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Kim HG, Kim SC, Park JH, Kim JS, Kim DY, Lee SM, Yoo JC. Clinical and Structural Outcomes of Arthroscopic Rotator Cuff Repair in Patients Over 75 Years Are Comparable to Those in Younger Patients: A Propensity Score-Matched Comparative Study. Arthroscopy 2024; 40:1739-1750. [PMID: 37952745 DOI: 10.1016/j.arthro.2023.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To compare clinical and structural outcomes of arthroscopic rotator cuff repair (ARCR) in patients over 75 years and those under 75 years and to analyze the factors associated with retear and clinical outcomes after ARCR. METHODS This retrospective study reviewed patients who underwent ARCR between 2011 and 2021 with at least 2 years of follow-up. Using propensity score matching for sex, tear size, subscapularis involvement, and follow-up time, this study included 54 patients older than 75 years (group A) and 54 patients younger than 75 years (group B). Cuff integrity was evaluated using magnetic resonance imaging (MRI). Structural and clinical outcomes were compared between the 2 groups. RESULTS The mean improvements in external rotation (P = .030) and the American Shoulder and Elbow Surgeons (ASES) score (P = .043) were significantly higher in group A. Visual analog scales for pain and function, ASES score, and Constant score were significantly improved in both groups (all P = .001). On routine postoperative MRI at 6 months, the retear rate was 20.4% (11/54) in group A and 18.5% (10/54) in group B with no statistical difference between the 2 groups (P = .808). Factor analysis in group A showed that follow-up duration (P = .019), tear size in mediolateral dimension (P = .037), occupation ratio (P = .036), and incomplete repair (P = .034) were associated with retear, and mild glenohumeral arthritis (P = .003) and subscapularis involvement (P = .018) were associated with inferior Constant score. CONCLUSIONS Clinical and structural outcomes after ARCR in patients aged 75 years or older are comparable to those in patients younger than 75 years. LEVEL OF EVIDENCE Level III, retrospective case-control study.
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Affiliation(s)
- Hyun Gon Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Su Cheol Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jong Hun Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jae Soo Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Dae Yeung Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea.
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2
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Martin JR, Castaneda P, Kisana H, McKee MD, Amini MH. Preoperative Patient-Reported Outcomes Predict Postoperative Clinical Outcomes Following Rotator Cuff Repair. Arthroscopy 2024; 40:1445-1452. [PMID: 37865130 DOI: 10.1016/j.arthro.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE To determine whether preoperative patient-reported outcomes (PROs) predict postoperative PROs and satisfaction following rotator cuff repair. METHODS We retrospectively identified patients who underwent a primary rotator cuff repair at a single institution. A receiver operating characteristics analysis was used to reach a preoperative American Shoulder and Elbow Surgeons (ASES) score threshold predictive of postoperative ASES and satisfaction scores. We evaluated patients above and below the receiver operating characteristics threshold by comparing their final ASES scores, ASES change (Δ) from baseline, percent maximum outcome improvement, and achievement of minimum clinically important differences, substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS). Fischer exact tests were used to analyze categorical data, and continuous data were analyzed using t-test. RESULTS A total of 348 patients who underwent rotator cuff repair were included in this study. The preoperative ASES value predictive of achieving SCB was 63 (area under the curve, 0.75; 95% confidence interval: 58-67; P < .001). Patients with preoperative ASES less than 63 were significantly more likely to achieve MCID (odds ratio [OR]: 4.7, P < .001) and SCB (OR:6.1, P < .001) and had significantly higher percent maximum outcome improvement (63% vs 41%; P = 0.003) and Δ ASES scores (36 vs 12; P < .001). However, patients with preoperative ASES scores above 63 had significantly higher final ASES scores (86 vs 79; P = .003), were more likely to achieve PASS (59% vs 48%; P = .045), and had higher satisfaction scores (7.4 vs 6.7; P = .024). CONCLUSIONS Patients with high preoperative ASES scores achieve less relative improvement; however, these patients may be more likely to achieve PASS and may have higher satisfaction scores postoperatively. LEVEL OF EVIDENCE: Level III, retrospective comparative prognostic trial.
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Affiliation(s)
- John R Martin
- University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
| | - Paulo Castaneda
- University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
| | - Haroon Kisana
- University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
| | - Michael D McKee
- University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
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3
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Shin KH, Jang IT, Han SB. Comparison of En Masse Repair versus Separate Double-Layer Repair for Delaminated Rotator Cuff Tears: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1393. [PMID: 38592671 PMCID: PMC10934360 DOI: 10.3390/jcm13051393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/11/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Delamination of cuff tendons has a negative impact on outcomes following arthroscopic rotator cuff repair (RCR). The purpose of this study is to compare en masse repair (EMR) and separate double-layer repair (SDLR) for delaminated rotator cuff tears. METHODS A systematic literature search was conducted on major databases (MEDLINE/PubMed, EMBASE, Cochrane Library, and Scopus) until 1 June 2023. Comparative studies with a minimum 24-month follow-up of patients undergoing arthroscopic RCR for delaminated tears were included. The outcomes assessed retear rates and functional outcomes. RESULTS Five eligible studies involving 325 cases were analyzed. The meta-analysis showed no significant difference in retear rates between SDLR and EMR for delaminated tears (OR = 0.73, 95% CI: 0.35-1.49). However, the meta-analysis demonstrated a significant intergroup difference in favor of the SDLR for the total Constant score (SMD = 0.68, 95% CI: 0.35 to 1.02), SST score (SMD = 0.37, 95% CI: 0.02 to 0.71), and postoperative range of abduction (SMD = 0.34, 95% CI: 0.03 to 0.64). CONCLUSION The evidence suggests that the SDLR in arthroscopic RCR for delaminated rotator cuff tears leads to improved short-term functional outcomes and range of motion compared to EMR. However, there is no significant difference in retear risk between the two approaches.
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Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopedic Surgery, Yeson Hospital, Bucheon 14555, Republic of Korea
| | - Il-Tae Jang
- Department of Neurosurgery, Gangnam Nanoori Hospital, Seoul 06048, Republic of Korea;
| | - Seung-Beom Han
- Department of Orthopedic Surgery, Anam Hospital, College of Medicine, Korea University, Seoul 02841, Republic of Korea;
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Shin KH, Kim JU, Jang IT, Han SB. Effect of Bone Marrow Stimulation on Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis. Orthop J Sports Med 2024; 12:23259671231224482. [PMID: 38282788 PMCID: PMC10812110 DOI: 10.1177/23259671231224482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/16/2023] [Indexed: 01/30/2024] Open
Abstract
Background Arthroscopic rotator cuff repair (RCR) is a common orthopaedic procedure, but it has a high rate of retears that can negatively affect the functional outcomes. Bone marrow stimulation (BMS) has been suggested as an additional treatment to improve the outcomes of RCR. Purpose To compare the effectiveness of the BMS procedure during RCR with conventional RCR. Study Design Systematic review; Level of evidence, 2. Methods A systematic literature search was conducted in MEDLINE/PubMed, Embase, Cochrane Library, and Scopus, on March 1, 2023, for studies comparing postoperative retear rates and functional outcomes between patients who underwent primary arthroscopic RCR with and without the BMS procedure. Only level 1 and 2 randomized controlled trials with a minimum 12-month follow-up were included. The primary outcomes were retear rates and functional outcomes as measured by the Constant; American Shoulder and Elbow Surgeons (ASES); and University of California, Los Angeles (UCLA) scores and by postoperative range of motion. Subgroup analyses were performed based on repair technique (single-row repair vs double-row or suture-bridge repair). The standardized mean difference (SMD) and odds ratio (OR) were utilized to synthesize continuous and dichotomous outcomes, respectively. Homogeneity was evaluated using the chi-square test and I2 statistic. Results The literature search yielded 661 articles, of which 6 studies (522 patients; 261 with BMS, 261 without BMS) met the eligibility criteria. The combined analysis showed no significant decrease in retear rates with the utilization of the BMS procedure during RCR (OR, 0.60; 95% CI, 0.35 to 1.03; P = .07; I2 = 24%). There was no significant intergroup difference in functional outcomes (Constant score: SMD, 0.13; 95% CI, -0.04 to 0.31; P = .13; I2 = 0%; ASES score: SMD, 0.04; 95% CI, -0.20 to 0.28; P = .73; I2 = 0%; UCLA score: SMD, -0.13; 95% CI, -0.50 to 0.23; P = .47; I2 = 0%). Subgroup analyses revealed no significant differences in postoperative retear risk or total Constant score according to the repair technique. Conclusion Based on the available evidence, this systematic review did not find a significant benefit of the BMS procedure at the footprint during arthroscopic RCR compared with conventional RCR in terms of retear rates and functional outcomes at short-term follow-up.
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Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopedic Surgery, Incheon Nanoori Hospital, Incheon, South Korea
| | - Jin-Uk Kim
- Department of Orthopedic Surgery, Incheon Nanoori Hospital, Incheon, South Korea
| | - Il-Tae Jang
- Nanoori Medical Research Institute, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
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Barbosa F, Titchener A, Tambe A, Espag M, Cresswell T, Clark D. Clinical Outcomes of Arthroscopic Revision Rotator Cuff Repair. Indian J Orthop 2023; 57:490-494. [PMID: 36825272 PMCID: PMC9941391 DOI: 10.1007/s43465-022-00811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/22/2022] [Indexed: 02/15/2023]
Abstract
Aims Multiple studies have shown excellent clinical results in primary rotator cuff repairs; however, not much evidence is available in the literature on the outcomes of arthroscopic revision rotator cuff repairs. The purpose of this study was to report a cohort of patients who underwent revision arthroscopic rotator cuff repair and identify factors that may influence its outcomes. Methods We examined a cohort of 62 patients which underwent revision arthroscopic rotator cuff repair in a single UK institution with a minimum of 24 months follow-up. Active shoulder movements including forward flexion, abduction and external rotation were evaluated, as well as Oxford Shoulder Score (OSS). Further subgroup analysis was performed looking of the effects of age, size of tear, obesity and diabetes mellitus had on clinical outcomes. Results 59 patients were available for final review. 39 male and 23 were female. The mean age was 64 years. Overall, significant improvements were seen in terms of OSS (p < 0.05), active forward flexion (p < 0.05), active abduction (p < 0.05) and active external rotation (p < 0.05). Our study showed that a significant proportion of patients undergoing arthroscopic revision rotator cuff repair achieve good outcomes. Repairing small- and medium-size tears was successful, diabetics had no post-operative improvements, obese patients achieved significant improvement in range of movement and age was not a predictor of surgical success. Conclusion Overall, arthroscopic revision surgery is a successful option; however, appropriate patient selection and counselling is paramount.
