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Liu YC, Huang SW, Adams CR, Lin CY, Chen YP, Kuo YJ, Chuang TY. Preoperative handgrip strength can predict early postoperative shoulder function in patients undergoing arthroscopic rotator cuff repair. J Orthop Surg Res 2024; 19:270. [PMID: 38689328 PMCID: PMC11059705 DOI: 10.1186/s13018-024-04750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Rotator cuff tears (RCTs) are a common musculoskeletal disorder, and arthroscopic rotator cuff repair (ARCR) is widely performed for tendon repair. Handgrip strength correlates with rotator cuff function; however, whether preoperative grip strength can predict functional outcomes in patients undergoing ARCR remains unknown. This study aimed to investigate the correlation between preoperative grip strength and postoperative shoulder function following ARCR. METHODS A total of 52 patients with full-thickness repairable RCTs were prospectively enrolled. Baseline parameters, namely patient characteristics and intraoperative findings, were included for analysis. Postoperative shoulder functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) questionnaire and Constant-Murley scores (CMSs). Patients were followed up and evaluated at three and six months after ARCR. The effects of baseline parameters on postoperative outcomes were measured using generalized estimating equations. RESULTS At three and six months postoperatively, all clinical outcomes evaluated exhibited significant improvement from baseline following ARCR. Within 6 months postoperatively, higher preoperative grip strength was significantly correlated with higher CMSs (β = 0.470, p = 0.022), whereas increased numbers of total suture anchors were significantly correlated with decreased CMSs (β = - 4.361, p = 0.03). Higher body mass index was significantly correlated with higher postoperative QDASH scores (β = 1.561, p = 0.03) during follow-up. CONCLUSIONS Higher baseline grip strength predicts more favorable postoperative shoulder function following ARCR. A preoperative grip strength test in orthopedic clinics may serve as a predictor for postoperative shoulder functional recovery in patients undergoing ARCR.
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Affiliation(s)
- Yu-Cheng Liu
- Department of General Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shu-Wei Huang
- Department of Applied Science, National Taitung University, Taitung City, Taitung County, Taiwan
| | - Christopher R Adams
- Arthrex, Inc., Naples, FL, USA
- Orthopaedic Department, Naples Community Hospital, Naples, FL, USA
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedics, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tai-Yuan Chuang
- Department of Orthopedics, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Solari HE, Hackett LM, Lam P, Murrell GAC. The Fate of the Shoulder Post Rotator Cuff Repair: Biomechanical Properties of the Supraspinatus Tendon and Surrounding Structures. Sports Med Arthrosc Rev 2024; 32:51-57. [PMID: 38695504 DOI: 10.1097/jsa.0000000000000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
The study aimed to describe the changes in biomechanical properties of the supraspinatus tendon, deltoid muscle, and humeral head post arthroscopic rotator cuff repair using shear wave elastography. Shear wave velocity of the tendon, deltoid, and humeral head of 48 patients was measured at predetermined sites at 1 week, 6 weeks, 12 weeks, 6 months, and 12 months post repair. One-way ANOVA with Tukey's correction and Spearman's correlation were performed. Mean±SEM healing tendon stiffness, adjacent to tendon footprint, increased from 1 week (6.2±0.2 m/s) to 6 months (7.5±0.3 m/s) and 12 months (7.8±0.3 m/s) (P<0.001). Mean±SEM deltoid muscle stiffness was higher at 12 months (4.1±0.2 m/s) compared to 1 week (3.4±0.1 m/s) and 12 weeks (3.5±0.1 m/s) (P<0.05). Humeral head stiffness did not change. Following arthroscopic rotator cuff repair, supraspinatus tendon stiffness increased in a curvilinear fashion over 6 months. From 6 months, deltoid muscle stiffness increased, corresponding to when patients were instructed to return to normal activities.
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Affiliation(s)
- Hannah E Solari
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia
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Feichtinger X, Heimel P, Tangl S, Keibl C, Nürnberger S, Schanda JE, Hercher D, Kocijan R, Redl H, Grillari J, Fialka C, Mittermayr R. Improved biomechanics in experimental chronic rotator cuff repair after shockwaves is not reflected by bone microarchitecture. PLoS One 2022; 17:e0262294. [PMID: 34986173 PMCID: PMC8730430 DOI: 10.1371/journal.pone.0262294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose The aim of this study was to investigate the effect of extracorporeal shockwave therapy (ESWT) on bone microstructure as well as the bone-tendon-interface and the musculo-tendinous transition zone to explain the previously shown improved biomechanics in a degenerative rotator cuff tear animal model. This study hypothesized that biomechanical improvements related to ESWT are a result of improved bone microstructure and muscle tendon properties. Methods In this controlled laboratory study unilateral supraspinatus (SSP) tendon detachment was performed in 48 male Sprague-Dawley rats. After a degeneration period of three weeks, SSP tendon was reconstructed transosseously. Rats were randomly assigned into three groups (n = 16 per group): control (noSW); intraoperative shockwave treatment (IntraSW); intra- and postoperative shockwave treatment (IntraPostSW). Eight weeks after SSP repair, all rats were sacrificed and underwent bone microstructure analysis as well as histological and immunohistochemical analyses. Results With exception of cortical porosity at the tendon area, bone microstructure analyses revealed no significant differences between the three study groups regarding cortical and trabecular bone parameters. Cortical Porosity at the Tendon Area was lowest in the IntraPostSW (p≤0.05) group. Histological analyses showed well-regenerated muscle and tendon structures in all groups. Immunohistochemistry detected augmented angiogenesis at the musculo-tendinous transition zone in both shockwave groups indicated by CD31 positive stained blood vessels. Conclusion In conclusion, bone microarchitecture changes are not responsible for previously described improved biomechanical results after shockwave treatment in rotator cuff repair in rodents. Immunohistochemical analysis showed neovascularization at the musculo-tendinous transition zone within ESWT-treated animals. Further studies focusing on neovascularization at the musculo-tendinous transition zone are necessary to explain the enhanced biomechanical and functional properties observed previously. Clinical relevance In patients treated with a double-row SSP tendon repair, an improvement in healing through ESWT, especially in this area, could prevent a failure of the medial row, which is considered a constantly observed tear pattern.
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Affiliation(s)
- Xaver Feichtinger
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- AUVA Trauma Center Vienna—Meidling, Vienna, Austria
- Department of Orthopaedic Surgery II, Herz-Jesu Krankenhaus, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- * E-mail:
| | - Patrick Heimel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Stefan Tangl
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Claudia Keibl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Sylvia Nürnberger
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Division of Trauma-Surgery, Department of Orthopaedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Jakob Emanuel Schanda
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- AUVA Trauma Center Vienna—Meidling, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - David Hercher
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology, 1st Medical Department at Hanusch Hospital, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Johannes Grillari
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Vienna—Meidling, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Rainer Mittermayr
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- AUVA Trauma Center Vienna—Meidling, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
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Zhao J, Luo M, Liang G, Pan J, Han Y, Zeng L, Yang W, Liu J. What Factors Are Associated with Symptomatic Rotator Cuff Tears: A Meta-analysis. Clin Orthop Relat Res 2022; 480:96-105. [PMID: 34424222 PMCID: PMC8673964 DOI: 10.1097/corr.0000000000001949] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/02/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff tears are common. A previous systematic review reported on factors associated with rotator cuff tears; however, it included relatively few studies and few variables, and in addition, it had considerable heterogeneity. To identify the factors associated with symptomatic rotator cuff tears and to help guide clinicians to potentially modifiable factors, we felt a broader and more inclusive meta-analysis would be useful. QUESTIONS/PURPOSES In this systematic review and meta-analysis, we asked what (1) demographic, (2) disease, and (3) imaging factors are associated with symptomatic rotator cuff tears? METHODS PubMed, Embase, and Web of Science were searched, and the search period were from the inception of each database through February 2021. The keywords included "risk factor," "rotator cuff injury," "rotator cuff tears," and "rotator cuff tendinitis." All comparative studies on symptomatic rotator cuff tears were included. We considered that the diagnosis of rotator cuff tear could be made by any imaging tool (MRI or ultrasound). We considered either partial- or full-thickness tears to be a rotator cuff tear. No language restrictions were applied. Twenty-six articles from 14 countries involving 9809 individuals, consisting of 3164 patients and 6645 controls, were included. The Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality (AHRQ) scale were used to evaluate the risk of bias of the included studies, and the highest scores were 9 and 11, respectively. The Newcastle-Ottawa Scale was used for retrospective comparative studies, and the AHRQ was used to evaluate prospective comparative studies. The eight retrospective comparative studies we included were scored from 4 to 9. The quality score of the 18 prospective comparative studies ranged from 6 to 9. Publication bias was explored using the Egger test. Heterogeneity was estimated using the I2 value. If there was no heterogeneity (I2 ≤ 50%), a fixed-effects model was used to determine the overall effect size; if there was heterogeneity (I2 > 50%), a random-effects model was used to merge the effect values. A meta-analysis was performed with RevMan 5.3, and the risk ratio (RR) and weighted mean difference of related factors were calculated. RESULTS Our meta-analysis identified the following demographic factors associated with an increased risk of rotator cuff tears: older age (mean difference 3.1 [95% CI 1.4 to 4.8]; p < 0.001), greater BMI (mean difference 0.77 [95% CI 0.37 to 1.17]; p < 0.001), smoking (RR 1.32 [95% CI 1.17 to 1.49]; p < 0.001), dominant arm (RR 1.15 [95% CI 1.06 to 1.24]; p < 0.001), greater height (mean difference 0.9 [95% CI 0.4 to 1.4]; p < 0.001), and heavier weight (mean difference 2.24 [95% CI 0.82 to 3.66]; p = 0.002). Regarding disease factors, we found that traumatic events (RR 1.91 [95% CI 1.40 to 2.54]; p < 0.001) and hypertension (RR 1.50 [95% CI 1.32 to 1.70]; p < 0.001) were associated with symptomatic rotator cuff tears. Regarding imaging factors, we found that the following three factors were associated with symptomatic rotator cuff tears: greater acromion index (mean difference 0.11 [95% CI 0.06 to 0.16]; p < 0.001), greater critical shoulder angle (mean difference 1.9 [95% CI 1.5 to 2.3]; p < 0.001), and smaller glenoid version angle (mean difference -1.3 [95% CI -1.9 to -0.8]; p < 0.001). We found no association between the patient's sex or the presence or absence of thyroid disease and the likelihood of a rotator cuff tear being present. CONCLUSION This study identified several factors associated with symptomatic rotator cuff tears, including blood glucose, blood pressure, weight, and smoking. Clinicians may seek to modify these factors, possibly in patients with symptomatic rotator cuff tears, but also in symptomatic patients who have not yet been diagnosed with rotator cuff tears because there would be no harm or risk associated with modifying any of the factors we identified. Future research should further study whether addressing these factors can delay the progression and size of rotator cuff tears.Level of Evidence Level III, prognostic study.
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Affiliation(s)
- Jinlong Zhao
- The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guagnzhou, China
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
| | - Minghui Luo
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Guihong Liang
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Jianke Pan
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Yanhong Han
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Lingfeng Zeng
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Weiyi Yang
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Jun Liu
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
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Anderson LE, Pearson JJ, Brimeyer AL, Temenoff JS. Injection of Micronized Human Amnion/Chorion Membrane Results in Increased Early Supraspinatus Muscle Regeneration in a Chronic Model of Rotator Cuff Tear. Ann Biomed Eng 2021; 49:3698-3710. [PMID: 34766224 DOI: 10.1007/s10439-021-02880-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 10/18/2021] [Indexed: 01/08/2023]
Abstract
Surgical repair of severe rotator cuff tear often results in retear due to unaddressed muscle degeneration. The objective of this study was to test the regenerative potential of micronized dehydrated Human Amnion/Chorion Membrane (dHACM), in a clinically relevant delayed reattachment model of rotator cuff repair. Micronized dHACM was injected into rat supraspinatus muscle during tendon re-attachment surgery, three weeks after original tendon injury. One week after material injection, inflammatory and mesenchymal stem cell infiltration into supraspinatus muscles was assessed via flow cytometry. Histological methods were utilized to assess structural and regenerative changes in muscle one and three weeks after material injection. Micronized dHACM injection resulted in increased M1-like macrophages (17.1 [Formula: see text] fold change over contralateral controls) and regenerating muscle fibers (4.3% vs 1.7% in saline treated muscles) one week after injection compared to saline treated muscles. Tendon reattachment itself exhibited intrinsic healing in this model, demonstrated by a general return of muscle weight and reduced fibrosis. Our results indicate that injection of micronized dHACM may initiate an inflammatory response in degenerated muscle that promotes early muscle regeneration, and that our animal model may be a suitable platform for studying treatments in muscle at early timepoints, before intrinsic healing occurs.
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Affiliation(s)
- Leah E Anderson
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech, Emory University, 315 Ferst Dr., Atlanta, GA, 30332, USA
| | - Joseph J Pearson
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech, Emory University, 315 Ferst Dr., Atlanta, GA, 30332, USA
| | - Alexandra L Brimeyer
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech, Emory University, 315 Ferst Dr., Atlanta, GA, 30332, USA
| | - Johnna S Temenoff
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech, Emory University, 315 Ferst Dr., Atlanta, GA, 30332, USA.
- Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.
