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Garcia M, Landi G, Covan B, Caro D, Khak M, Razavi AH, DeAngelis JP, Ramappa AJ, Nazarian A. Effect of Tear Size and Location on Supraspinatus Tendon Strain During Activities of Daily Living and Physiotherapy. Ann Biomed Eng 2024; 52:2496-2508. [PMID: 39033199 DOI: 10.1007/s10439-024-03538-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 05/06/2024] [Indexed: 07/23/2024]
Abstract
The supraspinatus tendon plays a crucial role in shoulder abduction, making it one of the common structures affected by injury. Clinically, crescent-shaped tears are the most commonly seen tear shape. By developing six specimen-specific, three-dimensional, supraspinatus-infraspinatus finite element model with heterogeneous material properties, this study aimed to examine the changes in tissue deformation (maximum principal strain) of the supraspinatus tendon due to specimen-specific material properties and rotator cuff tear size. FE models with small- and medium-sized full-thickness crescent-shaped tears were subjected to loads seen during activities of daily living and physiotherapy. Six fresh-frozen cadaveric shoulders were dissected to mechanically test the supraspinatus tendon and develop and validate FE models that can be used to assess changes in strain due to small (< 1 cm, equivalent to 20-30% of the tendon width) and medium-sized (1-3 cm, equivalent to 40-50% of the tendon width) tears that are located in the middle and posterior regions of the supraspinatus tendon. FE predictions of maximum principal strain at the tear tips were examined to determine whether failure strain was reached during activities of daily living (drinking and brushing teeth) and physiotherapy exercises (prone abduction and external rotation at 90° abduction). No significant differences were observed between the middle and posterior tear failure loads for small- and medium-sized tears. For prone abduction, there was a potential risk for tear progression (exceeded failure strain) for medium-sized tears in the supraspinatus tendon's middle and posterior regions. For external rotation at 90° abduction, one model with a middle tear and two with posterior tears experienced failure. For all daily activity loads, the strain never exceeded the failure strain. Our three-dimensional supraspinatus-infraspinatus FE model shows that small tears appear unlikely to progress based on the regional strain response; however, medium-sized tears are at higher risk during more strenuous physiotherapy exercises. Furthermore, differences in patient-specific tendon material properties are important in determining whether the tear will progress. Therefore, patient-specific management plans based on tear size may be beneficial to improve clinical outcomes.
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Affiliation(s)
- Mason Garcia
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Mechanical Engineering Department, Boston University, Boston, MA, USA
| | - Gabriel Landi
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
| | - Bailee Covan
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
| | - Daniela Caro
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
| | - Mohammad Khak
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ahmad Hedayatzadeh Razavi
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Mechanical Engineering Department, Boston University, Boston, MA, USA
| | - Joseph P DeAngelis
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arun J Ramappa
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA.
- Mechanical Engineering Department, Boston University, Boston, MA, USA.
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
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Kararti C, Özyurt F, Kodak Mİ, Basat HÇ, Özsoy G, Özsoy İ, Tayfur A. Pain Neuroscience Education Following Arthroscopic Rotator Cuff Repair for Patients With Rotator Cuff Tears: A Double-Blind Randomized Controlled Clinical Trial. Am J Phys Med Rehabil 2024; 103:690-697. [PMID: 38547029 DOI: 10.1097/phm.0000000000002481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
OBJECTIVE This trial examines the efficacy of the pain neuroscience education on clinical outcomes in patients with arthroscopic rotator cuff repair. DESIGN A total of 36 participants undergoing arthroscopic rotator cuff repair were assigned to either the experimental group ( n = 18) or control group ( n = 18) in this randomized study. A 6-wk-long conventional physiotherapy program was administered for both groups. In addition, a pain neuroscience education protocol was administered for the experimental group for a whole period of 6 wks (1 session/week, 15-60 mins per session). The primary outcomes were to compare pretreatment and posttreatment scores of the experimental versus control groups on the pain and disability. Our secondary outcomes included the comparisons of scores on the catastrophizing, anxiety, depression, kinesiophobia, and quality of life. The participants were assessed both at baseline and posttreatment. RESULTS The improvement in pain catastrophizing, anxiety, depression, and kinesiophobia was greater in the experimental group ( P < 0.05). The improvement was similar in both groups in terms of the rest of outcome measures. CONCLUSIONS This study showed that the pain neuroscience education improved only psychological aspects of the chronic pain in arthroscopic rotator cuff repair. Therefore, adding pain neuroscience education to the conventional program might be useful to improve pain catastrophizing, anxiety, depression, and kinesiophobia in patients with arthroscopic rotator cuff repair.
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Affiliation(s)
- Caner Kararti
- From the Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey (CK, FÖ, MIK, AT); Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey (HCB); and Department of Physiotherapy and Rehabilitation, Selçuk University, Selçuk, Turkey (GÖ, IÖ)
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Wong KC, Lee M, Binte Abdul Kadir H, Lie DTT. Pre-Operative Transverse Tendon Thickness In Small and Mid Sized Rotator Cuff Tears Does Not Affect Clinical Outcomes After Arthroscopic Repair. J ISAKOS 2024:S2059-7754(24)00131-7. [PMID: 39043294 DOI: 10.1016/j.jisako.2024.07.003] [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: 01/07/2024] [Revised: 07/11/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Previous studies on rotator cuff tears have examined both clinical and radiographic parameters which may influence post-operative clinical outcomes. While rotator cuff tears are frequently classified by size or depth, there is currently no literature available examining the thickness of the remnant tendon, and its impact on post-operative outcomes. We hypothesize that decreased pre-operative transverse tendon thickness will result in poorer post-operative clinical outcomes. METHODS We prospectively recruited patients who underwent arthroscopic repair of small to medium full-thickness rotator cuff tears. These patients were followed up for a minimum of 2 years post-operatively. Basic biodata, as well as Visual Analog Scale (VAS) for pain, Constant-Murley Score (CMS), UCLA Shoulder Score (USS), and Oxford Shoulder Score (OSS) at 3 different time points (pre-operatively, 1 year post-operatively, and 2 year post-operatively) were collected. Transverse tendon thickness was measured by independent blinded radiologists on pre-operative ultrasonographic images. Wilcoxon signed-rank test was used to compare outcome scores and multivariable robust linear model was fitted to assess the effect of transverse tendon thickness on post-operative scores. RESULTS A total of 63 patients were enrolled in this study, predominantly female (65%) and had a median age of 72 years. Pre-operatively, the median transverse cuff thickness was 5.0 mm and median tear size was 1.4 cm. The median VAS at preoperative was 7, which reduced to 0 at 2 year post-operative, indicating statistically significant improvement in pain levels (p<0.001). Statistically significant improvement in shoulder function measured by CMS, UCLA score and OSS were also seen over time (p<0.001). Robust regression analysis revealed that transverse cuff thickness had no statistically significant effect on VAS (p=0.99), CMS (p=0.84), UCLA score (p=0.22), and OSS scores (p=0.73) at 2 year postoperatively. DISCUSSION Pre-operative transverse tendon thickness of small- to mid-sized supraspinatus tears do not influence clinical outcomes after arthroscopic repair. Differences in transverse tendon thickness may have an association with tendon healing but does not translate to an association with post-operative outcomes in terms of pain, function, and patient reported outcome measures. Level of evidenceIV.
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Affiliation(s)
- Khai Cheong Wong
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | - Merrill Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Morimoto T, Izumi M, Aso K, Ikeuchi M. Role of tear size and tendon degeneration for development of pain in rat models of rotator cuff tear. J Shoulder Elbow Surg 2024; 33:1473-1482. [PMID: 38311102 DOI: 10.1016/j.jse.2023.12.013] [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: 08/30/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Rotator cuff tear (RCT) is a frequent etiology of shoulder pain and disability; however, the triggers for the onset and aggravation of pain remain obscure. In this study, we established novel rat RCT models to examine the impact of tear size and tendon degeneration on pain. METHODS Fifty-five adult male Sprague-Dawley rats were allocated into 4 study groups: large tear (L group, n = 10), small tear (S group, n = 15), small tear with scratching (S+ group n = 15), and sham surgery (Sham group, n = 15). Pain-related behaviors were evaluated by weight distribution of forelimbs during a 5-minute free gait using a dynamic weight-bearing apparatus at 2, 4, 6, and 8 weeks. Calcitonin gene-related peptide (CGRP) expressions in ipsilateral dorsal root ganglion (DRG) neurons of C4, C5, and C6 were evaluated at 4 and 8 weeks. The area of scar tissues around the torn tendon, infiltration of inflammatory cells, and severity of tendon degeneration (modified Bonar score) were histologically assessed at 4 and 8 weeks. Additionally, enzyme-linked immunosorbent assay (ELISA) was conducted to evaluate the levels of cyclooxygenase-2 (COX-2) and nerve growth factor (NGF) expression in torn tendons and surrounding tissues at 4 weeks. RESULTS The weight distribution ratio (ipsilateral and contralateral side) was significantly decreased in the L and S+ group compared with its baseline and Sham group (P < .05), but the S group showed no significant difference compared with the Sham. The ratio of CGRP-immunoreactive neurons in the DRGs was significantly higher in the L and S+ groups than in the S and Sham groups. The histologic assessment indicated that scar tissue formation was more extensive in the L group than in the S and S+ groups. Still, there was no significant difference between the S and S+ groups. The modified Bonar score was considerably higher in the S+ group than in the S group. Furthermore, ELISA analysis demonstrated no significant disparity in COX-2 levels between the groups; however, NGF levels were substantially higher in the S+ group than in the S and Sham groups. CONCLUSION The present study provides compelling evidence that large RCT is strongly associated with heightened pain severity in a rat model. Nevertheless, even a small tear can significantly aggravate pain when the torn tendon is degenerated. CGRP upregulation driven by peripheral NGF possibly played a pivotal role in the genesis and exacerbation of pain in small RCT.
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Affiliation(s)
- Toru Morimoto
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masashi Izumi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan; Department of Rehabilitation, Kochi Medical School Hospital, Kochi University, Nankoku, Japan.
| | - Koji Aso
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan; Department of Rehabilitation, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
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Gutowski CT, Pohl N, Stern M, Gentile PM, Rivera-Pintado C, Johnsen PH, Hunter K, Fedorka C. Accuracy of Clinical Suspicion for Rotator Cuff Tears by Orthopedic Surgeons When MRI Was Ordered on Initial Visits: Should Physical Therapy Be Mandated by Insurance Before MRI? Cureus 2024; 16:e62079. [PMID: 38989344 PMCID: PMC11235402 DOI: 10.7759/cureus.62079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION Insurance companies often mandate six weeks of physical therapy (PT) prior to approving MRIs for patients with atraumatic rotator cuff (RTC) tears. While this is designed to limit unnecessary imaging orders, it can increase healthcare costs and delay diagnosis and surgery. This study investigated the incidence of full- and partial-thickness tears when an MRI was ordered at the time of initial consultation for shoulder pain by an orthopedic provider. METHODS A retrospective review of patients who had an MRI ordered upon initial orthopedic consultation for chronic shoulder pain was conducted. The primary outcome measured was the presence of RTC tears as determined by the MRI report. The cost of six weeks of PT versus the cost of immediate MRI in these patients was collected from our institution's financial database. ANOVA, independent T-test, and chi-square test were used to analyze the differences between groups. RESULTS A total of 365 patients were included. There were no significant differences in demographics between patients with full, partial, or no tears, with the exception that patients with full-thickness tears were older. Specifically, 43.0% had a full-thickness tear, 24.7% had a partial-thickness tear, and 32.2% had no tear on MRI. A total of 56.1% of the full-thickness tears proceeded to surgery. The cost of an upper extremity MRI without contrast averages $2,268, while two sessions of PT per week for six weeks totals $2,328. DISCUSSION Over 67% of MRI orders yielded a positive finding of an RTC tear and remained at 67.2% in the absence of a history of conservative treatment, validating a specialist's clinical suspicion for an RTC tear and indication for MRI. Pre-MRI PT to satisfy insurance requirements may therefore delay intervention and increase healthcare costs when an orthopedic provider believes an MRI is warranted for clinical decision-making.