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Affiliation(s)
- Francisco Barbosa
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE UK
| | - Andrew Titchener
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE UK
| | - Amol Tambe
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE UK
| | - Marius Espag
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE UK
| | - Tim Cresswell
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE UK
| | - David Clark
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE UK
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Migliorini F, Maffulli N, Eschweiler J, Schenker H, Tingart M, Betsch M. Arthroscopic versus mini-open rotator cuff repair: A meta-analysis. Surgeon 2023; 21:e1-e12. [PMID: 34961701 DOI: 10.1016/j.surge.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 10/22/2021] [Accepted: 11/05/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND An all-arthroscopic rotator cuff repair (ASR) may result in less postoperative pain and better functional outcomes than the mini-open (MOR) approach. This meta-analysis provides an updated assessment of the current literature which compares the clinical outcomes of mini-open versus all arthroscopic rotator cuff repair techniques. MATERIAL AND METHODS The main online databases were accessed in October 2021. All the trials directly comparing primary ASR versus MOR for rotator cuff rupture were accessed. Studies concerning revision settings were not eligible, nor where those combining the surgical procedures with other adjuvants. RESULTS A total of 21 articles were retrieved. Data from 1644 procedures (ASR = 995, MOR = 649) were collected. The mean follow-up was 26.7 (6.0-56.4) months. Comparability was found between ASR and MOR groups at baseline with regards to age (P = 0.3), gender (P = 0.7) and mean duration of the follow-up (P = 0.7). No difference was found between ASR and MOR with regard to surgical duration (P = 0.05), Constant score (P = 0.2), University of California at Los Angeles Shoulder (P = 0.3), American Shoulder and Elbow Surgeons Shoulder (P = 0.5), VAS (P = 0.2), forward flexion (P = 0.3), abduction (P = 0.3), external rotation (P = 0.2), internal rotation (P = 0.7), re-tear (P = 0.9), adhesive capsulitis (P = 0.5). CONCLUSION Arthroscopic and mini-open rotator cuff repair result in similar clinical outcomes. Male gender and older age lead to greater rates of rotator cuff re-tears, while longer surgical duration was associated with a greater rate of adhesive capsulitis.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi 84081, SA, Italy; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England, UK; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, UK.
| | - Joerg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Hanno Schenker
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Markus Tingart
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of the University Heidelberg, Mannheim, Germany.
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Lapner P, Bouliane M, Pollock JW, Coupal S, Sabri E, Hodgdon T, Old J, Mcilquham K, MacDonald P, Stranges G, Berdusco R, Marsh J, Dubberley J, McRae S. Intraoperative Channeling in Arthroscopic Rotator Cuff Repair: A Multicenter Randomized Controlled Trial. Am J Sports Med 2023; 51:323-330. [PMID: 36453726 DOI: 10.1177/03635465221138562] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Despite recent advances in arthroscopic rotator cuff repair, the retear rate remains high. New methods to optimize healing rates must be sought. Bone channeling may create a quicker and more vigorous healing response by attracting autologous mesenchymal stem cells, cytokines, and growth factors to the repair site. HYPOTHESIS Arthroscopic rotator cuff repair with bone channeling would result in a higher healing rate compared with arthroscopic rotator cuff repair without adjuvant channeling. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Our primary objective was to compare healing rates in patients undergoing arthroscopic rotator cuff repair for degenerative tears, with and without bone channeling. Secondary objectives included comparisons of the Western Ontario Rotator Cuff Index (WORC) score, American Shoulder and Elbow Surgeons (ASES) score, Constant score, Constant strength subscore, and visual analog scale (VAS) for pain score between groups. Patients undergoing arthroscopic rotator cuff repair were recruited at 3 sites and were randomized to receive either bone channeling augmentation or standard repair. Healing was determined via ultrasound at 24 months postoperatively. WORC, ASES, and Constant scores were compared between groups at baseline and at 3, 6, 12, and 24 months postoperatively. RESULTS A total of 168 patients were enrolled between 2013 and 2018. Intention-to-treat analysis revealed no statistical differences in healing rates between the 2 interventions at 24 months postoperatively. Statistically significant improvements occurred in both groups from preoperatively to all time points for the WORC, the ASES score, the Constant score or Constant strength subscore, and the VAS for pain (P < .0001). No differences were observed between the bone channeling and control groups in WORC, ASES, Constant, and VAS pain scores at any time point. CONCLUSION This trial did not demonstrate the superiority of intraoperative bone channeling in rotator cuff repair over standard rotator cuff repair at 24 months postoperatively. Healing rates, patient-reported function, and quality-of-life outcomes were similar between groups. REGISTRATION NCT01877772 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Peter Lapner
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Martin Bouliane
- Glen Sather Sports Medicine Clinic, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - J W Pollock
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephanie Coupal
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Elham Sabri
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Taryn Hodgdon
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Jason Old
- Department of Orthopaedics & The Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Katie Mcilquham
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa
| | - Peter MacDonald
- Department of Orthopaedics & The Pan Am Clinic, University of Manitoba, Winnipeg, Canada
| | - Greg Stranges
- Pan Am Clinic, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Randa Berdusco
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jonathan Marsh
- Pan Am Clinic, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Dubberley
- Pan Am Clinic, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheila McRae
- Pan Am Clinic, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Investigation performed at The Ottawa Hospital, Ottawa, Ontario, Canada; the Glen Sather Sports Medicine Clinic, Edmonton, Alberta, Canada; and the Pan Am Clinic, Winnipeg, Manitoba, Canada
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8
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Erşen A, Şahin K, Albayrak MO. Older age and higher body mass index are independent risk factors for tendon healing in small- to medium-sized rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2023; 31:681-690. [PMID: 36399192 DOI: 10.1007/s00167-022-07234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Many previous research efforts have been made to identify prognostic factors for rotator cuff healing. However, majority of these studies were conducted with heterogeneous cohorts consisted of different tear characteristics. Healing properties of a rotator cuff tear may differ depending on tear characteristics such as tear size or fatty infiltration. Therefore, studies with subgroups confined by these variables may reflect more accurate results. This study aims to investigate predictive factors for rotator cuff healing in a subgroup with small- to medium-sized tears without significant fatty infiltration. METHODS This retrospective case-control study was conducted with 94 patients with small- to medium-sized rotator cuff tears. Mean age of patients was 56.0 ± 9.0 years and mean follow-up duration was 38.3 ± 8.1 months. Post-operative magnetic resonance imaging assessment showed that there were 75 (79.8%) successfully healed repairs and 19 (20.2%) healing failures. Age, gender, hand dominancy, body mass index (BMI), smoking habit, diabetes, corticosteroid injection, baseline clinical status, duration of surgery and biceps procedure were variables evaluated as predictive factors. RESULTS Both study groups showed significant improvement from baseline regarding clinical outcome measures (p < 0.05). However, successfully healed patients had significantly higher post-operative functional scores and lower pain scores (p < 0.05). The univariate analysis revealed that healing was significantly affected by age (p = 0.004), BMI (p = 0.01) and diabetes (p = 0.03). In the multivariate analysis, age (p = 0.02) and BMI (p = 0.02) were found to be significant independent factors for healing. Cutoff values for oldest age and highest BMI were 63 years and 28.1 kg/m2, respectively, for a successful healing according to receiver-operating characteristic curve analysis. CONCLUSION Healing failure after rotator cuff repair in small- to medium-sized tears is associated with poorer outcomes. Age and BMI are independent predictive factors for healing. A successful repair is more likely in patients younger than 63 years and with BMI less than 28.1 kg/m2. Surgeons should consider this information during risk assessment, decision making and patient counselling. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ali Erşen
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, Istanbul, Turkey
| | - Koray Şahin
- Faculty of Medicine, Department of Orthopedics and Traumatology, Bezmialem Vakif University, Topkapi Adnan Menderes Bulvari, 34093, Fatih, Istanbul, Turkey.
| | - Muhammed Oğuzhan Albayrak
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, Istanbul, Turkey
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9
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Meng C, Jiang B, Liu M, Kang F, Kong L, Zhang T, Wang C, Wang J, Han C, Ren Y. Repair of rotator cuff tears in patients aged 75 years and older: Does it make sense? A systematic review. Front Public Health 2023; 10:1060700. [PMID: 36733288 PMCID: PMC9887178 DOI: 10.3389/fpubh.2022.1060700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023] Open
Abstract
Background Rotator cuff injuries are common, and morbidity increases with age. The asymptomatic full-thickness tear rate is 40% in the over 75-year-old population. Purpose This study aimed to systematically review the literature on the outcomes of rotator cuff repair among >75 years old patients. Study design Systematic review. Methods A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search was performed in the electronic databases of PubMed, Medline, Embase, and The Cochrane Library. Studies in English evaluating repair of full-thickness rotator cuff tears in patients aged >75 years were included. Results Six studies were reviewed, including 311 patients (313 shoulders) treated with arthroscopic and/or open rotator cuff repair. Sixty-one patients were lost to follow-up, leaving 252 shoulders with outcome data. Patients in this age group demonstrated a significant improvement in the clinical and functional scores after rotator cuff repair, with a high satisfaction rate. The mean American Shoulder and Elbow Surgeons scores improved from 43.8 (range, 42.0-45.5) preoperatively to 85.3 (range, 84.0 to 86.5) postoperatively, and the mean Constant scores improved from 45.4 (range, 34.7-55.5) to 78.6 (range, 67.0-91.6). Pain, evaluated in all studies by the visual analog scale for pain, showed a significant improvement at the last follow-up compared with the mean preoperative score. Furthermore, range of motion and return to daily activities and sports gained marked improvements. Conclusion Rotator cuff repair in patients aged >75 years could achieve high clinical success rates with good outcomes and pain relief. Although patients in this age group are at a high risk of retear, rotator cuff repair may offer a good option with significant functional and clinical improvement.
