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Haft M, Pearson ZC, Ahiarakwe U, Nelson SY, Srikumaran U. Evaluating The Effect of Arthroscopic Rotator Cuff Repair with Concomitant Subacromial Decompression on 2, 4, and 6 Year Reoperation Rates. J Am Acad Orthop Surg 2024; 32:697-704. [PMID: 38657174 DOI: 10.5435/jaaos-d-23-00636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/10/2023] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION The risks and benefits of including an arthroscopic subacromial decompression (ASD) during arthroscopic rotator cuff repair (RCR) are uncertain. Some studies suggest no difference in revision surgery rates, whereas others have found higher revision surgery rates associated with concomitant ASD. In this study, we compare mid-term revision surgery rates in patients undergoing arthroscopic RCR with or without concomitant ASD. METHODS A retrospective cohort analysis was conducted using a national all-payer claims database. Current Procedural Terminology and International Classification of Disease , 10th Revision , codes were used to identify patients who underwent primary arthroscopic RCR with or without ASD in the United States. The primary study outcome was revision surgery at 2, 4, and 6 years. Univariate analysis was conducted on demographic variables (age, sex) and comorbidities in the Elixhauser Comorbidity Index using chi-square and Student t -tests. Multivariate analysis was conducted using logistic regression. RESULTS A total of 11,188 patients were identified who underwent RCR and met the inclusion criteria. Of those, 8,994 (80%) underwent concomitant ASD. Concomitant ASD was associated with lower odds of all-cause revision surgery to the ipsilateral shoulder at 2 years (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.51 to 0.73), 4 years (OR, 0.60; 95% CI, 0.51 to 0.70), and 6 years (OR, 0.59; 95% CI, 0.51 to 0.69). Concomitant ASD was also associated with lower odds of revision RCR at 2 years (OR, 0.68; 95% CI, 0.53 to 0.86), 4 years (OR, 0.63; 95% CI, 0.50 to 0.78), and 6 years (OR, 0.61; 95% CI, 0.49 to 0.76). DISCUSSION Arthroscopic RCR with concomitant ASD is associated with lower odds of all-cause revision surgery in the ipsilateral shoulder at 2, 4, and 6 years. The lower mid-term revision surgery rates suggest benefits to performing concomitant ASD with primary arthroscopic RCR. Continued research on the mid to long-term benefits of ASD is needed to determine which patient populations benefit most from this procedure. DATA AVAILABILITY The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Affiliation(s)
- Mark Haft
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Zhao J, Huang H, Zeng L, Pan J, Liu J, Luo M. Acromioplasty combined with arthroscopic rotator cuff repair can reduce the risk of reoperation: a systematic review and meta-analysis. Postgrad Med 2024:1-12. [PMID: 38975648 DOI: 10.1080/00325481.2024.2377533] [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: 03/28/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Whether to perform acromioplasty in arthroscopic rotator cuff repair (ARCR) is controversial, and the optimal surgical approach for rotator cuff tear repair is unknown. The purpose of this study was to compare the reoperation rate, retear rate and patient-reported outcomes (PROs) of ARCR with those of ARCR combined with acromioplasty (ARCR-A). METHODS PubMed, Embase and Cochrane Library were searched for relevant literature dated between database inception and 4 December 2023. The primary outcomes of this study were the reoperation rate and the retear rate. The secondary outcomes were PROs, including the visual analogue scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the University of California-Los Angeles (UCLA) score, the Constant score and the Western Ontario Rotator Cuff (WORC) score. The quality of the included studies was evaluated by using the risk of bias assessment tool. RevMan 5.3 software was used for meta-analysis. Fixed (I2 <50%) or random (I2 ≥50%) effects models were applied to calculate the effect size. RESULTS Meta-analysis revealed that ARCR-A had a lower reoperation rate (OR = 0.35, 95%CI: 0.15-0.85, p = 0.02), but the difference in the retear rate between ARCR-A and ARCR was not significant (p = 0.25). In type 2 acromion patients, the reoperation rate was not significantly different between ARCR and ARCR-A (p = 0.12), but, for type 3 acromion patients, the retear rate was lower for ARCR-A than for ARCR (OR = 0.12, 95%CI: 0.01-0.94, p = 0.04). There were statistically significant differences in the 6-month postoperative Constant scores (p < 0.001), VAS pain scores (p = 0.003) 12-month postoperative ASES scores (p = 0.02) and 24-month postoperative WORC scores (p = 0.04), but these differences were not clinically significant. CONCLUSIONS Combining ARCR with acromioplasty can reduce the rate of reoperation, especially in patients with type 3 acromion, but it provides no clinically important change in the retear rate and postoperative PRO compared with ARCR.