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Affiliation(s)
| | - Nicholas Pohl
- Medicine, Cooper Medical School of Rowan University, Camden, USA
| | - Matthew Stern
- Medicine, Cooper Medical School of Rowan University, Camden, USA
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Zhang M, Lai J, Chen D, Jian C. Use of a Spinal Needle Through the Deep Rotator Cuff Tissue to Treat Rotator Cuff Tears Under Direct Articular Vision. Arthrosc Tech 2024; 13:102960. [PMID: 38835475 PMCID: PMC11144957 DOI: 10.1016/j.eats.2024.102960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/20/2024] [Indexed: 06/06/2024] Open
Abstract
Achieving sufficient attachment of deep rotator cuff tissue to the footprint area on the greater tubercle of the humerus is essential for functional recovery, yet the optimal approach remains uncertain. We introduce a surgical technique for rotator cuff tear repair using a spinal needle to penetrate deep rotator cuff tissue under direct arthroscopic visualization. After trimming the torn edge, an arthroscope is inserted into the joint cavity through a posterior portal, and a hole is drilled into the humeral head cartilage margin using an upper approach, facilitating the implantation of an internal shoulder row nail. A spinal needle is used to introduce a No. 2 polydioxanone (PDS; Johnson & Johnson) line through sufficient deep rotator cuff tissue. Graspers are then used to extract the stitch and PDS together through the anterolateral opening. Once the PDS is knotted, the stitch is introduced into the rotator cuff. This process is replicated to insert additional stitches into the rotator cuff. Our proposed technique, involving a spinal needle under direct visualization, ensures sufficient coverage of the deep rotator cuff tissue over the footprint area and promotes the healing of the repaired rotator cuff. This method is safe, effective, convenient, and reproducible.
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Affiliation(s)
- Minghua Zhang
- Department of Bone and Joint Sports Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Jiajing Lai
- Department of Bone and Joint Sports Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Daohua Chen
- Department of Bone and Joint Sports Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Chunfang Jian
- Department of Anesthesiology, Longyan First Affiliated Hospital of Fujian Medical University, Fujian, China
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Devarasetty VVNM, Kuhn JE, Bowman EN. Public Perceptions of Rotator Cuff Tears. Clin Pract 2024; 14:729-738. [PMID: 38804390 PMCID: PMC11130954 DOI: 10.3390/clinpract14030058] [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: 01/29/2024] [Revised: 03/18/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
(1) Background: Full-thickness rotator cuff tears (RCTs) impact 25% of those over 60 and 50% over 80; however, minimal data exists on public understanding; (2) Methods: The primary outcome was to determine the public's baseline understanding of RCTs utilizing a 36-question survey regarding anatomy and function, risk factors, diagnosis and treatment options, and expectations. Secondarily, we evaluated the effect of an educational video and informational handout created by the authors to improve understanding. Participants ≥ 18 years were recruited from the senior author's clinic and online discussion platforms over a 5-month period; (3) Results: Baseline surveys were completed by 382 individuals: 56% men, 64% Caucasian, 27% with at least a master's degree, and 56% with very little or no RCT knowledge. Mean correct answer scores improved from 47% to 68% posteducational intervention (p < 0.001). Males, higher education level, healthcare experience, and a higher self-rated understanding of RCTs were significantly correlated with higher survey performance (p < 0.001); (4) Conclusions: The public's knowledge of RCTs at baseline was poor, with demographic factors correlating with survey performance. The educational intervention effectively enhanced participants' understanding. By focusing on common misconceptions, this data can help clinicians align patient expectations and enhance patient outcomes.
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Affiliation(s)
| | - John E. Kuhn
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Eric N. Bowman
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
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Patel M, McDaniel L, Sekar M, Kisana H, Sykes JB, Amini MH. One- and 2-Year American Shoulder and Elbow Surgeons Scores Do Not Vary Significantly After Arthroscopic Rotator Cuff Repair: A Prospective Multicenter Analysis of 1,567 Patients. Arthroscopy 2024; 40:1066-1072. [PMID: 37813205 DOI: 10.1016/j.arthro.2023.09.024] [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: 03/12/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE To evaluate whether there are clinically significant changes in patient-reported outcomes between 1 and 2 years' postoperatively after arthroscopic rotator cuff repair (RCR). METHODS A retrospective analysis of prospective, multicenter registry was queried for all patients who underwent RCR. Patients with preoperative, 6-month, 1-year, and 2-year postoperative American Shoulder and Elbow Surgeons (ASES) scores were included. We evaluated mean postoperative ASES scores, Δ (change from preoperative) ASES, and the %MOI (% maximum outcome improvement). We also evaluated achievement of clinically significant outcomes (CSOs) for the ASES score, including the minimal clinically important difference (MCID), substantial clinical benefit, and patient-acceptable symptom state. RESULTS There were 1,567 patients with complete data through 2-year follow-up. There were small differences in achievement of CSOs from 1 to 2 years: 88% to 91% for MCID, 81% to 83% for substantial clinical benefit, and 65% to 71% for patient-acceptable symptom state. There were statistically significant differences from 1 to 2 years in mean ASES (87 to 88, P < .001), Δ ASES (37 to 39, P < .001), and %MOI (72% to 76%, P < .001); however, these changes were well below the MCID of 11.1. From 1 to 2 years, the mean ASES improved only 1.7 points (P < .001). At 1 year, patients achieved, on average, 97% of their 2-year ASES. CONCLUSIONS Both patient-reported outcomes and achievement of CSOs show small differences at 1 and 2 years after RCR. Given the large sample size, there were statistical differences, but these are unlikely to be clinically relevant. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Midhat Patel
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
| | - Lea McDaniel
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
| | - Molly Sekar
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
| | - Haroon Kisana
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
| | - Joshua B Sykes
- United Hospital Center, West Virginia University, Bridgeport, West Virginia, U.S.A
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Zhi X, Ke H, Zhou L, Li J, Yin P, Zhang H, Zeng C, Cai D, Chen H. Rapamycin facilitates healing of the tendon-bone interface in an aging rat model of chronic rotator cuff injury. J Shoulder Elbow Surg 2024:S1058-2746(24)00217-9. [PMID: 38527620 DOI: 10.1016/j.jse.2024.01.056] [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: 11/21/2023] [Revised: 01/13/2024] [Accepted: 01/30/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Tendon-bone interface (TBI) healing in chronic rotator cuff injury (CRCI) in older individuals is a common clinical challenge due to cellular senescence, as well as decreased tissue repair and regeneration. Many studies have demonstrated the antiaging, improved tissue repair, and bone regeneration properties of rapamycin (RPM) in multiple age-related diseases. This study aimed to explore the effects of RPM on TBI healing after CRCI in an aging rat model. METHODS A CRCI model was established in 60 Sprague-Dawley rats (24 months old). Rats were then randomly allocated into the control, 0.1 μg RPM, and 1 μg RPM groups. At 4 and 8 weeks postreconstructive surgery, the supraspinatus tendon-humerus complexes were harvested for biomechanical, microimaging, histological, and immunohistochemical evaluations. RESULTS Biomechanical testing results demonstrated that the failure load, ultimate strength, and stiffness of the 2 RPM groups were significantly higher than those of the control group at 4 and 8 weeks postoperatively. Microradiographically, both RPM groups had significantly higher values of bone mineral density and the ratio of trabecular bone volume to total volume than controls at each time point. Moreover, the RPM groups had higher histological scores and showed better regenerated TBI, characterized by better organizational tissue, more fibrocartilage cells, and more bone formation. Immunohistochemical evaluations showed that RUNX2-, SOX9-, and SCX-positive cells were significantly more in the 2 RPM groups than in the controls at each time point. CONCLUSIONS RPM may effectively enhance CRCI healing after reconstruction by facilitating osteogenesis, tenogenesis, and fibrocartilage reformation at the TBI, as well as improving biomechanical properties.
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Affiliation(s)
- Xinwang Zhi
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics·Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China; Department of Pediatric Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Haolin Ke
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics·Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Li Zhou
- Department of Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine, Suzhou, China
| | - Jintao Li
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics·Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Panjing Yin
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics·Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Haiyan Zhang
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics·Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Chun Zeng
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics·Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
| | - Daozhang Cai
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics·Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
| | - Huabin Chen
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics·Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
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Kararti C, Özüdoğru A, Basat HÇ, Özsoy İ. Favorable Clinical Outcomes After Humeral Head Depressor Muscle Coactivation Training With EMG for Patients With Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Sports Health 2024:19417381241235184. [PMID: 38499998 DOI: 10.1177/19417381241235184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The coactivation (Co-A) of shoulder muscles that contribute to humeral head depression can lead to mechanical unloading of the subacromial structures during abduction and thus can be beneficial for patients with arthroscopic rotator cuff repair (ARCR). The present study aims to examine the effectiveness of humeral head depressor muscle Co-A (DM-Co-A) training on clinical outcomes in a sample of patients with ARCR. HYPOTHESIS We hypothesized that DM-Co-A training with medioinferior vector during glenohumeral exercises can improve clinical results in the rehabilitation of ARCR. STUDY DESIGN Randomized controlled single-blind study. LEVEL OF EVIDENCE Level 1B. METHODS A total of 27 patients who underwent ARCR after a medium-sized rotator cuff tear and completed their Phase 1 training with ≥80% compliance were included. Together with 14 weeks of conservative treatment (6 weeks of Phase 2 training and 8 weeks of Phase 3 training), synchronized "DM-Co-A Training" was applied to the treatment group with an electromyography (EMG) biofeedback (EMG-BF) device. Patients in the treatment group were asked to voluntarily activate the humeral head depressor muscles guided by visual and auditory feedback of the EMG-BF device during the Phase 2 and Phase 3 conservative treatment exercises performed by the control group. Demographic characteristics of the participants were recorded. Visual analog scale and universal goniometer were used to assess pre- and posttreatment pain severity and joint range of motion, respectively. The Disabilities of Arm, Shoulder and Hand Questionnaire, Revised Oxford Shoulder Score, Modified Constant-Murley Shoulder Score, and the Western-Ontario Rotator Cuff Index were used to assess functionality. RESULTS There was a clinically meaningful improvement in pain severity, active ROM excluding internal rotation, and functionality in the treatment group compared with the control group (P < 0.05). CONCLUSION A 14-week duration DM-Co-A with EMG may be beneficial in the postoperative rehabilitation of patients after ARCR.
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Affiliation(s)
- Caner Kararti
- Kırşehir Ahi Evran University Department of Physiotherapy and Rehabilitation, Kırşehir, Turkey
| | - Anıl Özüdoğru
- Kırşehir Ahi Evran University Department of Physiotherapy and Rehabilitation, Kırşehir, Turkey
| | - Hakkı Çağdaş Basat
- Kırşehir Ahi Evran University Department of Orthopedics and Traumatology, Kırşehir, Turkey
| | - İsmail Özsoy
- Selçuk University Department of Physiotherapy and Rehabilitation, Selçuklu/Konya, Turkey
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11
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Ribeiro LP, Curiel-Montero F, Rodrigues-de-Souza DP, Camargo PR, Alburquerque-Sendín F. Assessment of description and implementation fidelity of clinical trials involving exercise-based treatment in individuals with rotator cuff tears: a scoping review. Braz J Phys Ther 2024; 28:101062. [PMID: 38640642 PMCID: PMC11039315 DOI: 10.1016/j.bjpt.2024.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND For evidence-based practice, clinicians and researchers can rely on well-conducted randomized clinical trials that exhibit good methodological quality, provide adequate intervention descriptions, and implementation fidelity. OBJECTIVE To assess the description and implementation fidelity of exercise-based interventions in clinical trials for individuals with rotator cuff tears. METHODS A systematic search was conducted in PubMed, Embase, CINAHL, LILACS, Cochrane Library, Web of Science, SCOPUS and SciELO. Randomized clinical trials that assessed individuals with rotator cuff tears confirmed by imaging exam were included. All individuals must have received an exercise-based treatment. The methodological quality was scored with the Physiotherapy Evidence Database (PEDro) scale. The Template for Intervention Description and Replication (TIDieR) checklist and the National Institutes of Health Behaviour Change Consortium (NIHBCC) were used to assess intervention description and implementation fidelity, respectively. RESULTS A total of 13 studies were included. Despite their adequate methodological quality, the description of the intervention was poor with TIDieR scores ranging from 6 to 15 out of 24 total points. The TIDieR highest-scoring item was item 1 (brief name) that was reported in all studies. Considering fidelity, only one of the five domains of NIHBCC (i.e., treatment design) reached just over 50%. CONCLUSION Exercise-based interventions used in studies for individuals with rotator cuff tears are poorly reported. The description and fidelity of the intervention need to be better reported to assist clinical decision-making and support evidence-based practice.
