trial arms and all operative subgroup arms. CONCLUSION Patients with full-thickness rotator cuff tears demonstrated a consistent pattern of improvement in Constant score with nonoperative and operative care. The natural history of patients with rotator cuff tears included in RCTs is to improve over time, whether treated operatively or nonoperatively.
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Affiliation(s)
- Chetan Khatri
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - Imran Ahmed
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - Helen Parsons
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - Nicholas A Smith
- Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Thomas M Lawrence
- Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Chetan S Modi
- Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Stephen J Drew
- Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Gev Bhabra
- Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Nicholas R Parsons
- Statistics & Epidemiology Unit, University of Warwick Medical School, Coventry, UK
| | - Martin Underwood
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - Andrew J Metcalfe
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
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Aramberri-Gutiérrez M, Martínez-Menduiña A, Boyle S, Valencia M. Biomechanical testing of trans-humeral all-suture anchors for rotator cuff repair. Shoulder Elbow 2019; 11:77-85. [PMID: 31019566 PMCID: PMC6463375 DOI: 10.1177/1758573218779078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/03/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rotator cuff tears are one of the most common causes of shoulder pain. All-suture anchors are increasingly being used in the arthroscopic repair of rotator cuff tears. The purpose of this experimental study is to evaluate the biomechanical properties of all-suture anchors at different insertion sites in the proximal humerus relevant to rotator cuff repairs and the remplissage procedure. METHODS Sixteen cadaveric shoulders were used for the study. Four all-suture anchors were inserted in each proximal humerus at common anchor insertion sites on the rotator cuff footprint and a simulated Hill-Sachs defect. Cyclic loading and load-to-failure tests were undertaken. The number of cycles, load to failure and nature of failure were recorded. RESULTS The all-suture anchors placed in the cuff footprint using a transosseous technique displayed superior biomechanical properties. Sutures sited in this way demonstrated a maximum tensile load to failure of 542 N as well as a highest mean load to failure and the maximum number of cycles before anchor failure. In descending order, all-suture anchors placed in the lateral footprint were significantly superior to those located in the medial row and in a simulated Hill-Sachs defect. DISCUSSION Anchors placed in the rotator cuff footprint exceeded the physiological isometric abduction forces for the supraspinatus and infraspinatus. Data obtained from our study suggest that all-suture anchors are strong enough to be used for the repair of rotator cuff tears.
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Affiliation(s)
- Mikel Aramberri-Gutiérrez
- Alai Sports Medicine Clinic, Madrid, Spain
- Mikel Aramberri-Gutiérrez, Alai Sports Medicine Clinic, Madrid, Spain
| | | | | | - Maria Valencia
- Fundacion Jimenez Diaz, Orthopaedics; Shoulder and Elbow Unit, Madrid, Spain
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Zhang K, de Sa D, Kanakamedala A, Sheean AJ, Vyas D. Management of Concomitant Preoperative Rotator Cuff Pathology and Adhesive Capsulitis: A Systematic Review of Indications, Treatment Approaches, and Outcomes. Arthroscopy 2019; 35:979-993. [PMID: 30733032 DOI: 10.1016/j.arthro.2018.10.126] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/06/2018] [Accepted: 10/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Concomitant preoperative adhesive capsulitis (AC) and rotator cuff (RC) pathology pose therapeutic challenges in light of contrasting interventional and rehabilitative goals. The purposes of this systematic review were to assess the literature regarding the management and rehabilitation of patients with concomitant RC tears and preoperative AC and to compare overall clinical outcomes between strategies for this common scenario. METHODS In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 3 databases (MEDLINE, Embase, and PubMed) were searched and screened in duplicate using predetermined criteria for studies on the aforementioned patient population. Descriptive statistics are presented. RESULTS Of 952 studies, 17 involving 662 shoulders, with a mean age of 59.6 ± 3.5 years, 57.9% female patients, and a mean follow-up period of 18.6 months, were included. Capsular release (CR) (86.1%) and manipulation under anesthesia (MUA) (33.1%) were the most common co-interventions with RC repair. Across studies, mean preoperative American Shoulder and Elbow Surgeons scores ranged from 29.0 to 61.3, visual analog scale scores (pain) ranged from 5.3 to 8.0, and Constant scores ranged from 18.0 to 48.0. Mean postoperative American Shoulder and Elbow Surgeons scores ranged from 76.9 to 92.0, visual analog scale scores (pain) ranged from 0.3 to 2.5, and Constant scores ranged from 72.6 to 93.2. Postoperative rehabilitation comprised abduction braces and passive range of motion immediately postoperatively for mean durations of 5.0 weeks and 5.3 weeks, respectively, followed by active range of motion at a mean of 5.3 weeks and strengthening at 10.9 weeks. Postoperative complications included stiffness, RC retear, instability, glenoid fracture, and superficial infection. CONCLUSIONS The results of this systematic review support treatment of patients with degenerative RC tears and concomitant AC with a combination of RC repair and MUA, CR, or both MUA and CR. Regardless of the treatment modality, accelerated postoperative rehabilitative protocols are beneficial in preventing postoperative persistence of AC and can be safely used in this scenario without a substantial increase in complication rates compared with patients undergoing RC repair alone with conservative rehabilitation. LEVEL OF EVIDENCE Level V, systematic review of Level II, III, IV, and V studies.