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Affiliation(s)
- Jinlong Zhao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Hetao Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Lingfeng Zeng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jianke Pan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
| | - Minghui Luo
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Zhuhai, China
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Yang S, Pang L, Zhang C, Wang J, Lei Y, Li Y, Huang Y, Tang X. Lower Reoperation Rate and Superior Patient-reported Outcome Following Arthroscopic Rotator Cuff Repair with Concomitant Acromioplasty: An Updated Systematic Review of Randomized Controlled Trials. Arthroscopy 2024:S0749-8063(24)00408-0. [PMID: 38876445 DOI: 10.1016/j.arthro.2024.05.026] [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: 01/30/2024] [Revised: 05/13/2024] [Accepted: 05/18/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE This study aims to systematically assess the postoperative outcomes in patients undergoing arthroscopic rotator cuff repairs with or without concomitant acromioplasty through a rigorous systematic review of randomized controlled trial s (RCTs). METHODS This systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, aimed to identify RCTs comparing clinical outcomes of patients with full thickness rotator cuff tears undergoing arthroscopic rotator cuff repair with acromioplasty versus those without at a minimum of 12 months follow-up. Databases searched included PubMed, Web of Science, Embase, and the Cochrane Library. The risk of bias in the included studies was assessed using the revised Cochrane Risk of Bias 2 (RoB2). Meta-analysis was conducted for outcomes with at least three studies reporting, with pooled effect estimates calculated using either fixed-effect or random-effects models based on heterogeneity levels. Results were presented as the weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CIs). For outcomes with fewer than three studies reporting, a Fisher exact test was conducted, with continuity correction applied if necessary. Primary outcomes include rates of retear and reoperation, while secondary outcomes included improvement in American Shoulder and Elbow Surgeons (ASES) score, range of motion (ROM), and complication rate. RESULTS Five high-quality RCTs, with low bias risk, involving 409 patients, revealed demographics of 58.4% males, mean age 58.4 years, and acromion types: 12.2% type I, 70.7% type II, and 17.1% type III. Mean follow-up was 52.2 months. Retear (12.5% versus 16.1%, P = 0.536) and complication rates (OR, 3.11; 95% CI, 0.31-30.73; P=0.33) were comparable between the two groups. However, reoperation rate (5.3% versus 15.9%, P < 0.001) and improvement in ASES score (WMD, 3.99; 95% CI, 1.00-6.99; P=0.009) favored the acromioplasty group. Both groups showed significant improvements in ROM, but insufficient data prevented a comparison. CONCLUSIONS Compared to arthroscopic rotator cuff repair alone, arthroscopic rotator cuff repair with acromioplasty demonstrated similar rates of retear and complications, but a significantly lower reoperation rate and superior improvement in ASES score. The available data were insufficient to draw a definitive conclusion regarding ROM. This conclusion is fragile due to a limited sample size.
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Affiliation(s)
- Songyun Yang
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China; Department of Orthopedics, People's hospital of Santai County; Santai, 621100, People's Republic of China
| | - Long Pang
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China
| | - Chunsen Zhang
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China
| | - Jiapeng Wang
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China
| | - Yao Lei
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China
| | - Yinghao Li
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China
| | - Yizhou Huang
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China; Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan Universiy; Chengdu, 610041, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University; Chengdu, 610041, People's Republic of China.
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Kilinc O, Ertem K, Ergen E, Aslanturk O. What are the Factors that Impact the Outcomes of Arthroscopic Rotator Cuff Repair? Niger J Clin Pract 2024; 27:483-488. [PMID: 38679771 DOI: 10.4103/njcp.njcp_706_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/28/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The cuff is a complex structure with many factors affecting it. How much it is affected after repair is still being investigated. AIM The aim of this study was to analyze the functional results of individuals who received arthroscopic rotator cuff repair and assess the various factors that could impact these outcomes. METHODS The study included 57 patients with a mean age of 58.8 years (range: 39-71) who underwent arthroscopic rotator cuff repair between 2013 and 2020, with a minimum of 6 months after the operation. Functional and clinical outcomes of the patients were evaluated using preoperative and postoperative scores (QDASH, ASES, and VAS). The study also analyzed how demographic factors, type and duration of the tear, comorbidities such as diabetes mellitus (DM) and hypertension (HT), and other pathologies may have affected the patients' scores. RESULTS The effect of the operation on the scores in rotator cuff tears was highly significant (P < 0.05). Age, gender, tear size, fatty degeneration, anchor configuration, comorbidities, and additional procedures presented variable values on postoperative scores, but were not statistically significant. The effect of DM and HT on VAS scores was statistically significant (P < 0.05). CONCLUSION The results of rotator cuff repair appear to be influenced by several factors, including the sex of the patient, type and duration of tear, comorbidities, and surgical procedures used. Although these factors had an effect on the scores, they were not statistically significant.
