The Effect of the Overweight Condition on Arthroscopic Rotator Cuff Repair Outcomes

Sling Is Not Inferior to Brace Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

PURPOSE

To compare the safety and efficacy of immobilizing the upper limb with a brace versus a less-constrained sling in the rehabilitation after arthroscopic rotator cuff repair (ARCR), by documenting clinical and radiologic results.

METHODS

ARCR was performed in 110 patients (54.9 ± 8.3 years) randomized in group A, using a brace for 6 weeks after surgery (3 weeks day and night then 3 weeks only at night), and group B, using a simple sling for 2 weeks only. Patients were evaluated at baseline, 6 weeks, and 3 and 6 months. Functional outcomes were range of motion, strength, Disabilities of the Arm, Shoulder and Hand score, and Constant-Murley Score (CMS). Pain was assessed with a visual analog scale and quality of life with the SF-36 questionnaire. The primary outcome was the CMS at 6 months. At 6 months, 3-Tesla magnetic resonance imaging was performed to document the status of the rotator cuff repair. The minimal clinically important difference was also analyzed.

RESULTS

Both groups A and B showed a worsening at 6 weeks and an improvement at 3 and 6 months of Disabilities of the Arm, Shoulder and Hand and CMS, as well as a significant visual analog scale decrease at every follow-up (P < .005). SF-36 showed a different trend: General health improved at 6 weeks, then decreased at 3 months, and increased again at 6 months. No difference was retrieved between the 2 groups at any follow-up in terms of pain, functional, and general health scores. The minimal clinically important difference for the primary outcome was 14.5 points and was reached in 56.5% and 61.2% of patients in the sling and brace group, respectively. The evaluation of magnetic resonance imaging scans identified 5 patients in each group with a supraspinatus tendon re-rupture, with no statistical difference in the re-rupture rate between the 2 groups.

CONCLUSIONS

This randomized controlled trial demonstrated that ARCR postoperative sling immobilization was not inferior to immobilization with a brace, having no differences in terms of functional scores, pain levels, general health, and risk of tendon re-rupture.

LEVEL OF EVIDENCE

Level I, high-quality randomized controlled trial (designed as a therapeutic study investigating the results of treatment) with statistically significant difference.

What are the common factors that lead to the failure to achieve minimal clinically important difference after shoulder surgery? A scoping review

INTRODUCTION

The goal of this research is to identify the factors that negatively impact the achievement of the minimum clinically significant change (MCID) for the American Shoulder and Elbow Surgeons (ASES) score within the realm of various orthopedic shoulder procedures.

METHODS

We conducted a comprehensive review of studies published from 2002 to 2023, utilizing OvidMedline and PubMed databases. Our search criteria included terms such as "minimal clinically important difference" or "MCID" along with associated MeSH terms, in addition to "American shoulder and elbow surgeon" or "ASES." We selectively included primary investigations that assessed factors linked to the failure to achieve MCID for the ASES score subsequent to orthopedic shoulder procedures, while excluding papers addressing anatomical, surgical, or injury-related aspects.

RESULTS

Our analysis identified 149 full-text articles, leading to the inclusion of 12 studies for detailed analysis. The selected studies investigated outcomes following various orthopedic shoulder procedures, encompassing biceps tenodesis, total shoulder arthroplasty, and rotator cuff repair. Notably, factors, such as gender, body mass index, diabetes, smoking habits, opioid usage, depression, anxiety, workers' compensation, occupational satisfaction, and the preoperative ASES score, were all associated with the inability to attain MCID.

CONCLUSION

In summary, numerous factors exert a negative influence on the attainment of MCID following shoulder procedures, and these factors appear to be irrespective of the specific surgical technique employed. Patients presenting with these factors may perceive their surgical outcomes as less successful when compared to those without these factors. Identifying these factors can enable healthcare providers to provide more effective counseling to patients regarding their expected outcomes and rehabilitation course. Furthermore, these findings can aid in the development of a screening tool to better identify these risk factors and optimize them before surgery.