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Aung TKK, Chuah TY, Chua MWJ. More Than Meets the Eye: A Patient with Hand Swelling and Newly Diagnosed Diabetes Mellitus. Am J Med 2021; 134:1357-1361. [PMID: 34102158 DOI: 10.1016/j.amjmed.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Tyng Yu Chuah
- Department of General Medicine (Rheumatology), Sengkang General Hospital, Singapore
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Lemaster NG, Hettrich CM, Jacobs CA, Heebner N, Westgate PM, Mair S, Montgomery JR, Uhl TL. Which Risk Factors Are Associated with Pain and Patient-reported Function in Patients with a Rotator Cuff Tear? Clin Orthop Relat Res 2021; 479:1982-1992. [PMID: 33835100 PMCID: PMC8373537 DOI: 10.1097/corr.0000000000001750] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/08/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported measures guide physicians in clinical decision making and therefore it is critical to determine what clinical factors are associated with these scores. Psychological and physical factors are commonly studied separately in patients with rotator cuff tears to determine their influence on outcomes. It is well established that psychological distress and scapular motion change in the presence of a symptomatic rotator cuff tear. However, these factors have not been studied simultaneously in a clinical setting to determine their association with shoulder outcome scores. QUESTION/PURPOSE After controlling for relevant confounding variables, what physical and psychological factors are associated with better (1) American Shoulder and Elbow Surgeons (ASES) scores for function, (2) ASES pain scores, and (3) total ASES scores? METHODS Fifty-nine patients with a potential symptomatic rotator cuff tear were recruited and agreed to participate in this cross-sectional study. Of those, 85% (50 of 59) met eligibility criteria for a primary diagnosis of an MRI-confirmed symptomatic partial-thickness or full-thickness rotator cuff tear without a history of shoulder surgery. Demographics, rotator cuff tear size, arm flexion, and clinical scapular motion during active arm flexion were evaluated by experienced examiners using standardized procedures. Patients completed the ASES questionnaire and the Optimal Screening for Prediction of Referral and Outcomes-Yellow Flag assessment form, which measures 11 different pain-related psychological distress symptoms. Three separate stepwise multiple linear regression analyses were performed for ASES pain, function, and total scores, with significance set at p < 0.05. RESULTS This model found that ASES function scores were associated with four factors: older age, increased arm flexion, increased percentage of scapular external rotation during arm flexion, and increased scores for acceptance of chronic pain (adjusted r2 = 0.67; p = 0.01). Those four factors appear to explain 67% of the observed variance in ASES function scores in patients with rotator cuff tears. Furthermore, increased percentage of scapular external rotation during arm flexion and decreased fear-avoidance beliefs related to physical activity scores (adjusted r2 = 0.36; p < 0.01) were associated with better ASES pain scores. And finally, better ASES total scores were associated with four factors: increased arm flexion, increased percentage of scapular upward rotation, increased scapular external rotation during arm flexion, and decreased fear-avoidance beliefs related to physical activity scores (adjusted r2 = 0.65; p < 0.001). CONCLUSION Our results favor adopting a comprehensive biopsychological clinical assessment for patients with rotator cuff tears that specifically includes humeral and scapular motion, fear-avoidance behaviors, and pain coping behaviors along with demographics. These particular physical and psychological variables were found to be associated with the ASES and, therefore, should be clinically examined simultaneously and targeted as part of a tailored treatment plan. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Nicole G. Lemaster
- Department of Rehabilitation Science, University of Kentucky, Lexington, KY, USA
| | | | - Cale A. Jacobs
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Nick Heebner
- Department of Rehabilitation Science, University of Kentucky, Lexington, KY, USA
| | | | - Scott Mair
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Tim L. Uhl
- Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
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Haleem A, Gohal C, Leroux T, Henry P, Alolabi B, Khan M. Primary arthroscopic repair of massive rotator cuff tears results in significant improvements with low rate of re-tear. Knee Surg Sports Traumatol Arthrosc 2021; 29:2134-2142. [PMID: 32748233 DOI: 10.1007/s00167-020-06190-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/27/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE To conduct a systematic review of outcomes following primary arthroscopic repair of chronic massive rotator cuff tears (RCTs) and to assess clinical outcomes and rates of repair failure. The authors' preferred treatment algorithm is also provided. METHODS Medline, Embase and PubMed were searched identifying articles pertaining to primary arthroscopic repair of chronic massive RCTs without the use of augmentation. Primary outcomes were patient-reported outcomes and the secondary outcome was the rate of repair failure. Outcome data were pooled and presented as well as assessment of study methodological quality. Data from studies reporting similar outcome measures were pooled when possible, and mean differences alongside confidence intervals and p values were reported, where appropriate. RESULTS Twenty-six studies (1405 participants) were included, with mean age of 62 years (range 52-69). The mean duration of symptoms pre-operatively was 31 months (range 6-40), and the mean follow-up time was 39 months (range 12-111). Complete repair was performed in 78% of patients and partial repair was performed in 22%. Both complete and partial repairs resulted in significant improvements with respect to pain, range of motion and functional outcome scores. The rate of repair failure for the total cohort was 36% at a mean follow-up of 31 months, and for the complete and partial repair subgroups the failure rate was 35% and 40%, respectively. CONCLUSIONS Arthroscopic repairs of chronic, massive RCTs, whether complete or partial, are associated with significant improvements in pain, function and objective outcome scores. The rate of repair failure is lower than previously reported, however, still high at 36%. The present paper finds that arthroscopic repair is still a viable treatment option for massive RCTs. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ahmed Haleem
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Chetan Gohal
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Timothy Leroux
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Patrick Henry
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Bashar Alolabi
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Moin Khan
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada.
- St. Joseph's Healthcare Hamilton, 50 Charlton Ave E., Mary Grace Wing, Room G807, Hamilton, ON, L8N 4A6, Canada.
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Uzun E, Mısır A, Kızkapan TB, Özçamdallı M, Sekban H, Güney A. Factors associated with the development of re-tear following arthroscopic rotator cuff repair: A retrospective comparative study. Acta Orthop Traumatol Turc 2021; 55:213-219. [PMID: 34100361 PMCID: PMC10566352 DOI: 10.5152/j.aott.2021.20091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 12/16/2020] [Accepted: 04/11/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the risk factors for the development of re-tear following Arthroscopic Rotator Cuff Repair (aRCR). METHODS This retrospective clinical study included 196 consecutive aRCRs with a minimum 3-year follow-up. Pre- and postoperative clinical and functional outcomes were measured using the Visual Analog Scale (VAS), the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the University of California at Los Angeles Shoulder Rating Scale (UCLA), the Constant-Murley Score (CMS), and the Douleur Neuropathique (DN4) questzionnaire. The Goutallier staging of fatty infiltration, Occupational Ratio (OR), the Acromiohumeral Interval (AHI), Acromioclavicular Joint (ACJ) arthritis, acromion type, Critical Shoulder Angle (CSA), and tangent sign (tan- sign) were evaluated as radiological parameters. Different subgroup parameters were evaluated after dividing the patients into re-tear (-) and re-tear (+) groups, according to clinical and radiological outcomes as well as patient and intraoperative characteristics. RESULTS The mean follow-up period was 72.0 ± 15.8 months. The mean age at the time of surgery was 58.4 ± 8.9 years. A significant improvement was found in clinical and functional scores in the re-tear (-) group (P < 0.001 for all). However, the retear (+) group had poorer outcome scores than the re-tear (-) group. Twenty patients (10.2%) had re-tear at the last follow-up. There was a significant difference between groups regarding pre-and postoperative clinical scores, with worse scores in the retear (+) group (P < 0.001 for all). Also, pre-and postoperative pseudoparalysis (P = 0.001 for both), acromioclavicular joint arthritis (ACJ) (P = 0.001), intraoperative rotator cuff wear (P = 0.007) or stiffness (P = 0.025), a longer time period between symptom onset and surgery (P = 0.031), larger tear size (P = 0.010), preoperative shoulder stiffness (P = 0.001), higher duration of postoperative analgesia use (P < 0.001), higher degrees of preoperative Occupational Ratio (OR) (P < 0.001), and higher degrees of fatty degeneration (P < 0.001) were found to be associated with re- tear development. CONCLUSION Surgeons should consider the preoperative degree of fatty degeneration, clinical and functional scores, presence of ACJ arthritis, intraoperative tendon quality, tear size and chronicity as well as postoperative prolong analgesic requirement, and development of pseudoparalysis as factors regarding re-tear development risk following aRCR. LEVEL OF EVIDENCE Level IV, Therapeutic Study.
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Affiliation(s)
- Erdal Uzun
- Department of Orthopaedics and Traumatology, Erciyes University, School of Medicine, Kayseri,
Turkey
| | - Abdulhamit Mısır
- Department of Orthopaedics and Traumatology, Health Sciences University, Gaziosmanpasa Taksim Training and Research Hospital, İstanbul,
Turkey
| | - Turan Bilge Kızkapan
- Clinic of Orthopaedics and Traumatology, Bursa Çekirge State Hospital, Bursa,
Turkey
| | - Mustafa Özçamdallı
- Department of Orthopaedics and Traumatology, Ahi Evran University, School of Medicine, Kırşehir,
Turkey
| | - Hazım Sekban
- Department of Orthopaedics and Traumatology, Health Sciences University, Kayseri City Hospital, Kayseri,
Turkey
| | - Ahmet Güney
- Department of Orthopaedics and Traumatology, Erciyes University, School of Medicine, Kayseri,
Turkey
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10
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Karahan N, Yılmaz B, Öztermeli A, Kaya M, Duman S, Çiçek ED. Evaluation of critical shoulder angle and acromion index in patients with anterior shoulder instability and rotator cuff tear. Acta Orthop Traumatol Turc 2021; 55:220-226. [PMID: 34100362 PMCID: PMC10566347 DOI: 10.5152/j.aott.2021.20072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/21/2020] [Accepted: 04/28/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate glenohumeral morphologic differences and their correlation between glenohumeral instability and rotator cuff pathology. METHODS Two-hundred radiographs and 100 MRI scans of 100 patients in whom the diagnosis of Anterior Shoulder Instability (Anl) or Rotator Cuff Tear (RCT) was arthroscopically verified were retrospectively identified and included in the study. All the patients were categorized into two groups: 50 patients with Anl (23 female, 28 male; mean age = 29 ± 7.4) and 50 patients with RCT (28 female, 22 male). Two separate control groups were then formed, one of which included contralateral shoulders of patients in the AnI group, and the other consisted of contralateral shoulders of patients in the RCT group. The x-ray and MRI scans were examined by an orthopedic surgeon and a radiologist. The Acromial Index (AI) and the Critical Shoulder Angle (CSA) were measured on true anteroposterior shoulder radiographs; Glenoid Inclination (GI), Glenoid Version (GV), and Acromion Angulation (AA) were measured on MRI. RESULTS In the AnI group, the measurements were as followed: AI, 0.66 ± 0.03; CSA, 33 ° ± 2.85; GI, 3.4° ± 6.2; GV, 4.1 ± 4.3; and AA, 12.9 ± 8.3. In the RCT group, AI 0.71 ± 0.04; CSA, 36° ± 2.69; GI, 9.1 ± 5; GV, 6.7 ° ± 5.7; and AA, 14.3° ± 8.7. A moderate correlation was found between CSA and GI (r = 0.41, P = 0.001) and between AI and GI (r = 0.42, P = 0.014). A weak correlation was found between AI and GI in the AnI group (r = 0.22, P = 0.001). The inter- and intra-observer intraclass correlation coefficients were respectively 0.81 and 0.84 for AI, 0.88 and 0.92 for CSA, 0.72 and 0.76 for GI, 0.69 and 0.73 for GV, and 0.72 and 0.77 for AA. CONCLUSION The results of this study have shown that lower AI, GI, and antevert GV may be associated with AnI. Investigating CSA, AI, and GV could be useful for diagnostic evaluation of patients with AnI. LEVEL OF EVIDENCE Level III, Diagnostic Study.
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Affiliation(s)
- Nazım Karahan
- Clinic of Orthopaedics and Traumatology, Çorlu State Hospital, Tekirdağ,
Turkey
| | - Barış Yılmaz
- Department of Orthopaedic and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul,
Turkey
| | - Ahmet Öztermeli
- Clinic of Orthopaedic and Traumatology, Gebze State Hospital, Gebze,
Turkey
| | - Murat Kaya
- Department of Orthopaedic and Traumatology, Marmara University, School of Medicine, İstanbul,
Turkey
| | - Serda Duman
- Department of Orthopaedic and Traumatology, Selahattin Eyyubi State Hospital, Diyarbakır,
Turkey
| | - Esin Derin Çiçek
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul,
Turkey
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11
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Weekes DG, Campbell RE, Wicks ED, Hadley CJ, Chaudhry ZS, Carter AH, Pepe MD, Tucker BS, Freedman KB, Tjoumakaris FP. Do Relaxation Exercises Decrease Pain After Arthroscopic Rotator Cuff Repair? A Randomized Controlled Trial. Clin Orthop Relat Res 2021; 479:870-884. [PMID: 33835103 PMCID: PMC8051979 DOI: 10.1097/corr.0000000000001723] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/11/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pain after rotator cuff repair is commonly managed with opioid medications; however, these medications are associated with serious adverse effects. Relaxation exercises represent a potential nonpharmacologic method of pain management that can be easily implemented without substantial adverse effects; however, the effects of relaxation exercises have not been studied in a practical, reproducible protocol after arthroscopic rotator cuff repair. QUESTIONS/PURPOSES (1) Does performing relaxation exercises after arthroscopic rotator cuff repair (ARCR) decrease pain compared with standard pain management medication? (2) Does performing relaxation exercises after ARCR decrease opioid consumption? (3) What proportion of patients who used the relaxation techniques believed they decreased their pain level, and what proportion continued using these techniques at 2 weeks? (4) Does performing relaxation exercises after ARCR affect shoulder function? METHODS During the study period, 563 patients were eligible for inclusion; however, only 146 were enrolled, randomized, and postoperatively followed (relaxation group: 74, control group: 72); 68% (384 of 563) of patients were not contacted due to patient and research staff availability. Thirty-three patients were unenrolled preoperatively or immediately postoperatively due to change in operative procedure (such as, only debridement) or patient request; no postoperative data were collected from these patients. Follow-up proportions were similar between the relaxation and control groups (relaxation: 80%, control: 81%; p = 0.90). The relaxation group received and reviewed educational materials consisting of a 5-minute video and an educational pamphlet explaining relaxation breathing techniques, while the control group did not receive relaxation education materials. Patients recorded their pain levels and opioid consumption during the 5 days after ARCR. Patients also completed the American Shoulder and Elbow Surgeons shoulder score preoperatively and 2, 6, 13, 18, and 26 weeks postoperatively. Linear mixed models were created to analyze postoperative pain, opioid consumption measured in morphine milligram equivalents (MMEs), and shoulder function outcomes. A per-protocol approach was used to correct for patients who were enrolled but subsequently underwent other procedures. RESULTS There was no difference in pain scores between the relaxation and control groups during the first 5 days postoperatively. There was no difference in pain scores at 2 weeks postoperatively between the relaxation and control groups (3.3 ± 3 versus 3.5 ± 2, mean difference -0.22 [95% CI -1.06 to 0.62]; p = 0.60). There was no difference in opioid consumption during the first 5 days postoperatively between the relaxation and control groups. The use of relaxation exercises resulted in lower 2-week narcotics consumption in the relaxation group than in the control group (309 ± 241 MMEs versus 442 ± 307 MMEs, mean difference -133 [95% CI -225 to -42]; p < 0.01). Sixty-two percent (41 of 66) of patients in the relaxation group believed the relaxation exercises decreased their pain levels. Fifty-two percent (34 of 66) were still performing the exercises at 2 weeks postoperatively. During the 6-month follow-up period, there was no difference in shoulder function between the relaxation and control groups. CONCLUSION The preoperative administration of quick, basic relaxation exercises allowed patients to use appreciably lower opioid analgesic doses over the first 2 weeks after ARCR, without any worsening of pain scores. We consider this result promising but preliminary; it is possible that a more intense mindfulness intervention-the one we studied here was disseminated using only a 5-minute video-would deliver reductions in pain and further reductions in opioid usage. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Danielle G. Weekes
- D. G. Weekes, R. E. Campbell, E. D. Wicks, C. J. Hadley, Z. S. Chaudhry, A. H. Carter, M. D. Pepe, B. S. Tucker, K. B. Freedman, F. P. Tjoumakaris, The Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
- R. E. Campbell, The University of Virginia Medical Center, Charlottesville, VA, USA
- E. D. Wicks, Lakeland Regional Health Physician Group, Lakeland, FL, USA
- A. H. Carter, Town Center Orthopaedic Associates, Reston, VA, USA