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Affiliation(s)
- O Kilinc
- Department of Orthopaedics and Traumatology, Mersin City Education and Research Hospital, Mersin, Turkey
| | - K Ertem
- Department of Orthopedics and Traumatology, Inonu University Medicine Faculty, Malatya, Turkey
| | - E Ergen
- Department of Orthopedics and Traumatology, Inonu University Medicine Faculty, Malatya, Turkey
| | - O Aslanturk
- Department of Orthopedics and Traumatology, Inonu University Medicine Faculty, Malatya, Turkey
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Kim S, Deivert KT, Goodeill T, Firoved AB, Morgan CN, Worcester KS, Kim W, Bonner KF. Concomitant Biceps Tenodesis Does Not Compromise Arthroscopic Rotator Cuff Repair Outcomes. Arthroscopy 2024:S0749-8063(24)00170-1. [PMID: 38479637 DOI: 10.1016/j.arthro.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE To compare outcomes of patients who underwent rotator cuff repair (RCR) with concomitant biceps tenodesis with those who underwent an isolated RCR. METHODS Exclusion criteria included previous ipsilateral shoulder surgery, irreparable rotator cuff tears, rotator cuff arthropathy, calcific tendinitis, adhesive capsulitis requiring a capsular release, or advanced osteoarthritis of the glenohumeral joint. Patients were indicated for biceps tenodesis if they had any degree of tendon tearing, moderate-to-severe tenosynovitis, instability, or a significant degenerative SLAP tear. Primary outcome measures included American Shoulder and Elbow Surgeons score, Simple Shoulder Test, EuroQoL 5-Dimension 5-Level visual analog scale, EuroQoL 5-Dimension 5-Level, and a site-specific questionnaire, which focused on surgical expectations, satisfaction, and complications. Multivariate analysis of variance to analyze descriptive statistics and determine significant differences between the patient groups for subjective and objective outcome measures were performed. RESULTS There were no significant differences for pain/visual analog scale (0.34 ± 0.09 vs 0.47 ± 0.09, P = .31), American Shoulder and Elbow Surgeons score (96.69 ± 0.87 vs 94.44 ± 0.91, P = .07), and Simple Shoulder Test (11.42 ± 0.17 vs 10.95 ± 0.18, P = .06) between the RCR with concomitant biceps tenodesis and isolated RCR at a minimum of 2 years' postoperatively. This is despite the RCR with concomitant biceps tenodesis group having significantly larger rotator cuff tears (4.25 ± 0.30 cm2 vs 2.80 ± 0.32 cm2, P = .001) than the isolated RCR group. CONCLUSIONS This study revealed that concomitant biceps tenodesis does not compromise outcomes when compared with an isolated RCR at 2-year follow-up, despite this group having larger rotator cuff tears. LEVEL OF EVIDENCE Level III, retrospective case study.
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Affiliation(s)
- Samuel Kim
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A..
| | - Kyle T Deivert
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | | | - Amanda B Firoved
- Jordan-Young Institute for Orthopedic Surgery and Sports Medicine, Virginia Beach, Virginia, U.S.A
| | - Caleb N Morgan
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Katherine S Worcester
- Jordan-Young Institute for Orthopedic Surgery and Sports Medicine, Virginia Beach, Virginia, U.S.A
| | - William Kim
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Kevin F Bonner
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A.; Jordan-Young Institute for Orthopedic Surgery and Sports Medicine, Virginia Beach, Virginia, U.S.A
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Maguire JA, Dhillon J, Scillia AJ, Kraeutler MJ. Rotator Cuff Repair With or Without Acromioplasty: A Systematic Review of Randomized Controlled Trials With Outcomes Based on Acromial Type. Am J Sports Med 2024:3635465231213009. [PMID: 38312081 DOI: 10.1177/03635465231213009] [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] [Indexed: 02/06/2024]
Abstract
BACKGROUND It is unclear whether the use of concomitant acromioplasty during rotator cuff repair (RCR) improves clinical outcomes and whether the outcomes are affected by acromial type. PURPOSE To perform a systematic review of randomized controlled trials comparing clinical outcomes of RCR with and without acromioplasty, with a subanalysis of outcomes based on acromial type. STUDY DESIGN Systematic review; Level of evidence, 2. METHODS A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify randomized controlled trials that directly compared outcomes between RCR with versus without acromioplasty. A subanalysis was performed on the studies that provided outcomes based on acromial type. The search phrase used was rotator cuff repair (acromioplasty OR subacromial decompression) randomized. Patients were evaluated based on retear rate, reoperation rate, and patient-reported outcomes (PROs). RESULTS Application of inclusion criteria yielded 5 studies (2 studies were level 1, and 3 studies were level 2) including a total of 409 patients, with 211 patients undergoing RCR alone (group A) and 198 patients undergoing RCR with acromioplasty (group B). The mean patient age was 58.5 and 58.3 years in groups A and B, respectively. The mean follow-up time was 52.9 months, and the overall percentage of male patients was 54.1%. The rotator cuff tear size was 20.7 mm and 19.8 mm for groups A and B, respectively. No significant differences were found between groups for any of the PROs at final follow-up. Overall retear rates did not significantly differ between groups based on acromial type. Between 2 studies that measured reoperation rate, a significantly higher reoperation rate was found for the nonacromioplasty group (15%) versus the acromioplasty group (4.1%) (P = .031). One of these studies found that 5 of 9 patients (56%) with a type III acromion in the nonacromioplasty group underwent reoperation compared with 0 of 4 patients with a type III acromion in the acromioplasty group. CONCLUSION There is some evidence that acromioplasty during RCR reduces the risk for later reoperation. This may be particularly true for patients with type III acromions, although further studies with larger sample sizes are needed to corroborate these data.