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Affiliation(s)
- Larissa Pechincha Ribeiro
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Francisca Curiel-Montero
- Department of Nursing, Pharmacology and Physical Therapy, Universidad de Córdoba, Córdoba, Spain
| | - Daiana Priscila Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Universidad de Córdoba, Córdoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Universidad de Córdoba, Córdoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
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12
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Bedi A, Bishop J, Keener J, Lansdown DA, Levy O, MacDonald P, Maffulli N, Oh JH, Sabesan VJ, Sanchez-Sotelo J, Williams RJ, Feeley BT. Rotator cuff tears. Nat Rev Dis Primers 2024; 10:8. [PMID: 38332156 DOI: 10.1038/s41572-024-00492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
Rotator cuff tears are the most common upper extremity condition seen by primary care and orthopaedic surgeons, with a spectrum ranging from tendinopathy to full-thickness tears with arthritic change. Some tears are traumatic, but most rotator cuff problems are degenerative. Not all tears are symptomatic and not all progress, and many patients in whom tears become more extensive do not experience symptom worsening. Hence, a standard algorithm for managing patients is challenging. The pathophysiology of rotator cuff tears is complex and encompasses an interplay between the tendon, bone and muscle. Rotator cuff tears begin as degenerative changes within the tendon, with matrix disorganization and inflammatory changes. Subsequently, tears progress to partial-thickness and then full-thickness tears. Muscle quality, as evidenced by the overall size of the muscle and intramuscular fatty infiltration, also influences symptoms, tear progression and the outcomes of surgery. Treatment depends primarily on symptoms, with non-operative management sufficient for most patients with rotator cuff problems. Modern arthroscopic repair techniques have improved recovery, but outcomes are still limited by a lack of understanding of how to improve tendon to bone healing in many patients.
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Affiliation(s)
- Asheesh Bedi
- Department of Orthopedic Surgery, University of Chicago, Chicago, IL, USA
- NorthShore Health System, Chicago, IL, USA
| | - Julie Bishop
- Department of Orthopedic Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jay Keener
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Drew A Lansdown
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Peter MacDonald
- Department of Surgery, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Vani J Sabesan
- HCA Florida JFK Orthopaedic Surgery Residency Program, Atlantis Orthopedics, Atlantis, FL, USA
| | | | - Riley J Williams
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Brian T Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA.
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13
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Clinker C, Smith KM, Ishikawa H, Joyce C, Tashjian RZ, Chalmers PN. Three-month Delay in Rotator Cuff Repair: 2-year Follow-up. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202401000-00009. [PMID: 38252563 PMCID: PMC10805414 DOI: 10.5435/jaaosglobal-d-23-00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION This study examined 2-year outcomes of patients who underwent delayed rotator cuff repair (RCR) compared with those who underwent RCR without delay. METHODS In this prospective comparative study, two groups were formed: (1) patients planning RCR during a 6-week elective surgery ban and (2) patients undergoing RCR at least 6 weeks after the ban. The Simple Shoulder Test, American Shoulder and Elbow Surgeon score, and visual analog scale for pain were collected preoperatively and at 2 years postoperatively. Magnetic resonance imaging assessed healing 6 months postoperatively. RESULTS With a 93.3% 2-year follow-up (13/15 delay group, 15/15 control), there was an 87-day difference in presentation to surgery (P = 0.001), with no significant preoperative demographic or tear characteristic differences between groups. Intraoperatively, there were no differences between groups in repair characteristics. Preoperative versus postoperative differences in American Shoulder and Elbow Surgeon score (P < 0.001), visual analog scale (P < 0.001), and Simple Shoulder Test scores (P < 0.001) were significant but not between groups (P = 0.650, 0.586, 0.525). On MRI, 58% in the delay group and 85% in the control group had healed (P = 0.202). DISCUSSION Although a 3-month delay showed no statistically significant effect on outcomes, the delay group had an approximately 27% higher failure rate. Thus, although a 3-month period of nonsurgical treatment before RCR may be reasonable, larger studies are warranted for definitive conclusions.
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Affiliation(s)
- Christopher Clinker
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Mr. Clinker, Dr. Ishikawa, Dr. Joyce, Dr. Tashjian, Dr. Chalmers); Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Dr. Smith)
| | - Karch M. Smith
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Mr. Clinker, Dr. Ishikawa, Dr. Joyce, Dr. Tashjian, Dr. Chalmers); Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Dr. Smith)
| | - Hiroaki Ishikawa
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Mr. Clinker, Dr. Ishikawa, Dr. Joyce, Dr. Tashjian, Dr. Chalmers); Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Dr. Smith)
| | - Christopher Joyce
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Mr. Clinker, Dr. Ishikawa, Dr. Joyce, Dr. Tashjian, Dr. Chalmers); Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Dr. Smith)
| | - Robert Z. Tashjian
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Mr. Clinker, Dr. Ishikawa, Dr. Joyce, Dr. Tashjian, Dr. Chalmers); Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Dr. Smith)
| | - Peter N. Chalmers
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Mr. Clinker, Dr. Ishikawa, Dr. Joyce, Dr. Tashjian, Dr. Chalmers); Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Dr. Smith)
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14
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Mattar LT, Mahboobin AB, Popchak AJ, Anderst WJ, Musahl V, Irrgang JJ, Debski RE. Individuals with rotator cuff tears unsuccessfully treated with exercise therapy have less inferiorly oriented net muscle forces during scapular plane abduction. J Biomech 2024; 162:111859. [PMID: 37989027 PMCID: PMC10843663 DOI: 10.1016/j.jbiomech.2023.111859] [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: 07/13/2023] [Revised: 09/29/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
Exercise therapy for individuals with rotator cuff tears fails in approximately 25.0 % of cases. One reason for failure of exercise therapy may be the inability to strengthen and balance the muscle forces crossing the glenohumeral joint that act to center the humeral head on the glenoid. The objective of the current study was to compare the magnitude and orientation of the net muscle force pre- and post-exercise therapy between subjects successfully and unsuccessfully (e.g. eventually underwent surgery) treated with a 12-week individualized exercise therapy program. Twelve computational musculoskeletal models (n = 6 successful, n = 6 unsuccessful) were developed in OpenSim (v4.0) that incorporated subject specific tear characteristics, muscle peak isometric force, in-vivo kinematics and bony morphology. The models were driven with experimental kinematics and the magnitude and orientation of the net muscle force was determined during scapular plane abduction at pre- and post-exercise therapy timepoints. Subjects unsuccessfully treated had less inferiorly oriented net muscle forces pre- and post-exercise therapy compared to subjects successfully treated (p = 0.039 & 0.045, respectively). No differences were observed in the magnitude of the net muscle force (p > 0.05). The current study developed novel computational musculoskeletal models with subject specific inputs capable of distinguishing between subjects successfully and unsuccessfully treated with exercise therapy. A less inferiorly oriented net muscle force in subjects unsuccessfully treated may increase the risk of superior migration leading to impingement. Adjustments to exercise therapy programs may be warranted to avoid surgery in subjects at risk of unsuccessful treatment.
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Affiliation(s)
- Luke T Mattar
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - Arash B Mahboobin
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States
| | - Adam J Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, United States
| | - William J Anderst
- Biodynamics Laboratory, University of Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - James J Irrgang
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States; Department of Physical Therapy, University of Pittsburgh, Pittsburgh, United States
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States.
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15
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Kochar SS, Ramteke SU, Samal S. The Rehabilitation Journey of a Cricket Player With Partial Rotator Cuff Tear: A Case Report of Pre and Postoperative Physiotherapy. Cureus 2024; 16:e52336. [PMID: 38361674 PMCID: PMC10867298 DOI: 10.7759/cureus.52336] [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: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
In adults, partial rotator cuff injuries can frequently be the root cause of pain in the shoulder. One recurrent pathology that may significantly impact a broad spectrum of individuals, including athletes, laborers, and sedentary people, is partial rotator cuff tears (RCTs). Physical therapy, anti-inflammatories, painkillers, rest or activity modifications, and corticosteroid injections are a few nonoperative treatment options for partial RCTs. We report a case of a 27-year-old male who sustained a rotator cuff injury of the right shoulder. The patient presented with pain and restriction of the right shoulder joint following the injury, which had occurred while throwing a ball forcefully with his right hand. The rehabilitation program emphasized pain management, restoring range of motion (ROM), increasing strength of muscles, and functional activities to optimize the patient's recovery. Concurrently, isometrics, ROM, and strengthening exercises were integrated into the rehabilitation program to enhance muscle strength, prevent tightness, and maintain ROM. The patient's progress was monitored by using the Disabilities of Arm, Shoulder, and Hand (DASH) score and the Upper Extremity Functional Scale (UEFS) at specific intervals during rehabilitation. The treatment and healing of a patient with an RCT who underwent both pre and postoperative physiotherapy are explored in this case report.
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Affiliation(s)
- Shraddha S Kochar
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapnil U Ramteke
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Subrat Samal
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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16
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Fairley JA, Pollock JW, McIlquham K, Lapner P. Bone channeling in arthroscopic rotator cuff repair: a systematic review and meta-analysis of level I studies. J Shoulder Elbow Surg 2024; 33:210-222. [PMID: 37757905 DOI: 10.1016/j.jse.2023.08.012] [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: 04/06/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND There is ongoing controversy regarding the effect of bone channeling in arthroscopic rotator cuff repair. Since the most recent systematic reviews in 2019, several large high-level trials have been completed. This study assessed all available level I randomized controlled trials (RCTs) that compared arthroscopic rotator cuff repair with and without bone marrow channeling. METHODS A systematic search of the Ovid MEDLINE, Embase, and Cochrane Library databases was conducted through mid January 2023. Two reviewers performed screening of studies meeting the eligibility criteria: English-language RCTs in patients aged ≥18 years comparing arthroscopic rotator cuff repair of full-thickness tears with and without bone marrow channeling (channeling group and control group, respectively). Functional scores, pain, healing rates, and reoperations were reviewed using pooled analysis where appropriate. The methodologic quality of included studies was assessed using the Cochrane risk-of-bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS A total of 6 randomized studies (N = 593) met the inclusion criteria. Pooled analysis of all 6 studies showed no significant mean difference in function (1.32; 95% confidence interval [CI], -0.63 to 3.26), as measured by the Constant-Murley score. Retear rates were also not statistically different between groups (risk ratio, 0.99; 95% CI, 0.57 to 1.71), with pooled retear rates of 19.6% (48 of 245) with channeling and 19.8% (51 of 257) without. The other outcomes of interest were only available for analysis in a subset of studies. There were no standardized mean differences in pain (0.09; 95% CI, -0.18 to 0.36), and there were similar reoperation rates (risk ratio, 1.19; 95% CI, 0.43 to 3.34) in the channeling and control groups. For the included studies, the overall quality of evidence by outcome was judged to be moderate (function, pain, and reoperations) or low (retear rates), mainly owing to risk of bias (all outcomes) and inconsistency (retear rates). CONCLUSION The results of this study refute the findings of prior systematic reviews that showed that channeling reduces the retear rate when combined with arthroscopic rotator cuff repair. This meta-analysis of level I evidence, including recent larger RCTs, demonstrates that bone marrow stimulation in the setting of primary arthroscopic rotator cuff repair has no significant effect on functional outcomes, healing, pain, or reoperation rates.
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Affiliation(s)
- Jillian A Fairley
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - J W Pollock
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Katie McIlquham
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Peter Lapner
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
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17
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Karasuyama M, Gotoh M, Oike T, Nishie K, Shibuya M, Nakamura H, Ohzono H, Kawakami J. Does physiotherapy after rotator cuff repair require supervision by a physical therapist?: a meta-analysis. Clin Shoulder Elb 2023; 26:296-301. [PMID: 37442778 PMCID: PMC10497919 DOI: 10.5397/cise.2022.01410] [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: 12/07/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND A supervised physiotherapy program (SPP) is a standard regimen after surgical rotator cuff repair (RCR); however, the effect of a home-based exercise program (HEP), as an alternative, on postoperative functional recovery remains unclear. Therefore, the purpose of this meta-analysis was to compare the functional effects of SPP and HEP after RCR. METHODS We searched electronic databases including Central, Medline, and Embase in April 2022. The primary outcomes included the Constant score, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, and pain score. Secondary outcomes included range of motion, muscle strength, retear rate, and patient satisfaction rate. A meta-analysis using random-effects models was performed on the pooled results to determine the significance. RESULTS The initial database search yielded 848 records, five of which met our criteria. Variables at 3 months after surgery were successfully analyzed, including the Constant score (mean difference, -8.51 points; 95% confidence interval [CI], -32.72 to 15.69; P=0.49) and pain score (mean difference, 0.02 cm; 95% CI, -2.29 to 2.33; P=0.99). There were no significant differences between the SPP and HEP. Other variables were not analyzed owing to the lack of data. CONCLUSIONS Our data showed no significant differences between SSP and HEP with regard to the Constant and pain scores at 3 months after RCR. These results suggest that HEP may be an alternative regimen after RCR. Level of evidence: I.