| | - Richard E. Campbell
- D. G. Weekes, R. E. Campbell, E. D. Wicks, C. J. Hadley, Z. S. Chaudhry, A. H. Carter, M. D. Pepe, B. S. Tucker, K. B. Freedman, F. P. Tjoumakaris, The Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
- R. E. Campbell, The University of Virginia Medical Center, Charlottesville, VA, USA
- E. D. Wicks, Lakeland Regional Health Physician Group, Lakeland, FL, USA
- A. H. Carter, Town Center Orthopaedic Associates, Reston, VA, USA
| | - Eric D. Wicks
- D. G. Weekes, R. E. Campbell, E. D. Wicks, C. J. Hadley, Z. S. Chaudhry, A. H. Carter, M. D. Pepe, B. S. Tucker, K. B. Freedman, F. P. Tjoumakaris, The Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
- R. E. Campbell, The University of Virginia Medical Center, Charlottesville, VA, USA
- E. D. Wicks, Lakeland Regional Health Physician Group, Lakeland, FL, USA
- A. H. Carter, Town Center Orthopaedic Associates, Reston, VA, USA
| | - Christopher J. Hadley
- D. G. Weekes, R. E. Campbell, E. D. Wicks, C. J. Hadley, Z. S. Chaudhry, A. H. Carter, M. D. Pepe, B. S. Tucker, K. B. Freedman, F. P. Tjoumakaris, The Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
- R. E. Campbell, The University of Virginia Medical Center, Charlottesville, VA, USA
- E. D. Wicks, Lakeland Regional Health Physician Group, Lakeland, FL, USA
- A. H. Carter, Town Center Orthopaedic Associates, Reston, VA, USA
| | - Zaira S. Chaudhry
- D. G. Weekes, R. E. Campbell, E. D. Wicks, C. J. Hadley, Z. S. Chaudhry, A. H. Carter, M. D. Pepe, B. S. Tucker, K. B. Freedman, F. P. Tjoumakaris, The Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
- R. E. Campbell, The University of Virginia Medical Center, Charlottesville, VA, USA
- E. D. Wicks, Lakeland Regional Health Physician Group, Lakeland, FL, USA
- A. H. Carter, Town Center Orthopaedic Associates, Reston, VA, USA
| | - Aaron H. Carter
- D. G. Weekes, R. E. Campbell, E. D. Wicks, C. J. Hadley, Z. S. Chaudhry, A. H. Carter, M. D. Pepe, B. S. Tucker, K. B. Freedman, F. P. Tjoumakaris, The Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
- R. E. Campbell, The University of Virginia Medical Center, Charlottesville, VA, USA
- E. D. Wicks, Lakeland Regional Health Physician Group, Lakeland, FL, USA
- A. H. Carter, Town Center Orthopaedic Associates, Reston, VA, USA
| | - Matthew D. Pepe
- D. G. Weekes, R. E. Campbell, E. D. Wicks, C. J. Hadley, Z. S. Chaudhry, A. H. Carter, M. D. Pepe, B. S. Tucker, K. B. Freedman, F. P. Tjoumakaris, The Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
- R. E. Campbell, The University of Virginia Medical Center, Charlottesville, VA, USA
- E. D. Wicks, Lakeland Regional Health Physician Group, Lakeland, FL, USA
- A. H. Carter, Town Center Orthopaedic Associates, Reston, VA, USA
| | - Bradford S. Tucker
- D. G. Weekes, R. E. Campbell, E. D. Wicks, C. J. Hadley, Z. S. Chaudhry, A. H. Carter, M. D. Pepe, B. S. Tucker, K. B. Freedman, F. P. Tjoumakaris, The Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
- R. E. Campbell, The University of Virginia Medical Center, Charlottesville, VA, USA
- E. D. Wicks, Lakeland Regional Health Physician Group, Lakeland, FL, USA
- A. H. Carter, Town Center Orthopaedic Associates, Reston, VA, USA
| | - Kevin B. Freedman
- D. G. Weekes, R. E. Campbell, E. D. Wicks, C. J. Hadley, Z. S. Chaudhry, A. H. Carter, M. D. Pepe, B. S. Tucker, K. B. Freedman, F. P. Tjoumakaris, The Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
- R. E. Campbell, The University of Virginia Medical Center, Charlottesville, VA, USA
- E. D. Wicks, Lakeland Regional Health Physician Group, Lakeland, FL, USA
- A. H. Carter, Town Center Orthopaedic Associates, Reston, VA, USA
| | - Fotios P. Tjoumakaris
- D. G. Weekes, R. E. Campbell, E. D. Wicks, C. J. Hadley, Z. S. Chaudhry, A. H. Carter, M. D. Pepe, B. S. Tucker, K. B. Freedman, F. P. Tjoumakaris, The Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
- R. E. Campbell, The University of Virginia Medical Center, Charlottesville, VA, USA
- E. D. Wicks, Lakeland Regional Health Physician Group, Lakeland, FL, USA
- A. H. Carter, Town Center Orthopaedic Associates, Reston, VA, USA
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12
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Grusky AZ, Song A, Kim P, Ayers GD, Higgins LD, Kuhn JE, Baumgarten KM, Matzkin E, Jain NB. Factors Associated With Symptomatic Rotator Cuff Tears: The Rotator Cuff Outcomes Workgroup Cohort Study. Am J Phys Med Rehabil 2021; 100:331-336. [PMID: 33443862 PMCID: PMC7969413 DOI: 10.1097/phm.0000000000001684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although rotator cuff tear is one of the most common musculoskeletal disorders, its etiology is poorly understood. We assessed factors associated with the presence of rotator cuff tears in a cohort of patients with shoulder pain. DESIGN From February 2011 to July 2016, a longitudinal cohort of patients with shoulder pain was recruited. Patients completed a detailed questionnaire in addition to a magnetic resonance imaging scan and a clinical shoulder evaluation. The association of multiple factors associated with rotator cuff tears was assessed using multivariate logistic regression. RESULTS In our cohort of 266 patients, 61.3% of patients had a rotator cuff tear. Older age (per 1 yr: odds ratio = 1.03, 95% confidence interval = 1.02-1.07), involvement of the dominant shoulder (odds ratio = 2.02, 95% confidence interval = 1.16-3.52), and a higher body mass index (per 1 kg/m2: odds ratio = 1.06, 95% confidence interval = 1.03-1.12) were independently associated with rotator cuff tears. Sex, depression, smoking status, shoulder use at work, hypertension, and diabetes were not significantly associated with rotator cuff tear. CONCLUSIONS In a cohort of patients with shoulder pain, we identified older age, involvement of the dominant shoulder, and a higher body mass index to be independently associated with rotator cuff tear. The mechanism of how these factors possibly lead to rotator cuff tears needs further research. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Identify factors associated with an increased risk of developing rotator cuff tears in adults; (2) Describe the current epidemiological trends of rotator cuff tears in the United States; and (3) Discuss the pathophysiological role of aging in the development of nontraumatic rotator cuff tears. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
| | - Amos Song
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | | | - Gregory D. Ayers
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | | | - John E. Kuhn
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | | | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Nitin B. Jain
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
- Departments of Physical Medicine and Rehabilitation, Orthopaedics, and Population & Data Sciences, University of Texas Southwestern
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13
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Gu J, Dai B, Shi X, He Z. Clinical short-term outcomes of articular-sided and bursal-sided partial-thickness rotator cuff tears of less than 50% in a single surgeon series: A protocol of randomized controlled trial. Medicine (Baltimore) 2021; 100:e24965. [PMID: 33725860 PMCID: PMC7969290 DOI: 10.1097/md.0000000000024965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There have been no published randomized clinical trial to assess the clinical outcomes between the articular-sided and bursal-sided tears. Therefore, a comparative analysis of evaluating and comparing the functional outcomes following arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tearsis essential. METHODS This study is a present randomized controlled trial which is conducted in our hospital. Consecutive patients with symptomatic articular-sided or bursal-sided partial-thickness rotator cuff tears underwent arthroscopic repair between June 2020 and January 2022. The institutional review board approved the study proposal (with number 10012030), and informed consent was obtained from all patients. Inclusion criteria were existence of an articular- or bursal-sided tear involving <50% of the tendon thickness-confirmed intraoperatively and treated with arthroscopic debridement with or without other decompression surgery (acromioplasty/distal clavicle resection)-and a minimum follow-up of 2 years. All patients followed the same postoperative rehabilitation program. The patients were assessed at baseline preoperatively, and at 1 year and 2 years postoperatively. Outcome parameters were measured at each respective follow-up, which included active range of motion in forward flexion and abduction of the affected shoulder, pain score as measured on the Numeric Pain Rating Scale, as well as outcome scores in terms of the Constant-Murley Score, and Oxford Shoulder Score. RESULTS Table 1 and Table 2 describe the data indicators that this article wants to evaluate and collect. CONCLUSIONS We hypothesize that both groups of patients will show improvement in range of motion, functional outcome scores, and pain at 2 years, and that results would be similar between the two groups. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry6496).
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14
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Gilat R, Haunschild ED, Williams BT, Fu MC, Garrigues GE, Romeo AA, Verma NN, Cole BJ. Patient Factors Associated With Clinical Failure Following Arthroscopic Superior Capsular Reconstruction. Arthroscopy 2021; 37:460-467. [PMID: 32998042 DOI: 10.1016/j.arthro.2020.09.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify demographic, clinical, and radiographic factors associated with failure after superior capsular reconstruction (SCR). METHODS Prospectively collected data were analyzed from patients who underwent SCR using a decellularized dermal allograft for an irreparable rotator cuff tear. Demographic characteristics, radiographic findings, concomitant procedures, and patient-reported outcomes (PROs) were recorded. Failure was defined by ≥1 of the following criteria: (1) conversion to reverse total shoulder arthroplasty (RTSA), (2) a decrease in 1-year postoperative shoulder-specific PROs compared with preoperative scores, or (3) patient reports at final follow-up that the shoulder was in a worse condition than before surgery. Preoperative variables were compared between patients meeting the criteria for clinical failure and those who did not. RESULTS Fifty-four patients (mean age 56.3 ± 5.8 years, range 45 to 70) who underwent SCR, with minimum 1-year follow-up, were included in the analysis. Mean follow-up after surgery was 24 months (range 12 to 53). Eleven patients (20.4%) met criteria for clinical failure. Of the 11, 8 reported decreased American Shoulder and Elbow Surgeons (ASES) or Constant scores or indicated that the operative shoulder was in a worse condition than before surgery. Three patients underwent RTSA in the 6 to 12 months after SCR. Female sex and the presence of a subscapularis tear were associated with failure (P = .023 and P = .029, respectively). A trend toward greater body mass index (BMI), lower preoperative forward flexion, and lower preoperative acromiohumeral distance (AHD) was found in patients with clinical failure (P = .075, P = .088, and P = .081, respectively). No other variable included in the analysis was significantly associated with failure. CONCLUSION The proportions of female patients and those with subscapularis tear were greater among patients with clinical failure after SCR. Greater BMI, lower preoperative forward flexion, and lower preoperative AHD trended toward association with clinical failure of SCR. LEVEL OF EVIDENCE 4, case series.
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Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A.; Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Eric D Haunschild
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A
| | - Brady T Williams
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A
| | - Michael C Fu
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A
| | - Anthony A Romeo
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A..
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15
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Kwong CA, Woodmass JM, Gusnowski EM, Bois AJ, Leblanc J, More KD, Lo IKY. Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial. Arthroscopy 2021; 37:510-517. [PMID: 33127554 DOI: 10.1016/j.arthro.2020.10.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a randomized controlled trial comparing platelet-rich plasma (PRP) with standard corticosteroid (CS) injection in providing pain relief and improved function in patients with rotator cuff tendinopathy and partial-thickness rotator cuff tears (PTRCTs). METHODS This double-blind randomized controlled trial enrolled patients with ultrasound-proven or magnetic resonance imaging-proven PTRCTs who received either an ultrasound-guided PRP or CS injection. Patients completed patient-reported outcome assessments at baseline and at 6 weeks, 3 months, and 12 months after injection. The primary outcome was improvement in the visual analog scale (VAS) score for pain. Secondary outcomes included changes in American Shoulder and Elbow Surgeons (ASES) and Western Ontario Rotator Cuff Index (WORC) scores. Treatment failure was defined as subsequent injection, consent to undergo surgery, or operative intervention. RESULTS We followed up 99 patients (47 in the PRP group and 52 in the CS group) until 12 months after injection. There were no differences in baseline patient demographic characteristics including age, sex, or duration of symptoms. Despite randomization, patients in the PRP group had worse baseline VAS (46.0 vs 34.7, P = .01), ASES (53.9 vs 61.8, P = .02), and WORC (42.2 vs 49.5, P = .03) scores. At 3 months after injection, the PRP group had superior improvement in VAS (-13.6 vs 0.4, P = .03), ASES (13.0 vs 2.9, P = .02), and WORC (16.8 vs 5.8, P = .03) scores. There were no differences in patient-reported outcomes at 6 weeks or 12 months. There was no difference in the rate of failure (P = .31) or conversion to surgery (P = .83) between groups. CONCLUSIONS Patients with PTRCTs or tendinopathy experienced clinical improvement in pain and patient-reported outcome scores after both ultrasound-guided CS and PRP injections. Patients who received PRP obtained superior improvement in pain and function at short-term follow-up (3 months). There was no sustained benefit of PRP over CS at longer-term follow-up (12 months). LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Cory A Kwong
- Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Calgary, Alberta, Canada.
| | - Jarret M Woodmass
- Pan Am Clinic, Department of Orthopedics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eva M Gusnowski
- Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Aaron J Bois
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Justin Leblanc
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Kristie D More
- University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada
| | - Ian K Y Lo
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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Veen EJD, Koorevaar CT, Verdonschot KHM, Sluijter TE, de Groot T, van der Hoeven JH, Diercks RL, Stevens M. Compensatory Movement Patterns Are Based on Abnormal Activity of the Biceps Brachii and Posterior Deltoid Muscles in Patients with Symptomatic Rotator Cuff Tears. Clin Orthop Relat Res 2021; 479:378-388. [PMID: 33177479 PMCID: PMC7899608 DOI: 10.1097/corr.0000000000001555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/12/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Abnormal movement patterns due to compensatory mechanisms have been reported in patients with rotator cuff tears. The long head of the biceps tendon may especially be overactive and a source of pain and could induce abnormal muscle activation in these patients. It is still unknown why some patients with a rotator cuff tear develop complaints and others do not. QUESTIONS/PURPOSES (1) Which shoulder muscles show a different activation pattern on electromyography (EMG) while performing the Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) in patients with a symptomatic rotator cuff tear compared with age-matched controls with an intact rotator cuff? (2) Which shoulder muscles are coactivated on EMG while performing the FIT-HaNSA? METHODS This comparative study included two groups of people aged 50 years and older: a group of patients with chronic symptomatic rotator cuff tears (confirmed by MRI or ultrasound with the exclusion of Patte stage 3 and massive rotator cuff tears) and a control group of volunteers without shoulder conditions. Starting January 2019, 12 patients with a chronic rotator cuff tear were consecutively recruited at the outpatient orthopaedic clinic. Eleven age-matched controls (randomly recruited by posters in the hospital) were included after assuring the absence of shoulder complaints and an intact rotator cuff on ultrasound imaging. The upper limb was examined using the FIT-HaNSA (score: 0 [worst] to 300 seconds [best]), shoulder-specific instruments, health-related quality of life, and EMG recordings of 10 shoulder girdle muscles while performing a tailored FIT-HaNSA. RESULTS EMG (normalized root mean square amplitudes) revealed hyperactivity of the posterior deltoid and biceps brachii muscles during the upward phase in patients with rotator cuff tears compared with controls (posterior deltoid: 111% ± 6% versus 102% ± 10%, mean difference -9 [95% confidence interval -17 to -1]; p = 0.03; biceps brachii: 118% ± 7% versus 111% ± 6%, mean difference -7 [95% CI -13 to 0]; p = 0.04), and there was decreased activity during the downward phase in patients with rotator cuff tears compared with controls (posterior deltoid: 89% ± 6% versus 98% ± 10%, mean difference 9 [95% CI 1 to 17]; p = 0.03; biceps brachii: 82% ± 7% versus 89% ± 6%, mean difference 7 [95% CI 0 to 14]; p = 0.03). The posterior deltoid functioned less in conjunction with the other deltoid muscles, and lower coactivation was seen in the remaining intact rotator cuff muscles in the rotator cuff tear group than in the control group. CONCLUSION Patients with a symptomatic rotator cuff tear show compensatory movement patterns based on abnormal activity of the biceps brachii and posterior deltoid muscles when compared with age-matched controls. The posterior deltoid functions less in conjunction with the other deltoid muscles, and lower coactivation was seen in the remaining intact rotator cuff muscles in the rotator cuff tear group than the control group. CLINICAL RELEVANCE This study supports the potential benefit of addressing the long head biceps tendon in the treatment of patients with a symptomatic rotator cuff tear. Moreover, clinicians might use these findings for conservative treatment; the posterior deltoid can be specifically trained to help compensate for the deficient rotator cuff.
