1
|
Baum C, Audigé L, Stojanov T, Müller SA, Candrian C, Müller AM, Rosso C, Fankhauser L, Willscheid G, Moroder P, Akgün D, Danzinger V, Gebauer H, Imiolczyk JP, Karpinski K, Lacheta L, Minkus M, Paksoy A, Samaniego E, Thiele K, Weiss I, Suter T, Müller-Lebschi J, Mueller S, Saner M, Haag-Schumacher C, Tamborrini-Schütz G, Trong MLD, Buitrago-Tellez C, Hasler J, Riede U, Weber S, Moor B, Biner M, Fournier S, Gallusser N, Marietan D, Pawlak S, Spormann C, Hansen B, Mamisch N, Durchholz H, Bräm J, Cunningham G, Kourhani A, Ossipow S, Simao P, Lädermann A, Egli R, Erdbrink S, Flückiger R, Lombardo P, Pinworasarn T, Scacchi P, Weihs J, Zumstein M, Flury M, Berther R, Ehrmann C, Hübscher L, Schwappach D, Eid K, Bensler S, Fritz Y, Grünberger N, Kriechling P, Langthaler D, Niehaus R, Nobs R, Benninger E, de Groot Q, Doert A, Ebert S, Grimm P, Mottier F, Pisan M, Schätz J, Schwank A, Wiedenbach J, Scheibel M, Audigé L, Bellmann F, Brune D, de Jong M, Diermayr S, Endell D, Etter M, Freislederer F, Gkikopoulos N, Glanzmann M, Grobet C, Jung C, Moro F, Moroder P, Ringer R, Schätz J, Schwyzer HK, Weber B, Wehrli M, Wirth B, Nötzli M, Franz A, Oswald J, Steiger B, Ameziane Y, Child C, Spagna G, Candrian C, Del Grande F, Feltri P, Filardo G, Marbach F, Schönweger F, Jost B, Badulescu M, Lüscher S, Napieralski F, Öhrström L, Olach M, Rechsteiner J, Scheler J, Spross C, Zdravkovic V, Zumstein MA, Chlasta A, Gerber K, Hayoz A, Müller-Lebschi J, Schuster F, Wieser K, Borbas P, Bouaicha S, Camenzind R, Catanzaro S, Gerber C, Grubhofer F, Hasler A, Hochreiter B, Marcus R, Selman F, Sutter R, Wyss S, Appenzeller-Herzog C, Aghlmandi S, Ahlborn I, Baum C, Eckers F, Grezda K, Hatz S, Hunziker S, Stojanov T, Taha M, Tamborrini-Schütz G, Mueller AM. Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon. Am J Sports Med 2024; 52:441-450. [PMID: 38259113 PMCID: PMC10838469 DOI: 10.1177/03635465231219253] [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: 06/16/2023] [Accepted: 10/02/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors-including age, sex, and tear severity-have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial. PURPOSE To investigate the influence of tear etiology (degenerative vs traumatic) on functional and structural outcomes in patients with supraspinatus tendon tears. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients undergoing ARCR from 19 centers were prospectively enrolled between June 2020 and November 2021. Full-thickness, nonmassive tears involving the supraspinatus tendon were included. Tears were classified as degenerative (chronic shoulder pain, no history of trauma) or traumatic (acute, traumatic onset, no previous shoulder pain). Range of motion, strength, the Subjective Shoulder Value, the Oxford Shoulder Score (OSS), and the Constant-Murley Score (CMS) were assessed before (baseline) and 6 and 12 months after ARCR. The Subjective Shoulder Value and the OSS were also determined at the 24-month follow-up. Repair integrity after 12 months was documented, as well as additional surgeries up to the 24-month follow-up. Tear groups were compared using mixed models adjusted for potential confounding effects. RESULTS From a cohort of 973 consecutive patients, 421 patients (degenerative tear, n = 230; traumatic tear, n = 191) met the inclusion criteria. The traumatic tear group had lower mean baseline OSS and CMS scores but significantly greater score changes 12 months after ARCR (OSS, 18 [SD, 8]; CMS, 34 [SD,18] vs degenerative: OSS, 15 [SD, 8]; CMS, 22 [SD, 15]) (P < .001) and significantly higher 12-month overall scores (OSS, 44 [SD, 5]; CMS, 79 [SD, 9] vs degenerative: OSS, 42 [SD, 7]; CMS, 76 [SD, 12]) (P≤ .006). At the 24-month follow-up, neither the OSS (degenerative, 44 [SD, 6]; traumatic, 45 [SD, 6]; P = .346) nor the rates of repair failure (degenerative, 14 [6.1%]; traumatic 12 [6.3%]; P = .934) and additional surgeries (7 [3%]; 7 [3.7%]; P = .723) differed between groups. CONCLUSION Patients with degenerative and traumatic full-thickness supraspinatus tendon tears who had ARCR show satisfactory short-term functional results. Although patients with traumatic tears have lower baseline functional scores, they rehabilitate over time and show comparable clinical results 1 year after ARCR. Similarly, degenerative and traumatic rotator cuff tears show comparable structural outcomes, which suggests that degenerated tendons retain healing potential.