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Affiliation(s)
- Chenyang Meng
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Boyong Jiang
- Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Ming Liu
- Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Fujia Kang
- Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Lingyue Kong
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Ting Zhang
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Caixia Wang
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Jingjuan Wang
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Changxu Han
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China,*Correspondence: Changxu Han ✉
| | - Yizhong Ren
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China,Yizhong Ren ✉
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10
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Green A, Loyd K, Molino J, Evangelista P, Gallacher S, Adkins J. Long-term functional and structural outcome of rotator cuff repair in patients 60 years old or less. JSES Int 2022; 7:58-66. [PMID: 36820436 PMCID: PMC9937847 DOI: 10.1016/j.jseint.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background The long-term outcomes of rotator cuff repair (RCR) have not been well studied. The purpose of this study was to evaluate long-term functional and structural outcomes after RCR in younger patients. Methods A total of 49 patients (34 [69%] male) with a mean age of 51 ± 6 years were evaluated preoperatively, and at short- and long-term follow-ups (minimum 15 years). There were 13 (27%) small, 17 (35%) medium, 14 (29%) large, and 5 (10%) massive tears. 15 (31%) had an acute repair of a traumatic tear. Long-term evaluation included physical examination, plain radiographs, ultrasound, and patient reported outcome measures (PROMs) (visual analog scale pain, Disability of Arm, Shoulder and Hand, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, and Short Form-36). Statistical analysis was performed to determine associations between preoperative and intraoperative factors and long-term functional and structural outcome. Results There were significant improvements in the mean short- and long-term PROMs compared to preoperatively that exceeded reported minimal clinically important differences and substantial clinical benefits. There was a slight decrease in the PROMs from the short-term to long-term follow-up. Male sex and traumatic rotator cuff tears were associated with better long-term outcomes. The number of medical co-morbidities was associated with worse long-term outcomes. Smaller initial tear size was associated with better long-term outcomes. There were 15 (31%) full thickness and 9 (18%) partial thickness recurrent rotator cuff tears, 17 (35%) had rotator cuff tear arthropathy (2 Hamada grade 1, 15 Hamada grade 2), 5 (10%) had revision surgery (2 revision RCR, 2 anatomic total shoulder, and 1 reverse total shoulder), and 13 (26%) had subsequent contralateral RCR. There were weak correlations between the presence of arthropathy and DASH (r = 0.34; P = .02) and visual analog scale pain (r = 0.29; P = .049). There were no significant correlations between the structural outcomes (recurrent rotator cuff tear, recurrent full thickness tear, acromiohumeral space, and critical shoulder angle,) and the PROMs. Discussion and Conclusion Long-term follow-up of RCR in this relatively young patient cohort demonstrated substantial and durable patient reported functional outcome and improvement despite considerable structural deterioration. This suggests that while RCR does not arrest the progression of rotator cuff disease it may delay this progression and that patients adapt to the structural changes as they age.
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Affiliation(s)
- Andrew Green
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA,Corresponding author: Andrew Green, MD, Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA.
| | - Kelsey Loyd
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Janine Molino
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Peter Evangelista
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Stacey Gallacher
- Advanced Orthopedics and Sports Medicine Institute, Freehold, NJ, USA
| | - Jacob Adkins
- Warren Alpert Medical School, Brown University, Providence, RI, USA
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11
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Association between functional outcome scores and MRI-based structural integrity after rotator cuff repair: a prospective cohort study. Arch Orthop Trauma Surg 2022; 142:1117-1123. [PMID: 34019146 DOI: 10.1007/s00402-021-03938-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 05/02/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Natural history of rotator cuff tears is poorly understood. Repair of rotator cuff tears has shown to improve functional outcomes in full-thickness tears. However, high re-tear rates have been reported in literature, which does not correlate with poorer outcomes. Primary aim of this study was to explore association between functional outcome scores and structural integrity of rotator cuff, using magnetic resonance imaging (MRI)-based grading. METHODS Patients with MRI-proven full-thickness rotator cuff tears, undergoing mini-open rotator cuff repair, were assessed for shoulder abduction strength and functional outcome scores before the surgery and 2 years after the procedure. Association between functional outcome scores and MRI grading for rotator cuff healing (Sugaya grading) was analyzed. RESULTS A total of 38 patients (18 females and 20 males), with a mean age of 50.6 years (SD: 10.9), were included in the study. Mean duration of symptoms was 6.05 months (SD: 4.2). On postoperative MRI, healing of the cuff was categorized as Sugaya grade 1 in 12 patients, grade 2 in 20 patients and grade 3 in 6 patients. Higher Sugaya grades (T: 13.48, p: 0.001) and grades of fatty degeneration (T: 14.05, p: 0.001) were found to be associated with longer duration of symptoms. Improvement in shoulder abduction strength correlated negatively with the duration of symptoms (r: -0.39, p: 0.01). There was a significant improvement in functional outcome scores after the surgery. There was no association between postoperative structural integrity of the repaired tendon (Sugaya grading) and functional outcome scores. CONCLUSION Early repair of rotator cuff results in better functional outcomes and shoulder strength. The findings from this study suggest there is a dissociation between MRI-based grades of healing of repaired rotator cuff and function of the shoulder. STUDY DESIGN Level II, Prospective cohort study.
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12
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de Andrade ALL, Garcia TA, Brandão HDS, Sardeli AV, Mouraria GG, Belangero WD. Benefits of Patch Augmentation on Rotator Cuff Repair: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671211071146. [PMID: 35360882 PMCID: PMC8961381 DOI: 10.1177/23259671211071146] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Despite technological advances, the overall retear rate on rotator cuff
repair is still high. Patches have shown significant reduction in retear
rate and pain scores; however, this is not a universal finding and
conflicting results have been shown among functional shoulder scales. Purpose: To analyze previous controlled trials of the literature to bring a consensus
about the effectiveness of patch use on rotator cuff repair. Study Design: Systematic review; Level of evidence, 1. Methods: The search was conducted in PubMed, Web of Science, EMBASE, Scopus, and
Cochrane in April 2020. The results of rotator cuff repair with patch
augmentation versus without augmentation (control) were compared through
odds ratio (OR), raw mean difference (RMD), and standardized mean difference
(SMD) of retear rate; functional shoulder scales; strength; and range of
motion (ROM). Results: Of 733 initial studies, 7 of them met the criteria to be included in the
analysis. Compared with the control group, the patch augmentation group had
a significantly lower retear rate (OR, 0.32 [95% CI, 0.18 to 0.55];
P < .001), lower pain (SMD, –0.42 [–0.71 to –0.12];
P < .01), a higher University of California Los
Angeles Shoulder Rating Scale (RMD, 0.87 [0.15 to 1.60], P
= .017), and a trend toward higher strength (SMD, 0.95 [–0.03 to 1.94],
P = .05) and lower forward elevation ROM (RMD, –10.50
[–21.86 to 0.67]; P = .06), while no changes were noted for
other functional scales or for internal and external rotation ROM. Conclusion: The results point to benefits of patch augmentation in rotator cuff repair,
particularly a reduction in retear rate. More interventional studies with
better methodological quality should be conducted to confirm the results of
this initial review.
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Affiliation(s)
| | - Thiago Alves Garcia
- Orthopaedic Biomaterials Laboratory (LABIMO), School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | | | - Amanda Veiga Sardeli
- Exercise Physiology Laboratory, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
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13
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Kothandaraman V, Kunkle B, Reid J, Oldenburg KS, Johnson C, Eichinger JK, Friedman RJ. Increased Risk of Perioperative Complications in Dialysis Patients Following Rotator Cuff Repairs and Knee Arthroscopy. Arthrosc Sports Med Rehabil 2021; 3:e1651-e1660. [PMID: 34977617 PMCID: PMC8689219 DOI: 10.1016/j.asmr.2021.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 07/24/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To determine the effects of dialysis on postoperative and perioperative complications following rotator cuff repair (RCR) and knee arthroscopy (KA). Methods The National Surgical Quality Improvement Program (NSQIP) was queried from 2006 to 2018. Groups were matched for age, sex, body mass index, smoking status, preoperative functional status, and the American Society of Anesthesiologists (ASA) status. Chi-squared tests and Fisher’s exact tests were used to analyze the comorbidities. Differences in occurrences of postoperative adverse events (AE), mortality within 30 days, reoperations with 30 days, extended hospital stay (≥2 days), and readmissions within 30 days were analyzed using the Mantel-Haenszel test. Sign tests were used to evaluate differences in operative time, as well as length of hospital stay. Results Dialysis patients in both the RCR and KA groups had greater odds of experiencing any AE (OR: 6.33 and 7.46, P value: .031 and <.001, respectively) and readmission within 30 days (OR: 10.5 and 4.1, P value: .015 and .014, respectively). They also had significantly greater operating times (P = .049 for both). Dialysis patients undergoing KA had greater odds of staying in the hospital ≥2 days (OR: 10, P = <.001) and being reoperated on within 30 days (OR: 3.78, P = .033). The total hospital stay was significantly greater for dialysis patients in the KA group (P < .001) but not in the RCR group (P = .088). None of the individual AE’s significantly differed between the dialysis and non-dialysis patients in the RCR cohort; however, dialysis patients in the KA cohort had greater incidences of three AE’s. Conclusions This study identified significantly worse short-term complication rates in dialysis patients undergoing RCR and KA. Careful preoperative evaluation and postoperative surveillance are warranted in this high-risk patient group. Patients should be counseled appropriately on the increased complication risks associated with RCR and KA surgeries. Level of Evidence Level III, retrospective cohort study.
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14
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Kang HJ, Park JS, Ryu KN, Rhee YG, Jin W, Park SY. Assessment of postoperative acromial and subacromial morphology after arthroscopic acromioplasty using magnetic resonance imaging. Skeletal Radiol 2021; 50:761-770. [PMID: 32978678 DOI: 10.1007/s00256-020-03607-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify the morphological characteristics of the acromion and subacromial bursal space after arthroscopic acromioplasty using magnetic resonance imaging (MRI). MATERIALS AND METHODS One hundred patients who received arthroscopic rotator cuff repair and acromioplasty each received at least three MRI examinations (preoperative, first immediate postoperative, and second follow-up imaging between 8 months and 1 year postoperatively). Changes over time in the thickness and morphology of the postoperative acromion as well as the subacromial bursal space were assessed. Clinical and radiological parameters were also analyzed to identify any association with changes in acromial morphology. RESULTS Despite minimal acromial thinning observed at the first immediate postoperative state, the acromions showed significant thinning at the second postoperative MRI, with a mean reduction of 32%. Along with acromial thinning, an exaggerated concave contour of the acromial undersurface was observed in some patients. In the subacromial space, a loculated fluid collection developed in 91% of the patients at the second postoperative follow-up. No statistically significant association was noted between postoperative acromial thickness change and clinical or radiological factors (P value > 0.05). CONCLUSION A significant delayed reduction in acromial thickness within approximately 1 year of arthroscopic acromioplasty is thought to be a normal postoperative feature. The simultaneous collection of a loculated, cyst-like fluid in the subacromial bursal space may be an important associated factor of postoperative acromial thinning.