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Affiliation(s)
- Kailai Zhang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, U.S.A..
| | | | - Andrew J Sheean
- UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Dharmesh Vyas
- UPMC Lemieux Sports Complex, Cranberry, Pennsylvania, U.S.A
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Effect of Platelet-Rich Plasma and Amniotic Membrane in Patients with Rotator Cuff Repair. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2018. [DOI: 10.4028/www.scientific.net/jbbbe.39.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Rotator cuff disorders are the most common source of shoulder problems, ranging from mild strain to massive tears. Platelet-rich plasma (PRP), an autologous blood with platelets concentration above baseline values represents a source of multiple growth factors that promotes tissue repair. This review examines the potential of using PRP to augment rotator cuff repair. Reporting 4 patients with impingement syndrome and supraspinatus tear who underwent decompression acromioplasty and supraspinatus repair augmented with platelet-rich plasma and amniotic membrane. An evaluation was made 3-24 months postoperative using Shoulder Pain and Disability Index (SPADI). Average preoperative pain score is 64%, disability score 54.58%, and total score 58.19%. Average postoperative pain score is 0%, disability score 0.42%, and total score 0.26% (Minimum Detectable Change at 90% confidence for pain score is 18%, disability score 13%, and total score 11%). This result is consequent with research by Luoay Fallouh, stating that improvement is caused by growth factor effects in platelet-rich plasma which promotes soft tissue healing. It can be concluded that platelet-rich plasma and amniotic membrane have promising effects to enhance soft tissue healing in patients with rotator cuff syndrome. Shoulder function is restored with no limitation on daily activity and pain is no longer present.
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Titan A, Andarawis-Puri N. Tendinopathy: Investigating the Intersection of Clinical and Animal Research to Identify Progress and Hurdles in the Field. JBJS Rev 2018; 4:01874474-201610000-00002. [PMID: 27792676 DOI: 10.2106/jbjs.rvw.15.00088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Biological treatments, surgical interventions, and rehabilitation exercises have been successfully used to treat tendinopathy, but the development of effective treatments has been hindered by the lack of mechanistic data regarding the pathogenesis of the disease. While insightful, clinical studies are limited in their capacity to provide data regarding the pathogenesis of tendinopathies, emphasizing the value of animal models and cell culture studies to fill this essential gap in knowledge. Clinical pathological findings from imaging studies or histological analysis are not universal across patients with tendinopathy and have not been clearly associated with the onset of symptoms. There are several unresolved controversies, including the cellular changes that accompany the tendinopathic disease state and the role of inflammation. Additional research is needed to correlate the manifestations of the disease with its pathogenesis, with the goal of reaching a field-wide consensus on the pathology of the disease state. Such a consensus will allow standardized clinical practices to more effectively diagnose and treat tendinopathy.