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Affiliation(s)
- Egbert J D Veen
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Cornelis T Koorevaar
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Koen H M Verdonschot
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tim E Sluijter
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tom de Groot
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes H van der Hoeven
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ronald L Diercks
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Zhou P, Liu J, Deng X, Li Z. Biceps tenotomy versus tenodesis for lesions of the long head of the biceps tendon: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e23993. [PMID: 33545991 PMCID: PMC7837917 DOI: 10.1097/md.0000000000023993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Biceps tenotomy and biceps tenodesis are 2 most common surgical procedures for long head of the biceps tendon (LHBT) pathology, but debate still exists regarding the choice of treatment. This meta-analysis was conducted to compare clinical results between tenotomy and tenodesis for the treatment of lesions of LHBT. It was hypothesized that there is no difference in outcomes of tenotomy and tenodesis for lesions of LHBT. METHODS A comprehensive search of literature published between 1980 and April 2020 was performed using MEDLINE, EMBASE, Web of Science, and the Cochrane Library databases. Randomized controlled trials (RCTs) comparing tenotomy and tenodesis for LHBT lesions were included. The primary outcomes were Constant score and Popeye deformity. The secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain, muscle strength, cramping pain, and operative time. For primary outcomes, trial sequential analysis (TSA) was conducted to reduce the risk of random errors and the GRADE (grading of recommendations, assessment, development, and evaluations) approach was used to assess the quality of the body of evidence. RESULTS A total of 9 RCTs were included. In pooled analysis, statistical significance was observed in the Constant score (mean difference [MD], 1.59; 95% confidence interval [CI] 0.04-3.14; P = .04), Popeye deformity (risk ratio [RR], 0.33; 95% CI, 0.22-0.49; P < .00001) and operative time (MD, 9.94; 95% CI 8.39-11.50; P < .00001). However, there were no significant differences between the tenodesis and tenotomy in ASES score (P = .71), VAS for pain (P = .79), cumulative elbow flexion strength (P = .85), cumulative elbow supination strength (P = .23), and cramping pain (P = .61) TSA revealed that the results for Constant score was inconclusive. CONCLUSION For the treatment of LHBT lesions, with the exception of constant score, there was no significant benefit of tenodesis over tenotomy. Although tenotomy is affected by a higher risk of Popeye sign, it is more timesaving.
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Affiliation(s)
- Peng Zhou
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University
- Sichuan ProvincialLaboratory of Orthopaedic Engineering, Lu Zhou, Si Chuan Province
| | - Juncai Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University
- Sichuan ProvincialLaboratory of Orthopaedic Engineering, Lu Zhou, Si Chuan Province
| | - Xiangtian Deng
- School of Medicine, Nankai University, Tianjin, P.R. China
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University
- Sichuan ProvincialLaboratory of Orthopaedic Engineering, Lu Zhou, Si Chuan Province
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Xie Y, Liu S, Qiao Y, Hu Y, Zhang Y, Qu J, Shen Y, Tao H, Chen S. Quantitative T2 mapping-based tendon healing is related to the clinical outcomes during the first year after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2021; 29:127-135. [PMID: 31807835 DOI: 10.1007/s00167-019-05811-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/19/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE The objective of this study was to determine the correlation between quantitative T2 mapping-based tendon healing and clinical outcomes during the first year after arthroscopic rotator cuff repair. METHODS Twenty-two patients with rotator cuff tear were prospectively recruited. Serial clinical and MRI follow-up assessments were carried out at 1 month, 6 months and 12 months after surgery. Twenty healthy volunteers were involved and were examined with clinical and MRI assessments. Clinical assessments included Constant Score (CS), the American Shoulder and Elbow Surgeons (ASES), the modified University of California, Los Angles (UCLA) scores and Visual Analog Scale (VAS). The region of interest of tendon healing was defined directly over the medial suture anchor on T2 mapping. Spearman correlation coefficient was used to analyze the correlations between MRI measurements and clinical outcomes. RESULTS All clinical scores indicated significant improvements over the postoperative observation period compared with the initial preoperative values (all P < 0.001). At 12 months, all of the patients returned to their daily life activities. The T2 values of the healing site significantly decreased over time (P < 0.001) and were comparable to those of healthy tendons at 12 months (n.s.). Additionally, the T2 values were negatively correlated with CS (r = - 0.5, P < 0.001), ASES (r = - 0.5, P < 0.001), and UCLA (r = - 0.5, P < 0.001); and positively correlated with VAS score (r = 0.4, P < 0.001). No significant correlations were found between Sugaya classification and clinical scores (all n.s.). CONCLUSIONS With regard to tendon healing during the first follow-up year, the T2 values of the healing site decreased with the improvement of clinical outcomes over time. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Yuxue Xie
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, 12 Middle Wulumuqizhong Road, Shanghai, 200040, China
| | - Shaohua Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, 12 middle Wulumuqizhong Road, Shanghai, 200040, China
| | - Yang Qiao
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, 12 Middle Wulumuqizhong Road, Shanghai, 200040, China
| | - Yiwen Hu
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, 12 Middle Wulumuqizhong Road, Shanghai, 200040, China
| | - Yuyang Zhang
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, 12 Middle Wulumuqizhong Road, Shanghai, 200040, China
| | | | | | - Hongyue Tao
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, 12 Middle Wulumuqizhong Road, Shanghai, 200040, China.
| | - Shuang Chen
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, 12 Middle Wulumuqizhong Road, Shanghai, 200040, China.
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Liu F, Dong J, Kang Q, Zhou D, Xiong F. Subacromial balloon spacer implantation for patients with massive irreparable rotator cuff tears achieves satisfactory clinical outcomes in the short and middle of follow-up period: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:143-153. [PMID: 31894368 DOI: 10.1007/s00167-019-05834-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/13/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE This meta-analysis was performed systematically to evaluate the efficacy of subacromial balloon spacers for patients with massive, irreparable rotator cuff tears. METHODS Electronic databases, including Medline/PubMed, Embase and Cochrane Library, were systematically searched to identify studies evaluating the efficacy of subacromial spacers for patients with irreparable or massive rotator cuff tears. Meta-analyses were performed to pool the outcome estimates of interest, such as the total constant score (TCS) and its sub-score (pain, activities of daily living [ADL], range of motion [ROM], and strength), Oxford shoulder score (OSS), American Shoulder and Elbow Society scores (ASES) and numeric rating scale (NRS), as well as different outcomes at different time points in the follow-up period. RESULTS Ten studies with a total of 261 patients involving 270 shoulders were deemed viable for inclusion in the meta-analysis. The combined results demonstrated significant improvements in the TCS at the final follow-up (pooled mean difference = 26.4, 95% confidence intervals [CIs] 23.3 to 29.5). A sensitivity analysis and subgroup analysis, which were implemented based on two factors, different follow-up points and sub-scores (pain, ADL, ROM, and strength), revealed a consistent trend. The combined shoulder motion results demonstrated significant improvements in the forward flexion and external rotation (0° abduction) variables rather than in the abduction and external rotation (90° abduction) variables. Additionally, significant improvements in the OSS and ASES and a decrease in the NRS were observed in the middle of the follow-up period. CONCLUSION This meta-analysis indicated that subacromial balloon spacer implantation for patients with massive irreparable rotator cuff tears may achieve satisfactory outcomes between 3 months and 3 years of follow-ups. Although the short- and middle- term effect is significant, the long-term effect needs to be confirmed by large-sample randomized controlled trial. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Qinglin Kang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Xuhui District, Shanghai, 200233, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Fei Xiong
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Xuhui District, Shanghai, 200233, China.
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Martetschläger F, Zampeli F, Tauber M, Habermeyer P, Leibe M. A classification for partial subscapularis tendon tears. Knee Surg Sports Traumatol Arthrosc 2021; 29:275-283. [PMID: 32285157 PMCID: PMC7862509 DOI: 10.1007/s00167-020-05989-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to analyze partial subscapularis tendon (SSC) tears and provide a descriptive classification. METHODS The retrospective study included 50 patients with arthroscopically confirmed partial SSC tears. Internal rotation (IR) force measurements and IR ROM have been made and compared to the healthy contralateral side. Then the footprint of the SSC was routinely investigated by arthroscopy with standardized measurement of the bony footprint lesion. The partial tears were classified according to the mediolateral and craniocaudal extension of the rupture in the transverse and coronal plane, respectively. RESULTS Partial SSC tears could be classified into split lesions (type 1, n = 11) and 3 further groups depending on the mediolateral peeled-off length of the bony footprint (type 2: < 10 mm, n = 20; type 3: 10-15 mm, n = 10; type 4: > 15 mm, n = 9). Type 2-4 could be further divided depending on the craniocaudal peeled-off length of the bony footprint (group A: < 10 mm, group B: 10-15 mm, group C: > 15 mm). Significantly decreased IR strength was shown for types 2-4 (p < 0.05) but not for split lesions as compared to healthy side. Types 1-4 showed significant decreased active IR ROM and all except type 3 (n.s.) which showed decreased passive IR ROM compared to the healthy side (p < 0.05). CONCLUSION We present a novel classification for partial SSC tears for a more detailed and reproducible description. This can help to improve the current knowledge about the appropriate treatment. It could be shown that partial tears of the subscapularis can have an impact on IR strength and motion. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Frank Martetschläger
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925, Munich, Germany.
- Department for Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
| | - Frantzeska Zampeli
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925, Munich, Germany
| | - Mark Tauber
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925, Munich, Germany
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Peter Habermeyer
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925, Munich, Germany
| | - Markus Leibe
- Helios Clinic Munich West, Department of Orthopedic Sports Medicine, Trauma Surgery and Hand Surgery, Munich, Germany
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Olmos MI, Boutsiadis A, Swan J, Brossard P, Barthelemy R, Delsol P, Barth J. Lateral acromioplasty cannot sufficiently reduce the critical shoulder angle if preoperatively measured over 40°. Knee Surg Sports Traumatol Arthrosc 2021; 29:240-249. [PMID: 32248274 DOI: 10.1007/s00167-020-05951-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/23/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate whether arthroscopic lateral acromion resection can sufficiently reduce the critical shoulder angle (CSA) without damaging deltoid muscle insertion. METHODS Ninety patients who underwent arthroscopic rotator cuff (RC) repair were retrospectively analysed. According to the preoperative CSA, patients were categorized as Group I (CSA < 35°) and Group II (CSA ≥ 35°). Additional arthroscopic lateral acromion resection was performed in Group II. The CSA was measured 1 week postoperatively, while RC integrity and the deltoid attachment were assessed at 3, 6 and 12 months via ultrasound. Deltoid function was evaluated using the Akimbo test, in which patients place their hands on the iliac crest with abduction in the coronal plane and internal rotation of the shoulder joint while simultaneously flexing the elbow joint and pronating the forearm. RESULTS Large and massive RC tears were more prevalent in Group II (p = 0.017). In both groups, the CSA reduction was statistically significant (Group I = 1°: range 0°-3°, Group II = 3.7°: range 1°-8°; p < 0.001). When the preoperative CSA was > 40°, the respective postoperative CSA remained > 35° in 83.3% of cases (p < 0.001). Final shoulder strength was correlated with the amount of CSA reduction (rho = 0.41, p = 0.002). The postoperative CSA was higher, but not significantly different (n.s.), in patients with re-torn (36°, range 32°-40°) than with healed RC (33°, range 26°-38°). No clinical detachment or hypotrophy of the deltoid was observed with the Akimbo test and ultrasound evaluation. CONCLUSIONS Arthroscopic lateral acromion resection is a safe procedure without affecting deltoid muscle origin or function, and it is effective in significantly reducing the CSA. However, the CSA cannot always be reduced to < 35°, especially in patients with preoperative CSA values > 40°. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Manuel Ignacio Olmos
- Department of Orthopaedic Surgery, Centre Osteoarticulaire Des Cèdres, Parc Sud Galaxie, 5 Rue Des Tropiques, Echirolles, 38130, Grenoble, France
| | - Achilleas Boutsiadis
- Department of Orthopedic Surgery, 401 Military Hospital of Athens, Athens, Greece
| | - John Swan
- Department of Orthopaedic Surgery, Centre Osteoarticulaire Des Cèdres, Parc Sud Galaxie, 5 Rue Des Tropiques, Echirolles, 38130, Grenoble, France
| | - Paul Brossard
- Department of Orthopedic Surgery, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | - Philippe Delsol
- Department of Orthopaedic Surgery, Centre Osteoarticulaire Des Cèdres, Parc Sud Galaxie, 5 Rue Des Tropiques, Echirolles, 38130, Grenoble, France
| | - Johannes Barth
- Department of Orthopaedic Surgery, Centre Osteoarticulaire Des Cèdres, Parc Sud Galaxie, 5 Rue Des Tropiques, Echirolles, 38130, Grenoble, France.