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Affiliation(s)
- Hye Jin Kang
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, Republic of Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, Republic of Korea.
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, Republic of Korea
| | - Yong Girl Rhee
- Department of Orthopedic Surgery, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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15
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Aouad D, El Rassi G. Shoulder Arthroscopic Rotator Cuff Repair With Biceps Tenodesis and Acromioplasty Using a Single Working Portal. Arthrosc Tech 2021; 10:e1125-e1129. [PMID: 33981560 PMCID: PMC8085508 DOI: 10.1016/j.eats.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/08/2021] [Indexed: 02/03/2023] Open
Abstract
Rotator cuff repair, acromioplasty, and biceps tenodesis operations have become some of the most common shoulder surgical procedures, evolving from open techniques to minimally invasive arthroscopic techniques. The use of many arthroscopic portals has been associated with surgical risks to many surrounding anatomic structures. We present an arthroscopic technique using a single anterolateral working portal for rotator cuff repair, acromioplasty, distal clavicle excision, and long head of the biceps tenodesis; this technique decreases the risk of injury to the surrounding neurovascular and musculotendinous structures, enables a faster recovery, and is minimally invasive.
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Affiliation(s)
| | - George El Rassi
- Address correspondence to George El Rassi, M.D., Department of Orthopedic Surgery and Traumatology, Saint Georges University Medical Center, Balamand University, St Georges Street, Achrafieh, Beirut, Lebanon.
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16
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Moore ML, Pollock JR, McQuivey KS, Bingham JS. The Top 50 Most-Cited Shoulder Arthroscopy Studies. Arthrosc Sports Med Rehabil 2021; 3:e277-e287. [PMID: 33615275 PMCID: PMC7879187 DOI: 10.1016/j.asmr.2020.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/04/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose To determine the 50 most frequently cited studies in the orthopaedic shoulder arthroscopy literature and to conduct a bibliometric analysis of these studies. Methods The Clarivate Analytics Web of Knowledge database was used to gather data and metrics using Boolean queries to capture all possible iterations of shoulder arthroscopy research. The search list was sorted so that articles were organized in descending order based on the number of citations and included or excluded based on relevance to shoulder arthroscopy. The information extracted for each article included author name, publication year, country of origin, journal name, article type, and the level of evidence. Results For these 50 studies, the total number of citations was calculated to be 13,910, with an average of 278.2 citations per paper. The most-cited article was cited 1134 times, whereas the second- and third-most cited articles were cited 920 and 745 times, respectively. All 50 articles were published in English and came from 7 different orthopaedic journals. The United States was responsible for most of the included articles (31), followed by France (9) and Japan (3). Conclusions The majority of the most-cited articles in shoulder arthroscopy are case series and descriptive studies originating from the United States. In addition, more than one half of the top 50 most-cited studies were published after 2004, which suggests that article age may be less important in the accumulation of citations for a rapidly growing field like shoulder arthroscopy. Clinical Relevance The top 50 most-cited studies list will provide researchers, medical students, residents, and fellows with a foundational list of the most important and influential academic contributions to shoulder arthroscopy.
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Affiliation(s)
- M Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A
| | | | - Kade S McQuivey
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Joshua S Bingham
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A.,Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
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17
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Muniandy M, Niglis L, Claude Dosch J, Meyer N, Kempf JF, Collin P. Postoperative rotator cuff integrity: can we consider type 3 Sugaya classification as retear? J Shoulder Elbow Surg 2021; 30:97-103. [PMID: 32778379 DOI: 10.1016/j.jse.2020.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sugaya classification is a widely accepted classification system that is used to analyze postoperative rotator cuff tendon integrity. However, there are inconsistencies in the literature as to whether type 3 Sugaya should be considered as a retear or healed tendon. PURPOSE We aimed to show that type 3 Sugaya is not a retear by comparing the long-term supraspinatus and infraspinatus muscle degeneration and the functional outcomes of type 3 with those of type 4 and 5 Sugaya. We hypothesized that the clinical course of type 3 Sugaya would be different from type 4 or 5 Sugaya. METHOD The study was a retrospective multicenter review of all the rotator cuff repair done in 2003-2004. We included all the patients who had undergone supraspinatus repair with 10-year follow-up (magnetic resonance imaging done with full functional assessment). Data collection included pre- and postoperative supraspinatus and infraspinatus fatty infiltration, supraspinatus muscle atrophy, and Constant score with a separate analysis of its Strength subsection. Supraspinatus tendon integrity at 10-year follow-up was determined according to Sugaya classification. The patients were divided into 2 groups: type 3 Sugaya and type 4 and 5 Sugaya. Statistical comparison was done between the groups. RESULTS There was no significant difference in the preoperative fatty infiltration of the supraspinatus and infraspinatus, supraspinatus muscle atrophy, and Constant score between the 2 groups. However, type 3 Sugaya patients had significantly better scores in the preoperative Strength subsection. Postoperatively, type 3 Sugaya patients showed significantly lesser fatty infiltration of the supraspinatus and infraspinatus, lesser supraspinatus muscle atrophy, and higher Constant score compared with type 4 and 5 Sugaya (P < .001). CONCLUSION Patients with type 3 Sugaya supraspinatus tendon exhibited lesser muscle degeneration in the supraspinatus and infraspinatus and performed better in functional assessment compared with type 4 and 5 Sugaya patients. We inferred that type 3 Sugaya should not be considered as a retear.
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Affiliation(s)
| | - Lucas Niglis
- Service de chirurgie orthopédique du membre supérieur, CCOM, Illkirch, France
| | | | - Nicolas Meyer
- Laboratoire de biostatistique, hôpital civil, Strasbourg, France
| | - Jean Francois Kempf
- Service de chirurgie orthopédique du membre supérieur, CCOM, Illkirch, France
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18
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Kim W, Kim GE, Attia Abdou M, Kim S, Kim D, Park S, Kim YK, Gwon Y, Jeong SE, Kim MS, Kim J. Tendon-Inspired Nanotopographic Scaffold for Tissue Regeneration in Rotator Cuff Injuries. ACS OMEGA 2020; 5:13913-13925. [PMID: 32566858 PMCID: PMC7301599 DOI: 10.1021/acsomega.0c01328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
Acute and chronic rotator cuff (RC) tears are common etiologies of shoulder disabilities. Despite the advanced surgical techniques and graft materials available for tendon repair, the high re-tear rate remains a critical challenge in RC healing. Inspired by the highly organized nanotopography of the extracellular matrix (ECM) in tendon tissue of the shoulder, nanotopographic scaffolds are developed using polycaprolactone for the repair and regeneration of RC tendons. The scaffolds show appropriate flexibility and mechanical properties for application in tendon tissue regeneration. It is found that the highly aligned nanotopographic cues of scaffolds could sensitively control and improve the morphology, attachment, proliferation, and differentiation of tendon-derived cells as well as promote their wound healing capacity in vitro. In particular, this study showed that the scaffolds could promote tendon regeneration along the direction of the nanotopography in the rabbit models of acute and chronic RC tears. Nanotopographic scaffold-augmented rotator cuff repair showed a more appropriate healing pattern compared to the control groups in a rabbit RC tear model. We demonstrated that the tendon ECM-like nanoscale structural cues of the tendon-inspired patch may induce the more aligned tissue regeneration of the underlying tissues including tendon-to-bone interface.
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Affiliation(s)
- Woochan Kim
- Department
of Rural and Biosystems Engineering, Chonnam
National University, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
| | - Ga-Eon Kim
- Department
of Pathology, Chonnam National University
Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61649, Republic of Korea
| | - Mohamed Attia Abdou
- Department
of Orthopedics, Chonnam National University
Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61649, Republic of Korea
| | - Sujin Kim
- Department
of Rural and Biosystems Engineering, Chonnam
National University, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
| | - Daun Kim
- Department
of Rural and Biosystems Engineering, Chonnam
National University, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
| | - Sunho Park
- Department
of Rural and Biosystems Engineering, Chonnam
National University, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
| | - Yang-Kyung Kim
- Department
of Orthopedics, Chonnam National University
Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61649, Republic of Korea
| | - Yonghyun Gwon
- Department
of Rural and Biosystems Engineering, Chonnam
National University, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
| | - Sung-Eun Jeong
- Department
of Orthopedics, Chonnam National University
Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61649, Republic of Korea
| | - Myung-Sun Kim
- Department
of Orthopedics, Chonnam National University
Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61649, Republic of Korea
| | - Jangho Kim
- Department
of Rural and Biosystems Engineering, Chonnam
National University, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
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19
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Roth TS, Welsh ML, Osbahr DC, Varma A. Arthroscopic Single-Row Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears. Arthrosc Tech 2020; 9:e675-e681. [PMID: 32489844 PMCID: PMC7253793 DOI: 10.1016/j.eats.2020.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/25/2020] [Indexed: 02/03/2023] Open
Abstract
Massive, irreparable rotator cuff tears are challenging to manage. Often, these tears are not amenable to primary repair and necessitate additional treatment options. This is especially true in patients with absent glenohumeral arthritis in the setting of a massive, irreparable rotator cuff tear. Superior capsular reconstruction (SCR), originally described by Mihata using a fascia lata autograft, has grown in popularity for the treatment of irreparable rotator cuff tears as a salvage option with good clinical outcomes. More recently, SCR techniques have been described using dermal allograft. Biomechanical studies and reported clinical series show promising results, with favorable postoperative clinical outcomes. The procedure, however, may be technically challenging, especially when performed using an all-arthroscopic technique. This article describes an all-arthroscopic technique using a predetermined graft size, unique medial fixation to ease graft passage, and knotless single-row lateral fixation to optimize suture management and efficiency.