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Affiliation(s)
- Ashley Titan
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
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Jeanfavre M, Husted S, Leff G. EXERCISE THERAPY IN THE NON-OPERATIVE TREATMENT OF FULL-THICKNESS ROTATOR CUFF TEARS: A SYSTEMATIC REVIEW. Int J Sports Phys Ther 2018; 13:335-378. [PMID: 30038823 PMCID: PMC6044593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Although commonly prescribed, the evidence to support exercises therapy (ET) and conservative management for the treatment of full-thickness rotator cuff tears (FTT) is equivocal. PURPOSE The purpose of this systematic review of the literature was to determine the current level of evidence available for ET in the treatment of FTT and to provide a formal Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group of recommendation. METHODS Five databases were systematically searched to evaluate the effectiveness of ET for FTT. Inclusion criteria: experimental or observational studies of adults clinically diagnosed with FTT, or massive, or inoperable tears that contained a treatment group that received ET for FTT. Exclusion criteria included: history of surgical repair, concurrent significant trauma, neurological impairment, and level V studies. Articles were assessed for quality, the level of evidence (I - V) and GRADE of recommendation (A to F) was determined. Data extraction included: demographics, specific interventions, and outcomes. RESULTS One thousand, five-hundred and sixty-nine unique citations were identified, 35 studies were included: nine randomized controlled studies, six cohort studies, 15 case series and five case reports. There were 2010 shoulders in 1913 subjects with an average age of 64.2 years, 54% males, 73% of tears were > 1 cm and 37% were classified as massive. Based on studies that reported, >58% of tears were > 1 year and 73% were atraumatic. Of the non-operatively treated cohorts that reported the respective outcomes: 78% improved in pain (9/10 cohorts that reported statistically significant differences [stat-sig] p<0.05), 81% improved in ROM (14/14 cohorts that reported, met stat-sig), 85% improved in strength (7/8 cohorts that reported, met stat-sig), 84% improved in functional outcomes (17/17 cohorts that reported, met stat-sig). Dissatisfied outcomes occurred in 15% of patients, who then transitioned to surgery. CONCLUSION The current literature indicates GRADE B recommendation (moderate strength) to support the use of ET in the management of FTT. There is further need for well-designed randomized controlled trials. LEVEL OF EVIDENCE 2a.
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Affiliation(s)
| | - Sean Husted
- Advanced Physical Therapy, Thousand Oaks, CA, USA
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Lau AY, Piper K, Bokor D, Martin P, Lau VS, Coiera E. Challenges During Implementation of a Patient-Facing Mobile App for Surgical Rehabilitation: Feasibility Study. JMIR Hum Factors 2017; 4:e31. [PMID: 29217504 PMCID: PMC5740262 DOI: 10.2196/humanfactors.8096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/23/2017] [Accepted: 09/28/2017] [Indexed: 12/14/2022] Open
Abstract
Background Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challenges of implementing patient-facing digital technologies in health care settings. Objective The aim of this study was to report challenges experienced when implementing mobile apps for patients to support their postsurgical rehabilitation in an orthopedic setting. Methods A mobile app was tailored to the needs of patients undergoing rotator cuff repair. A 30-min usability session and a 12-week feasibility study were conducted with patients to evaluate the app in routine care. Implementation records (observation reports, issues log, and email correspondence) explored factors that hindered or facilitated patient acceptance. Interviews with clinicians explored factors that influenced app integration in routine care. Results Participant completion was low (47%, 9/19). Factors that affected patient acceptance included digital literacy, health status, information technology (IT) infrastructure at home, privacy concerns, time limitations, the role of a caregiver, inconsistencies in instruction received from clinicians and the app, and app advice not reflective of patient progress over time. Factors that negatively influenced app integration in routine care included competing demands among clinicians, IT infrastructure in health care settings, identifying the right time to introduce the app to patients, user interface complexity for older patients, lack of coordination among multidisciplinary clinicians, and technical issues with app installation. Conclusions Three insights were identified for mobile app implementation in routine care: (1) apps for patients need to reflect their journey over time and in particular, postoperative apps ought to be introduced as part of preoperative care with opportunities for patients to learn and adopt the app during their postoperative journey; (2) strategies to address digital literacy issues among patients and clinicians are essential; and (3) impact of the app on patient outcomes and clinician workflow needs to be communicated, monitored, and reviewed. Lastly, digital health interventions should supplement but not replace patient interaction with clinicians.