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Affiliation(s)
- James A Maguire
- St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Jaydeep Dhillon
- Rocky Vista University College of Osteopathic Medicine, Greenwood Village, Colorado, USA
| | | | - Matthew J Kraeutler
- University of Colorado Anschutz Medical Campus, Department of Orthopedics, Aurora, Colorado, USA
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Özcan S, Yurten H. The Effect of Acromioplasty Performed During Rotator Cuff Repairs on Clinical Outcomes in Patients With Type 3 Acromion: A Retrospective Study. Cureus 2023; 15:e48867. [PMID: 38106787 PMCID: PMC10724503 DOI: 10.7759/cureus.48867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVE Rotator cuff (RC) tears often necessitate surgery, with acromioplasty being frequently performed alongside RC repair. However, the impact of acromioplasty on clinical outcomes remains a subject of discussion. The current study aimed to investigate the effect of acromioplasty during RC repair on clinical outcomes in patients with type 3 acromion. MATERIALS AND METHODS Eighty-five patients, who underwent RC repair between January 2016 and December 2020, were categorized into two groups: Group 1, comprising 40 patients without acromioplasty, and Group 2, including 45 patients who received acromioplasty. Subacromial distance (SAD) and clinical scores were assessed pre- and post-operatively. RESULTS Group 1, comprising 40 patients without acromioplasty, had an average age of 59.45±10.43 years. Among them, 27 (67.5%) were female. The mean symptom duration was 10.4±4.3 months, and the mean follow-up period was 16.2±1.9 months. Group 2, which underwent acromioplasty, included 45 patients with an average age of 56.49±8.97 years, with 30 (66.7%) of them being female. The mean symptom duration was 9.5±3.6 months, and the mean follow-up time was 15.78±2.17 months in this group. Group 2 showed a relatively greater improvement in SAD compared to Group 1. The evaluation of clinical outcomes did not reveal any significant differences between the groups. CONCLUSION Concomitant acromioplasty does not have a significant effect on clinical outcomes in patients undergoing arthroscopic RC repair.
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Affiliation(s)
- Seçkin Özcan
- Orthopedics and Traumatology, Yalova Education and Research Hospital, Yalova, TUR
| | - Hakan Yurten
- Orthopedics and Traumatology, Ministry of Health Elaziğ Fethi̇ Seki̇n City Hospital, Elazığ, TUR
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Current Understanding and New Advances in the Surgical Management of Reparable Rotator Cuff Tears: A Scoping Review. J Clin Med 2023; 12:jcm12051713. [PMID: 36902499 PMCID: PMC10003213 DOI: 10.3390/jcm12051713] [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: 12/17/2022] [Revised: 02/05/2023] [Accepted: 02/18/2023] [Indexed: 02/23/2023] Open
Abstract
Rotator cuff (RC) tears are among the most common musculoskeletal disorders and can be associated with pain, weakness, and shoulder dysfunction. In recent years, there have been significant advances with regard to the understanding of rotator cuff disease and its management. With technological improvements and advanced diagnostic modalities, there has been much progress as to improved understanding of the pathology. Similarly, with advanced implant designs and instrumentation, operative techniques have evolved. Furthermore, refinements in postoperative rehabilitation protocols have improved patient outcomes. In this scoping review, we aim to provide an overview of the current knowledge on the treatment of rotator cuff disorders and to highlight recent advances in its management.
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Acromial Morphology and Its Relation to the Glenoid Is Associated with Different Partial Rotator Cuff Tear Patterns. J Clin Med 2022; 12:jcm12010233. [PMID: 36615033 PMCID: PMC9821296 DOI: 10.3390/jcm12010233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
The pathogenesis of subacromial impingement syndrome is controversially discussed. Assuming that bursal sided partial tears of the supraspinatus tendons are rather the result of a direct subacromial impact, the question arises whether there is a morphological risk configuration of the acromion and its spatial relation to the glenoid. Patients who underwent arthroscopic repair of either a partial articular supraspinatus tendon avulsion (PASTA) or bursal-sided supraspinatus tear (BURSA) were retrospectively allocated to two groups. Various previously described and new omometric parameters on standard anteroposterior and axial shoulder radiographs were analyzed. We hypothesized that acromial shape and its spatial relation to the glenoid may predispose to a specific partial supraspinatus tendon tear pattern. The measurements included the critical shoulder angle (CSA), the acromion index (AI), Bigliani acromial type and the new short sclerotic line, acromioclavicular offset angle (ACOA), and AC offset. The ratio length/width of acromion and the medial acromial offset were measured on axial radiographs. A total of 73 patients were allocated to either PASTA (n = 45) or BURSA (n = 28). The short sclerotic line showed a statistically significant difference between PASTA and BURSA (16.2 mm versus 13.1 mm, p = 0.008). The ratio acromial width/length was statistically significant (p = 0.021), with BURSA having slightly greater acromial length (59 vs. 56 mm). The mean acromial offset was 42.9 mm for BURSA vs. 37.7 mm for PASTA (p = 0.021). ACOA and AC offset were both higher for BURSA, without reaching statistical significance. The CSA did not differ significantly between PASTA and BURSA (33.73° vs. 34.56°, p = 0.062). The results revealed an association between a narrow acromial morphology, increased medial offset of the acromion in relation to the glenoid, and the presence of a short sclerotic line in the anteroposterior radiograph in bursal-sided tears of the supraspinatus tendon. Assuming that bursal-sided tears are rather the result of a direct conflict of the tendon with the undersurface of the acromion, this small subgroup of patients presenting with impingement syndrome might benefit from removing a harming acromial spur.