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Affiliation(s)
- Travis S. Roth
- American Sports Medicine Institute, Birmingham, Alabama, U.S.A.,Address correspondence to Travis S. Roth, M.D., M.S., American Sports Medicine Institute, 805 St. Vincent’s Dr, Birmingham, AL 35205, U.S.A.
| | - Matthew L. Welsh
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Daryl C. Osbahr
- Orlando Health Orthopedic Institute, Orlando, Florida, U.S.A
| | - Amit Varma
- Florida Sports Injury & Orthopaedic Institute, Clermont, Florida, U.S.A
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20
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Itoigawa Y, Wada T, Kawasaki T, Morikawa D, Maruyama Y, Kaneko K. Supraspinatus Muscle and Tendon Stiffness Changes After Arthroscopic Rotator Cuff Repair: A Shear Wave Elastography Assessment. J Orthop Res 2020; 38:219-227. [PMID: 31517408 DOI: 10.1002/jor.24469] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 09/03/2019] [Indexed: 02/04/2023]
Abstract
Re-tearing after arthroscopic rotator cuff repair (ARCR) frequently occurs, and high stiffness of the rotator cuff may be one of the factors. We investigated changes in stiffness of the supraspinatus muscle and tendon after ARCR as measured by shear wave elastography (SWE) with B-mode ultrasound, and compared the supraspinatus muscle stiffness of patients with recurrent tears and patients with healed rotator cuffs. Sixty patients with supraspinatus tears requiring ARCR underwent serial SWE of their supraspinatus muscles and repaired tendons. SWE was performed before surgery (Pre-Op) and at 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, and 6 months after surgery. Additionally, the repaired rotator cuffs were evaluated using magnetic resonance imaging at 6 months after surgery to classify patients into a healed rotator cuff group and a recurrent tear group. Differences in SWE values between the groups were assessed at each time point. The SWE value of the repaired tendon at 1 week after ARCR was significantly greater than at 3 and 6 months. The SWE value for the supraspinatus muscle at 1 month after ARCR surgery in the healed group was lower than at Pre-Op and 4, 5, and 6 months after surgery, and it was also lower than that at 1 month after surgery in the re-tear group. There were no significant differences between time points in the SWE values of the supraspinatus muscle in the re-tear group. The SWE value of the muscle in the re-tear group was greater than in the healed group at 1 month after surgery (p < 0.05). Increased SWE values at 1 month after ARCR may predict recurrent rotator cuff tears after surgery rather than evaluating the tendon. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:219-227, 2020.
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Affiliation(s)
- Yoshiaki Itoigawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 2790021, Japan
| | - Tomoki Wada
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 2790021, Japan
| | - Takayuki Kawasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 2790021, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 2790021, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Herring MJ, White M, Braman JP. The WORC Index and Predicting Treatment Failure in Patients Undergoing Primary Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2019; 7:2325967119859518. [PMID: 31384619 PMCID: PMC6664644 DOI: 10.1177/2325967119859518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Rotator cuff tears are common injuries that are reliably treated with
arthroscopic repair, producing good to excellent results. The Western
Ontario Rotator Cuff (WORC) index is a validated disease-specific instrument
used to assess patient outcomes; however, no study to date has correlated
WORC index with treatment failure. Purpose: To evaluate the WORC index as a predictor for successful treatment in
arthroscopic rotator cuff repair. An additional purpose was to identify
patient and tear characteristics associated with risk of treatment
failure. Study Design: Case-control study; Level of evidence, 3. Methods: This study reviewed a total of 500 patients who underwent arthroscopic
rotator cuff repair with a minimum of 2-year follow-up. Patient charts were
reviewed for treatment failures, defined as persistent or recurrent shoulder
pain or weakness, leading to further workup and identification of a failure
to heal or recurrent tear by magnetic resonance imaging. Patient demographic
and comorbidity data were gathered and correlated with risk of failure. All
patients completed WORC questionnaires, and scores were correlated with risk
of treatment failure. Results: There were 28 (5.6%) treatment failures at a median 28 weeks (SD, 42 weeks)
postoperatively. Patients claiming workers’ compensation were 3.21 times
more likely (odds ratio; P = .018) to fail treatment.
Posterior interval tears (those including infraspinatus) were 3.14 times
more likely (P = .01) to fail than anterior interval tears.
Tear size was associated with treatment failure; the odds of failure was
3.24 for a 2-tendon tear and 5.83 for a 3-tendon tear (P =
.03). Tears involving the nondominant arm were associated with an increased
risk of failure by a factor of 3.04 (95% CI, 1.01-9.11; P =
.047). A WORC score ≥80 was associated with a 95% probability of treatment
success at 1 year. Conclusion: After arthroscopic rotator cuff repair, patients with WORC scores ≥80 at 1
year have a 95% probability of successful treatment and likely do not
benefit from continued follow-up visits. Furthermore, several risk factors
were identified that may influence outcomes after rotator cuff repair,
including workers’ compensation, location of tear, tear size, and hand
dominance.
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Affiliation(s)
- Matthew J Herring
- Orthopaedic Trauma Institute (OTI), San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
| | - Melissa White
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonathan P Braman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Nicholson JA, Searle HKC, MacDonald D, McBirnie J. Cost-effectiveness and satisfaction following arthroscopic rotator cuff repair: does age matter? Bone Joint J 2019; 101-B:860-866. [PMID: 31256664 DOI: 10.1302/0301-620x.101b7.bjj-2019-0215.r1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIMS The aim of this study was to investigate the influence of age on the cost-effectiveness of arthroscopic rotator cuff repair. PATIENTS AND METHODS A total of 112 patients were prospectively monitored for two years after arthroscopic rotator cuff repair using the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), the Oxford Shoulder Score (OSS), and the EuroQol five-dimension questionnaire (EQ-5D). Complications and use of healthcare resources were recorded. The incremental cost-effectiveness ratio (ICER) was used to express the cost per quality-adjusted life-year (QALY). Propensity score-matching was used to compare those aged below and above 65 years of age. Satisfaction was determined using the Net Promoter Score (NPS). Linear regression was used to identify variables that influenced the outcome at two years postoperatively. RESULTS A total of 92 patients (82.1%) completed the follow-up. Their mean age was 59.5 years (sd 9.7, 41 to 78). There were significant improvements in the mean DASH (preoperative 47.6 vs one-year 15.3; p < 0.001) and OSS scores (26.5 vs 40.5; p < 0.001). Functional improvements were maintained with no significant change between one and two years postoperatively. The mean preoperative EQ-5D was 0.54 increasing to 0.81 at one year (p < 0.001) and maintained at 0.86, two years postoperatively. There was no significant difference between those aged below or above 65 years of age with regards to postoperative shoulder function or EQ-5D gains. Smoking was the only characteristic that significantly adversely influenced the EQ-5D at two years postoperatively (p = 0.005). A total of 87 were promoters and five were passive, giving a mean NPS of 95 (87/92). The total mean cost per patient was £3646.94 and the mean EQ-5D difference at one year was 0.2691, giving a mean ICER of £13 552.36/QALY. At two years, this decreased further to £5694.78/QALY. This was comparable for those aged below or above 65 years of age (£5209.91 vs £5525.67). Smokers had an ICER that was four times more expensive. CONCLUSION Arthroscopic rotator cuff repair results in excellent patient satisfaction and cost-effectiveness, regardless of age. Cite this article: Bone Joint J 2019;101-B:860-866.
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Affiliation(s)
- J A Nicholson
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - H K C Searle
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - D MacDonald
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - J McBirnie
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
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Wu KT, Chou WY, Ko JY, Siu KK, Yang YJ. Inferior outcome of rotator cuff repair in chronic hemodialytic patients. BMC Musculoskelet Disord 2019; 20:209. [PMID: 31084618 PMCID: PMC6515659 DOI: 10.1186/s12891-019-2597-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 04/30/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Repair of rotator cuff tears has yielded excellent functional outcomes in recent decades; however, poor outcomes and dissatisfaction have been noted in specific groups. Spontaneous tendon rupture has been reported in patients receiving long-term hemodialysis owing to alteration of tendon structure, which might impede functional recovery after rotator cuff repair. The purpose of the present study was to compare the clinical outcomes between hemodialysis and non-hemodialysis patients after rotator cuff repair. METHODS We retrospectively reviewed patients who underwent mini-open rotator cuff repair from Jan 2013 to Jan 2017. A total of 14 patients under chronic hemodialysis (HD) were matched to non-hemodialysis (NHD) patients at a 1:2 ratio according to age, gender, tear size, severity of fatty infiltration and history of diabetes. Pre- and post-operative functional outcome was assessed using the simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES), Shoulder Rating Scale of the University of California at Los Angeles (UCLA) and visual analog scale (VAS) scores. Clinical functional outcome at the last follow-up was adopted for comparison of the HD and NHD groups. RESULTS A total of 42 patients were enrolled in this comparative study, with a mean age of 66.64 ± 1.68 years in the HD group and 65.71 ± 5.40 years in the NHD group. At the final clinical assessment, the post-operative functional outcome was significantly improved in both groups (p < 0.001). However, the functional outcome of the HD group was significantly inferior to that of the NHD group in terms of the SST score (6.50 ± 2.24 vs 9.39 ± 1.87, p < 0.001), ASES score (63.17 ± 15.93 vs 86.96 ± 11.43, p < 0.001), UCLA score (20.14 ± 7.71 vs 29.82 ± 5.08, p < 0.001) and VAS score (3.00 ± 0.96 vs 1.21 ± 1.03, p < 0.001). CONCLUSION The improvement of pain and functional improvement of long-term hemodialysis patients were inferior to those of patients without hemodialysis after mini-open rotator cuff repair.