Collapse
Affiliation(s)
- Cornelia Baum
- Investigation performed at University Hospital Basel, Basel and the Schulthess Klinik, Zurich, Switzerland
| | - Laurent Audigé
- Surgical Outcome Research Center, Department of Clinical Research, University Hospital of Basel, Basel, Switzerland; Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Thomas Stojanov
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland; Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Sebastian A. Müller
- Department of Orthopaedic and Trauma Surgery, Shoulder and Elbow, Cantonal Hospital Baselland, Bruderholz, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Christian Candrian
- Trauma and Ortho Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | | | - Andreas M. Müller
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sandra Weber
- Hôpital du Valais–Centre Hospitalier du Valais Romand, Martigny, CH
| | | | | | | | | | | | | | | | | | | | | | - Jakob Bräm
- Hirslanden Clinique la Colline, Geneva, CH
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Larissa Hübscher
- Institute of Social and Preventive Medicine, University of Bern, Bern, CH
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sabine Wyss
- University Library Basel, University of Basel, Basel, CH
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Schwank A, Struyf T, Struyf F, Blazey P, Mertens M, Gisi D, Pisan M, Meeus M. Are psychosocial variables, sleep characteristics or central pain processing prognostic factors for outcome following rotator cuff repair? A protocol for a prospective longitudinal cohort study. BMJ Open 2022; 12:e058803. [PMID: 35926993 PMCID: PMC9358941 DOI: 10.1136/bmjopen-2021-058803] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Prognosis following surgical rotator cuff repair (RCR) is often established through the assessment of non-modifiable biomedical factors such as tear size. This understates the complex nature of recovery following RCR. There is a need to identify modifiable psychosocial and sleep-related variables, and to find out whether changes in central pain processing influence prognosis after RCR. This will improve our knowledge on how to optimise recovery, using a holistic rehabilitation approach. METHODS AND ANALYSIS This longitudinal study will analyse 141 participants undergoing usual care for first time RCR. Data will be collected 1-21 days preoperatively (T1), then 11-14 weeks (T2) and 12-14 months (T3) postoperatively. We will use mixed-effects linear regression to assess relationships between potential prognostic factors and our primary and secondary outcome measures-the Western Ontario Rotator Cuff Index; the Constant-Murley Score; the Subjective Shoulder Value; Maximal Pain (Numeric Rating Scale); and Quality of Life (European Quality of Life, 5 dimensions, 5 levels). Potential prognostic factors include: four psychosocial variables; pain catastrophising, perceived stress, injury perceptions and patients' expectations for RCR; sleep; and four factors related to central pain processing (central sensitisation inventory, temporal summation, cold hyperalgesia and pressure pain threshold). Intercorrelations will be assessed to determine the strength of relationships between all potential prognostic indicators.Our aim is to explore whether modifiable psychosocial factors, sleep-related variables and altered central pain processing are associated with outcomes pre-RCR and post-RCR and to identify them as potential prognostic factors. ETHICS AND DISSEMINATION The results of the study will be disseminated at conferences such as the European Pain Congress. One or more manuscripts will be published in a peer-reviewed SCI-ranked journal. Findings will be reported in accordance with the STROBE statement and PROGRESS framework. Ethical approval is granted by the Ethical commission of Canton of Zurich, Switzerland, No: ID_2018-02089 TRIAL REGISTRATION NUMBER: NCT04946149.