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Woodmass JM, Al Khatib L, McRae S, Lapner P, Mascarenhas R, Neogi D, MacDonald PB. Arthroscopic Rotator Cuff Repair with and without Acromioplasty in the Treatment of Full-Thickness Rotator Cuff Tears: Long-Term Outcomes of a Multicenter, Randomized Controlled Trial. J Bone Joint Surg Am 2022; 104:2101-2107. [PMID: 36476738 DOI: 10.2106/jbjs.22.00135] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to reevaluate patients from a previous randomized controlled trial at a long-term follow-up to determine the long-term efficacy of subacromial decompression in patients with full-thickness rotator cuff tears. METHODS This is a secondary study based on a previous, multicenter, randomized controlled trial with patients allocated to arthroscopic rotator cuff repair with or without acromioplasty. The original study was conducted between 2003 and 2011, and the secondary study was conducted between 2015 and 2021. Patients were invited by a blinded assessor to return to complete the Western Ontario Rotator Cuff (WORC) index and a questionnaire about reoperation and to undergo a clinical assessment. If participants were unable to return, they were asked to complete the questionnaires by mail. A chart review on all participants in the original study was conducted. RESULTS Eighty-six patients were randomized in the original trial, with 31 of 45 from the group without acromioplasty and 25 of 41 from the acromioplasty group returning for long-term follow-up. The mean duration (and standard deviation) of follow-up was 11.2 ± 2.4 years for the group without acromioplasty and 11.5 ± 2.6 years for the acromioplasty group. There was no significant difference in WORC scores between the groups with and without acromioplasty at the time of the long-term follow-up (p = 0.30). Seven (16%) of the 45 patients in the group without acromioplasty underwent reoperation. One (2%) of the initial 41 patients allocated to acromioplasty underwent reoperation. All patients who underwent a reoperation had a Type-2 or 3 acromion. CONCLUSIONS Patients who underwent rotator cuff repair with or without acromioplasty experienced improvement of outcomes from their preoperative level at a long-term follow-up (mean, 11 years), and there were no differences in patient-reported outcomes, specifically WORC scores, between these groups. However, a significantly higher reoperation rate was observed in patients who had rotator cuff repair without acromioplasty, specifically in those with a Type-2 or 3 acromion. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jarret M Woodmass
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic, Winnipeg, Manitoba, Canada
| | | | - Sheila McRae
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic Foundation, Winnipeg, Manitoba, Canada
| | - Peter Lapner
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Peter B MacDonald
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Pan Am Clinic, Winnipeg, Manitoba, Canada
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Khazzam M. Settling the Controversy of Acromioplasty During Rotator Cuff Repair: Commentary on an article by Jarrett M. Woodmass, MD, FRCSC, et al.: "Arthroscopic Rotator Cuff Repair with and without Acromioplasty in the Treatment of Full-Thickness Rotator Cuff Tears. Long-Term Outcomes of a Multicenter, Randomized Controlled Trial". J Bone Joint Surg Am 2022; 104:2130. [PMID: 36476741 DOI: 10.2106/jbjs.22.01019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Michael Khazzam
- Department of Orthopaedic Surgery; Shoulder Service, University of Texas Southwestern Medical Center, Dallas, Texas
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12
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Hardy V, Rony L, Bächler J, Favard L, Hubert L. Does isolated arthroscopic anterior acromioplasty modify critical shoulder angle? Orthop Traumatol Surg Res 2022; 108:103040. [PMID: 34389495 DOI: 10.1016/j.otsr.2021.103040] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/08/2021] [Accepted: 02/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Critical shoulder angle (CSA)>35° correlates significantly with primary rotator cuff tear and re-tear after repair. Acromial axial orientation varies between individuals. The present study aimed to assess the impact of strictly anterior acromioplasty on CSA. HYPOTHESIS CSA is reduced by arthroscopic anterior acromioplasty. MATERIAL AND METHODS A single-center retrospective study included patients receiving isolated arthroscopic acromioplasty between January 2016 and December 2017. Exclusion criteria comprised history of surgery and fracture or dislocation of the shoulder. Pre- and post-operative AP shoulder radiographs were taken. The angle subtended by a line