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Affiliation(s)
- Kuan-Ting Wu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital Medical Center, 123 Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Wen-Yi Chou
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital Medical Center, 123 Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan.
| | - Jih-Yang Ko
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital Medical Center, 123 Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ka-Kit Siu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital Medical Center, 123 Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Ya-Ju Yang
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital Medical Center, 123 Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
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Bailey JR, Kim C, Alentorn-Geli E, Kirkendall DT, Ledbetter L, Taylor DC, Toth AP, Garrigues GE. Rotator Cuff Matrix Augmentation and Interposition: A Systematic Review and Meta-analysis. Am J Sports Med 2019; 47:1496-1506. [PMID: 29906191 DOI: 10.1177/0363546518774762] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical management of rotator cuff tears is controversial and complex, ranging from nonoperative management to reverse shoulder arthroplasty. PURPOSE To systematically review and evaluate the outcomes of graft augmentation or interposition versus rotator cuff repair (RCR) alone and evaluate via meta-analysis whether the use of a graft leads to superior outcomes versus RCR alone. STUDY DESIGN Systematic review and meta-analysis. METHODS An electronic literature search (Medline, Embase, CINAHL) was conducted. Studies with a minimum follow-up of 1 year and minimum sample size of 10 that provided clinical results of RCR or rotator cuff reconstruction using any type of augmentation tissue or matrix were included. Methodological quality was evaluated by assessment of the risk of bias in the included studies. Studies comparing outcomes of RCR with graft augmentation or interposition versus repair alone (control group) were subjected to meta-analysis. RESULTS The authors identified 774 articles and included 36 in the systematic review; 5 of the 36 studies underwent meta-analysis. Except for one outcome measure in a single study, all surgical interventions (RCR alone, RCR with augmentation, and RCR with interposition) improved clinical scores and outcome measures. Because of variability in study outcomes, no graft option was found to be superior. Compared with RCR alone, graft augmentation or interposition provided significantly lower retear rates ( P = .05) and higher American Shoulder and Elbow Surgeons (ASES) scores ( P = .005), but improvements in UCLA (University of California, Los Angeles) scores ( P = .29) and pain scores ( P = .1) did not reach statistical significance. CONCLUSION In the meta-analysis, graft augmentation or interposition appeared to provide a lower retear rate and improved ASES scores when compared with RCR alone. Future prospective, randomized, controlled, and appropriately powered trials are needed for more definitive recommendations.
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Affiliation(s)
- James R Bailey
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher Kim
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Eduard Alentorn-Geli
- Fundación García-Cugat, Artroscopia GC, Hospital Quirón, and Mutualidad Catalana de Futbolistas, Barcelona, Spain
| | - Donald T Kirkendall
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Leila Ledbetter
- Duke University Medical Center Library, Duke University Medical Center, Durham, North Carolina, USA
| | - Dean C Taylor
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Alison P Toth
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Grant E Garrigues
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Itoigawa Y, Maruyama Y, Kawasaki T, Wada T, Yoshida K, An KN, Kaneko K. Shear Wave Elastography Can Predict Passive Stiffness of Supraspinatus Musculotendinous Unit During Arthroscopic Rotator Cuff Repair for Presurgical Planning. Arthroscopy 2018; 34:2276-2284. [PMID: 29685838 DOI: 10.1016/j.arthro.2018.01.059] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/21/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine the feasibility of shear wave elastography (SWE) with B-mode ultrasound in predicting the stiffness of the rotator cuff muscle before arthroscopic rotator cuff repair to evaluate the difficulty of the surgical procedure, as well as to compare SWE with the Goutallier stage on magnetic resonance imaging (MRI). METHODS Thirty-eight patients with a full-thickness supraspinatus tear requiring arthroscopic rotator cuff repair participated. The Goutallier stage of fatty infiltration on MRI was measured before surgery, as was the SWE modulus of the anterior superficial, anterior deep, posterior superficial, and posterior deep (PD) regions of the supraspinatus muscle. To measure the stiffness of the supraspinatus musculotendinous unit during surgery, the supraspinatus tendon was axially stretched until the anatomic insertion site was reached, and force per deformation was recorded. The correlation between stiffness of the supraspinatus and SWE value in each region of the supraspinatus muscle or Goutallier stage was determined. In addition, patients were divided into 2 groups: (1) In the complete footprint coverage group, greater than 50% of the footprint was covered during the stiffness measurement, and (2) in the incomplete footprint coverage group, less than 50% of the footprint was covered during the stiffness measurement. Differences in SWE value and Goutallier stage were measured between the 2 groups. RESULTS The best correlation of stiffness with the SWE modulus of the PD muscle of the supraspinatus was R = 0.69, and the correlation of stiffness with the Goutallier stage on MRI was R = 0.48. The SWE value of the PD region was greater in the incomplete footprint coverage group than in the complete footprint coverage group, although the Goutallier stage was not significantly different. CONCLUSIONS The highest correlation with stiffness of the supraspinatus musculotendinous unit was with the SWE modulus of the PD muscle, as compared with SWE evaluation of the other regions or the Goutallier stage on MRI. Ultrasound SWE can predict the stiffness of the supraspinatus musculotendinous unit best. CLINICAL RELEVANCE Rotator cuff retraction adds difficulty to arthroscopic rotator cuff repair. Ultrasound SWE may be used for presurgical planning.
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Affiliation(s)
- Yoshiaki Itoigawa
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan.
| | - Yuichiro Maruyama
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | | | - Tomoki Wada
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Keiichi Yoshida
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kai-Nan An
- Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kazuo Kaneko
- Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
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26
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Galvin JW, Waterman BR, Cole BJ. Patch Augmentation and Patch Extension for Complex Rotator Cuff Tears. OPER TECHN SPORT MED 2018. [DOI: 10.1053/j.otsm.2017.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Yoshida M, Collin P, Josseaume T, Lädermann A, Goto H, Sugimoto K, Otsuka T. Post-operative rotator cuff integrity, based on Sugaya's classification, can reflect abduction muscle strength of the shoulder. Knee Surg Sports Traumatol Arthrosc 2018. [PMID: 28643102 DOI: 10.1007/s00167-017-4608-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Magnetic resonance (MR) imaging is common in structural and qualitative assessment of the rotator cuff post-operatively. Rotator cuff integrity has been thought to be associated with clinical outcome. The purpose of this study was to evaluate the inter-observer reliability of cuff integrity (Sugaya's classification) and assess the correlation between Sugaya's classification and the clinical outcome. It was hypothesized that Sugaya's classification would show good reliability and good correlation with the clinical outcome. METHODS Post-operative MR images were taken two years post-operatively, following arthroscopic rotator cuff repair. For assessment of inter-rater reliability, all radiographic evaluations for the supraspinatus muscle were done by two orthopaedic surgeons and one radiologist. Rotator cuff integrity was classified into five categories, according to Sugaya's classification. Fatty infiltration was graded into four categories, based on the Fuchs' classification grading system. Muscle hypotrophy was graded as four grades, according to the scale proposed by Warner. The clinical outcome was assessed according to the constant scoring system pre-operatively and 2 years post-operatively. RESULTS Of the sixty-two consecutive patients with full-thickness rotator cuff tears, fifty-two patients were reviewed in this study. These subjects included twenty-three men and twenty-nine women, with an average age of fifty-seven years. In terms of the inter-rater reliability between orthopaedic surgeons, Sugaya's classification showed the highest agreement [ICC (2.1) = 0.82] for rotator cuff integrity. The grade of fatty infiltration and muscle atrophy demonstrated good agreement, respectively (0.722 and 0.758). With regard to the inter-rater reliability between orthopaedic surgeon and radiologist, Sugaya's classification showed good reliability [ICC (2.1) = 0.70]. On the other hand, fatty infiltration and muscle hypotrophy classifications demonstrated fair and moderate agreement [ICC (2.1) = 0.39 and 0.49]. Although no significant correlation was found between overall post-operative constant score and Sugaya's classification, Sugaya's classification indicated significant correlation with the muscle strength score. CONCLUSIONS Sugaya's classification showed repeatability and good agreement between the orthopaedist and radiologist, who are involved in the patient care for the rotator cuff tear. Common classification of rotator cuff integrity with good reliability will give appropriate information for clinicians to improve the patient care of the rotator cuff tear. This classification also would be helpful to predict the strength of arm abduction in the scapular plane. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Masahito Yoshida
- Centre of Shoulder Surgery, Saint-Gregoire Private Hospital Center, Saint-Grégoire, France.
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-Cho, Mizuho-Ward, Nagoya, Aichi, 467-8601, Japan.
| | - Phillipe Collin
- Centre of Shoulder Surgery, Saint-Gregoire Private Hospital Center, Saint-Grégoire, France
| | - Thierry Josseaume
- Centre of Radiology, Saint-Gregoire Private Hospital Center, Saint-Grégoire, France
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, Latour Hospital, Meyrin, Switzerland
| | - Hideyuki Goto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-Cho, Mizuho-Ward, Nagoya, Aichi, 467-8601, Japan
| | | | - Takanobu Otsuka
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-Cho, Mizuho-Ward, Nagoya, Aichi, 467-8601, Japan
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Characterizing the macro and micro mechanical properties of scaffolds for rotator cuff repair. J Shoulder Elbow Surg 2017; 26:2038-2046. [PMID: 28865966 DOI: 10.1016/j.jse.2017.06.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 05/18/2017] [Accepted: 06/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Retearing after rotator cuff surgery is a major clinical problem. Numerous scaffolds are being used to try to reduce retear rates. However, few have demonstrated clinical efficacy. We hypothesize that this lack of efficacy is due to insufficient mechanical properties. Therefore, we compared the macro and nano/micro mechanical properties of 7 commercially available scaffolds to those of the human supraspinatus tendons, whose function they seek to restore. METHODS The clinically approved scaffolds tested were X-Repair, LARS ligament, Poly-Tape, BioFiber, GraftJacket, Permacol, and Conexa. Fresh frozen cadaveric human supraspinatus tendon samples were used. Macro mechanical properties were determined through tensile testing and rheometry. Scanning probe microscopy and scanning electron microscopy were performed to assess properties of materials at the nano/microscale (morphology, Young modulus, loss tangent). RESULTS None of the scaffolds tested adequately approximated both the macro and micro mechanical properties of human supraspinatus tendon. Macroscale mechanical properties were insufficient to restore load-bearing function. The best-performing scaffolds on the macroscale (X-Repair, LARS ligament) had poor nano/microscale properties. Scaffolds approximating tendon properties on the nano/microscale (BioFiber, biologic scaffolds) had poor macroscale properties. CONCLUSION Existing scaffolds failed to adequately approximate the mechanical properties of human supraspinatus tendons. Combining the macroscopic mechanical properties of a synthetic scaffold with the micro mechanical properties of biologic scaffold could better achieve this goal. Future work should focus on advancing techniques to create new scaffolds with more desirable mechanical properties. This may help improve outcomes for rotator cuff surgery patients.