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Vogler T, Andreou D, Gosheger G, Kurpiers N, Velmans C, Ameziane Y, Schneider K, Rickert C, Liem D, Schorn D. Long-term outcome of arthroscopic debridement of massive irreparable rotator cuff tears. PLoS One 2020; 15:e0241277. [PMID: 33180802 PMCID: PMC7660551 DOI: 10.1371/journal.pone.0241277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives To evaluate the clinical and radiographic outcome of low-demand patients with massive rotator cuff tears undergoing arthroscopic debridement in mid- and long-term follow-up, as well as the rate of conversion to reverse shoulder arthroplasty. Methods We performed a retrospective analysis of 19 patients with a mean age at surgery of 68 years (range, 55–80 years) from a previously described consecutive cohort and after a mean follow up of 47 month (FU1) and 145 month (FU2). The functional outcome was evaluated with the VAS score, the American Shoulder and Elbow Surgeons (ASES) score, and the age- and gender-adjusted Constant (aCS) score. The radiographic outcome was classified according to the Hamada classification. Non-parametric analyses were carried out with the Mann-Whitney U for independent samples and the Wilcoxon signed-rank test for related samples. Results Five patients (26%) developed symptomatic cuff tear arthropathy and underwent reverse shoulder arthroplasty after a mean time of 63 months (range, 45–97 months). These patients were excluded from further analyses. The mean VAS score of the remaining 14 patients at FU1 was significantly lower compared to preoperatively (P = .041), while there were no significant differences between the VAS score at FU1 and FU2 (P = 1.0). The ASES score of the affected shoulder at FU1 was significantly higher compared to prior to surgery (P = .028), while there were no significant differences between the scores of the affected shoulder between FU1 and FU2 (P = .878). While the ASES score of the contralateral shoulder at FU1 was significantly higher than the score of the affected shoulder (P = .038), there were no significant differences in the ASES scores of the affected and the healthy shoulder at FU2 (P = .575). The evaluation of the aCS produced similar results. A progression of the Hamada grade was documented in 6 patients. Conclusions Arthroscopic debridement is a safe and valid option for low-demand middle-age or elderly patients with symptomatic massive rotator cuff tears, leading to a significant pain relief and significantly improved functional outcome at mid- and long-term follow up. However, about a quarter of the patients in our cohort had to undergo reverse shoulder arthroplasty due to symptomatic cuff tear arthropathy. Furthermore, some of the remaining patients continued to undergo radiographic progression. This might be due to the natural history of their disease and/or the surgical procedure, and the clinical relevance of this finding should be evaluated in further studies.
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Affiliation(s)
- Tim Vogler
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
- * E-mail:
| | - Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Georg Gosheger
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Nico Kurpiers
- Institute of Sports Science, University of Hildesheim, Hildesheim, Germany
| | - Clara Velmans
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Yacine Ameziane
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Kristian Schneider
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Carolin Rickert
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Dennis Liem
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Dominik Schorn
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
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Cauchon AM, Tétreault P, Bascans C, Skalli W, Hagemeister N. Morphologic and radiologic parameters correlating to shoulder function at diagnosis for patients with rotator cuff tear. J Shoulder Elbow Surg 2020; 29:2272-2281. [PMID: 32684281 DOI: 10.1016/j.jse.2020.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/17/2020] [Accepted: 03/26/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The magnetic resonance imaging (MRI) parameters used to diagnose rotator cuff tears are weakly correlated to shoulder function. Our hypothesis was that adding 3-dimensional morphologic parameters resulting from biplanar radiographs (3DXR parameters) to the MRI parameters would improve this correlation. METHODS We assessed 52 patients with rotator cuff tears with an EOS Imaging radiographic examination, MRI study, and clinical evaluation of the shoulder, as well as the Constant score. The bones of the 52 shoulders were reconstructed 3-dimensionally, and eleven 3DXR parameters were automatically extracted. First, the trueness and reliability of these parameters were evaluated. Then, bivariate correlations between each parameter and the Constant score were made. A linear regression model was subsequently built to correlate the 11 parameters and 5 MRI findings with shoulder function at diagnosis, as assessed by the Constant score. RESULTS The parameters showed good trueness and reliability of most 3DXR parameters. Supraspinatus tear extension, muscle atrophy, and the distance between the greater and deltoid tuberosities were the only parameters with a statistically significant correlation to a lower Constant score (P < .05) in the bivariate study. These correlations were either weak or negligible. A regression model was successfully built with one MRI parameter and four 3DXR parameters. Correlation to function increased from 16.7% to 43.3% with this model. CONCLUSION For patients with rotator cuff tears, the combination of MRI and 3DXR parameters of the shoulder in a linear regression model improves the correlation with the Constant score (shoulder function) at diagnosis.
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Makki D, Cooke RA, Tang QO, Peach CA, Morgan BW. Clinical Outcome of Transtendon Repair of Partial Articular Supraspinatus Tendon Avulsion Tear. Orthopedics 2020; 43:e533-e537. [PMID: 32818281 DOI: 10.3928/01477447-20200812-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/12/2019] [Indexed: 02/03/2023]
Abstract
Partial articular supraspinatus tendon avulsion (PASTA) tears are common. However, there is no consensus on the optimal surgical technique for the management of grade 3 tears (>50%). The authors report a retrospective consecutive case series of 64 patients with grade 3 PASTA lesions. The patients were treated by 2 surgeons from 2 centers with the same transtendon repair technique and implant system. The preoperative Oxford Shoulder Score (OSS) was compared with the postoperative OSS at final follow-up (mean, 28 months). Significant improvement in mean OSS occurred from 19.2 (SD, 7.5) preoperatively to 39.8 (SD, 7.8) postoperatively (P=.0001), and patient satisfaction rates were high (88%). The authors believe that transtendon repair of PASTA lesions of 50% or more is beneficial. High-quality randomized controlled trials are required to compare the benefit of repair vs debridement alone. [Orthopedics. 2020;43(6):e533-e537.].
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Elhassan BT, Wagner ER, Kany J. Latissimus dorsi transfer for irreparable subscapularis tear. J Shoulder Elbow Surg 2020; 29:2128-2134. [PMID: 32573448 DOI: 10.1016/j.jse.2020.02.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
UNLABELLED There is a paucity of information on latissimus dorsi transfer (LDT) for subscapularis insufficiency. The purpose of this study is to report the outcome of LDT to reconstruct an irreparable subscapularis tear. METHODS Excluding patients with prior failed Latarjet procedures, we examined 56 consecutive patients who underwent open (n = 14) or arthroscopic (n = 42) LDT. The average age was 53 years (range, 23-79), and 46 patients had a prior surgery. Outcome measures included visual analog scale score for pain, range of motion (ROM), subjective shoulder value (SSV), and Constant shoulder score (CSS). RESULTS At a mean 13-month follow-up (7-51 months), patients had significant improvements in their pain, ROM, SSV, and CSS when compared to preoperatively. At final follow-up, 26% of patients continued to have proximal migration, and 11% of patients had anterior subluxation. The patients with frank anterior escape had a higher likelihood of having proximal migration and anterior subluxation, but this was not statistically significant. Stages of arthritis did not progress. Revision surgeries included 2 patients who revised to a reverse shoulder arthroplasty for rupture of the tendon transfer. Furthermore, 3 patients had LDT ruptures but did not elect to undergo further surgery. CONCLUSIONS LDT for irreparable subscapularis tears has the potential to lead to significant clinical improvements. Most patients improve in many of the signs of subscapularis insufficiency, including anterior and/or proximal subluxation, clinical examination maneuvers, and shoulder function. Overall, this transfer represents a reasonable option for this difficult pathology.
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Affiliation(s)
| | - Eric R Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Jean Kany
- Department of Orthopaedic Surgery, Clinique de l'Union, Toulouse, France
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Sun Y, Kwak JM, Qi C, Kholinne E, Wang Y, Koh KH, Jeon IH. Remnant Tendon Preservation Enhances Rotator Cuff Healing: Remnant Preserving Versus Removal in a Rabbit Model. Arthroscopy 2020; 36:1834-1842. [PMID: 32272201 DOI: 10.1016/j.arthro.2020.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess whether anatomic repair preserving remnant tendon tissue can enhance tendon-to-bone healing biomechanically and histologically in a rabbit rotator cuff tear model. METHODS In this controlled laboratory study, bilateral infraspinatus tenotomy from the greater tuberosity, with remnant tendon on the footprint, was performed in 26 New Zealand white rabbits. An open transosseous technique was used to perform bilateral infraspinatus tendon repair 1 week later. Preservation and removal of the remaining tendon were performed on the left and right sides, respectively. Seven rabbits each were killed humanely for biomechanical testing and 6 rabbits each were killed humanely for histologic evaluation at 4 and 12 weeks. RESULTS Significantly superior biomechanical properties were shown in the remnant tissue-preservation group at 4 and 12 weeks in terms of maximum load (89.6 ± 24.3 N vs 68.2 ± 20.7 N at 4 weeks, P = .048; 120.8 ± 27.5 N vs 93.3 ± 25.1 N at 12 weeks, P = .035) and stiffness (25.3 ± 3.4 N/mm vs 17.7 ± 5.2 N/mm at 4 weeks, P = .009; 26.7 ± 5.2 N/mm vs 19.4 ± 5.2 N/mm at 12 weeks, P < .001). Improved bone-tendon interface histologic maturity scores (14.8 ± 0.9 vs 8.2 ± 1.5 at 4 weeks, P = .027; 16.8 ± 0.7 vs 10.5 ± 1.4 at 12 weeks, P = .027) and large metachromasia areas (0.117 ± 0.053 mm2 vs 0.032 ± 0.017 mm2 at 4 weeks, P = .022; 0.14 ± 0.046 mm2 vs 0.037 ± 0.016 mm2 at 12 weeks, P = .007) were obtained in the preservation group compared with the removal group at 4 and 12 weeks. CONCLUSIONS This study showed that preserving remnant tissue in anatomic repair can significantly improve rotator cuff healing compared with remnant tissue removal on the footprint in terms of biomechanical properties, bone-tendon interface histologic maturity scores, and metachromasia at 4 and 12 weeks after repair in a rabbit rotator cuff tear model. CLINICAL RELEVANCE The results suggest that preservation of remnant tissue on the footprint containing the native bone-tendon interface, when present, may be a better option for rotator cuff healing in rotator cuff repair surgery.
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Affiliation(s)
- Yucheng Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, College of Medicine, Nantong University, Nantong, China
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Chao Qi
- Department of Sports Medicine, Qingao University Affiliated Hospital, Qingdao, China
| | - Erica Kholinne
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea; Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Yang Wang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, College of Medicine, Nantong University, Nantong, China
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
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Kim D, Lee B, Yeom J, Cha J, Han J. Three-dimensional in vivo comparative analysis of the kinematics of normal shoulders and shoulders with massive rotator cuff tears with successful conservative treatment. Clin Biomech (Bristol, Avon) 2020; 75:104990. [PMID: 32222472 DOI: 10.1016/j.clinbiomech.2020.104990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study used in vivo three-dimensional to two-dimensional image registration techniques to compare the glenohumeral kinematics of shoulders with massive rotator cuff tears that were successfully treated conservatively and those of normal shoulders. METHODS Ten patients (age, 67.4 ± 3.63 years) with massive rotator cuff tears on one side and without contralateral tears were enrolled. We performed computed tomography and fluoroscopy on both shoulder joints and created three-dimensional bone models of the humerus and scapula using image registration techniques. We measured the humeral superoinferior translation, angle of humeral external rotation, scapular upward rotation, scapular anteroposterior tilt, and scapular external rotation of the torn shoulders with good range of motion after effective conservative treatment and compared these measurements to those of the contralateral normal shoulders. FINDINGS There was a significant difference in the initial position of the humeral head relative to the glenoid in the tear group; it was 2.0 mm higher than that in the normal group (p < .05). This difference disappeared in the range from 40° to full elevation. The scapular motion of the tear group was significantly more upwardly rotated than that of the normal group: by 9.9° at rest (p < .05) and by 11.6° at terminal elevation (p < .05). No significant differences were detected for humeral head external rotation, scapular anteroposterior tilt, and scapular external rotation between the two groups. INTERPRETATION Kinematics of shoulders with massive cuff tears could not be recovered completely even though the patients had no significant symptoms after successful conservative treatment.
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Affiliation(s)
- Doosup Kim
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Republic of Korea.
| | - Bonggun Lee
- Department of Orthopedic Surgery, Hanyang University, Seoul, Republic of Korea.
| | - Junseop Yeom
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Republic of Korea
| | - Jaehack Cha
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Republic of Korea
| | - Jinyoung Han
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Republic of Korea
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Lee C, Liu M, Agha O, Kim HT, Liu X, Feeley BT. Beige fibro-adipogenic progenitor transplantation reduces muscle degeneration and improves function in a mouse model of delayed repair of rotator cuff tears. J Shoulder Elbow Surg 2020; 29:719-727. [PMID: 31784382 PMCID: PMC7085983 DOI: 10.1016/j.jse.2019.09.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/03/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Muscle atrophy and fatty infiltration (FI) are common occurrences following rotator cuff (RC) tears. Tears of all sizes are subject to muscle degeneration. The degree of muscle degeneration following RC tears is highly correlated with repair success and functional outcomes. We have recently discovered that muscle fibro-adipogenic progenitors (FAPs) can differentiate into uncoupling protein 1 (UCP-1)-expressing beige adipocytes and induce muscle regeneration. This study evaluated the potential of local cell transplantation of beige adipose FAPs (BAT-FAPs) to treat RC muscle degeneration in a murine model of RC repair. METHODS BAT-FAPs were isolated from muscle in UCP-1 reporter mice by flow cytometry as UCP-1+/Sca1+/PDGFR+/CD31-/CD45-/integrin α7-. C57/BL6J mice underwent supraspinatus tendon tear with suprascapular nerve transection followed by repair 2 or 6 weeks after the initial injury. At the time of repair, mice received either no additional treatment, phosphate-buffered saline injection, or BAT-FAP injection. Functional outcomes were assessed by gait analysis. Mice were humanely killed at 6 weeks after cell transplantation. Supraspinatus muscle FI, fibrosis, muscle fiber size, and vascularity were analyzed and quantified via ImageJ. Analysis of variance with post hoc Tukey test and P <.05 was used to determine statistical significance. RESULTS Cell transplantation diminished fibrosis, FI, and atrophy and enhanced vascularization in both delayed repair models. Cell transplantation resulted in improved shoulder function as assessed with gait analysis in both the delayed repair models. CONCLUSIONS BAT-FAPs significantly reduced muscle degeneration and improved shoulder function after RC repair. BAT-FAPs hold significant promise as a therapeutic adjunct to repair for patients with advanced RC pathology.
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Affiliation(s)
- Carlin Lee
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Mengyao Liu
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Obiajulu Agha
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Hubert T Kim
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Xuhui Liu
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Brian T Feeley
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
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Weekes DG, Campbell RE, Allegretto JR, Lopez SG, Pepe MD, Tucker BS, Freedman KB, Tjoumakaris FP. A Prospective Study of Patient Factors and Decision-making for Surgical Repair of Symptomatic Full-Thickness Rotator Cuff Tears. Orthopedics 2020; 43:85-90. [PMID: 31881088 DOI: 10.3928/01477447-20191223-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 10/18/2019] [Indexed: 02/03/2023]
Abstract
Factors motivating patients to undergo rotator cuff repair (RCR) have not been thoroughly investigated. The purpose of this study was to investigate patient and surgeon decision-making factors for RCR, as well as the use of conservative treatment, and their relationship with shoulder function. A total of 144 adult patients undergoing arthroscopic RCR completed a 13-item questionnaire assessing the importance of surgical decision-making factors. Preoperative conservative treatments were also recorded. Surgeons also completed a similar 5-item questionnaire assessing surgeon decision-making factors preoperatively. American Shoulder and Elbow Surgeons (ASES) functional outcome scores were collected preoperatively through 1 year postoperatively. The following factors received the greatest frequency of high-importance scores: limited shoulder function (80.6%), surgeon recommendation (79.2%), and daily chronic pain (76.4%). Among surgeons, patient activity (83.3%) and risk of tear progression (73.6%) received the greatest frequency of high-importance scores. Patients had worse preoperative ASES scores when they reported the following factors as highly important: limited shoulder function, daily chronic pain, concern for tear enlargement, inability to sleep, and failure of conservative management (P<.004). Female gender, corticosteroid injection, and opioid use were also associated with worse preoperative shoulder function (P<.01). Workers' compensation claims, preoperative physical therapy, and multiple corticosteroid injections were associated with worse postoperative ASES scores (P<.05). Limitations in shoulder function and surgeon recommendation were the most common factors influencing patients to undergo RCR. Multiple factors were associated with worse shoulder function. Surgeons should be cognizant of patient decision-making factors and their relationship with shoulder function. [Orthopedics. 2020; 43(2): 85-90.].