between the inferior and superior edges of the glenoid and a line between the inferior edge of the glenoid and the most lateral point on the acromion was measured. RESULTS One hundred and two patients were included: mean age, 50.5±10.1 years (range, 23-82 years). Mean CSA was 34.7±4.4° (range, 26-48°) preoperatively and 31.7±3.7° (range, 23-40°) postoperatively (p<0.001). In the group with CSA >35°, the decrease was significant: 34.4±3.2° (range, 28-40°) versus 38.9±2.8° (range, 36-48°) (p<0.001), with 64% CSA <35° after isolated anterior acromioplasty. DISCUSSION CSA was decreased by arthroscopic acromioplasty. However, in 36% of cases with preoperative CSA >35°, CSA was not normalized. CONCLUSION Anterior arthroscopic acromioplasty significantly reduced CSA in the overall population, and especially in case of high CSA. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Vincent Hardy
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, Avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Louis Rony
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4 Rue Larrey, 49100 Angers, France
| | - Julien Bächler
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4 Rue Larrey, 49100 Angers, France
| | - Luc Favard
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, Avenue de la République, 37170 Chambray-lès-Tours, France; Faculté de Médecine de Tours, 10 Boulevard Tonnelé, 37032 Tours cedex 1, France
| | - Laurent Hubert
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4 Rue Larrey, 49100 Angers, France
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Bruchmann M, Rossi L, Gorodischer T, Burgos Flor J, Atala N, Tanoira I, Bongiovanni S, Ranalletta M. [Translated article] Midterm functional outcomes and tendon integrity after in situ repair of partial bursal supraspinatus tears without acromioplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Hillesheim RA, Kumar P, Brolin TJ, Bernholt DL, Sethi PM, Kowalsky MS, Azar FM, Throckmorton TW. Periarticular liposomal bupivacaine mixture injection vs. single-shot interscalene block for postoperative pain in arthroscopic rotator cuff repair: a prospective randomized controlled trial. J Shoulder Elbow Surg 2021; 30:2691-2697. [PMID: 34537339 DOI: 10.1016/j.jse.2021.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The pain control efficacy, postoperative opioid requirements, and costs among patients undergoing major shoulder surgery using different perioperative analgesia modalities have been topics of active debate. Several studies have compared periarticular injection (PAI) to interscalene block (ISB) in shoulder arthroplasty, but there is a paucity of data comparing them in arthroscopic rotator cuff repair. METHODS Patients aged 18-80 years with full-thickness rotator cuff tears and undergoing primary arthroscopic rotator cuff repair at 2 different shoulder centers were screened and subsequently randomized to receive either periarticular injection (PAI) of liposomal bupivacaine mixed with 0.25% bupivacaine (n = 41) or single-shot interscalene nerve block (ISB) (n = 36). Visual analog scale (VAS) pain scores, oral morphine equivalent (OME) use, Single Assessment Numerical Evaluation (SANE) scores, and costs were collected. Differences with P <.05 were considered statistically significant. RESULTS Day of surgery VAS score and OME usage were significantly reduced with ISB vs. PAI (0.69 vs. 4.65, P < .001, and 18.66 vs. 34.39, P < .001, respectively). There were no significant differences between groups regarding VAS score on postoperative days (PODs) 1-3; however, OME usage on PODs 1 (50.5 vs. 38.8, P = .03) and 2 (48.1 vs. 37.8, P = .04) was significantly more in the ISB group. At POD 3, VAS score (4.13 vs. 3.97, P = .60) and OME use (28.60 vs. 31.16, P = .51) were similar. At 6 and 12 weeks, there were also no significant differences between groups regarding VAS and OME use. There was no difference in SANE score at 12 weeks following surgery between groups and no difference between average 12-week cumulative OME use between groups. The average charge for the PAI was $455, and the average charge for ISB was $745. CONCLUSION Both ISB and PAI provide acceptable pain control following arthroscopic rotator cuff repair. Patients have less pain on the day of surgery with ISB, but rebound pain is significant after the block wears off, resulting in substantially increased opioid use in the first 2 PODs. However, cumulative opioid use between groups was similar. There were also no significant differences at the end of the 12-week episode of care in any of the other variables studied. The charge per patient for PAI is approximately $300 less than ISB. Thus, PAI may offer surgeons and patients an effective postoperative analgesic modality as an alternative to ISB.