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Affiliation(s)
- Masaki Karasuyama
- Department of Rehabilitation, Minamikawa Orthopedic Hospital, Fukuoka, Japan
- Kurume University School of Medicine Graduate School, Kurume, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Japan
| | - Takuya Oike
- Department of Rehabilitation, Tahara Orthopedic Clinic, Kitakyushu, Japan
| | - Kenichi Nishie
- Department of Respiratory Medicine, Iida Municipal Hospital, Nagano, Japan
| | - Manaka Shibuya
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Hidehiro Nakamura
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Japan
| | - Hiroki Ohzono
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Japan
| | - Junichi Kawakami
- Department of Physical Therapy, Kyushu Nutrition Welfare University, Kitakyushu, Japan
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18
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Allaart LJH, Lech J, Macken AA, Kling A, Lafosse L, Lafosse T, van den Bekerom MPJ, Buijze GA. Biomodulating healing after arthroscopic rotator cuff repair: the protocol of a randomised proof of concept trial (BIOHACK). BMJ Open 2023; 13:e071078. [PMID: 37586862 PMCID: PMC10432644 DOI: 10.1136/bmjopen-2022-071078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE/INTRODUCTION Over the last decades, there has been increasing interest in biological stimulation or bioaugmentation after rotator cuff repair. So far, there is no consensus on the appropriate composition of biologicals or which patients would benefit most, and moreover, these biologicals are often expensive. However, there are other, non-pharmacological strategies that are also believed to achieve biological stimulation. This randomised controlled trial evaluates the possible cumulative effect of pragmatic application of cryobiomodulation, photobiomodulation and electrobiomodulation-collectively called biomodulation-on the bone-to-tendon healing process after rotator cuff repair. METHODS In this randomised, controlled proof of concept study, 146 patients undergoing arthroscopic repair of a full thickness posterosuperior or anterosuperior rotator cuff tear will be 1:1 randomly assigned to either a control group or to the additional biomodulation protocol group. The adjuvant biomodulation protocol consists of seven self-applicable therapies and will be administered during the first 6 weeks after surgery. Primary outcome will be healing of the rotator cuff as evaluated by the Sugaya classification on MRI at 1-year postoperatively. ETHICS AND DISSEMINATION This study has been accepted by the National Ethical Review Board CPP Sud-Est IV in France and has been registered at Clinicaltrials.gov. The results of this study will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04618484.
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Affiliation(s)
- Laurens Jan Houterman Allaart
- Division of Orthopaedics and Trauma Surgery, Clinique Générale Annecy, Annecy, France
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - James Lech
- Radiology, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Department of Physics and Astronomy, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arno Alexander Macken
- Division of Orthopaedics and Trauma Surgery, Clinique Générale Annecy, Annecy, France
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Agathe Kling
- Division of Orthopaedics and Trauma Surgery, Clinique Générale Annecy, Annecy, France
| | - Laurent Lafosse
- Division of Orthopaedics and Trauma Surgery, Clinique Générale Annecy, Annecy, France
| | - Thibault Lafosse
- Division of Orthopaedics and Trauma Surgery, Clinique Générale Annecy, Annecy, France
| | - Michel P J van den Bekerom
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Geert Alexander Buijze
- Division of Orthopaedics and Trauma Surgery, Clinique Générale Annecy, Annecy, France
- Department of Orthopedic Surgery, University of Amsterdam, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Montpellier University Medical Center, Lapeyronie Hospital, University of Montpellier, Montpellier, France
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19
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McFarland EG, Brand JC, Ring D. Clinical Faceoff: Is Preventative Surgery a Good Idea for Patients With Rotator Cuff Tendinopathy? Clin Orthop Relat Res 2023; 481:1486-1490. [PMID: 37404134 PMCID: PMC10344515 DOI: 10.1097/corr.0000000000002752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/05/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Edward G. McFarland
- Department of Orthopaedic Surgery, Division of Shoulder Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jefferson C. Brand
- Heartland Orthopedic Specialists, 111 17th Ave E, Ste. 101, Alexandria, MN, USA
| | - David Ring
- Associate Dean for Comprehensive Care, Dell Medical School, Department of Surgery and Perioperative Care, Austin, TX, USA
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20
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Murphy RJ, Bintcliffe F. Ask the expert: assessment of shoulder pain in primary care. BMJ 2023; 382:1255. [PMID: 37419617 DOI: 10.1136/bmj.p1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
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21
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Dey Hazra RO, Dey Hazra ME, Hanson JA, Rutledge JC, Doan KC, Horan MP, Millett PJ. Minimum 10-Year Outcomes After Arthroscopic Repair of Partial-Thickness Supraspinatus Rotator Cuff Tears. Am J Sports Med 2023; 51:2404-2410. [PMID: 37306068 DOI: 10.1177/03635465231176557] [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] [Indexed: 06/13/2023]
Abstract
BACKGROUND The prevalence of partial-thickness rotator cuff tears (PTRCTs) has been reported to be 13% to 40% within the adult population, accounting for 70% of all rotator cuff tears. Approximately 29% of PTRCTs will progress to full-thickness tears if left untreated. The long-term clinical course after arthroscopic repair of PTRCTs is not well known. PURPOSE To investigate minimum 10-year patient-reported outcomes (PROs) after arthroscopic rotator cuff repair (RCR) of the supraspinatus tendon and to report reoperation and complication rates. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients were included who underwent arthroscopic RCR of a PTRCT performed by a single surgeon between October 2005 and October 2011. Arthroscopic RCR was performed with a transtendon repair of partial, articular-sided supraspinatus tendon avulsions, bursal-sided repair, or conversion into a full-thickness tear and repair. PRO data were collected preoperatively and at a minimum 10 years postoperatively. PRO measures included the American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, the shortened version of Disabilities of the Arm, Shoulder and Hand score (QuickDASH), the 12-Item Short Form Health Survey Physical Component Summary, and patient satisfaction. Subanalyses were performed to determine if tear location or age was associated with outcomes. Retears, revision surgery, and surgical complications were recorded. RESULTS In total, 33 patients (21 men, 12 women) at a mean age of 50 years (range, 23-68) met criteria for inclusion. Follow-up was obtained in 28 (87.5%) of the 32 eligible patients ≥10 years out from surgery (mean, 12 years; range, 10-15 years). Of the 33 PTCRTs, 21 were articular sided and 12 were bursal sided. Of the 33 patients, 26 underwent concomitant biceps tenodesis. At follow-up, the mean PROs were significantly improved when compared with preoperative levels: American Shoulder and Elbow Surgeons score from 67.3 to 93.7 (P < .001), Single Assessment Numeric Evaluation from 70.9 to 91.2 (P = .004), QuickDASH from 22.3 to 6.6 (P < .004), and 12-Item Short Form Health Survey Physical Component Summary from 44.8 to 54.2 (P < .001). Median postoperative satisfaction was 10 (range, 5-10). No patient underwent revision surgery. CONCLUSION Arthroscopic repair of PTRCTs results in excellent clinical outcomes and high patient satisfaction at minimum 10-year follow-up. Furthermore, the procedure is highly durable, with a clinical survivorship rate of 100% at 10 years.
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Affiliation(s)
- Rony-Orijit Dey Hazra
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | | | - Jared A Hanson
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Kent C Doan
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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22
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Zhou T, Han C, Weng X. Present situation and development prospects of the diagnosis and treatment of rotator cuff tears. Front Surg 2023; 10:857821. [PMID: 37440927 PMCID: PMC10333593 DOI: 10.3389/fsurg.2023.857821] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/24/2023] [Indexed: 07/15/2023] Open
Abstract
Rotator cuff tears are an important cause of shoulder pain and are caused by degeneration or trauma of the shoulder tendon at the anatomical neck of the humeral head. The understanding and research of rotator cuff tears have a history of hundreds of years, and their etiology, diagnosis, and treatment have a complete system, but some detailed rules of diagnosis and treatment still have room for development. This research paper briefly introduces the diagnosis and treatment of rotator cuff tears. The current situation and its valuable research direction are described.
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Affiliation(s)
- Tianjun Zhou
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Chang Han
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Xisheng Weng
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
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23
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Guo D, Liu X, Wang D, Tang X, Qin Y. Development and clinical validation of deep learning for auto-diagnosis of supraspinatus tears. J Orthop Surg Res 2023; 18:426. [PMID: 37308995 DOI: 10.1186/s13018-023-03909-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Accurately diagnosing supraspinatus tears based on magnetic resonance imaging (MRI) is challenging and time-combusting due to the experience level variability of the musculoskeletal radiologists and orthopedic surgeons. We developed a deep learning-based model for automatically diagnosing supraspinatus tears (STs) using shoulder MRI and validated its feasibility in clinical practice. MATERIALS AND METHODS A total of 701 shoulder MRI data (2804 images) were retrospectively collected for model training and internal test. An additional 69 shoulder MRIs (276 images) were collected from patients who underwent shoulder arthroplasty and constituted the surgery test set for clinical validation. Two advanced convolutional neural networks (CNN) based on Xception were trained and optimized to detect STs. The diagnostic performance of the CNN was evaluated according to its sensitivity, specificity, precision, accuracy, and F1 score. Subgroup analyses were performed to verify its robustness, and we also compared the CNN's performance with that of 4 radiologists and 4 orthopedic surgeons on the surgery and internal test sets. RESULTS Optimal diagnostic performance was achieved on the 2D model, from which F1-scores of 0.824 and 0.75, and areas under the ROC curves of 0.921 (95% confidence interval, 0.841-1.000) and 0.882 (0.817-0.947) were observed on the surgery and internal test sets. For the subgroup analysis, the 2D CNN model demonstrated a sensitivity of 0.33-1.000 and 0.625-1.000 for different degrees of tears on the surgery and internal test sets, and there was no significant performance difference between 1.5 and 3.0 T data. Compared with eight clinicians, the 2D CNN model exhibited better diagnostic performance than the junior clinicians and was equivalent to senior clinicians. CONCLUSIONS The proposed 2D CNN model realized the adequate and efficient automatic diagnoses of STs, which achieved a comparable performance of junior musculoskeletal radiologists and orthopedic surgeons. It might be conducive to assisting poor-experienced radiologists, especially in community scenarios lacking consulting experts.
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Affiliation(s)
- Deming Guo
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, 130041, People's Republic of China
- Jilin Provincial Key Laboratory of Orhtopeadics, Changchun, People's Republic of China
| | - Xiaoning Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, 130041, People's Republic of China
| | - Dawei Wang
- Beijing Infervision Technology Co Ltd, Beijing, People's Republic of China
| | - Xiongfeng Tang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, 130041, People's Republic of China.
- Jilin Provincial Key Laboratory of Orhtopeadics, Changchun, People's Republic of China.
| | - Yanguo Qin
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, 130041, People's Republic of China.
- Jilin Provincial Key Laboratory of Orhtopeadics, Changchun, People's Republic of China.
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24
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Dickinson RN, Kuhn JE. Nonoperative Treatment of Rotator Cuff Tears. Phys Med Rehabil Clin N Am 2023; 34:335-355. [PMID: 37003656 DOI: 10.1016/j.pmr.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Rotator cuff tears are common with prevalence increasing with age. Diagnosis by physical examination may require a cluster of tests. Although radiographs can be helpful, MRI, MRI arthrography, and ultrasound represent the most used imaging technique to identify rotator cuff tears. Although surgery is sometimes necessary, a large portion of patients may respond to conservative treatment including physical therapy and injections. Physical therapy should include restoring the range of motion, addressing any pectoralis minor or posterior capsule stiffness, and restoring motor control/strength to the scapula and rotator cuff. Other conservative treatments may include nonsteroidal anti-inflammatory drugs, corticosteroid injects, and platelet-rich plasma.