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Hollman F, Wolterbeek N, Auw Yang G. Non-inferiority and cost-effectiveness trial of isolated biceps tenotomy versus tenotomy with rotator cuff repair in patients with stage 2-3 Goutallier fatty degenerative cuff lesions (TenCuRe study): protocol of a multicentre randomised controlled trial. BMJ Open 2020; 10:e032936. [PMID: 32005781 PMCID: PMC7044917 DOI: 10.1136/bmjopen-2019-032936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION For patients who are diagnosed with lesions of the rotator cuff that present advanced levels of fatty degeneration, arthroscopic repair of the rotator cuff remains controversial. This controversy can be attributed to the frequently reported high failure rate of the tendon fixation and the fact that it remains unclear why repair for these tears results in significant clinical improvement independent of the occurrence of such a re-tear. Recent publications have reported comparable clinical improvements when merely a tenotomy of the long head of the biceps tendon was performed and the rotator cuff tear was left untreated. These observations raise questions on the value of performing the more extensive cuff repairs in degenerative cuff tears. Even more, rehabilitation after an isolated tenotomy is much less cumbersome as compared with rehabilitation after rotator cuff repair and, therefore, might result in improved patient satisfaction. The goal of this trial is to study function and quality-of-life of patients undergoing arthroscopic biceps tenotomy with or without an additional cuff repair and to include an economic evaluation. METHODS AND ANALYSIS This multicentre randomised controlled non-inferiority trial, including an economic evaluation, is designed to compare the short-term and long-term outcome of patients who underwent an arthroscopic tenotomy of the long head of the biceps tendon with or without a cuff repair. We will include 172 patients with stage 2-3 Goutallier fatty infiltration cuff tears and with clinical symptoms of biceps pathology. Primary outcome is the rotator cuff specific quality-of-life (Western Ontario Rotator Cuff index) on the short term (6 months postoperatively). Secondary outcomes are quality-of-life 1, 2 and 5 year postoperatively and function (Constant-Murley score, glenohumeral range of motion), recovery status, pain (visual analogue scale), economic evaluation, satisfaction of treatment on the short-term and long-term and re-tear rate at 6 months determined with an ultrasound. ETHICS AND DISSEMINATION This trial has been approved by the Medical Research Ethics Committees United (MEC-U), Nieuwegein, the Netherlands (NL54313.100.15) and will be performed in accordance with the Declaration of Helsinki with the Medical Research Involving Human Subjects Act (WMO). The results of this study will be reported in peer-reviewed journals and at (inter)national conferences. Furthermore, we will share our findings with the appropriate guideline committees. TRIAL REGISTRATION NUMBER The Dutch Trial Registry (NL4010).
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Affiliation(s)
- Freek Hollman
- Orthopedic Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Nienke Wolterbeek
- Orthopedic Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Gie Auw Yang
- Orthopedic Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
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Keener JD, Aleem AW, Chamberlain AM, Sefko J, Steger-May K. Factors associated with choice for surgery in newly symptomatic degenerative rotator cuff tears: a prospective cohort evaluation. J Shoulder Elbow Surg 2020; 29:12-19. [PMID: 31627964 PMCID: PMC7197028 DOI: 10.1016/j.jse.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The patient-related factors for the perceived need for surgery for degenerative rotator cuff tears are not known. The purpose of this study is to examine patient- and tear-specific factors leading to surgery in newly painful degenerative rotator cuff tears. METHODS Asymptomatic, degenerative rotator cuff tears were followed prospectively to identify the onset of pain and tear enlargement. Newly painful tears were continually monitored with a focus on identifying patient-specific (age, occupation, activity level) and tear-specific (tear type and size, tear progression, American Shoulder and Elbow Surgeons score, muscle degeneration) factors that are associated with surgical intervention. RESULTS Forty-eight of 169 newly painful shoulders were eventually managed surgically. Factors associated with surgical treatment included younger age (P = .0004), pain development earlier in surveillance (P = .0002), a greater increase in pain (P = .0001), a decline in American Shoulder and Elbow Surgeons score (P < .0001), and a history of contralateral shoulder surgery (P = .0006). Eighty-five of the 169 tears (50%) enlarged either before or within 2 years of pain development. Neither tear type (P = .13), tear enlargement (P = .67) nor tear size (P = .51) was associated with surgery. Neither the severity of muscle degeneration, occupational status, hand dominance, Shoulder Activity Score, nor changes in RAND-12 mental or physical scales differed between groups. DISCUSSION For newly painful rotator cuff tears, patient-specific factors such as younger age and prior surgery on the contralateral shoulder are more predictive of future surgery than tear-specific factors or changes in tear size over time.
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Affiliation(s)
- Jay D Keener
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
| | - Alexander W Aleem
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Julianne Sefko
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Karen Steger-May
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA
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Yamak K, Karahan HG, Altay T, Kayalı C, Ozan F. Is Subacromial Balloon Spacer Appropriate for Treatment of Irreparable Rotator Cuff Tears in Elderly Patients? Ortop Traumatol Rehabil 2019; 21:417-426. [PMID: 32100716 DOI: 10.5604/01.3001.0013.7399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the clinical and radiographic results of surgical treatment of irreparable rotator cuff tears by subacromial balloon spacer insertion in patients over 65 years old. MATERIAL AND METHODS Results of patients with failed conservative treatment for irreparable rotator cuff tears and who underwent subacromial balloon spacer insertion were evaluated retrospectively. The VAS and Quick-DASH scores were used for clinical and functional assessment. RESULTS Eleven patients were included. Mean age of patients was 69.1 (range: 65-77) years old. Evaluation of anteroposterior shoulder x-rays revealed Hamada grade 2 and grade 1 arthropathy in 10 patients (91%) and 1 patient (9%),respectively. Mean duration of follow-up was 45.09 (±5.43,37-52) months. The difference in the subacromial space measured from standard AP shoulder x-rays in the preoperative period, in the 6th postoperative month, and at the end of follow-up was 5.44 mm (2.29), 6.51 mm (±2.23), and 5.08 mm (±2.13), respectively. Mean Quick-DASH score was 74.49(±14.36) in the preoperative period, compared to 72.19 (±14.38) at the end of follow-up. There was no statistically significant difference between preoperative period and end of follow-up scores in terms of mean Quick-DASH scores (p= 0.232). Mean VAS score was 7.09 (±0.831) in the preoperative period and 6.64 (±0.809) at the end of follow-up. No statistically significant difference was revealed in terms of mean VAS scores when preoperative and end of follow-up scores were compared (p=0.333). CONCLUSION Clinical and radiographic results of subacromial balloon spacer insertion in the treatment of irreparable rotator cuff tears could not be evaluated as satisfactory.
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Affiliation(s)
- Kamil Yamak
- 1 Department of Orthopedics and Traumatology, University of Health Sciences, İzmir Bozyaka Education and Research Hospital, İzmir, Turkey
| | - Hüseyin Gökhan Karahan
- Department of Orthopedics and Traumatology, University of Health Sciences, İzmir Bozyaka Education and Research Hospital, İzmir, Turkey
| | - Taşkın Altay
- Department of Orthopedics and Traumatology, University of Health Sciences, İzmir Bozyaka Education and Research Hospital, İzmir, Turkey
| | - Cemil Kayalı
- Department of Orthopedics and Traumatology, University of Health Sciences, İzmir Bozyaka Education and Research Hospital, İzmir, Turkey
| | - Fırat Ozan
- Department of Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, Turkey
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Jo CH, Lee YJ, Lee YG, Lee JM, Kim JE. Factors associated with degeneration of rotator cuff tendon : a histological study in patients with rotator cuff tear. Acta Orthop Belg 2019; 85:393-399. [PMID: 32374227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Factors associated with tendon degeneration have not been fully investigated. The purpose of this study was to identify factors associated with tendon degeneration in patients with rotator cuff tear. A total of 93 patients with a full-thickness rotator cuff tear (fRCT) were included in the study. A full-thickness supraspinatus tendon sample was harvested from the middle portion between the lateral edge and the musculotendinous junction, and assessed histologically. Association between the degree of tendon degeneration and factors in demographic, clinical, radiologic, and arthroscopic categories were investigated. The mean of the total degeneration score was significantly lower in patients with symptom duration of 6 months or less than longer than 6 months (13.1 ± 2.6 vs 14.4 ± 2.3, p = 0.010). This study showed that tendon degeneration significantly progressed 6 months after the onset of symptoms, and suggested early intervention to avoid further deterioration of tendon degeneration.
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Kim JH, Ha DH, Kim SM, Kim KW, Han SY, Kim YS. Does arthroscopic preemptive extensive rotator interval release reduce postoperative stiffness after arthroscopic rotator cuff repair?: a prospective randomized clinical trial. J Shoulder Elbow Surg 2019; 28:1639-1646. [PMID: 31326340 DOI: 10.1016/j.jse.2019.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 05/05/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND To investigate whether preemptive extensive rotator interval (RI) release during arthroscopic rotator cuff repair (ARCR) would reduce postoperative stiffness. METHODS From July 2015 to September 2016, a total of 80 patients who were scheduled for ARCR were enrolled and randomly allocated into 2 groups: the preemptive extensive RI release group (group 1, n=40) and the RI nonrelease group (group 2, n=40). The American Shoulder and Elbow Surgeons scale, Constant score, Korean Shoulder Scale (KSS), visual analog scale (VAS) pain score, and range of motion (ROM) were evaluated before surgery; 3, 6, and 12 months after surgery; and at last follow-up. Magnetic resonance imaging was performed at postoperative 12 months. RESULTS The mean follow-up period was 26.5 months. The functional and pain scores in both groups were significantly improved at the last follow-up (P < .05). Group 1 showed a significantly higher sum of ROM with a difference of 27° and 1.6 vertebral level of internal rotation compared to group 2 at postoperative 3 months (P < .05). Constant score and KSS were significantly higher in group 1 than in group 2 at this time point (P < .05). Functional scores and ROM were not significantly different between 2 groups at postoperative 6 or 12 months or at the last follow-up (P > .05). The retear rate and pathologic change of the long head of the biceps tendon during follow-up were not significantly different between the 2 groups (P > .05). CONCLUSION Arthroscopic preemptive extensive RI release can reduce early postoperative shoulder stiffness after ARCR but does not significantly change the overall clinical outcome after surgery.
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Affiliation(s)
- Jong-Ho Kim
- Department of Orthopedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, Republic of Korea
| | - Dae-Ho Ha
- Department of Orthopedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, Republic of Korea
| | - Seung-Min Kim
- Department of Orthopedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, Republic of Korea
| | - Ki-Won Kim
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Yup Han
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Dabija DI, Pennings JS, Archer KR, Ayers GD, Higgins LD, Kuhn JE, Baumgarten KM, Matzkin E, Jain NB. Which Is the Best Outcome Measure for Rotator Cuff Tears? Clin Orthop Relat Res 2019; 477:1869-1878. [PMID: 31335605 PMCID: PMC7000030 DOI: 10.1097/corr.0000000000000800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 04/11/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The American Shoulder and Elbow Surgeons Standardized Shoulder Form (ASES), the Shoulder Pain and Disability Index (SPADI), and the shortened Disability of the Arm, Shoulder, and Hand (quickDASH) are patient-reported upper extremity-specific outcome scales currently used to evaluate patients with rotator cuff tears. This heterogeneity does not allow for a uniform metric for research and patient care. QUESTIONS/PURPOSES Our objective was to determine psychometric properties (reliability, convergent and discriminant validity, and responsiveness) of five commonly used outcome instruments (the ASES, the SPADI, the quickDASH, the SF-12, and the EuroQol-5D) in a longitudinal study of patients undergoing treatment for rotator cuff tears. METHODS From February 2011 through June 2015, 120 patients completed a standardized history, the five outcome scales under study, a physical examination, and an MRI. Of these, 47 (39%) were lost to followup before 18 months, and another 24 (20%) were accounted for at 18 months but had missing data at one or more of the earlier prespecified followup intervals (3, 6, or 12 months). Reliability (the reproducibility of an outcome instrument between subjects; tested by Cronbach's alpha), convergent and discriminant validity (determining which outcome measures correlate most strongly with others; tested by Spearman's correlation coefficients), and responsiveness (the change in outcome scales over time based on percent improvement in shoulder functionality using the minimal clinically important difference [MCID] and the subjective shoulder value) were calculated. RESULTS All outcomes measures had a Cronbach's alpha above 0.70 (range, 0.74-0.94) and therefore were considered reliable. Convergent validity was demonstrated as the upper extremity-specific measures (SPADI, ASES, and quickDASH) were more strongly correlated with each other (rho = 0.74-0.81; p < 0.001) than with any of the other measures. Discriminant validity was demonstrated because the Spearman's correlation coefficients were stronger for the relationships between upper extremity measures compared with the correlations between upper extremity measures and general health measures for 53 of the 54 correlations that were compared. Both internal and external responsiveness of the measures was supported. Patients who achieved the MCID and at least a 30% change on the subjective shoulder value had more positive change in scores over time compared with those who did not. Mixed model linear regressions revealed that all three upper extremity-specific measures had a group by time interaction for the MCID, indicating that patients who achieved the MCID had greater change over time compared with those who did not achieve the MCID. Results showed that the measure with the best discrimination between groups, or best internal responsiveness, was the ASES (beta = -8.26, 95% confidence interval [CI], -11.39 to -5.14; p < 0.001; η = 0.089) followed by the SPADI (beta = 6.88, 95% CI, 3.78-9.97; p < 0.001; η = 0.088) then the quickDASH (beta = 3.43, 95% CI, 0.86-6.01; p = 0.009, η = 0.027). Measures with the best external responsiveness followed the same pattern of results. CONCLUSIONS All the upper extremity-specific scales had acceptable psychometric properties. Correlations were high and thus only one upper extremity-specific instrument is needed for outcome assessment. Given the overall psychometric assessment, we recommend SPADI be the shoulder-specific instrument used to assess outcomes in patients with rotator cuff tears. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Dominique I Dabija
- D. I. Dabija, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA J. S. Pennings, K. R. Archer, J. E. Kuhn, N. B. Jain, Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA K. R. Archer, N. B. Jain, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA G. D. Ayers, Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA L. D. Higgins, E. Matzkin, Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA K. M. Baumgarten, Orthopedic Institute, Sioux Falls, SD, USA
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Ackley JF, Kolosky M, Gurin D, Hampton R, Masin R, Krahe D. Cryopreserved amniotic membrane and umbilical cord particulate matrix for partial rotator cuff tears: A case series. Medicine (Baltimore) 2019; 98:e16569. [PMID: 31348285 PMCID: PMC6709267 DOI: 10.1097/md.0000000000016569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Amniotic membrane (AM) and umbilical cord (UC) are well known to have anti-inflammatory properties and have been shown to promote healing in various orthopedic indications. This study investigated whether intra-articular injection of AM/UC particulate matrix promotes healing of partial rotator cuff tears (RCTs).A case series was performed on 10 patients that received injection of 50 mg AM/UC for partial RCTs that were refractory to conservative treatment. Outcomes included Penn Shoulder Score (PSS) questionnaire, range of motion examination, and magnetic resonance imaging (MRI) analysis before and at 6 months. Final MRI analysis was performed by a musculoskeletal radiologist in a blinded fashion.Average PSS score (out of 100) increased from 46.8 ± 23.7 at baseline to 82.0 ± 19.1 at 6 months. The average PSS sub-scores of pain, satisfaction, and function increased 78.4%, 37.1%, and 82.3% from baseline, respectively. The subject's range of motion was 77.9% at baseline and increased to 99.9% at 6-months. Follow-up MRI scans did not demonstrate any significant change in RCT size. No adverse events were noted.This small case series provides preliminary data for use of cryopreserved AM/UC particulate matrix in patients with refractory partial RCTs.