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Affiliation(s)
- Annie Ys Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kalman Piper
- Department of Orthopaedic Surgery, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, Australia
| | - Desmond Bokor
- Department of Orthopaedic Surgery, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, Australia
| | - Paige Martin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Victor Sl Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Artul S, Habib G. Ultrasonographic clues for acuity/chronicity of rotator cuff tear. Eur J Rheumatol 2017; 4:260-263. [PMID: 29308280 PMCID: PMC5741338 DOI: 10.5152/eurjrheum.2017.17047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/25/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To look prospectively for ultrasonographic clues for acuity/chronicity of rotator cuff tear (RCT) among patients with shoulder pain. MATERIAL AND METHODS Patients with shoulder pain who were referred for musculoskeletal ultrasonography and diagnosed with RCT were asked to participate in our study. After consent, demographic, clinical, laboratory, and ultrasonographic findings, including age, gender, history of trauma, type of tendon with tear, tendon tear size, tendon effusion, bursal effusion, calcification, tendon thickness, and duration of shoulder pain were documented. Shoulder pain duration of ≤2 months was considered as an acute case. Patients were divided into group 1 (with acute shoulder pain) and group 2 (patients with chronic shoulder pain; pain duration of >2 months), and the various parameters of the two groups were compared to look for significant differences between the two groups. Student's unpaired t-test and the chi-square test were used for continuous and categorical parameters, respectively. RESULTS A total of 112 patients were diagnosed with RCT, and 132 tears were documented. Sixty-three patients (~56%) were male, and the mean age of all the patients was 54.2±15.2 years. A total of 44% of the patients belonged to group 1 (with acute pain). The existence of either a subdeltoid bursal effusion (SBE) or a biceps peritendon effusion (BPE) and thick tendon were observed significantly more among patients in group 1 compared to patients in group 2. CONCLUSION The existence of either an SBE or a BPE and thick tendon were signs of an acute RCT.
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Affiliation(s)
- Suheil Artul
- Department of Radiology, Nazareth Hospital, Faculty of Medicien, Gallile School of Mediciene, Bar-Ilan University, Ramat Gan, Israel
| | - George Habib
- Rheumatology Unit, Laniado Medical Center, Netanya, School of Medicine, Technion, Israel Institute of Technology Haifa, and Rheumatology Clinic, Nazareth Hospital, Nazareth, Israel
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Niglis L, Collin P, Dosch JC, Meyer N, Kempf JF. Intra- and inter-observer agreement in MRI assessment of rotator cuff healing using the Sugaya classification 10years after surgery. Orthop Traumatol Surg Res 2017; 103:835-839. [PMID: 28655629 DOI: 10.1016/j.otsr.2017.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 05/15/2017] [Accepted: 06/01/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The long-term outcomes of rotator cuff repair are unclear. Recurrent tears are common, although their reported frequency varies depending on the type and interpretation challenges of the imaging method used. The primary objective of this study was to assess the intra- and inter-observer reproducibility of the MRI assessment of rotator cuff repair using the Sugaya classification 10years after surgery. The secondary objective was to determine whether poor reproducibility, if found, could be improved by using a simplified yet clinically relevant classification. HYPOTHESIS Our hypothesis was that reproducibility was limited but could be improved by simplifying the classification. MATERIAL AND METHOD In a retrospective study, we assessed intra- and inter-observer agreement in interpreting 49 magnetic resonance imaging (MRI) scans performed 10years after rotator cuff repair. These 49 scans were taken at random among 609 cases that underwent re-evaluation, with imaging, for the 2015 SoFCOT symposium on 10-year and 20-year clinical and anatomical outcomes of rotator cuff repair for full-thickness tears. Each of three observers read each of the 49 scans on two separate occasions. At each reading, they assessed the supra-spinatus tendon according to the Sugaya classification in five types. RESULTS Intra-observer agreement for the Sugaya type was substantial (κ=0.64) but inter-observer agreement was only fair (κ=0.39). Agreement improved when the five Sugaya types were collapsed into two categories (1-2-3 and 4-5) (intra-observer κ=0.74 and inter-observer κ=0.68). CONCLUSION Using the Sugaya classification to assess post-operative rotator cuff healing was associated with substantial intra-observer and fair inter-observer agreement. A simpler classification into two categories improved agreement while remaining clinically relevant. LEVEL OF EVIDENCE II, prospective randomised low-power study.