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Affiliation(s)
- Richard A Hillesheim
- University of Tennessee-Campbell Clinic Department of Orthopedic Surgery & Biomedical Engineering, Memphis, TN, USA
| | - Padam Kumar
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA
| | - Tyler J Brolin
- University of Tennessee-Campbell Clinic Department of Orthopedic Surgery & Biomedical Engineering, Memphis, TN, USA
| | - David L Bernholt
- University of Tennessee-Campbell Clinic Department of Orthopedic Surgery & Biomedical Engineering, Memphis, TN, USA
| | - Paul M Sethi
- Orthopedic & Neurosurgical Specialists, ONS Foundation, Greenwich, CT, USA
| | - Marc S Kowalsky
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA
| | - Frederick M Azar
- University of Tennessee-Campbell Clinic Department of Orthopedic Surgery & Biomedical Engineering, Memphis, TN, USA
| | - Thomas W Throckmorton
- University of Tennessee-Campbell Clinic Department of Orthopedic Surgery & Biomedical Engineering, Memphis, TN, USA.
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15
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Bruchmann MG, Rossi LA, Gorodischer T, Burgos Flor JA, Atala NA, Tanoira I, Bongiovanni S, Ranalletta M. Midterm functional outcomes and tendon integrity after in situ repair of partial bursal supraspinatus tears without acromioplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:10-16. [PMID: 34362697 DOI: 10.1016/j.recot.2021.04.005] [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: 08/23/2020] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to analyze midterm functional outcomes and tendon integrity in patients treated with in situ arthroscopic repair of Partial Bursal Rotator Cuff Tears (PBRCTs) without acromioplasty. MATERIALS AND METHODS Sixty two patients were included. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons (ASES) score. Pain was rated by using a visual analog scale (VAS). A postoperative ultrasound image control was performed at a minimum 5 years follow up to assess tendon integrity. RESULTS Mean age was 57.2 years (range, 44-77 years) and mean follow up was 7 years (range of 5-9 years). Significant improvements in range of motion, functional outcomes and pain were observed postoperatively (P<.0001). The ASES score improved from 46.5 to 90.2; and the VAS improved from 6.5 to 1.73 (P<.0001). Fifty six patients (90%) performed ultrasound evaluation at the end of follow up. Fifty-one patients (91%) presented tendon integrity on ultrasound. Five patients presented re-tears (9%). Three patients (5%) had a complete tendon re-tear and two patients (4%) had a partial re-tear. No difference in range of motion or functional outcomes were found between patients with intact tendon and those who had re-tears. CONCLUSIONS In the midterm follow up, arthroscopic in situ repair PBRCTs without acromioplasty showed excellent functional outcomes and high healing rates in most patients with low complication rates.
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Affiliation(s)
- M G Bruchmann
- Unidad de Patología de Hombro, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - L A Rossi
- Unidad de Patología de Hombro, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - T Gorodischer
- Unidad de Patología de Hombro, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J A Burgos Flor
- Unidad de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - N A Atala
- Unidad de Patología de Hombro, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - I Tanoira
- Unidad de Patología de Hombro, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Bongiovanni
- Unidad de Patología de Hombro, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Ranalletta
- Unidad de Patología de Hombro, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Hardy V, Rony L, Bächler J, Favard L, Hubert L. WITHDRAWN: Does anterior arthroscopic acromioplasty modify critical shoulder angle? Orthop Traumatol Surg Res 2021; 107:102936. [PMID: 33872821 DOI: 10.1016/j.otsr.2021.102936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/16/2020] [Indexed: 02/04/2023]
Abstract
This article has been withdrawn because we accidentally published the same article twice due to an error by the Managing editor/Elsevier. The correct version of the article has been published later in Orthop Traumatol Surg Res, 108 (2022) 103040, https://doi.org/10.1016/j.otsr.2021.103040. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- Vincent Hardy
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Louis Rony
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Julien Bächler
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Luc Favard
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France; Faculté de Médecine de Tours, 10, boulevard Tonnelé, 37032 Tours cedex 1, France
| | - Laurent Hubert
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
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Kang HJ, Park JS, Ryu KN, Rhee YG, Jin W, Park SY. Assessment of postoperative acromial and subacromial morphology after arthroscopic acromioplasty using magnetic resonance imaging. Skeletal Radiol 2021; 50:761-770. [PMID: 32978678 DOI: 10.1007/s00256-020-03607-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify the morphological characteristics of the acromion and subacromial bursal space after arthroscopic acromioplasty using magnetic resonance imaging (MRI). MATERIALS AND METHODS One hundred patients who received arthroscopic rotator cuff repair and acromioplasty each received at least three MRI examinations (preoperative, first immediate postoperative, and second follow-up imaging between 8 months and 1 year postoperatively). Changes over time in the thickness and morphology of the postoperative acromion as well as the subacromial bursal space were assessed. Clinical and radiological parameters were also analyzed to identify any association with changes in acromial morphology. RESULTS Despite minimal acromial thinning observed at the first immediate postoperative state, the acromions showed significant thinning at the second postoperative MRI, with a mean reduction of 32%. Along with acromial thinning, an exaggerated concave contour of the acromial undersurface was observed in some patients. In the subacromial space, a loculated fluid collection developed in 91% of the patients at the second postoperative follow-up. No statistically significant association was noted between postoperative acromial thickness change and clinical or radiological factors (P value > 0.05). CONCLUSION A significant delayed reduction in acromial thickness within approximately 1 year of arthroscopic acromioplasty is thought to be a normal postoperative feature. The simultaneous collection of a loculated, cyst-like fluid in the subacromial bursal space may be an important associated factor of postoperative acromial thinning.