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Affiliation(s)
- Rebecca N Dickinson
- Vanderbilt Orthopedics Nashville, 1215 21 Street Avenue South, Suite 3200, Medical Center East, South Tower, Nashville, TN 37232, USA.
| | - John E Kuhn
- Vanderbilt Orthopedics Nashville, 1215 21 Street Avenue South, Suite 3200, Medical Center East, South Tower, Nashville, TN 37232, USA
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25
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Verweij LPE, Doornberg JN, van den Bekerom MPJ. Early Treatment of Shoulder Pathology May Be Necessary, but Let Us First Improve Patient Risk Stratification to Prevent Overtreatment. Arthroscopy 2023; 39:1123-1125. [PMID: 37019526 DOI: 10.1016/j.arthro.2023.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/28/2023] [Indexed: 04/07/2023]
Affiliation(s)
- Lukas P E Verweij
- Academic Medical Center, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise, Amsterdam, The Netherlands
| | - Job N Doornberg
- University Medical Center, Groningen, Department of Orthopaedic & Trauma Surgery, the Netherlands; Flinders University, Department of Orthopaedic Trauma, Adelaide, Australia
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Centre of Expertise, Amsterdam, The Netherlands; Department of Orthopedic Surgery, Shoulder and Elbow Unit, Amsterdam, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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26
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Naseri F, Dadgoo M, Pourahmadi M, Amroodi MN, Azizi S, Tabrizian P, Amiri A. Dry needling in a multimodal rehabilitation protocol following rotator cuff repair surgery: study protocol for a double-blinded randomized sham-controlled trial. BMC Musculoskelet Disord 2023; 24:330. [PMID: 37101278 PMCID: PMC10131318 DOI: 10.1186/s12891-023-06269-1] [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: 11/03/2022] [Accepted: 02/23/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Rotator cuff tear (RCT) is one of the main causes of shoulder pain and dysfunction. Rotator cuff repair (RCR) is a common surgical procedure for the management of RCTs. Presence of myofascial trigger points (MTrP) as a result of surgical procedure can aggravate postoperative shoulder pain. The purpose of this protocol is to describe a randomized controlled trial design to evaluate the effect of implementing 4 sessions of myofascial trigger point dry needling (MTrP-DN) within a multimodal rehabilitation protocol following RCR surgery. METHODS Forty-six participants aged 40-75 will be recruited having postoperative shoulder pain after RCR and meeting the inclusion criteria. Participants will be randomly divided into 2 groups: One group will undergo MTrP-DN, manual therapy, exercise therapy and electrotherapy and the other will receive sham dry needling (S-DN), manual therapy, exercise therapy and electrotherapy. This protocol will cover 4 weeks of intervention. The primary outcome measure will be the Numeric Pain Rating Scale (NPRS) for pain. Secondary outcome measures will be Shoulder Pain and Disability Index (SPDI), range of motion (ROM), strength and adverse events. DISCUSSION This is the first study to investigate the use of 4 sessions of MTrP-DN in combination with a multimodal rehabilitation protocol for postoperative shoulder pain, restriction, weakness and dysfunction following RCR. The results of this study may help to determine the effect of MTrP-DN on various outcomes after RCR surgery. TRIAL REGISTRATION This trial was registered at the ( https://www.irct.ir ), (IRCT20211005052677N1) on 19/2/2022.
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Affiliation(s)
- Faeze Naseri
- Department of Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran All., Shahnazari St., Madar Sq., Mirdamad Blvd., Tehran, Iran
| | - Mehdi Dadgoo
- Department of Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran All., Shahnazari St., Madar Sq., Mirdamad Blvd., Tehran, Iran.
| | - Mohammadreza Pourahmadi
- Department of Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran All., Shahnazari St., Madar Sq., Mirdamad Blvd., Tehran, Iran
| | - Morteza Nakhaei Amroodi
- Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Azizi
- Department of Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran All., Shahnazari St., Madar Sq., Mirdamad Blvd., Tehran, Iran
| | - Pouria Tabrizian
- Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Amiri
- Department of Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran All., Shahnazari St., Madar Sq., Mirdamad Blvd., Tehran, Iran
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Barret H, Langlais T, Laumonerie P, Faruch M, Mansat P, Bonnevialle N. Which preoperative factors influence the patient's short-term subjective assessment after rotator cuff repair? Orthop Traumatol Surg Res 2023; 109:103490. [PMID: 36442808 DOI: 10.1016/j.otsr.2022.103490] [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: 08/15/2021] [Revised: 01/07/2022] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To highlight the preoperative risk factors that influence postoperative patient satisfaction following Rotator Cuff Repair (RCR) and to determine whether this satisfaction was correlated with tendon healing. HYPOTHESIS Preoperative factors influence patient satisfaction, assessed by SSV (Subjective Shoulder Value) postoperatively, with a correlation with tendon healing. METHODS With a mean age of 60.6 years (40-72), 102 patients with arthroscopic RCR were included retrospectively. The preoperative SSV score was less than or equal to 50%. There was clinical and radiological follow-up with an ultrasound evaluation of tendon healing 6 months postoperatively. We divided the patients into 2 groups using a postoperative SSV of 85% as the cut-off; 55 patients in the first group (SSV>85%); and 47 patients in the second group (SSV<85%). RESULTS In multivariate analysis, Preoperative risk factors for poor postoperative SSV after RCR were: tobacco use [-8.41 (-13.64; -3.17) p=0.002], fatty infiltration [-3.65 (-6.24 -1.06) p=0.006] and workers compensation [-19.15 (-24.04; -14.27) p<0.001]. When patients were not in workers compensation, the lower their SSV score before surgery, the higher their postoperative SSV score. For patients in workers compensation, the higher the SSV preoperatively, the less elevated was SSV postoperatively. The Sugaya ultrasound classification did not influence the SSV score (p=0.15) CONCLUSIONS: Smoking, fatty infiltration and patients in workers compensation are factors of poorer subjective results evaluated by the SSV score. Tendon healing did not influence the SSV score and patient satisfaction. LEVEL OF EVIDENCE IV, cohort study.
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Emam M, Cohen C, Willeford S, Mahesh K, Le MQ, Wilckens J. Role of Conservative Treatment vs Surgical Treatment for Rotator Cuff Tears: A Narrative Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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29
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Fang S, You M, Wei J, Chen P. Caveolin-1 is involved in fatty infiltration and bone-tendon healing of rotator cuff tear. Mol Med 2023; 29:33. [PMID: 36918760 PMCID: PMC10015686 DOI: 10.1186/s10020-023-00627-4] [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: 11/22/2022] [Accepted: 02/17/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Caveolin-1 has been predicted, based on RNA transcriptome sequencing, as a key gene in rotator cuff tear (RCT) and it is related to fatty infiltration. This study aims to elucidate the upstream and downstream mechanism of Caveolin-1 in fatty infiltration and bone-tendon healing after RCT in rat models. METHODS Differentially expressed genes related to RCT were screened, followed by functional enrichment analysis and protein-protein interaction analysis. GATA6 was overexpressed and Caveolin-1 was knocked down in tendon stem cells (TSCs) to evaluate their effects on the adipogenic differentiation of TSCs. In addition, a RCT rat model was constructed and injected with lentivirus carrying oe-GATA6, oe-Caveolin-1 alone or in combination to assess their roles in fatty infiltration and bone-tendon healing. RESULTS AND CONCLUSION: Caveolin-1 was identified as a key gene involved in the RCT process. In vitro results demonstrated that Caveolin-1 knockdown inhibited adipogenic differentiation of TSCs by activating the cAMP/PKA pathway. GATA6 inhibited the transcription of Caveolin-1 and inhibited its expression, thus suppressing the adipogenic differentiation of TSCs. In vivo data confirmed that GATA6 overexpression activated the cAMP/PKA pathway by downregulating Caveolin-1 and consequently repressed fatty infiltration, promoted bone-tendon healing, improved biomechanical properties and reduced the rupture risk of injured tendon in rats after RCT. Overall, this study provides novel insights into the mechanistic action of Caveolin-1 in the fatty infiltration and bone-tendon healing after RCT.
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Affiliation(s)
- Shanhong Fang
- Department of Sports Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350212, China.,Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Taijiang District, Fujian Province, 350005, Fuzhou, China
| | - Mengqiang You
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Taijiang District, Fujian Province, 350005, Fuzhou, China
| | - Jie Wei
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Taijiang District, Fujian Province, 350005, Fuzhou, China
| | - Peng Chen
- Department of Sports Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350212, China. .,Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Taijiang District, Fujian Province, 350005, Fuzhou, China.
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30
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Ko SH, Na SC, Kim MS. Risk factors of tear progression in symptomatic small to medium-sized full-thickness rotator cuff tear: relationship between occupation ratio of supraspinatus and work level. J Shoulder Elbow Surg 2023; 32:565-572. [PMID: 36252783 DOI: 10.1016/j.jse.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Previous studies reported that full-thickness rotator cuff tear (FTRCT) is a risk factor for tear progression. However, there is no clear consensus on the risk factors of tear progression in FTRCT. PURPOSE To identify the demographic and radiologic risk factors of tear progression in small to medium FTRCTs. METHODS We retrospectively reviewed 81 shoulders of patients diagnosed with small or medium FTRCTs using magnetic resonance imaging (MRI) who underwent conservative treatment from January 2017 to November 2021. Various demographic factors, including patient work level and radiological factors such as atrophy of rotator cuff muscles were analyzed to evaluate their association with tear progression. Work level was divided into high (heavy manual labor), medium (manual labor with less activity), and low (sedentary work activity). The atrophy of rotator cuff muscles was calculated by occupation ratio. RESULTS Tear progression was observed in 48% (39/81) of patients (criterion for tear progression was medial-lateral or anterior-posterior tear length > 5 mm). In patients with tear progression, the lengths of medial-lateral and anterior-posterior tears progressed by 6 mm and 3 mm, respectively. Among the rotator cuff muscles, fatty degeneration and occupation ratio of the supraspinatus were only worsened (P = .014, P = 0.013, respectively). The mean MRI follow-up duration was 14.8 ± 9.0 months. The significant risk factors of tear progression were high work level (odds ratio [OR], 7.728; 95% CI, 1.204-49.610; P = .031), and occupation ratio of the supraspinatus muscle (OR, 0.308; 95% CI, 0.158-0.604; P = .001). The optimal cutoff value for the occupation ratio of the supraspinatus was 0.55 (sensitivity 74%, specificity 62%). CONCLUSIONS Tear progression was observed in approximately 50% of patients with symptomatic small to medium FTRCTs. High physical work level and atrophy of the supraspinatus muscle were independent risk factors of tear progression. The risk of tear progression increases with occupation ratio of the supraspinatus muscle < 0.55 and heavy manual labor.
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Affiliation(s)
- Sang Hun Ko
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Sung Cheon Na
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Myung Seo Kim
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
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Freshman RD, Oeding JF, Anigwe C, Zhang AL, Feeley BT, Ma CB, Lansdown DA. Pre-existing Mental Health Diagnoses Are Associated With Higher Rates of Postoperative Complications, Readmissions, and Reoperations Following Arthroscopic Rotator Cuff Repair. Arthroscopy 2023; 39:185-195. [PMID: 35970453 DOI: 10.1016/j.arthro.2022.06.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/18/2022] [Accepted: 06/25/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE To investigate the association between preoperative mental health disorders and postoperative complications, readmissions, and ipsilateral revision procedures among patients undergoing arthroscopic rotator cuff repair (RCR). METHODS A retrospective cohort study from 2010 to 2020 was performed using the PearlDiver database. Current Procedural Terminology and International Classification of Diseases codes were used to compare patients with and without mental health disorders who underwent arthroscopic RCR. Mental health disorders evaluated in this study include depressive disorder, major depressive disorder, major depressive affective disorder, bipolar disorder, dysthymic disorder, adjustment disorder, separation anxiety disorder, and posttraumatic stress disorder. Patients were matched at a 1:1 ratio based on age, sex, Charlson Comorbidity Index, body mass index, and tobacco use. Rates of complications and subsequent surgeries were compared between patients with and without a preoperative diagnosis of a mental health disorder. RESULTS The 1-year preoperative prevalence of a mental health disorder from 2010 to 2020 was 14.6%. After 1:1 matching, patients with a mental health disorder who underwent arthroscopic RCR were nearly twice as likely to undergo a revision procedure (odds ratio 1.94, 95% confidence interval 1.76-2.14, P < .001) and more than twice as likely to experience conversion to shoulder arthroplasty (odds ratio 2.29, 95% confidence interval 1.88-2.80, P < .001) within 2 years of initial arthroscopy when compared with patients without a mental disorder. Patients with a mental disorder also experienced increased risk for 90-day readmission (1.9% vs 0%, P < .001) as well as multiple postoperative medical complications. CONCLUSIONS Patients with pre-existing mental health diagnoses experience increased rates of 90-day postoperative complications and readmissions following arthroscopic RCR. In addition, patients with mental health diagnoses are more likely to undergo revision repair and conversion to shoulder arthroplasty within 2 years of the index procedure. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ryan D Freshman
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Jacob F Oeding
- NYU Grossman School of Medicine, New York, New York, U.S.A.
| | - Christopher Anigwe
- School of Medicine, University of California San Francisco, San Francisco, California, U.S.A
| | - Alan L Zhang
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Brian T Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - C Benjamin Ma
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Drew A Lansdown
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
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Kim E, Kopp B, Kortlever JT, Johnson A, Ring D. Correlation of defect size with fatty infiltration on MRIs of rotator cuff tendinopathy. J Orthop 2023; 36:125-129. [PMID: 36748092 PMCID: PMC9898575 DOI: 10.1016/j.jor.2023.01.007] [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: 07/30/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/21/2023] Open
Abstract
Introduction Sizable rotator cuff defects with limited muscle atrophy and fat replacement may represent acute traumatic ruptures that are less likely to recur after surgery to close the defect, while closure of defects with poor quality muscle are associated with defect recurrence. These distinct lesions are both referred to as tears. We analyzed the relationship between rotator cuff defect size and muscle quality to determine the relative proportion of sizable defects associated with good muscle and factors associated with muscle deterioration. Material and methods A cohort of 230 consecutive shoulder MRIs in patients with full-thickness rotator cuff tendon defects, limited acromioclavicular arthrosis (to avoid hindrance of defect measurement), and a duration of symptoms in the radiology report from a large urban center in the United States was evaluated for the measured distance between the supraspinatus tendon edge and the greater tuberosity medial to lateral (coronal plane defect size), anterior to posterior (sagittal plane defect width), and fatty infiltration (Goutallier classification), and atrophy (Warner classification) of the supraspinatus. We sought factors independently associated with fatty infiltration and muscle atrophy in multivariable logistic regression analyses. Results Forty-nine of 109 shoulders (45%) with a coronal plane defect >20 mm had reasonable muscle quality as defined by Goutallier grade less than 2 and Warner grade less than 2. Both greater fatty infiltration of the supraspinatus muscle and greater supraspinatus muscle atrophy were associated with older age and greater coronal plane defect size. Conclusion The observation that supraspinatus muscle health deteriorates with age and defect size, but nearly half of the largest defects had good muscle, suggests an important distinction between relatively recent traumatic ruptures and old untreated rupture or gradual attrition that may be obfuscated by referring to all lesions as tears. Level of evidence Level III; Retrospective diagnostic cohort.