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Affiliation(s)
- L Niglis
- Service de chirurgie orthopédique du membre supérieur, CCOM, 10, avenue Achille-Baumann, 67400 Illkirch, France.
| | - P Collin
- CHP Saint-Grégoire, 6, avenue de la Boutière, 35760 Saint-Grégoire, France
| | - J-C Dosch
- Service de radiologie, CCOM, 10, avenue Achille-Baumann, 67400 Illkirch, France
| | - N Meyer
- Laboratoire de biostatistique, hôpital civil, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - J-F Kempf
- Service de chirurgie orthopédique du membre supérieur, CCOM, 10, avenue Achille-Baumann, 67400 Illkirch, France
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- Société française de chirurgie orthopédique et traumatologique, 56, rue Boissonade, 75014 Paris, France
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Targeting Inflammation in Rotator Cuff Tendon Degeneration and Repair. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2017; 18:84-90. [PMID: 28947893 DOI: 10.1097/bte.0000000000000124] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Rotator cuff degeneration is a common affliction that results in pain and disability. Tendinopathy was historically classified with or without the involvement of the immune system. However, technological advancements in screening have shown that the immune system is both present and active in all forms of tendinopathy. During injury and healing, the coordinated effort of numerous immune cell populations work with the resident stromal cells to break down damaged tissues and stimulate remodeling. These cells deploy a wide array of tools, including phagocytosis, enzyme secretion, and chemotactic gradients to direct these processes. Yet, there remains a knowledge gap in our understanding of the sequence of critical events and regulatory factors that mediate this is process in injury and healing. Furthermore, current treatments do not specifically target inflammation at the molecular level. Typical regimens include non-steroidal anti-inflammatory drugs or corticosteroids; however, researchers have found irrevocable functional deficits following treatment, and have disputed their long-term efficacy. Therefore, developing therapeutics that specifically consider the nuances of the immune system are necessary to improve patient outcomes.
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Macías-Hernández SI, Vásquez-Sotelo DS, Ferruzca-Navarro MV, Badillo Sánchez SH, Gutiérrez-Martínez J, Núñez-Gaona MA, Meneses HA, Velez-Gutiérrez OB, Tapia-Ferrusco I, Soria-Bastida MDLÁ, Coronado-Zarco R, Morones-Alba JD. Proposal and Evaluation of a Telerehabilitation Platform Designed for Patients With Partial Rotator Cuff Tears: A Preliminary Study. Ann Rehabil Med 2016; 40:710-7. [PMID: 27606278 PMCID: PMC5012983 DOI: 10.5535/arm.2016.40.4.710] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/11/2015] [Indexed: 11/13/2022] Open
Abstract
Objective To propose and evaluate the effectiveness of a telerehabilitation platform designed for patients with rotator cuff (RC) tears. Methods During the first study phase, a virtual service platform that included information on RC tear pathology, joint care, and a series of instructions regarding therapeutic exercise was designed and created. Subsequently, in the clinical phase, a quasi-experimental study was performed. The platform was tested on patients and evaluated at baseline and at 1, 2, 3, and 6 months with respect to their pain levels and functionality on the Constant-Murley (CM) scale. Results Eleven patients were included, 5 women and 6 men, with a median age of 55 years (range, 42–68 years). Pain diminished from a baseline value of 64 mm (range, 40–80 mm) to 16 mm (range, 0–30 mm) at 6 months (p<0.001). Points on the CM scale rose from a baseline value of 54 points (range, 51–66 points) to 85 points (range, 70–100 points) at 6 months (p=0.001). Functionality in daily living and work activities, movement, and strength exhibited significant changes at 6 months (p<0.05). Conclusion Significant changes were observed in pain and functionality in this group of participants who used a telerehabilitation platform. To the best of our knowledge, this is the first study that included a specific program for RC tears.