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Predictive Factors of Retear in Patients With Repaired Rotator Cuff Tear on Shoulder MRI. AJR Am J Roentgenol 2017; 210:134-141. [PMID: 29045184 DOI: 10.2214/ajr.17.17915] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aimed to find independent prognostic factors related to retear of the rotator cuff tendon in patients with repaired full-thickness supraspinatus tendon tear by evaluation of pre- and postoperative MR images. MATERIALS AND METHODS Shoulder MR images were retrospectively analyzed for 83 patients who had undergone arthroscopic or open rotator cuff repair with acromioplasty for full-thickness supraspinatus tendon tear from April 2014 to March 2015. On preoperative MR images, the type of rotator cuff tear, extent of retraction of torn tendon, anteroposterior (AP) dimension of torn tendon, signal intensity of tear edge, degree of fat infiltration in supraspinatus and infraspinatus muscles, and acromiohumeral interval (AHI) were assessed. Postoperative cuff integrity seen on MR images was classified into five categories according to the Sugaya classification system, and patients were categorized into retear or intact groups. Factors assessed on preoperative MR images were compared between the two groups. RESULTS The overall retear rate was 57.8%. Significant differences were observed between the retear and intact groups in terms of the mean values of the extent of tendon retraction (20.4 vs 11.7 mm), AP dimension of the tear (16.1 vs 11.4 mm), AHI (6.8 vs 8.7 mm), and degree of fat infiltration of the supraspinatus and infraspinatus muscles (for the supraspinatus muscle, 3, 30, and 15 patients in the retear group vs 5, 27, and three patients in the intact group had Goutallier grade 1, grade 2, and grades 3 and 4 infiltration, respectively; for the infraspinatus muscle, 27, 12, and 9 patients in the retear group vs 29, 5, and one patient in the intact group had Goutallier grade 1, grade 2, and grades 3 and 4 infiltration, respectively). Multivariable analysis revealed that AHI and degree of tendon retraction were independent predictive factors affecting retear of rotator cuff after repair. CONCLUSION The retear rate of repaired rotator cuff tendon was about 57.8%. Independent prognostic factors of retear were degree of tendon retraction and AHI on preoperative MR images.
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31
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Mazzocca AD, Arciero RA, Shea KP, Apostolakos JM, Solovyova O, Gomlinski G, Wojcik KE, Tafuto V, Stock H, Cote MP. The Effect of Early Range of Motion on Quality of Life, Clinical Outcome, and Repair Integrity After Arthroscopic Rotator Cuff Repair. Arthroscopy 2017; 33:1138-1148. [PMID: 28111006 DOI: 10.1016/j.arthro.2016.10.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 10/04/2016] [Accepted: 10/20/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the effect of early versus delayed motion protocols on quality of life, clinical outcomes, and repair integrity in patients who have undergone arthroscopic single-tendon rotator cuff repair. METHODS This was a prospective, randomized, investigator-blinded clinical trial. Seventy-three patients from a single surgeon's practice who underwent arthroscopic repair of a single-tendon rotator cuff tear were randomized to either an early motion protocol (starting 2 to 3 days after surgery) or a delayed motion protocol (starting 28 days after surgery). The primary outcome measure was the Western Ontario Rotator Cuff index (WORC). Secondary outcome measures included clinical outcome scores, integrity of the repair on 6-month magnetic resonance imaging scans, pain scores, physical examination data, and ultrasonography. Study participants were followed up at 3, 6, and 12 weeks; 6 months; and 1 year postoperatively. RESULTS There was no statistically significant difference in WORC scores at 6 months (529 ± 472 in delayed group vs 325 ± 400 in early group, P = .08). Mixed-effects analysis indicated the early group maintained lower WORC scores throughout the postoperative period (estimated difference of 191, P = .04). The proportions of patients with tears on the 6-month postoperative magnetic resonance imaging scan were comparable (31% in delayed group vs 34% in early group, P = .78). CONCLUSIONS There was no difference between the delayed and early motion groups in WORC scores at 6 months after surgery. Early motion was associated with lower WORC scores throughout the postoperative period; however, both groups had a similar trajectory of improvement, suggesting both protocols have the same effect on patient-reported improvement. Although failure rates were similar between the groups, the sample size was not sufficient to support a statement regarding the relation between tear morphology and the rehabilitation protocol. LEVEL OF EVIDENCE Level II, lesser-quality randomized controlled trial.
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Affiliation(s)
| | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, U.S.A
| | - Kevin P Shea
- University of Connecticut Health Center, Farmington, Connecticut, U.S.A
| | | | - Olga Solovyova
- University of Connecticut Health Center, Farmington, Connecticut, U.S.A
| | - Gregg Gomlinski
- University of Connecticut Health Center, Farmington, Connecticut, U.S.A
| | - Karen E Wojcik
- University of Connecticut Health Center, Farmington, Connecticut, U.S.A
| | - Vincent Tafuto
- University of Connecticut Health Center, Farmington, Connecticut, U.S.A
| | - Harlan Stock
- University of Connecticut Health Center, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- University of Connecticut Health Center, Farmington, Connecticut, U.S.A..
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The effectiveness of demineralized cortical bone matrix in a chronic rotator cuff tear model. J Shoulder Elbow Surg 2017; 26:619-626. [PMID: 28162888 DOI: 10.1016/j.jse.2017.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/18/2016] [Accepted: 01/01/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to assess the effect of demineralized bone matrix (DBM) on rotator cuff tendon-bone healing. The hypothesis was that compared with a commercially available dermal matrix scaffold, DBM would result in a higher bone mineral density and regenerate a morphologically superior enthesis in a rat model of chronic rotator cuff degeneration. METHODS Eighteen female Wistar rats underwent unilateral detachment of the supraspinatus tendon. Three weeks later, tendon repair was carried out in animals randomized into 3 groups: group 1 animals were repaired with DBM (n = 6); group 2 received augmentation with the dermal scaffold (n = 6); and group 3 (controls) underwent nonaugmented tendon-bone repair (n = 6). Specimens were retrieved at 6 weeks postoperatively for histologic analysis and evaluation of bone mineral density. RESULTS No failures of tendon-bone healing were noted throughout the study. All groups demonstrated closure of the tendon-bone gap with a fibrocartilaginous interface. Dermal collagen specimens exhibited a disorganized structure with significantly more abnormal collagen fiber arrangement and cellularity than in the DBM-based repairs. Nonaugmented repairs exhibited a significantly higher bone mineral density than in DBM and the dermal collagen specimens and were not significantly different from control limbs that were not operated on. CONCLUSION The application of DBM to a rat model of chronic rotator cuff degeneration did not improve the composition of the healing enthesis compared with nonaugmented controls and a commercially available scaffold. However, perhaps the most important finding of this study was that the control group demonstrated a similar outcome to augmented repairs.
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Deren ME, Ehteshami JR, Dines JS, Drakos MC, Behrens SB, Doty S, Coleman SH. Simvastatin Exposure and Rotator Cuff Repair in a Rat Model. Orthopedics 2017; 40:e288-e292. [PMID: 27925641 DOI: 10.3928/01477447-20161128-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 10/10/2016] [Indexed: 02/03/2023]
Abstract
Simvastatin is a common medication prescribed for hypercholesterolemia that accelerates local bone formation. It is unclear whether simvastatin can accelerate healing at the tendon-bone interface after rotator cuff repair. This study was conducted to investigate whether local and systemic administration of simvastatin increased tendon-bone healing of the rotator cuff as detected by maximum load to failure in a controlled animal-based model. Supraspinatus tendon repair was performed on 120 Sprague-Dawley rats. Sixty rats had a polylactic acid membrane overlying the repair site. Of these, 30 contained simvastatin and 30 did not contain medication. Sixty rats underwent repair without a polylactic acid membrane. Of these, 30 received oral simvastatin (25 mg/kg/d) and 30 received a regular diet. At 4 weeks, 5 rats from each group were killed for histologic analysis. At 8 weeks, 5 rats from each group were killed for histologic analysis and the remaining 20 rats were killed for biomechanical analysis. One rat that received oral simvastatin died of muscle necrosis. Average maximum load to failure was 35.2±6.2 N for those receiving oral simvastatin, 36.8±9.0 N for oral control subjects, 39.5±12.8 N for those receiving local simvastatin, and 39.1±9.3 N for control subjects with a polylactic acid membrane. No statistically significant differences were found between any of the 4 groups (P>.05). Qualitative histologic findings showed that all groups showed increased collagen formation and organization at 8 weeks compared with 4 weeks, with no differences between the 4 groups at each time point. The use of systemic and local simvastatin offered no benefit over control groups. [Orthopedics. 2017; 40(2):e288-e292.].