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Affiliation(s)
- Eugene Kim
- Department of Surgery and Perioperative Care, Dell Medical School – the University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78705, USA
| | - Benjamin Kopp
- Department of Surgery and Perioperative Care, Dell Medical School – the University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78705, USA
| | - Joost T.P. Kortlever
- Department of Surgery and Perioperative Care, Dell Medical School – the University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78705, USA
| | - Anthony Johnson
- Department of Surgery and Perioperative Care, Dell Medical School – the University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78705, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School – the University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78705, USA
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Surgery and Rotator Cuff Disease. Clin Sports Med 2023; 42:1-24. [DOI: 10.1016/j.csm.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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No difference in clinical outcome after rotator cuff repair performed within or later than 3 months after trauma: a retrospective cohort study. Knee Surg Sports Traumatol Arthrosc 2023; 31:672-680. [PMID: 36287225 PMCID: PMC9898400 DOI: 10.1007/s00167-022-07193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Rotator cuff (RC) tear is one of the most common injuries of the shoulder. Patients with RC tears often report a trauma initiating shoulder pain and impaired function. The aim of this retrospective analysis of a prospectively registered cohort was to elucidate whether the time interval between the trauma and RC repair, using a cut off of 3 months, affects the functional outcome after 2 years. METHODS In a single orthopedic unit, 819 consecutive patients were treated with rotator cuff repair during the period from 2010 to 2014 and 733 of the patients completed the Western Ontario Rotator Cuff (WORC) index preoperatively and at 2-year follow-up. The Constant-Murley (CM) score was completed by trained physiotherapists after a clinical examination both preoperatively and at 2-year follow-up. Preoperative magnetic resonance imaging (MRI) was performed in all patients and postoperatively in 65% of the included patients. Re-tears and partial repairs were excluded, as were patients with pseudoparalysis who were given high priority and underwent surgery during the first 3 weeks after trauma. RESULTS Of the 733 treated patients, 437 (60%) reported having had a shoulder trauma in their medical history initiating their shoulder symptoms, and of these, 358 met the inclusion criteria. 296 patients with non-traumatic tears, 9 repairs done within 3 weeks after trauma, 25 partial repairs, 33 re-tears and 12 others were excluded. At 2-year follow-up there was no significant difference in WORC index (n.s.) or CM score (n.s.) between patients who had their RC repaired within or more than 3 months after trauma. In patients where RC repair was performed within 3 months, the WORC index improved by 42.9%, and in the group of patients operated later than 3 months, the increase was 38.7%. This difference between the groups was neither statistically significant (n.s.) nor clinically relevant. On postoperative MRI, 80% of the repairs were healed in both groups. CONCLUSION In this retrospective cohort study, no differences in clinical outcome were found when RC repair was performed between 3 weeks and 3 months or later than 3 months after injury in patients describing their onset of symptoms as traumatic. LEVEL OF EVIDENCE III.
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Kalogeropoulos A, Savvidou OD, Bissias C, Sarafis P, Savvidis M, Tanos A, Pikoulis E, Papagelopoulos PJ, Exadaktylos A, Eggli S. Milder impact of the COVID-19 pandemic on the practice of orthopaedic surgery in Greece and Cyprus than other European countries. Knee Surg Sports Traumatol Arthrosc 2023; 31:110-120. [PMID: 36114340 PMCID: PMC9483367 DOI: 10.1007/s00167-022-07159-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this study was to highlight the impact of the COVID-19 pandemic on the practice of orthopaedics in Greece and Cyprus. METHODS The survey used the online questionnaire from AGA (Gesellschaft für Arthroskopie und Gelenkchirurgie; Society for Arthroscopy and Joint Surgery) to facilitate the comparison between different European countries. The questionnaire was distributed online to members of the HAOST (Hellenic Association of Orthopaedic Surgery and Trauma), the ΟΤΑΜΑΤ (Orthopaedic and Trauma Association of Macedonia and Thrace) and the CAOST (Cypriot Association of Orthopaedic Surgery and Trauma). The questionnaire consisted of 29 questions, which included demographic data, questions on the impact of the pandemic on the practice of orthopaedic surgery and questions on the impact on the personal and family life of orthopaedic surgeons. RESULTS The questionnaire was sent to 1350 orthopaedic surgeons in Greece and Cyprus, 303 of whom responded (response rate 22.44%). 11.2% of the participants reported cancellation of overall orthopaedic procedures. According to 35.6-49.8% of the participants, arthroscopic procedures were continued. As regards elective primary arthroplasties, 35.3% of the participants reported that these continued to be performed at their hospitals. Post-operative follow-ups as well as physiotherapy were affected by the pandemic, and changes were also observed in the habits of orthopaedic surgeons in their personal and family lives. CONCLUSION The orthopaedic service in Greece and Cyprus decreased during the first wave of the COVID-19 pandemic. Arthroscopic procedures and total joint replacements decreased significantly, but not to the same extent as in other countries. Health systems were not fully prepared for the first wave of the pandemic and the various countries took social measures at different times and to different extents. Thus, studying the impact of the pandemic on the practice of orthopaedic surgery in different countries can help health systems to better prepare for future pandemics; public health can then be shielded and hospitals can continue to provide high-quality orthopaedic care. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
| | - Olga D. Savvidou
- 1st Department of Orthopedic Surgery, National and Kapodistrian University of Athens, ATTIKON” University General Hospital, Athens, Greece
| | | | - Pavlos Sarafis
- Department of Nursing, University of Thessaly, Volos, Greece
| | | | | | - Emmanouil Pikoulis
- 3rd Department of General Surgery, National and Kapodistrian University of Athens, ATTIKON” University General Hospital, Athens, Greece
| | - Panayiotis J. Papagelopoulos
- 1st Department of Orthopedic Surgery, National and Kapodistrian University of Athens, ATTIKON” University General Hospital, Athens, Greece
| | | | - Stefan Eggli
- Orthopädie Und Traumatologie, Sonnenhofspital, Buchserstrasse 30, 3006 Bern, Switzerland
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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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Cohen D, Le N, Zakharia A, Blackman B, de Sa D. MPFL reconstruction results in lower redislocation rates and higher functional outcomes than rehabilitation: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3784-3795. [PMID: 35616703 DOI: 10.1007/s00167-022-07003-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/04/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine the effect of early MPFL reconstruction versus rehabilitation on the rate of recurrent patellar dislocations and functional outcomes in skeletally mature patients with traumatic, first-time patellar dislocation. METHODS Three online databases MEDLINE, PubMed and EMBASE were searched from database inception (1946, 1966, and 1974, respectively) to August 20th, 2021 for literature addressing the management of patients sustaining acute first-time patellar dislocations. Data on redislocation rates, functional outcomes using the Kujala score, and complication rates were recorded. A meta-analysis was used to pool the mean postoperative Kujala score, as well as calculate the proportion of patients sustaining redislocation episodes using a random effects model. Quality assessment of included studies was performed for all included studies using the MINORS and Detsky scores. RESULTS A total of 19 studies and 1,165 patients were included in this review. The pooled mean redislocation rate in 14 studies comprising 734 patients in the rehabilitation group was 30% (95% CI 25-36%, I2 = 67%). Moreover, the pooled mean redislocation rate in 5 studies comprising 318 patients undergoing early MPFL reconstruction was 7% (95% CI 2-17%, I2 = 70%). The pooled mean postoperative Kujala anterior knee pain score in 7 studies comprising 332 patients in the rehabilitation group was 81 (95% CI 78-85, I2 = 78%), compared to a score of 87 (95% CI 85-89, I2 = 0%, Fig. 4) in 3 studies comprising 54 patients in the reconstruction group. CONCLUSION Management of acute first-time patellar dislocations with MPFL reconstruction resulted in a lower rate of redislocation of 7% in the reconstruction group vs 30% in the rehabilitation group and a higher Kujala score compared to the rehabilitation group. The information this review provides will help surgeons guide their decision to choose early MPFL reconstruction versus rehabilitation when treating patients with first-time patellar dislocations and may guide future studies on the topic. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, Hamilton, ON, 4E14L8N 3Z5, Canada
| | - NhatChinh Le
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Benjamin Blackman
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, Hamilton, ON, 4E14L8N 3Z5, Canada.
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Green A, Loyd K, Molino J, Evangelista P, Gallacher S, Adkins J. Long-term functional and structural outcome of rotator cuff repair in patients 60 years old or less. JSES Int 2022; 7:58-66. [PMID: 36820436 PMCID: PMC9937847 DOI: 10.1016/j.jseint.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background The long-term outcomes of rotator cuff repair (RCR) have not been well studied. The purpose of this study was to evaluate long-term functional and structural outcomes after RCR in younger patients. Methods A total of 49 patients (34 [69%] male) with a mean age of 51 ± 6 years were evaluated preoperatively, and at short- and long-term follow-ups (minimum 15 years). There were 13 (27%) small, 17 (35%) medium, 14 (29%) large, and 5 (10%) massive tears. 15 (31%) had an acute repair of a traumatic tear. Long-term evaluation included physical examination, plain radiographs, ultrasound, and patient reported outcome measures (PROMs) (visual analog scale pain, Disability of Arm, Shoulder and Hand, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, and Short Form-36). Statistical analysis was performed to determine associations between preoperative and intraoperative factors and long-term functional and structural outcome. Results There were significant improvements in the mean short- and long-term PROMs compared to preoperatively that exceeded reported minimal clinically important differences and substantial clinical benefits. There was a slight decrease in the PROMs from the short-term to long-term follow-up. Male sex and traumatic rotator cuff tears were associated with better long-term outcomes. The number of medical co-morbidities was associated with worse long-term outcomes. Smaller initial tear size was associated with better long-term outcomes. There were 15 (31%) full thickness and 9 (18%) partial thickness recurrent rotator cuff tears, 17 (35%) had rotator cuff tear arthropathy (2 Hamada grade 1, 15 Hamada grade 2), 5 (10%) had revision surgery (2 revision RCR, 2 anatomic total shoulder, and 1 reverse total shoulder), and 13 (26%) had subsequent contralateral RCR. There were weak correlations between the presence of arthropathy and DASH (r = 0.34; P = .02) and visual analog scale pain (r = 0.29; P = .049). There were no significant correlations between the structural outcomes (recurrent rotator cuff tear, recurrent full thickness tear, acromiohumeral space, and critical shoulder angle,) and the PROMs. Discussion and Conclusion Long-term follow-up of RCR in this relatively young patient cohort demonstrated substantial and durable patient reported functional outcome and improvement despite considerable structural deterioration. This suggests that while RCR does not arrest the progression of rotator cuff disease it may delay this progression and that patients adapt to the structural changes as they age.