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Affiliation(s)
- J Freeland Ackley
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
- Southwest Sports Medicine, Waco, TX
| | | | - Danielle Gurin
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
| | - Robert Hampton
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
| | - Richard Masin
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
| | - David Krahe
- Twinsburg Family Health and Surgery Center, Twinsburg, OH
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Gurger M, Ozer AB. A comparison of continuous interscalene block versus general anesthesia alone on the functional outcomes of the patients undergoing arthroscopic rotator cuff repair. Eur J Orthop Surg Traumatol 2019; 29:1659-1666. [PMID: 31243560 DOI: 10.1007/s00590-019-02482-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/21/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this prospective and randomized study was to compare the effects of general anesthesia to the combination of general anesthesia and continuous interscalene block on postoperative pain and functional outcomes in patients undergoing arthroscopic rotator cuff repair. METHODS This study included a total of 85 patients aged 45-74 years, who were scheduled for elective arthroscopic rotator cuff repair. One group consists of patients who underwent only general anesthesia (GA, N = 43), and the other group consists of patients who underwent a combination of continuous interscalene brachial plexus block and general anesthesia (CISB + GA, N = 42). Pain levels of the patients were evaluated postoperatively by a visual analog scale. Shoulder function was evaluated preoperatively and postoperatively using the Constant score. RESULTS Patients in the CISB + GA group had lower postoperative visual analog scores and less additional analgesic needs during the early postoperative period than those in the GA group. Constant scores of the patients in the CISB + GA group at postoperative week 6 were higher than those in the GA group. Evaluation of the functional outcomes at 6 months postoperatively showed that there were no significant differences between the two groups. CONCLUSION Although CISB significantly improved postoperative pain control and early (in the first 6 weeks) functional outcomes following arthroscopic rotator cuff repair, there was no significant difference between the CISB group and CISB + GA group at 6 months. LEVEL OF EVIDENCE Level II, Randomized Controlled Trial, Treatment Study.
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Affiliation(s)
- Murat Gurger
- Department of Orthopedics and Traumatology, Faculty of Medicine, Firat University Hospital, 23190, Elazig, Turkey.
| | - Ayse Belin Ozer
- Department of Anesthesiology, Faculty of Medicine, Inonu University Hospital, 44280, Malatya, Turkey
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Abstract
Asymptomatic rotator cuff tears (RCTs) are prevalent in the general population; they are positively associated with age and are common in the contralateral shoulder of individuals who are being treated for shoulder pain or a symptomatic RCT. Asymptomatic RCTs are likely to become symptomatic over time, corresponding with decreased patient-reported function, strength, and range of motion. Previous studies have largely reported inconsistent findings regarding patient-reported outcomes, strength, range of motion, and kinematics in individuals with asymptomatic RCTs. Future research would benefit from characterizing any functional alteration that is associated with asymptomatic rotator cuff pathology, including determining whether such alterations are detrimental or compensatory and understanding the mechanism by which an asymptomatic RCT becomes symptomatic.
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Affiliation(s)
- Rebekah L Lawrence
- Department of Orthopaedic Surgery, Bone & Joint Center, Henry Ford Health System, Detroit, Michigan
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Lindbloom BJ, Christmas KN, Downes K, Simon P, McLendon PB, Hess AV, Mighell MA, Frankle MA. Is there a relationship between preoperative diagnosis and clinical outcomes in reverse shoulder arthroplasty? An experience in 699 shoulders. J Shoulder Elbow Surg 2019; 28:S110-S117. [PMID: 31196504 DOI: 10.1016/j.jse.2019.04.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The influence of diagnosis on outcomes after reverse shoulder arthroplasty (RSA) is not completely understood. The purpose of this study was to compare clinical outcomes of different pathologies. METHODS A total of 699 RSAs were performed for the following diagnoses: (1) rotator cuff tear arthropathy (RCA), (2) massive cuff tear (MCT) with osteoarthritis (OA), (3) MCT without OA, (4) OA, (5) acute proximal humeral fracture, (6) malunion, (7) nonunion, and (8) inflammatory arthropathy. All patients had minimum 2-year clinical follow-up (mean, 47 months; range, 24-155 months). Range of motion, Simple Shoulder Test scores, American Shoulder and Elbow Surgeons scores, visual analog scale scores for function, and health-related quality-of-life measures were obtained preoperatively and postoperatively. RESULTS The RCA, MCT-with-OA, MCT-without-OA, and OA groups all exhibited significant improvements in all outcome scores and in all planes of motion from preoperatively until a minimum of 2 years postoperatively. The malunion, nonunion, and inflammatory arthropathy groups showed improvements in American Shoulder and Elbow Surgeons scores, Simple Shoulder Test scores, forward flexion, and abduction. The average changes for all other outcomes and planes of motions were also positive but did not reach statistical significance. After adjustment for age and compared with RCA, female patients with malunion had significantly poorer forward flexion (P < .05), those with OA had significantly better abduction (P < .05), and those with fractures had significantly worse patient satisfaction (P < .05). Among male patients, those with MCTs without OA had significantly worse satisfaction (P < .05). CONCLUSION RSA reliably provides improvement regardless of preoperative diagnosis. Although subtle differences exist between male and female patients, improvements in clinical outcome scores were apparent after RSA.
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Affiliation(s)
| | | | - Katheryne Downes
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Peter Simon
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | | | - A Vincent Hess
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
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Liu F, Meng Q, Yin H, Yan Z. Stem Cells in Rotator Cuff Injuries and Reconstructions: A Systematic Review and Meta-Analysis. Curr Stem Cell Res Ther 2019; 14:683-697. [PMID: 31244430 DOI: 10.2174/1574888x14666190617143952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Multiple studies have focused on stem cell-based treatments for rotator cuff disorders; however, the outcomes are not consistent. OBJECTIVES This systematic review and meta-analysis were performed to evaluate the effects of stem cells on rotator cuff healing. METHODS A detailed search of relevant studies was conducted in three databases including Pubmed/ Medline, Cochrane library, and Embase databases, using the following keywords: "rotator cuff" or "Tissue Engineering" AND "stem cell" from inception to January 01, 2019. The standard mean difference (SMD) and 95% confidence interval (CI) for each individual study were extracted from the original studies or calculated based on relevant data and pooled to obtain integrated estimates using random effects modeling. RESULTS A total of 22 studies were identified. The results demonstrated that the ultimate strain in the stem cell group was significantly higher than that in the control group at 4 and 8 weeks. Muscle weight in the stem cell group was higher than the control group at 8 weeks, while no significant differences were detected at 16 weeks. The stem cell group had lower visual analog scale scores (VAS) at 1, 3, and 6 months, and higher American shoulder and elbow surgeons score (ASES) at 3 months. In addition, the walking distance, time, and speed in the stem cell group were significantly superior to those in the control group. CONCLUSIONS This meta-analysis confirms that stem cells improved the rehabilitation of rotator cuff disorders. However, larger-scale studies are needed to further support these findings.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan 250021, Shandong, China
| | - Qingqi Meng
- Department of Orthopaedics, Guangzhou Red Cross Hospital, Jinan University, Tongfu road 396, Haizhu district, Guangzhou, China
| | - Heyong Yin
- Department of Trauma Surgery, University of Regensburg, Am biopark 9, 93049 Regensburg, Germany
| | - Zexing Yan
- Department of Trauma Surgery, University of Regensburg, Am biopark 9, 93049 Regensburg, Germany
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Kalina R, Neoral P, Holibka R, Gallo J. [Arthroscopic Superior Capsule Reconstruction Using the DX Reinforcement Matrix in Patients with Irreparable Rotator Cuff Tears - Pilot Data]. Acta Chir Orthop Traumatol Cech 2019; 86:264-270. [PMID: 31524587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF THE STUDY Irreparable rotator cuff tear continues to be a point of discussion. Several surgical techniques have been proposed so far. None of them, however, can be considered the method of choice. This study presents the first clinical results of superior capsule reconstruction (SCR) using the DX Reinforcement Matrix. MATERIAL AND METHODS The evaluation included patients with the minimum follow-up of 6 months. The follow-up period in these patients was 1 year (6-18 months) on average. The active (AROM) and passive (PROM) ranges of motion were assessed-anterior flexion, abduction, external rotation and external rotation at 90° abduction. The patients were assessed using clinical scores before and after the surgery-pain assessment scale (VAS), UCLA (University of California at Los Angeles) Shoulder Rating Scale and ASES (American Shoulder and Elbow Surgeons) Shoulder Score. RESULTS In the period from October 2016 to October 2018, a total of 20 SCRs were performed. The mean age of patients was 61 years. Nine patients were clinically assessed, with the mean follow-up of 1 year. The mean UCLA Shoulder Score was 10 points preoperatively. Postoperatively, the values went up to 29 points on average. The reported ASES score was 23.8 points preoperatively. Postoperatively, the mean score was 73.2 points. The VAS subjective pain score ranged around 7 points before the surgery. After the surgery, the mean VAS score was 2 points. The mean active shoulder flexion was 74° preoperatively and 161° postoperatively. The mean active abduction was 74° preoperatively and 161° postoperatively. The mean active external rotation of the shoulder joint was 20° preoperatively and 56° postoperatively. The mean active external rotation at 90° abduction was 21° preoperatively and 82° postoperatively. The changes in all the followed-up mean parameters of UCLA, ASES, VAS, AROM and PROM reported by our group show a relatively high level of substantive significance. DISCUSSION Results of arthroscopic superior capsule reconstruction using the DX Reinforcement Matrix have not been published in literature so far. Compared to the results for fascia lata published in literature, our results are slightly worse. By contrast, our results are similar to those achieved by human dermal allograft. CONCLUSIONS Arthroscopic superior capsule reconstruction currently appears to be the method of choice in unreconstructed supraspinatus and infraspinatus tear. Our group of patients shows that early clinical outcomes of SCR using xenograft are very promising. A significant pain relief and a considerable improvement in the range of motion of the operated shoulder joint were observed. No complication specifically associated with the use of xenograft has been reported as yet. A longer follow-up period and assessment of a larger group of patients will be necessary to confirm the success of this surgical procedure. Key words: massive rotator cuff tears; irreparable rotator cuff tears; superior capsular reconstruction; xenograft; DX Reinforcement Matrix.
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Vidt ME, Santago AC, Marsh AP, Hegedus EJ, Tuohy CJ, Poehling GG, Freehill MT, Miller ME, Saul KR. Modeling a rotator cuff tear: Individualized shoulder muscle forces influence glenohumeral joint contact force predictions. Clin Biomech (Bristol, Avon) 2018; 60:20-29. [PMID: 30308434 PMCID: PMC6252115 DOI: 10.1016/j.clinbiomech.2018.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/31/2018] [Accepted: 10/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rotator cuff tears in older individuals may result in decreased muscle forces and changes to force distribution across the glenohumeral joint. Reduced muscle forces may impact functional task performance, altering glenohumeral joint contact forces, potentially contributing to instability or joint damage risk. Our objective was to evaluate the influence of rotator cuff muscle force distribution on glenohumeral joint contact force during functional pull and axilla wash tasks using individualized computational models. METHODS Fourteen older individuals (age 63.4 yrs. (SD 1.8)) were studied; 7 with rotator cuff tear, 7 matched controls. Muscle volume measurements were used to scale a nominal upper limb model's muscle forces to develop individualized models and perform dynamic simulations of movement tracking participant-derived kinematics. Peak resultant glenohumeral joint contact force, and direction and magnitude of force components were compared between groups using ANCOVA. FINDINGS Results show individualized muscle force distributions for rotator cuff tear participants had reduced peak resultant joint contact force for pull and axilla wash (P ≤ 0.0456), with smaller compressive components of peak resultant force for pull (P = 0.0248). Peak forces for pull were within the glenoid. For axilla wash, peak joint contact was directed near/outside the glenoid rim for three participants; predictions required individualized muscle forces since nominal muscle forces did not affect joint force location. INTERPRETATION Older adults with rotator cuff tear had smaller peak resultant and compressive forces, possibly indicating increased instability or secondary joint damage risk. Outcomes suggest predicted joint contact force following rotator cuff tear is sensitive to including individualized muscle forces.