Collapse
Affiliation(s)
- Ariane Schwank
- Rehabilitation Sciences and Physiotherapy, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Institute for Therapy and Rehabilitation, Kantonsspital Winterthur, Winterthur, Zurich, Switzerland
| | - Thomas Struyf
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Filip Struyf
- Rehabilitation Sciences and Physiotherapy, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - Paul Blazey
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michel Mertens
- Rehabilitation Sciences and Physiotherapy, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - David Gisi
- Institute for Therapy and Rehabilitation, Kantonsspital Winterthur, Winterthur, Zurich, Switzerland
| | - Markus Pisan
- Orthopaedics and Traumatology, Shoulder and Elbow Unit, Kantonsspital Winterthur, Winterthur, Zurich, Switzerland
| | - Mira Meeus
- Rehabilitation Sciences and Physiotherapy, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Department of Rehabilitation Sciences, University of Ghent, Ghent, Belgium
| |
Collapse
|
4
|
Müller U, Exadaktylos A, Roeder C, Pisan M, Eggli S, Jüni P. Effect of a flow chart on use of blood transfusions in primary total hip and knee replacement: prospective before and after study. BMJ 2004; 328:934-8. [PMID: 15087341 PMCID: PMC390213 DOI: 10.1136/bmj.328.7445.934] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [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] [Indexed: 11/04/2022]
Abstract
PROBLEM A suspected high proportion of unnecessary blood transfusions occur in patients undergoing total joint replacement. DESIGN Prospective before and after study evaluating the impact of a one page flow chart aimed at reducing the use of blood transfusions. SETTING Orthopaedic tertiary care centre in Winterthur, Switzerland. 208 patients underwent primary total joint replacement of hips or knees during the control period (October 1998 to September 1999) and 217 during the intervention period (October 1999 to September 2000). KEY MEASURES FOR IMPROVEMENT Proportion of patients receiving allogeneic blood transfusions. STRATEGIES FOR CHANGE A simple one page flow chart, which summarised graphically the perioperative decision pathways for anaemic patients, was placed in all charts of patients undergoing total joint replacement and handed out to medical staff from 4 October 1999 onwards. The implementation of the flow chart focused on its endorsement by chief physicians and the development of a sense of "ownership" among physicians and nurses. EFFECTS OF CHANGE The proportion of patients receiving allogeneic blood decreased from 35.0% to 19.8% (absolute difference -15.2%, 95% confidence interval -23.3 to -7.0%). The percentage of patients donating and receiving autologous blood also decreased. This led to overall savings of about 23,000 pounds sterling (42,470 dollars; 34,441 euros) (103.50 pounds sterlingper patient undergoing total joint replacement). Differences became more pronounced after adjustment for confounding factors. LESSONS LEARNT Allogeneic blood transfusions in primary hip and knee replacement surgery may be reduced cost effectively by implementing a one page flow chart. Five key elements may have contributed: simplicity; wide distribution; no requirement for major changes; endorsement by local opinion leaders; and development of a sense of ownership. These elements may be used in other contexts to achieve sustained change of clinical practice.
Collapse
Affiliation(s)
- Urs Müller
- Institute for Evaluative Research in Orthopaedic Surgery, University of Berne, 3001 Berne, Switzerland
| | | | | | | | | | | |
Collapse
|
6
|
Abstract
To analyse the value and accuracy of preoperative planning for total hip replacement (THR) we digitised electronically and compared the hand-sketched preoperative plans with the pre- and postoperative radiographs of 100 consecutive primary THRs. The correct type of prosthesis was planned in 98%; the agreement between planned and actually used components was 92% on the femoral side and 90% on the acetabular side. The mean (± SD) absolute difference between the planned and actual position of the centre of rotation of the hip was 2.5 ± 1.1 mm vertically and 4.4 ± 2.1 mm horizontally. On average, the inclination of the acetabular component differed by 7 ± 2° and anteversion by 9 ± 3° from the preoperative plans. The mean postoperative leg-length difference was 0.3 ± 0.1 cm clinically and 0.2 ± 0.1 cm radiologically. More than 80% of intraoperative difficulties were anticipated. Preoperative planning is of significant value for the successful performance of THR.
Collapse
Affiliation(s)
- S. Eggli
- Department of Orthopaedic Surgery, University of Bern, Inselspital, Murtenstrasse 35, 3010 Bern, Switzerland
| | - M. Pisan
- Department of Orthopaedic Surgery, University of Bern, Inselspital, Murtenstrasse 35, 3010 Bern, Switzerland
| | - M. E. Müller
- Department of Orthopaedic Surgery, University of Bern, Inselspital, Murtenstrasse 35, 3010 Bern, Switzerland
| |
Collapse
|