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Affiliation(s)
- Andrew Green
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA,Corresponding author: Andrew Green, MD, Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA.
| | - Kelsey Loyd
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Janine Molino
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Peter Evangelista
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Stacey Gallacher
- Advanced Orthopedics and Sports Medicine Institute, Freehold, NJ, USA
| | - Jacob Adkins
- Warren Alpert Medical School, Brown University, Providence, RI, USA
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Vivekanantha P, Kahlon H, Cohen D, de Sa D. Isolated medial patellofemoral ligament reconstruction results in similar postoperative outcomes as medial patellofemoral ligament reconstruction and tibial-tubercle osteotomy: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 31:2433-2445. [PMID: 36214831 DOI: 10.1007/s00167-022-07186-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To determine the effect of isolated medial patellofemoral ligament reconstruction (MPFLR) versus concomitant MPFLR and tibial-tubercle osteotomy (TTO) on patient-reported functional outcomes, rate of patellar redislocation, and rate of return to sport in skeletally mature patients with recurrent patellar instability and lateralization as defined by elevated tibial-tubercle trochlear groove (TT-TG) distance. METHODS Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 10th, 2022 for literature outlining the management of patients with TT-TG indices greater than 15 mm with either isolated MPFLR or concomitant MPFLR and TTO procedures. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on functional outcomes via the Kujala anterior knee pain score, redislocation rates, return to sport rates, and complications were recorded. The MINORS score was used for all studies to perform a quality assessment of included studies. RESULTS A total of 31 studies comprising 1405 patients (1452 knees) were included in this review. The mean Kujala score in 13 studies comprising 848 total patients in the isolated MPFLR group was 85.0 (range 80.9-97.5) compared to a score of 83.7 (range 77.2-94.0) in 14 studies comprising 459 patients in the concomitant group. The mean pooled redislocation rate in 19 studies examining isolated MPFLR procedures comprising 948 patients was 3.1% (95% CI 2.1-4.4%, I2 = 7%) as opposed to 3.2% (95% CI 1.9-5.0%, I2 = 0%) in 15 studies comprising 486 patients in the concomitant group. The mean pooled return to sport rate in seven studies with 472 total patients in the isolated MPFLR group was 82% (95% CI 78-86%, I2 = 16%) compared to a score of 92% (95% CI 78-99%, I2 = 58%) in four studies comprising 54 patients in the concomitant group. There were similar complication rates between both treatment groups, including range of motion deficits, fractures, infections, and graft failures. CONCLUSION Isolated MPFLR leads to similar anterior knee pain, similar redislocation rates and lower return to sport rates than concomitant MPFLR and TTO procedures in patients with TT-TG distances greater than 15 mm. Information from this review can aid surgeons in their decision to choose MPFLR versus concomitant procedures for this patient population, and can also guide future studies on this topic. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Harjind Kahlon
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, Hamilton, ON, 4E14L8N 3Z5, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, Hamilton, ON, 4E14L8N 3Z5, Canada.
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Yao J, Chepelev L, Nisha Y, Sathiadoss P, Rybicki FJ, Sheikh AM. Evaluation of a deep learning method for the automated detection of supraspinatus tears on MRI. Skeletal Radiol 2022; 51:1765-1775. [PMID: 35190850 DOI: 10.1007/s00256-022-04008-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate if deep learning is a feasible approach for automated detection of supraspinatus tears on MRI. MATERIALS AND METHODS A total of 200 shoulder MRI studies performed between 2015 and 2019 were retrospectively obtained from our institutional database using a balanced random sampling of studies containing a full-thickness tear, partial-thickness tear, or intact supraspinatus tendon. A 3-stage pipeline was developed comprised of a slice selection network based on a pre-trained residual neural network (ResNet); a segmentation network based on an encoder-decoder network (U-Net); and a custom multi-input convolutional neural network (CNN) classifier. Binary reference labels were created following review of radiologist reports and images by a radiology fellow and consensus validation by two musculoskeletal radiologists. Twenty percent of the data was reserved as a holdout test set with the remaining 80% used for training and optimization under a fivefold cross-validation strategy. Classification and segmentation accuracy were evaluated using area under the receiver operating characteristic curve (AUROC) and Dice similarity coefficient, respectively. Baseline characteristics in correctly versus incorrectly classified cases were compared using independent sample t-test and chi-squared. RESULTS Test sensitivity and specificity of the classifier at the optimal Youden's index were 85.0% (95% CI: 62.1-96.8%) and 85.0% (95% CI: 62.1-96.8%), respectively. AUROC was 0.943 (95% CI: 0.820-0.991). Dice segmentation accuracy was 0.814 (95% CI: 0.805-0.826). There was no significant difference in AUROC between 1.5 T and 3.0 T studies. Sub-analysis showed superior sensitivity on full-thickness (100%) versus partial-thickness (72.5%) subgroups. DATA CONCLUSION Deep learning is a feasible approach to detect supraspinatus tears on MRI.
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Affiliation(s)
- Jason Yao
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada.
| | - Leonid Chepelev
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada
| | - Yashmin Nisha
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada
| | - Paul Sathiadoss
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, 234 Goodman Street, Box 670761, Cincinnati, OH, 45267-0761, USA
| | - Adnan M Sheikh
- Department of Radiology, The University of British Columbia Faculty of Medicine, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Lavoie-Gagne O, Fury MS, Mehta N, Harkin WE, Bernstein DN, Berlinberg EJ, Parvaresh K, O'Donnell E, Forsythe B. Double-Row Repair With Platelet-Rich Plasma Optimizes Retear Rates After Small to Medium Full-Thickness Rotator Cuff Repair: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Arthroscopy 2022; 38:2714-2729. [PMID: 35337958 DOI: 10.1016/j.arthro.2022.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the different interventions described in the literature for the surgical treatment of small and medium complete rotator cuff tears. METHODS A systematic review of randomized controlled trials of small-medium, full-thickness rotator cuff tears published since 2000 was performed. Clinical characteristics, re-tear rates, range of motion (ROM), and patient-reported outcomes (PRO) data were collected. Interventions were compared via arm-based Bayesian network meta-analysis in a random-effects model. Interventions were ranked for each domain (re-tear risk, pain, ROM, and PROs) via surface under the cumulative ranking curves. RESULTS A total of 18 studies comprising 2046 shoulders (47% females, mean age 61 ± 3 years, mean follow-up 21 ± 5 months) were included. Interventions that ranked highest for minimizing re-tear risk included arthroscopic single-row repair (A+SR) or double-row repair (A+DR) with or without platelet-rich plasma (PRP). Open repair and A+SR repair with acromioplasty (ACP) ranked highest for pain relief. Interventions that ranked highest for ROM improvement included open repair, PT, and A+DR with or without ACP. Interventions that ranked highest for PROs included arthroscopic footprint microfracture with or without SR, open repair, and A+SR with or without ACP. CONCLUSIONS Based on a network meta-analysis of level 1 studies, arthroscopic rotator cuff repair with a SR or DR construct demonstrates similar retear rates, PROs, and clinical outcomes. The highest-ranking treatment for minimizing retears was arthroscopic repair with DR constructs and PRP augmentation, although open repair and arthroscopic SR remain reliable options with excellent clinical outcomes. Addition of PRP to DR constructs trended toward a 56% decreased risk of retear as compared to DR repair alone. Although no single treatment emerged superior, several interventions offered excellent clinical improvements in pain, ROM, and PROs that exceeded minimal clinically important difference thresholds. LEVEL OF EVIDENCE I, systematic review and meta-analysis of level I studies.
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Affiliation(s)
| | - Matthew S Fury
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, U.S.A
| | - Nabil Mehta
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | - David N Bernstein
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, U.S.A
| | | | | | - Evan O'Donnell
- Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Pasculli RM, Bowers RL. Evidence-based Management of Rotator Cuff Tears (Acute and Chronic). CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00363-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Retear After Arthroscopic Rotator Cuff Repair Results in Functional Outcome Deterioration Over Time. Arthroscopy 2022; 38:2399-2412. [PMID: 35219797 DOI: 10.1016/j.arthro.2022.02.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to evaluate the effect of retear on long-term functional outcomes and glenohumeral joint osteoarthritis (OA) progression after arthroscopic rotator cuff repair (ASRCR). METHODS We retrospectively reviewed 201 patients who underwent ASRCR and were followed up for at least 5 years. Rotator cuff tendon structural integrity was evaluated using magnetic resonance imaging and/or ultrasonography. Pain, active range of motion, and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) were evaluated for functional outcomes. To evaluate deterioration over time, the minimal clinically important difference value of pain and ASES were used. RESULTS The mean follow-up period was 8.6 ± 2.2 years and overall retear rate was 21.4%. OA progression was strongly associated with retear (odds ratio 5.1, P < .001). Functional outcomes at the 2-year postoperative follow-up significantly improved compared to the preoperative status (all P < .017), regardless of retear. However, the retear group presented worse functional outcomes at the final follow-up (pain: 3.1 ± 2.6; ASES: 72.0 ± 17.4) than at the 2-year postoperative follow-up (pain: 1.2 ± 2.3, P = .014; ASES: 91.1 ± 9.9, P= .015) than the healed tendon group at final follow-up (pain: .6 ± 1.7; P < .001; ASES 95.5 ± 11.8; P < .001). The time for deterioration of pain (healed group vs. retear group: 5.5 ± 0.5 vs. 10.6 ± 0.4 years; P < .001) and ASES (healed group vs. retear group: 7.5 ± 0.5 vs. 12.8 ± 0.2 years; P < .001) decreased in the retear group. CONCLUSIONS The functional status improved after ASRCR in short- and long-term follow-up, regardless of retear. However, retear was strongly associated with OA progression, and long-term functional outcomes deteriorated over time in retear cases, which was not observed during short-term follow-up. STUDY DESIGN III, retrospective cohort study.
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Lähdeoja T, Karjalainen T. Adverse events after arthroscopic shoulder surgery. BMJ 2022; 378:o1571. [PMID: 35793822 DOI: 10.1136/bmj.o1571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tuomas Lähdeoja
- Finnish Centre for Evidence-Based Orthopaedics, Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Sahoo S, Stojanovska M, Imrey PB, Jin Y, Bowles RJ, Ho JC, Iannotti JP, Ricchetti ET, Spindler KP, Derwin KA, Entezari V. Changes From Baseline in Patient- Reported Outcomes at 1 Year Versus 2 Years After Rotator Cuff Repair: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:2304-2314. [PMID: 34473586 PMCID: PMC10510728 DOI: 10.1177/03635465211023967] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most orthopaedic journals currently require reporting outcomes of surgical interventions for at least 2 postoperative years, but there have been no rigorous studies on this matter. Various patient-reported outcome (PRO) measures (PROMs) have been used to assess the status of the shoulder after rotator cuff repair (RCR). HYPOTHESIS We hypothesized that the mean shoulder-specific PROMs at 1 year improve substantially over baseline but that there is no clinically meaningful difference between the mean 1- and 2-year PROMs after RCR. STUDY DESIGN Meta-analysis; Level of evidence, 2. METHODS We conducted a systematic review of published randomized controlled trials (RCTs) and prospective cohort studies (level of evidence 1 and 2) reporting the shoulder-specific American Shoulder and Elbow Surgeons (ASES), the Constant, or the Western Ontario Rotator Cuff (WORC) Index scores at baseline, 1 year, and 2 years after RCR. The methodologic quality of studies was assessed. Also, the random effects meta-analyses of changes in PROMs for each of the first and second postoperative years were conducted. RESULTS Fifteen studies (n = 11 RCTs; n = 4 cohort studies) with a total of 1371 patients were included. Studies were highly heterogeneous, but no visual evidence of major publication bias was observed. The weighted means of the baseline PROMs were 46.2 points for the ASES score, 46.4 points for the Constant score, and 38.8 points for the WORC Index. The first-year summary increments were 41.1 (95% CI, 36.0-46.2) points for the ASES score, 34.2 (95% CI, 28.8-39.6) points for the Constant score, and 42.9 (95% CI, 37.3-48.4) points for the WORC Index. In contrast, the second-year summary increments were 2.3 (95% CI, 1-3.6) points for the ASES score, 3.2 (95% CI, 1.9-4.4) points for the Constant score, and 2 (95% CI, -0.1 to 4) points for the WORC Index. CONCLUSION All PROMs improved considerably from baseline to 1 year, but only very small gains that were below the minimal clinically important differences were observed between 1 year and 2 years after RCR. This study did not find any evidence for requiring a minimum of 2 years of follow-up for publication of PROs after RCR. Our results suggest that focusing on 1-year PROMs after RCR would foster more timely reporting, better control of selection bias, and better allocation of research resources.