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Affiliation(s)
- Hye Jin Kang
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, Republic of Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, Republic of Korea.
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, Republic of Korea
| | - Yong Girl Rhee
- Department of Orthopedic Surgery, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Ahmad Z, Al-Wattar Z, Rushton N, Akinfala M, Dawson-Bowling S, Ang S. Holding on by a thread: the continuing story of rotator cuff tears. Br J Hosp Med (Lond) 2021; 82:1-10. [PMID: 33512285 DOI: 10.12968/hmed.2020.0351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Rotator cuff tears are a common cause of shoulder pain. The incidence of these tears has increased significantly over the years, with the demands of an increasingly active elderly population. Therefore, a detailed understanding of rotator cuff tears will help doctors manage their patients' condition. This field has rapidly advanced over the past decade and this review provided an insight into the latest developments.
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Affiliation(s)
- Zafar Ahmad
- Department of Orthopaedics, University of Western Ontario, London, Ontario, Canada
| | - Zaid Al-Wattar
- Department of Orthopaedics, Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - Neil Rushton
- Department of Orthopaedics, University of Cambridge, Cambridge, UK
| | - Michael Akinfala
- Department of Orthopaedics, Barts Health, London, UK Conflicts of interest
| | | | - Swee Ang
- Department of Orthopaedics, Barts Health, London, UK Conflicts of interest
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19
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Vaz A, Reifegerste CP, Trippia CR, Linhares LS, Trindade FB, Thomaz JE. Effect of the acromial inferolateral tilt on subacromial impingement syndrome: a retrospective magnetic resonance imaging assessment. Radiol Bras 2020; 53:366-374. [PMID: 33304003 PMCID: PMC7720662 DOI: 10.1590/0100-3984.2019.0127] [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] [Indexed: 05/30/2023] Open
Abstract
Objective To evaluate the effect of acromial inferolateral tilt on subacromial impingement syndrome. Materials and Methods The acromial inferolateral tilt was retrospectively quantified by two researchers on 346 shoulder magnetic resonance images using the glenoacromial (between the inferior proximal acromial surface and the glenoidal face) and acromioclavicular (between the axis of the proximal acromion and distal clavicle) angles. Results The glenoacromial angle was associated with subacromial impingement syndrome (p < 0.001) and complete supraspinatus tendon rupture (p < 0.001), and the acromioclavicular angle was associated with partial or complete supraspinatus tendon rupture (p = 0.003). The area under the receiver operating characteristic curve (AUC), best cut-off angle, and odds ratio (OR) of the glenoacromial angle for impingement syndrome were 0.579 (95% confidence interval [CI]: 0.508-0.649; p = 0.032), 72°, and 2.1 (95% CI: 1.136-4.053), respectively. For complete supraspinatus tendon rupture, the AUC, best cut-off angle, and OR of the glenoacromial angle were 0.731 (95% CI: 0.626-0.837; p = 0.001), 69°, and 8.496 (95% CI: 2.883-28.33), respectively. For partial or complete supraspinatus tendon rupture, the AUC, best cut-off angle and OR of the acromioclavicular angle were 0.617 (95% CI: 0.539-0.694; p = 0.002), 17°, and 3.288 (95% CI: 1.886-5.768), respectively. Interobserver agreement found for the glenoacromial and acromioclavicular angles were 0.737 (95% CI: 0.676-0.787; p < 0.001) and 0.507 (95% CI: 0.391-0.601; p = 0.001), respectively. Conclusion Inferolateral acromial tilt may have some impact on subacromial impingement syndrome; however, the best quantification method identified (glenoacromial angle) showed a moderate interobserver agreement and a fair performance to assess the risk of complete supraspinatus tendon rupture.
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Affiliation(s)
- André Vaz
- Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
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Hardy V, Rony L, Bächler J, Favard L, Hubert L. WITHDRAWN: Does anterior arthroscopic acromioplasty modify critical shoulder angle? Orthop Traumatol Surg Res 2020:S1877-0568(20)30111-0. [PMID: 32276845 DOI: 10.1016/j.otsr.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/21/2020] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Vincent Hardy
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Louis Rony
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Julien Bächler
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Luc Favard
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France; Faculté de Médecine de Tours, 10, boulevard Tonnelé, 37032 Tours cedex 1, France
| | - Laurent Hubert
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
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Rossi LA, Ranalletta M. Subacromial Decompression Is Not Beneficial for the Management of Rotator Cuff Disease. JBJS Rev 2020; 8:e0045. [DOI: 10.2106/jbjs.rvw.19.00045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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