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Affiliation(s)
| | | | | | | | - Josefina Gutiérrez-Martínez
- Subdirection of Technology/Biomedical Engineering, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Marco Antonio Núñez-Gaona
- Subdirection of Technology/Biomedical Engineering, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Heriberto Aguirre Meneses
- Subdirection of Technology/Biomedical Engineering, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | | | - Irene Tapia-Ferrusco
- Physical Therapy Division, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | | | - Roberto Coronado-Zarco
- Orthopedic Rehabilitation Division, Instituto Nacional de Rehabilitación, Mexico City, Mexico
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Ryösä A, Laimi K, Äärimaa V, Lehtimäki K, Kukkonen J, Saltychev M. Surgery or conservative treatment for rotator cuff tear: a meta-analysis. Disabil Rehabil 2016; 39:1357-1363. [PMID: 27385156 DOI: 10.1080/09638288.2016.1198431] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Comparative evidence on treating rotator cuff tear is inconclusive. The objective of this review was to evaluate the evidence on effectiveness of tendon repair in reducing pain and improving function of the shoulder when compared with conservative treatment of symptomatic rotator cuff tear. METHOD Search on CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science and Pedro databases. Randomised controlled trials (RCT) comparing surgery and conservative treatment of rotator cuff tear. Study selection and extraction based on the Cochrane Handbook for Systematic reviews of Interventions. Random effects meta-analysis. RESULTS Three identified RCTs involved 252 participants (123 cases and 129 controls). The risk of bias was considered low for all three RCTs. For Constant score, statistically insignificant effect size was 5.6 (95% CI -0.41 to 11.62) points in 1-year follow up favouring surgery and below the level of minimal clinically important difference. The respective difference in pain reduction was -0.93 (95% CI -1.65 to -0.21) cm on a 0-10 pain visual analogue scale favouring surgery. The difference was statistically significant (p = 0.012) in 1-year follow up but below the level of minimal clinically important difference. CONCLUSION There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. Thus, a conservative approach is advocated as the initial treatment modality. Implications for Rehabilitation There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. There was no clinically significant difference between surgery and active physiotherapy in 1-year follow-up in improving Constant score or reducing pain caused by rotator cuff tear. As physiotherapy is less proneness to complications and less expensive than surgery, a conservative approach is advocated as the initial treatment modality to rotator cuff tears.
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Affiliation(s)
- Anssi Ryösä
- a Department of Orthopaedics and Traumatology , Turku University Hospital and University of Turku , Turku , Finland
| | - Katri Laimi
- b Department of Physical and Rehabilitation Medicine , Turku University Hospital and University of Turku , Turku , Finland
| | - Ville Äärimaa
- a Department of Orthopaedics and Traumatology , Turku University Hospital and University of Turku , Turku , Finland
| | - Kaisa Lehtimäki
- a Department of Orthopaedics and Traumatology , Turku University Hospital and University of Turku , Turku , Finland
| | - Juha Kukkonen
- c Department of Surgery , Satakunta Central Hospital , Pori , Finland
| | - Mikhail Saltychev
- b Department of Physical and Rehabilitation Medicine , Turku University Hospital and University of Turku , Turku , Finland
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Macías-Hernández SI, Pérez-Ramírez LE. [Eccentric strength training for the rotator cuff tendinopathies with subacromial impingement. Current evidence]. CIR CIR 2016; 83:74-80. [PMID: 25982614 DOI: 10.1016/j.circir.2015.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 09/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rotator cuff tears are the leading cause of pain and functional disability of the shoulder. Conservative treatment is an essential part of their management. Despite the limited evidence, rehabilitation is the mainstay of the treatment for rotator cuff tears associated to impingement syndrome. There are current reports on the utility of strengthening with resistance, particularly by eccentric exercise. OBJECTIVE This report aims to present an overview of the efficacy of eccentric exercises in tendinopathies and current evidence of its benefit in rotator cuff tears. METHODS AND RESULTS We describe the information available in tendinopathy and analyzed four studies published on eccentric strengthening for rotator cuff tears. There is theoretical evidence about its usefulness in this pathology, but only a controlled clinical trial has been published with data on improvement in strength but not in pain or functionality. CONCLUSIONS More studies are needed with better methodological designs in order to generate evidence of their utility and recommendation.