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Affiliation(s)
- Sambit Sahoo
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Martina Stojanovska
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter B. Imrey
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Yuxuan Jin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard J. Bowles
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jason C. Ho
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Joseph P. Iannotti
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Eric T. Ricchetti
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Kurt P. Spindler
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Kathleen A. Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Vahid Entezari
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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46
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Liu Y, Fu SC, Yao SY, Chen XD, Yung PSH. Application of suture anchors for a clinically relevant rat model of rotator cuff tear. J Tissue Eng Regen Med 2022; 16:757-770. [PMID: 35670621 PMCID: PMC9546400 DOI: 10.1002/term.3326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/06/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022]
Abstract
Current rat model of rotator cuff (RC) tear could not mimic the suture anchor (SA) repair technique in the clinical practice. We designed a novel SA for RC repair of rats to establish a clinically relevant animal model. Small suture anchors that fit the rat shoulder were assembled. 60 rats were assigned to the transosseous (TO) repair group or SA repair group (n = 30/group). Micro‐computed tomography (Micro‐CT) scanning, biomechanical test and histological analysis were implemented at 2, 4, and 8‐week post‐repair. The failure load and stiffness in the SA group were significantly higher than those of TO group at 4‐week post‐repair. Micro‐computed tomography analysis showed the bone mineral density and trabecular thickness of the SA group were significantly lower than those of TO group. The SA group showed a better insertion continuity at 4‐week post‐repair compared to TO group. No significant difference in gait parameters was found between groups. Therefore, SA repair is applicable for the rat model of RC tears. The SA repair achieved superior RC tendon healing, but more extensive initial bone damage compared to TO repair, while the shoulder function was comparable. This model could replicate the current repair technique in the clinical situation and be considered for future preclinical studies on healing enhancement for RC tears. Statement of Clinical Significance: With high clinical relevance, this model may facilitate the translation from an animal study into clinical trials.
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Affiliation(s)
- Yang Liu
- Department of Bone and Joint Surgery, Shenzhen People's Hospital, Shenzhen, Guangdong, China.,Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shi-Yi Yao
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiao-Dan Chen
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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47
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Finger L, Dunn R, Hughes J, Lesniak B, Lin A. Clinical outcomes secondary to time to surgery for atraumatic rotator cuff tears. J Shoulder Elbow Surg 2022; 31:S18-S24. [PMID: 35085601 DOI: 10.1016/j.jse.2021.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The time from symptom onset to surgery has been shown to impact functional outcomes after repair of traumatic rotator cuff tears (RCTs), but this temporal relationship has not yet been evaluated in patients with atraumatic, degenerative cuff tears. Furthermore, it has been shown that over time, atraumatic cuff tears tend to enlarge and become more symptomatic, retracted, and atrophic-factors that have been shown to decrease success rates after repair. The aim of this study was to evaluate the relationship between the time from symptom onset to surgery and postoperative outcomes in patients with atraumatic RCTs. METHODS We performed a retrospective cohort study of patients with degenerative, atraumatic RCTs who underwent surgery performed by 2 fellowship-trained shoulder surgeons and had at least 12 months of postoperative follow-up. These patients were divided into 2 cohorts based on the duration between symptom onset and surgery: early (<12 months) and delayed (≥12 months). The primary outcome measures included reoperation rate and failure of repair. Secondary outcomes included clinical measures of strength and range of motion and patient-reported outcome measures consisting of the Subjective Shoulder Value, visual analog scale for pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment, and Brophy-Marx Activity Scale at last follow-up. RESULTS Of the 143 patients who met the inclusion criteria, 78 (54.5%) underwent surgery within 1 year of symptom onset whereas 65 (45.5%) underwent surgery after at least 1 year. There were no differences between groups regarding demographic or tear characteristics. At final follow-up, there were no differences between the early- and late-surgery groups regarding retear rate (12% vs. 9%, P = .65), reoperation rate (5% vs. 3%, P = .54), postoperative range of motion in any plane (P > .05), strength in external rotation and internal rotation, visual analog scale pain score, or Subjective Shoulder Value. A greater proportion of the early group (61%) than the late group (46%) experienced improvement in supraspinatus strength of ≥1 grade on manual muscle testing (P = .02) and post hoc analysis. CONCLUSION Despite our knowledge of the natural history of chronic, atraumatic RCTs, delaying surgical treatment for 1 year or more does not appear to significantly impact postoperative outcomes. Thus, it is reasonable for physicians to recommend either conservative or surgical treatment depending on patient-specific factors and expectations.
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Affiliation(s)
- Logan Finger
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robin Dunn
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Jonathan Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bryson Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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48
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Schanda JE, Obermayer-Pietsch B, Sommer G, Heuberer PR, Laky B, Muschitz C, Pastl K, Pastl E, Fialka C, Mittermayr R, Grillari J, Foessl I. Biomechanical properties of a suture anchor system from human allogenic mineralized cortical bone matrix for rotator cuff repair. BMC Musculoskelet Disord 2022; 23:422. [PMID: 35513813 PMCID: PMC9069722 DOI: 10.1186/s12891-022-05371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Suture anchors (SAs) made of human allogenic mineralized cortical bone matrix are among the newest developments in orthopaedic and trauma surgery. Biomechanical properties of an allogenic mineralized suture anchor (AMSA) are not investigated until now. The primary objective was the biomechanical investigation of AMSA and comparing it to a metallic suture anchor (MSA) and a bioabsorbable suture anchor (BSA) placed at the greater tuberosity of the humeral head of cadaver humeri. Additionally, we assessed the biomechanical properties of the SAs with bone microarchitecture parameters. Methods First, bone microarchitecture of 12 fresh frozen human cadaver humeri from six donors was analyzed by high-resolution peripheral quantitative computed tomography. In total, 18 AMSAs, 9 MSAs, and 9 BSAs were implanted at a 60° angle. All three SA systems were systematically implanted alternating in three positions within the greater tuberosity (position 1: anterior, position 2: central, position 3: posterior) with a distance of 15 mm to each other. Biomechanical load to failure was measured in a uniaxial direction at 135°. Results Mean age of all specimens was 53.6 ± 9.1 years. For all bone microarchitecture measurements, linear regression slope estimates were negative which implies decreasing values with increasing age of specimens. Positioning of all three SA systems at the greater tuberosity was equally distributed (p = 0.827). Mean load to failure rates were higher for AMSA compared to MSA and BSA without reaching statistical significance between the groups (p = 0.427). Anchor displacement was comparable for all three SA systems, while there were significant differences regarding failure mode between all three SA systems (p < 0.001). Maximum load to failure was reached in all cases for AMSA, in 44.4% for MSA, and in 55.6% for BSA. Suture tear was observed in 55.6% for MSA and in 22.2% for BSA. Anchor breakage was solely seen for BSA (22.2%). No correlations were observed between bone microarchitecture parameters and load to failure rates of all three suture anchor systems. Conclusions The AMSA showed promising biomechanical properties for initial fixation strength for RCR. Since reduced BMD is an important issue for patients with chronic rotator cuff lesions, the AMSA is an interesting alternative to MSA and BSA. Also, the AMSA could improve healing of the enthesis. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05371-0.
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Affiliation(s)
- Jakob E Schanda
- Department for Trauma Surgery, AUVA Trauma Center Vienna-Meidling, Vienna, Austria. .,Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria. .,Austrian Cluster for Tissue Regeneration, Vienna, Austria. .,Michael Ogon Laboratory for Orthopaedic Research, Vienna, Austria.
| | - Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Gerhard Sommer
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
| | - Philipp R Heuberer
- healthPi Medical Center, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
| | - Brenda Laky
- Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
| | - Christian Muschitz
- II Medical Department, Vinforce, St. Vincent Hospital Vienna, Vienna, Austria
| | | | - Eva Pastl
- surgebright GmbH, Lichtenberg, Austria
| | - Christian Fialka
- Department for Trauma Surgery, AUVA Trauma Center Vienna-Meidling, Vienna, Austria.,Department of Traumatology, Sigmund Freud Medical University Vienna, Vienna, Austria
| | - Rainer Mittermayr
- Department for Trauma Surgery, AUVA Trauma Center Vienna-Meidling, Vienna, Austria.,Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Johannes Grillari
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Institute of Molecular Biotechnology, Department of Biotechnology, University of Natural Resources and Life Science (BOKU), Vienna, Austria
| | - Ines Foessl
- Michael Ogon Laboratory for Orthopaedic Research, Vienna, Austria
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49
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Bourke J, Skouteris H, Hatzikiriakidis K, Fahey D, Malliaras P. Use of Behavior Change Techniques Alongside Exercise in the Management of Rotator Cuff-Related Shoulder Pain: A Scoping Review. Phys Ther 2022; 102:6482025. [PMID: 34972867 DOI: 10.1093/ptj/pzab290] [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: 01/20/2021] [Revised: 08/20/2021] [Accepted: 11/19/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The aims of this scoping review were to: (1) determine the frequency and types of behavior change techniques (BCTs) and education utilized in trials investigating exercise interventions for rotator cuff related shoulder pain (RCRSP); (2) subcategorize the BCTs and education found in the trials to summarize all behavior change approaches reported by trials; and (3) compare the frequency, types, and subcategories of BCTs and education utilized in the clinical guidelines for managing RCRSP between the trials. METHODS Data sources included Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE, CINAHL Plus, Google Scholar and PubMed, which were searched from inception to June 2020. Trials assessing exercise interventions for RCRSP were included. Three authors independently determined eligibility and extracted data. The frequency and types of BCTs and education in the trials and clinical practice guidelines were reported and compared descriptively. Two authors assessed the content of the BCTs to develop subcategories. RESULTS Most trials reported including at least 1 type of BCT (89.2%), which was most commonly feedback and monitoring (78.5%). There were many different approaches to the BCTs and education; for example, feedback and monitoring was subcategorized into supervised exercise, exercise monitoring, and feedback through external aids, such as mirrors. Clinical guidelines recommend supervision, goal setting, activity modification, pain management recommendations, information about the condition, and exercise education. CONCLUSION Although over two-thirds of trials reported including a BCT alongside exercise interventions for RCRSP, the breadth of these interventions is limited (supervision is the only common one). Future trialists should consider using any type of BCT that may improve exercise adherence and outcomes. IMPACT The findings of this review have: (1) identified gaps in the literature; and (2) contributed to the design of future exercise interventions for RCRSP.
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Affiliation(s)
- Jaryd Bourke
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kostas Hatzikiriakidis
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David Fahey
- Enhance Sports Performance and Rehabilitation, Maribyrnong, Victoria, Australia
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
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50
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Plachel F, Jo OI, Rüttershoff K, Andronic O, Ernstbrunner L. A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs. Am J Sports Med 2022:3635465211073332. [PMID: 35179393 DOI: 10.1177/03635465211073332] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic rotator cuff repair (aRCR) has shown similar midterm functional results and retear rates as open/mini-open rotator cuff repair (oRCR). A pooled analysis of long-term results of both techniques is yet missing. PURPOSE To evaluate the long-term results of aRCR and oRCR for full-thickness rotator cuff tears. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The CENTRAL (Cochrane), MEDLINE (PubMed), and Embase databases were searched for studies that reported on long-term clinical and radiographic outcomes of full-thickness aRCR and oRCR with a minimum follow-up of 9 years. RESULTS Eleven studies were included: 5 studies on aRCR and 6 studies on oRCR. Studies were based on 550 shoulders (539 patients) with a mean patient age of 56.3 years (range, 25-77). After a mean follow-up of 14.0 years (range, 9-20), the mean preoperative absolute Constant score (CS) and American Shoulder and Elbow Surgeons (ASES) shoulder score were significantly improved postoperatively (CS, 44 to 78 points; ASES, 52% to 91%; both comparisons, P < .001). The retear rate was 41% (141 of 342 shoulders) without a significant difference between groups (aRCR, 43%; oRCR, 39%) (P = .364). A retear was associated with significantly reduced CS as compared with a healed repair (P = .004). No significant differences were found in postoperative functional scores, complications, and retear rates after failed cuff repairs between the arthroscopic and open/mini-open repair groups. CONCLUSION Pooled analysis of arthroscopic and open rotator cuff repairs demonstrated sustained improvement in long-term shoulder scores and pain with a substantial retear rate in both groups, which was associated with inferior shoulder function. There were no significant differences in long-term functional outcomes, retear rates, and complications. Both surgical techniques may be used on the basis of factors such as patient or surgeon preference and cost. Further studies using a more robust randomized controlled trial or larger cohort design are recommended to ascertain whether one surgical repair technique is superior to the other. REGISTRATION CRD42020180448 (PROSPERO).
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Affiliation(s)
- Fabian Plachel
- Charité-Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Olivia Imkyeong Jo
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Katja Rüttershoff
- Charité-Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Octavian Andronic
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.,Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia.,Melbourne Orthopaedic Group, Windsor, Victoria 3181, Australia
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