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Affiliation(s)
- Meghan E Vidt
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Wake Forest Baptist Health, Biomedical Engineering, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Anthony C Santago
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Wake Forest Baptist Health, Biomedical Engineering, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, PO Box 7868, Winston-Salem, NC 27109, USA
| | - Eric J Hegedus
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC 27268, USA
| | - Christopher J Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Gary G Poehling
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Katherine R Saul
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Engineering Building 3, Campus Box 7910, 911 Oval Drive, Raleigh, NC 27695-7910, USA
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Baumgarten KM, Chang PS, Dannenbring TM, Foley EK. Does arthroscopic rotator cuff repair improve patients' activity levels? J Shoulder Elbow Surg 2018; 27:2167-2174. [PMID: 29880446 DOI: 10.1016/j.jse.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/09/2018] [Accepted: 04/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff repair decreases pain, improves range of motion, and increases strength. Whether these improvements translate to an improvement in a patient's activity level postoperatively remains unknown. The Shoulder Activity Level is a valid and reliable outcomes survey that can be used to measure a patient's shoulder-specific activity level. Currently, there are no studies that examine the effect of rotator cuff repair on shoulder activity level. METHODS Preoperative patient-determined outcomes scores collected prospectively on patients undergoing rotator cuff repair were compared with postoperative scores at a minimum of 2 years. These scores included the Shoulder Activity Level, Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Single Assessment Numeric Evaluation, and simple shoulder test. Inclusion criteria were patients undergoing arthroscopic rotator cuff repair. RESULTS Included were 281 shoulders from 273 patients with a mean follow-up of 3.7 years. The postoperative median Western Ontario Rotator Cuff Index (42 vs. 94), American Shoulder and Elbow Surgeons (41 vs. 95), Single Assessment Numeric Evaluation (30 vs. 95), and simple shoulder test (4 vs. 11) scores were statistically significantly improved compared with preoperative scores (P < .0001). The postoperative median Shoulder Activity Level score decreased compared with the preoperative score (12 vs. 11; P < .0001). CONCLUSIONS Patients reported a statistically significant deterioration of their Shoulder Activity Level score after rotator cuff repair compared with their preoperative scores, although disease-specific and joint-specific quality of life scores all had statistically significantly improvement. This study suggests that patients generally have (1) significant improvements in their quality of life and (2) small deteriorations in activity level after arthroscopic rotator cuff repair.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
| | - Peter S Chang
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
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Cheng C, Chen B, Xu H, Zhang Z, Xu W. Efficacy of concomitant acromioplasty in the treatment of rotator cuff tears: A systematic review and meta-analysis. PLoS One 2018; 13:e0207306. [PMID: 30439995 PMCID: PMC6237382 DOI: 10.1371/journal.pone.0207306] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 10/28/2018] [Indexed: 12/23/2022] Open
Abstract
Background Scientific evidence is not clear regarding the routine use of acromioplasty in the treatment of rotator cuff repair. The aim of this study was to compare clinical outcomes between patients undergoing arthroscopic rotator cuff repair with and without concomitant acromioplasty. Methods Medline, Cochrane Library, and EMBASE databases were searched to identify eligible studies focused on arthroscopic rotator cuff repair with and without acromioplasty from January 2000 to February 2018. Postoperative functional outcomes, visual analog scale (VAS) for pain and reoperation rate were extracted for systemic analysis. Results Six randomized controlled trials (RCTs) and one cohort study (CS), including 651 patients, fulfilled our selection criteria. The results showed a significant difference in American Shoulder and Elbow Surgeons (ASES) score, but not in the Constant score, University of California-Los Angeles (UCLA) score, or Simple Shoulder Test (SST) score, in the treatment of rotator cuff tear with or without concomitant acromioplasty at the final follow-up. In the subgroup analysis, the results showed no significant differences between the two treatments in reoperation rate at the final follow-up or VAS score at 6 months postoperatively and final follow-up, but there was a significant difference in VAS score at 12 months postoperatively in favor of acromioplasty treatment. The evidence quality for each outcome evaluated by the GRADE system was low. Conclusions In summary, our present study demonstrated that acromioplasty treatment is significantly superior to nonacromioplasty in shoulder pain relief at 12 months postoperatively and in ASES score improvement at the final follow-up in conjunction with rotator cuff repair. However, these significant differences were not clinically relevant. Thus, there were no differences in shoulder function or pain scores for patients undergoing rotator cuff repair with and without acromioplasty. Further high-quality studies with larger sample sizes and long-term follow-ups are needed to clarify this issue.
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Affiliation(s)
- Cong Cheng
- Orthopedics Department, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Bin Chen
- Orthopedics Department, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Hongwei Xu
- Orthopedics Department, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Zhongwei Zhang
- Orthopedics Department, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Weibin Xu
- Orthopedics Department, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
- * E-mail:
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Garcia GH, Liu JN, Wong AC, Gowd AK, Romeo AA, Dines JS, Gulotta LV. The Shoulder Self-Administered Motion Evaluation Has Excellent Patient Reliability and Reproducibility on Both Physician and Repeat Follow-up Testing. Orthopedics 2018; 41:e820-e826. [PMID: 30222789 DOI: 10.3928/01477447-20180912-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/12/2018] [Indexed: 02/03/2023]
Abstract
Long-term clinical evaluation is becoming more important, yet difficulties exist because there are substantial patient costs for extended follow-up. The goal of this study was to validate whether a new shoulder motion evaluation is reproducible and reliable with physician examination. Consecutive patients were administered a shoulder motion assessment during their clinic visit. Patients completed the same evaluation 2 weeks after their visit to determine test-retest reliability. Exact and approximate (within 20° or 4 spinal levels) agreements between patient and physician measurements were calculated. A total of 112 patients (224 shoulders) with an average age of 56.7 years were evaluated. The most common diagnoses were osteoarthritis (33.0%) and rotator cuff tear (32.1%). All motion questions had greater than 50% exact patient-physician agreement and greater than 70% approximate agreement. When agreement was off, patients more often underestimated their motion. There was substantial clinician-patient agreement for all questions and almost perfect agreement for forward elevation (intraclass correlation coefficient, 0.78) and internal rotation (intraclass correlation coefficient, 0.77). On test-retest reliability testing, patient-patient agreement was substantial for external rotation at the side (intraclass correlation coefficient, 0.71). There was near perfect agreement for internal rotation (intraclass correlation coefficient, 0.83) and abduction (intraclass correlation coefficient, 0.81) testing. This shoulder assessment tool had both good agreement to physician examination and substantial agreement on correlation testing. There was substantial agreement between follow-up visits, suggesting excellent reproducibility. This motion assessment shows effectiveness with most shoulder pathologies. It is recommended as a good screening tool for both clinical and research purposes requiring long-term follow-up in which in-person clinical examinations may be costly and time consuming. [Orthopedics. 2018; 41(6):e820-e826.].
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Jordan RW, Sloan R, Saithna A. Should we avoid shoulder surgery in wheelchair users? A systematic review of outcomes and complications. Orthop Traumatol Surg Res 2018; 104:839-846. [PMID: 29705081 DOI: 10.1016/j.otsr.2018.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/22/2018] [Accepted: 03/20/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The prevalence of shoulder pathology in wheelchair dependent patients is high. The shoulder joint is critical for maintaining independence but traditionally there has been reluctance to offer surgical intervention in view of perceived poor outcomes. The aim of this study was to provide patients and surgeons with a realistic overview of outcomes following surgical intervention for shoulder pathology in wheelchair dependent patients. METHODS A systematic review of the online databases Medline and Embase was performed in September 2017. Studies reporting functional outcomes, complications or rate of revision surgery after shoulder surgery in patients' dependent on wheelchair for mobility were included. A narrative synthesis of the studies and appraisal using the MINORS tool was performed. RESULTS The search strategy identified 11 eligible studies; 7 assessed rotator cuff repair and 4-shoulder arthroplasty. Six of the seven studies reporting on rotator cuff repairs demonstrated improvement in pain, range of motion and functional outcomes with a retear rate between 12 and 39%. Although total shoulder arthroplasty and hemiarthroplasty reportedly improved pain and function, the subsequent risk of rotator cuff failure was reported up to 100%. The two studies assessing reverse arthroplasty demonstrated significant improvement in function and pain with the largest series reporting a 15.8% failure rate. CONCLUSION Rotator cuff repairs and reverse shoulder arthroplasties performed in wheelchair users are associated with significant functional improvement and a slightly higher complication profile to those performed in ambulatory patients. This review provides a resource to aid surgeons and patients in holding realistic expectations following shoulder surgery in wheelchair users.
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Affiliation(s)
- Robert W Jordan
- University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX Coventry, UK.
| | - Roger Sloan
- Warwick Hospital, South Warwickshire Foundation Trust, CV34 5BW Warwick, UK
| | - Adnan Saithna
- Medical Technologies and Advanced Materials, Clifton Campus, Nottingham Trent University, NG11 8NS Nottingham, UK; Renacres Hospital, Halsall, L39 8SE Lancashire, UK
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Pouliquen L, Berhouet J, Istvan M, Thomazeau H, Ropars M, Collin P. Popeye sign: Frequency and functional impact. Orthop Traumatol Surg Res 2018; 104:817-822. [PMID: 29803774 DOI: 10.1016/j.otsr.2018.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 02/13/2018] [Accepted: 02/27/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is currently no consensus on the choice between tenotomy and tenodesis of the long head of the biceps tendon in rotator cuff repair. The Popeye sign is often seen as a drawback of tenotomy. The main objective of the present study was to determine the frequency and clinical impact of the Popeye sign. HYPOTHESIS The Popeye sign is rarely found clinically, and shows little functional impact following tenotomy. MATERIALS AND METHODS A single-center non-randomized prospective study was conducted between February and October 2015 in all patients undergoing rotator cuff surgery. Patients without surgery on the long head of the biceps tendon were excluded. The rate of Popeye sign was assessed 6 months postoperatively. Tenotomy patients with and without Popeye sign were compared in terms of pain on visual analog scale≤3, gain in range of motion, improvement in subjective shoulder value, discomfort or cramps and gain in Constant score. RESULTS Seven of the 55 patients included (15.2%) showed postoperative Popeye sign. There were no differences between the groups with and without Popeye sign on any of the assessment criteria except for a significantly greater improvement in mean Constant range of motion score in the Popeye group: gain of 13.8 versus 3.8 points; p=0.01. DISCUSSION The Popeye sign was relatively rarely observed. Functional impact in the present study was slight. Longhead of the biceps tenotomy is a justifiable treatment option in case of associated rotator cuff tear repair. LEVEL OF EVIDENCE IV, prospective non-randomized.
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Affiliation(s)
- Laure Pouliquen
- Service d'orthopédie, traumatologie, CHRU Pontchaillou, 35000 Rennes, France
| | - Julien Berhouet
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François Rabelais de Tours, CHRU Trousseau, 37170 Chambray-les-Tours, France
| | - Marion Istvan
- Service de Santé publique, CHRU Pontchaillou, 35000 Rennes, France
| | - Hervé Thomazeau
- Service d'orthopédie, traumatologie, CHRU Pontchaillou, 35000 Rennes, France
| | - Mickael Ropars
- Service d'orthopédie, traumatologie, CHRU Pontchaillou, 35000 Rennes, France
| | - Philippe Collin
- Service d'orthopédie, Clinique Saint-Grégoire, 35000 Rennes, France.
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Rhee SM, Kim DH, Kim SH, Jeong HJ, Oh JH. The Clinical Outcomes and Their Associated Factors in Staged Bilateral Arthroscopic Rotator Cuff Repair. Arthroscopy 2018; 34:2799-2807. [PMID: 30195959 DOI: 10.1016/j.arthro.2018.06.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare perioperative characteristics and postoperative outcomes of both shoulders in patients who underwent arthroscopic bilateral rotator cuff repair sequentially and to assess the associated factors that would affect the anatomic healing in staged bilateral rotator cuff repair. METHODS The study enrolled 64 patients who underwent bilateral rotator cuff repair with follow-up imaging at least 12 months postoperatively. We allocated the shoulders operated on first to the surgery I group and those operated on second to the surgery II group. Visual analog scale (VAS) pain and satisfaction scores, range of motion, the American Shoulder and Elbow Surgeons score, the Simple Shoulder Test score, and healing failure were evaluated. RESULTS Range of motion improved with no significant between-group differences (all P > .05). In the surgery II group, VAS pain and VAS satisfaction scores were significantly worse at 6 months postoperatively (P = .048 and P = .041, respectively) but were comparable at final follow-up (P = .598 and P = .065, respectively). American Shoulder and Elbow Surgeons and Simple Shoulder Test scores at 6 months were worse in the surgery II group (P = .038 and P = .048, respectively) but similar at final follow-up (P = .786 and P = .087, respectively). Tear size was similar between the 2 surgical procedures (κ = 0.537, P < .001). Of the 11 patients with nonhealing in the surgery I group, 7 (63.6%) had subsequent failure in the other shoulder, and if one shoulder had healing failure, the other shoulder had a high possibility of healing failure as well (κ = 0.373, P = .004). CONCLUSIONS Bilateral arthroscopic rotator cuff repair showed good outcomes at final follow-up on both sides. Tear size was closely related in both shoulders, and healing failure after the first rotator cuff repair was an associated factor with healing failure after the second operation. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Sung-Min Rhee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | | | - Sae Hoon Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
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Miller RM, Thunes J, Maiti S, Musahl V, Debski RE. Effects of Tendon Degeneration on Predictions of Supraspinatus Tear Propagation. Ann Biomed Eng 2018; 47:154-161. [PMID: 30242532 DOI: 10.1007/s10439-018-02132-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/12/2018] [Indexed: 01/05/2023]
Abstract
Rotator cuff tendons undergo degeneration with age, which could have an impact on tear propagation. The objective of this study was to predict tear propagation for different levels of tissue degeneration using an experimentally validated finite element model of a supraspinatus tendon. It was hypothesized that greater amounts of degeneration will result in tear propagation at lower loads than tendons with less degeneration. Using a previously-validated computational model of supraspinatus tendon, 1-cm tears were introduced in the anterior, middle, and posterior thirds of the tendon. Cohesive elements were assigned subject-specific failure properties to model tear propagation, and tendon degeneration ranging from "minimal" to "severe" was modeled by modifying its mechanical properties. Tears in tendons with severe degeneration required the smallest loads to propagate (122-207 N). Posterior tears required greater loads compared to middle and anterior tears at all levels of degeneration. Stress and strain required for tear propagation decreased substantially with degeneration, ranging from 8.5 MPa and 32.6% strain for minimal degeneration and 0.6 MPa and 4.5% strain for severe degeneration. Overall, this work indicates that greater amounts of tendon degeneration lead to greater risk of tear propagation, supporting the need for early detection and treatment of rotator cuff tears.
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Affiliation(s)
- R Matthew Miller
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
| | - James Thunes
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
| | - Spandan Maiti
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Richard E Debski
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA.
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA.
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Sasaki Y, Ochiai N, Nakajima A, Sasho T, Kenmoku T, Yamaguchi T, Kijima T, Hashimoto E, Sasaki Y, Ohtori S. Histological analysis and biomechanical evaluation of fatty infiltration after rotator cuff tear and suprascapular nerve injury in a rat model. J Orthop Sci 2018; 23:834-841. [PMID: 29880227 DOI: 10.1016/j.jos.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 03/26/2018] [Accepted: 04/09/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Rotator cuff tears are the most common shoulder injury, and little is known about the underlying etiology of fatty infiltration after rotator cuff tear. Previous studies speculated that rotator cuff tears lead to neural injury due to tethering of the suprascapular nerve at the notch. This study aimed to evaluate fatty infiltration after suprascapular nerve injury and rotator cuff tears. METHODS Ninety adult male Sprague-Dawley rats were used and were divided into four groups: sham, tendon transection only, suprascapular nerve ligation, and tendon transection plus suprascapular nerve ligation. The suprascapular nerve injury models were created by tying the suprascapular nerve. At 2, 4, and 8 weeks postoperatively, histological analysis and biomechanical testing were performed to evaluate fatty infiltration and elastic change in the supraspinatus muscles. RESULTS The amount of fatty infiltration in the supraspinatus muscle was significantly higher in both the suprascapular nerve ligation and tendon transection plus suprascapular nerve ligation groups than in the tendon transection only group at 2, 4, and 8 weeks. The ultimate failure load and tensile strength were significantly different among the tendon transection only, suprascapular nerve ligation, and tendon transection plus suprascapular nerve ligation groups at 8 weeks postoperatively. Furthermore, the mean Young's modulus of the muscle was significantly greater in the tendon transection plus suprascapular nerve ligation group than in both the tendon transection only and suprascapular nerve ligation groups at 8 weeks postoperatively. CONCLUSIONS In this study, based on the results of histological and biomechanical examinations in our rat models, the etiology of fatty infiltration after massive rotator cuff tear might be different from the suprascapular nerve injury.
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Affiliation(s)
- Yu Sasaki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Nobuyasu Ochiai
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Arata Nakajima
- Department of Orthopedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Takahisa Sasho
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Tomonori Kenmoku
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Takeshi Yamaguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takehiro Kijima
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Eiko Hashimoto
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yasuhito Sasaki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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