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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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Vellios EE, Nazemi AK, Yeranosian MG, Cohen JR, Wang JC, McAllister DR, Petrigliano FA. Demographic trends in arthroscopic and open biceps tenodesis across the United States. J Shoulder Elbow Surg 2015; 24:e279-85. [PMID: 26141196 DOI: 10.1016/j.jse.2015.04.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 04/19/2015] [Accepted: 04/25/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate trends in procedures and to report on demographic data of patients undergoing arthroscopic vs. open biceps tenodesis. METHODS A retrospective review of a commercially available database (PearlDiver) was conducted to identify cases of arthroscopic and open biceps tenodesis performed between 2007 and 2011 with concurrent diagnoses of commonly associated shoulder disorders. Each record provided the patient's age, gender, and region within the United States, and statistical significance was determined with respect to each of these demographics. RESULTS There were 9011 patients who underwent arthroscopic biceps tenodesis and 11,678 patients who underwent open biceps tenodesis between 2007 and 2011. The number of biceps tenodesis cases increased from 2007 to 2011 (2047 to 5832; P = .015). Both arthroscopic and open biceps tenodesis procedures were performed most commonly in the 30- to 59-year-old age group (76.3% and 76.1%; P < .00001). Men underwent arthroscopic or open biceps tenodesis more commonly than women did (66.1% and 71.9%; P < .00001). Rates of both open and arthroscopic biceps tenodesis varied significantly among the Midwest, South, Northeast, and West regions (P = .009; P = .007); 49.8% of arthroscopic and 44.6% of open biceps tenodesis cases were associated with rotator cuff tears, whereas 14.4% of arthroscopic and 16.2% of open cases were associated with biceps tendon disorders. CONCLUSION Both arthroscopic and open biceps tenodesis cases increased annually from 2007 to 2011. The majority of biceps tenodesis cases were performed in men aged 30 to 59 years, and the South had the highest overall number of cases. Further studies are required to evaluate the efficacy of these procedures with and without concomitant pathologic processes.
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Affiliation(s)
- Evan E Vellios
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Michael G Yeranosian
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeremiah R Cohen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - David R McAllister
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Brinkman RJ, Hage JJ. Andreas Vesalius' five hundreth anniversary: initiation of the rotator cuff concept. INTERNATIONAL ORTHOPAEDICS 2015; 39:2511-3. [PMID: 26122490 DOI: 10.1007/s00264-015-2823-6] [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: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE The rotator cuff concept refers to the four scapulohumeral muscles that stabilize and rotate the humerus relative to the scapula. To date, the first description of the rotator cuff remained unidentified. METHOD In light of the 500th birthday of Andreas Vesalius (1515-1564) we searched his 1543 masterwork "Fabrica Corporis Humani Libri Septem" for references to the morphology and function of the rotator cuff muscles. RESULT Even though he distinguished three rather than four scapulohumeral muscles, Vesalius recognized the need for structures that prevent dislocation of the shoulder inherent to the morphology of the humeral caput and scapular socket. He recorded "three strong ligaments" and the "three muscles that rotate the arm" of which the tendons completely "embrace the ligaments of the joint" as such structures. CONCLUSION Vesalius defined the rotator cuff concept avant la lettre.
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Affiliation(s)
- Romy J Brinkman
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 161, NL-1066 CX, Amsterdam, The Netherlands
| | - J Joris Hage
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 161, NL-1066 CX, Amsterdam, The Netherlands.
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Zhang Z, Gu B, Zhu W, Zhu L, Li Q. Arthroscopic versus mini-open rotator cuff repair: a prospective, randomized study with 24-month follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:845-50. [PMID: 23812851 DOI: 10.1007/s00590-013-1263-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/17/2013] [Indexed: 12/24/2022]
Abstract
This prospective, randomized study was performed to evaluate the results of mini-open and arthroscopic rotator cuff repair in a comparative case series of patients followed for 24 months. A total of 125 patients were randomized to mini-open (Group I) or arthroscopic (Group II) rotator cuff repair at the time of surgical intervention. The University of California Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) index, and muscle strength were measured to evaluate the clinical results, while magnetic resonance arthrography was used at 24-month follow-up to investigate the postoperative rotator cuff integrity. Fifty-three patients in Group I and 55 patients in Group II were available for evaluation at 24-month follow-up. At 24-month follow-up, the UCLA score, the ASES index, and muscle strength were statistically significantly increased in both groups postoperatively, while no significant difference was detected between the 2 groups. Intact rotator cuffs were investigated in 42 patients in Group I and 35 in Group II, and there was a significant difference in postoperative structural integrity between the two groups (P < 0.05). When analysis was limited to the patients with full-thickness tear, the muscle strength of the shoulder was significantly better in Group II, and the retearing rate was significantly higher in Group II. Based on the results obtained from this study, it can be indicated that arthroscopic and mini-open rotator cuff repair displayed substantially equal outcomes, except for higher retearing rate in the arthroscopic repair group. While for patients with full-thickness tear, arthroscopic rotator cuff repair displayed better shoulder strength and significantly higher retearing rate as compared to mini-open rotator cuff repair at 24-month follow-up.
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Affiliation(s)
- Zhenxiang Zhang
- Orthopedic Department, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, 225300, Jiangsu, People's Republic of China,
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