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Raman J, Walton D, MacDermid JC, Athwal GS. Predictors of outcomes after rotator cuff repair-A meta-analysis. J Hand Ther 2017; 30:276-292. [PMID: 28237073 DOI: 10.1016/j.jht.2016.11.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 09/23/2016] [Accepted: 11/02/2016] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION Clinical outcomes associated with rotator cuff repair (RCR) are generally favorable, but no study has attempted to establish a set of predictors that affect outcomes. PURPOSE OF STUDY This study aims to statistically analyze articles and establish a set of predictors that affect outcomes after RCR. METHODS An electronic literature search of multiple databases was conducted to identify studies that addressed prognosis after RCR. Quality ratings were conducted with a prognostic study evaluation tool. Summary data for predictors and outcomes were extracted, entered in comprehensive meta-analysis software, transformed where necessary, and pooled to allow for estimation of odds ratio for each predictor. RESULTS From 18 studies, 3 were high quality, 7 were moderate and 8 were low-quality studies. Fatty infiltration had a significant negative effect (OR = 9.3), whereas larger tear size, lower preoperative muscle strength (OR = 4.0), multiple tendon involvement (OR = 6.0), diabetes, and worker's compensation status (OR = 8.7) had a moderate negative effect on outcomes after RCR. Older age had a modest negative effect on cuff integrity at follow-up (OR = 2.8), but no significant effect on function. In addition, a history of trauma, smoking, and duration of symptoms before surgery had no significant effect on outcomes. DISCUSSION Injury to the cuff (body structure), physical impairment, personal factors and social factors affects outcomes; although the importance of predictors varies between anatomic and functional outcomes. CONCLUSIONS A multifactorial biopsychosocial prognosis should be considered in management. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Jayaprakash Raman
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - David Walton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Western University, London, Ontario, Canada; Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - George S Athwal
- Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
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Jung HJ, Sim GB, Bae KH, Kekatpure AL, Chun JM, Jeon IH. Rotator cuff surgery in patients older than 75 years with large and massive tears. J Shoulder Elbow Surg 2017; 26:265-272. [PMID: 27720414 DOI: 10.1016/j.jse.2016.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 06/02/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate whether rotator cuff repair improves subjective and functional outcomes in patients aged ≥75 years. METHODS From May 2005 to March 2013, 121 elderly patients who underwent rotator cuff repair for large and massive rotator cuff tears were evaluated retrospectively. Patients with an American Society of Anesthesiologists physical status classification system grade ≥4 were excluded. The patients were evaluated using visual analog scales, subjective satisfaction surveys, American Shoulder and Elbow Surgeons scores, and Constant scores. The Katz index of activity of daily living (ADL) and functional independence measure motor score were used to evaluate ADLs. Postoperative magnetic resonance imaging (MRI) was performed to investigate the structural integrity of repaired cuffs. RESULTS In total, 64 patients were enrolled in the study; 80% were satisfied with their results. Visual analog scale scores improved from 6.4 to 2.3, American Shoulder and Elbow Surgeons scores from 42 to 84, and Constant scores from 42 to 76. Katz ADL scores improved from 3.4 to 5.0. Functional independence measure motor score improved from 22 to 51. Of the 64 patients, 46 underwent MRI 1 year postoperatively. Follow-up MRI revealed retears in 26% of patients. All patients with retears had improved subjective outcomes and functional scores. No patients died or experienced complications requiring intensive care or extended hospitalization. CONCLUSIONS Surgical treatment for large to massive rotator cuff tears in elderly patients with American Society of Anesthesiologists grade <4 provides good functional outcomes without morbidity, even in those with retears.
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Affiliation(s)
- Hong Jun Jung
- Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Gyeong-Bo Sim
- Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Kun Hyung Bae
- Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Aashay L Kekatpure
- Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Jae-Myeung Chun
- Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Seoul, Republic of Korea.
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Hasegawa A, Mihata T, Yasui K, Kawakami T, Itami Y, Neo M. Intra- and Inter-rater Agreement on Magnetic Resonance Imaging Evaluation of Rotator Cuff Integrity After Repair. Arthroscopy 2016; 32:2451-2458. [PMID: 27318780 DOI: 10.1016/j.arthro.2016.04.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the intra- and inter-rater agreement of magnetic resonance imaging (MRI) evaluations of rotator cuff integrity at 6 and 24 months after arthroscopic rotator cuff repair (ARCR). METHODS Three shoulder surgeons reviewed 68 MRI scans from 34 patients who had undergone ARCR and MRI examination at both 6 and 24 months after surgery. Postoperative rotator cuff integrity was investigated by using Owen, Sugaya, and Hayashida classifications to determine whether the rotator cuff was intact or whether there was a partial-thickness retear or full-thickness retear and Burks score to assess tendon appearance. Multirater kappa statistics were used to measure intra- and inter-rater agreement. Kappa values were interpreted according to guidelines adapted from the work of Landis and Koch. RESULTS All classifications had similar intra- and inter-rater agreement (κ = 0.14 to 0.67, 0.23 to 0.60, respectively), but no intra- or inter-rater agreement scored "excellent." Inter-rater agreement after ARCR was higher at 24 months (κ = 0.31 to 0.60) than at 6 months (κ = 0.23 to 0.44) in all evaluations. Reviewers identified full-thickness retears with a moderate to good degree of inter-rater agreement in all evaluations, at both 6 months (κ = 0.42 to 0.73) and 24 months (κ = 0.61 to 0.80) after ARCR. However, poor inter-rater agreement (κ = 0.13 to 0.19) was found in the identification of partial-thickness retears in all evaluations at 6 months after ARCR. CONCLUSIONS Shoulder surgeons showed better intra- and inter-rater agreement in predicting full-thickness tears compared with partial-thickness tears. The inter-rater agreement at 24 months after ARCR was superior to that at 6 months in predicting not only full-thickness retear but also partial-thickness retear. MRI evaluation of rotator cuff integrity at 6 months after ARCR may be less reliable, regardless of which classification system is used. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan.
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Kenji Yasui
- Department of Orthopedic Surgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Takeshi Kawakami
- Department of Orthopedic Surgery, Shiroyama Hospital, Osaka, Japan
| | - Yasuo Itami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Arthroscopic Patch Augmentation for Rotator Cuff Repair. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2016. [DOI: 10.1097/bte.0000000000000112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Park JG, Cho NS, Song JH, Baek JH, Jeong HY, Rhee YG. Rotator Cuff Repair in Patients over 75 Years of Age: Clinical Outcome and Repair Integrity. Clin Orthop Surg 2016; 8:420-427. [PMID: 27904725 PMCID: PMC5114255 DOI: 10.4055/cios.2016.8.4.420] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 10/13/2015] [Indexed: 12/23/2022] Open
Abstract
Background Some studies have shown significant functional improvement after rotator cuff (RC) repair in elderly patients. However, few studies have reported the healing potential of RC tears in elderly patients. Methods Twenty-five patients aged ≥ 75 years who underwent RC repair were enrolled. The mean age at the time of surgery was 78.3 years (range, 75 to 88 years) while the mean follow-up was 36.3 months (range, 18 to 114 months). We evaluated clinical and structural outcomes after RC repair in the retear and healed groups. Results Of 25 patients, 16 (64%) had healed RC lesions and 9 (36%) had retorn cuff lesions. The retear rate increased significantly with increasing initial tear size (small to medium, 13%; large, 60%; massive, 80%; p = 0.024) but not with increasing age (p = 0.072). The mean visual analog scale (VAS), University of California Los Angeles (UCLA), and Constant scores significantly improved from 5.2, 15.8, and 49.3 preoperatively to 1.4, 31.1, and 71.9 in the healed group and from 6.0, 14.4, and 39.5 preoperatively to 2.4, 28.3, and 63.6 in the retear group at the final follow-up (p < 0.05, respectively). There were no significant differences in clinical outcomes between the 2 groups at the final follow-up. Retear was significantly correlated with initial tear size (p = 0.001; odds ratio [OR], 2.771; 95% confidence interval [CI], 1.394 to 5.509 for large to massive tears) (p = 0.001; OR, 0.183; 95% CI, 0.048 to 0.692 for small to medium tears). Conclusions There were significant improvements in clinical outcomes after RC repair in patients ≥ 75 years. Structural integrity after cuff repair did not affect the final clinical outcome. Even in elderly patients aged ≥ 75 years, healing of repaired RC can be expected in cases of small to medium tears. Although the retear rate was relatively high for large to massive tears, clinical outcomes still showed significant improvement.
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Affiliation(s)
- Jung Gwan Park
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Nam Su Cho
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jong Hoon Song
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jong Hun Baek
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ho Yeon Jeong
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
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Makhni EC, Swart E, Steinhaus ME, Mather RC, Levine WN, Bach BR, Romeo AA, Verma NN. Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Arthroscopic Rotator Cuff Repair for Symptomatic Large and Massive Rotator Cuff Tears. Arthroscopy 2016; 32:1771-80. [PMID: 27132772 DOI: 10.1016/j.arthro.2016.01.063] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the cost-effectiveness within the United States health care system of arthroscopic rotator cuff repair versus reverse total shoulder arthroplasty in patients with symptomatic large and massive rotator cuff tears without cuff-tear arthropathy. METHODS An expected-value decision analysis was constructed comparing the costs and outcomes of patients undergoing arthroscopic rotator cuff repair and reverse total shoulder arthroplasty for large and massive rotator cuff tears (and excluding cases of cuff-tear arthropathy). Comprehensive literature search provided input data to extrapolate costs and health utility states for these outcomes. The primary outcome assessed was that of incremental cost-effectiveness ratio (ICER) of reverse total shoulder arthroplasty versus rotator cuff repair. RESULTS For the base case, both arthroscopic rotator cuff repair and reverse total shoulder were superior to nonoperative care, with an ICER of $15,500/quality-adjusted life year (QALY) and $37,400/QALY, respectively. Arthroscopic rotator cuff repair was dominant over primary reverse total shoulder arthroplasty, with lower costs and slightly improved clinical outcomes. Arthroscopic rotator cuff repair was the preferred strategy as long as the lifetime progression rate from retear to end-stage cuff-tear arthropathy was less than 89%. However, when the model was modified to account for worse outcomes when reverse shoulder arthroplasty was performed after a failed attempted rotator cuff repair, primary reverse total shoulder had superior outcomes with an ICER of $90,000/QALY. CONCLUSIONS Arthroscopic rotator cuff repair-despite high rates of tendon retearing-for patients with large and massive rotator cuff tears may be a more cost-effective initial treatment strategy when compared with primary reverse total shoulder arthroplasty and when assuming no detrimental impact of previous surgery on outcomes after arthroplasty. Clinical judgment should still be prioritized when formulating treatment plans for these patients. LEVEL OF EVIDENCE: Level II, economic decision analysis.
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Affiliation(s)
- Eric C Makhni
- Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Eric Swart
- Department of Orthopedic Trauma, Carolinas Medical Center, Charlotte, North Carolina, U.S.A
| | - Michael E Steinhaus
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Richard C Mather
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Bernard R Bach
- Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
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Steinhaus ME, Makhni EC, Cole BJ, Romeo AA, Verma NN. Outcomes After Patch Use in Rotator Cuff Repair. Arthroscopy 2016; 32:1676-90. [PMID: 27157657 DOI: 10.1016/j.arthro.2016.02.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide a comprehensive review of clinical outcomes and retear rates after patch use in rotator cuff repair, and to determine the differences between available graft types and techniques. METHODS A systematic review was conducted from database (PubMed, Medline, Scopus, Embase) inception to January 2015 for English-language articles reporting outcome data with 9 months' minimum follow-up. Studies were assessed by 2 reviewers who collected pertinent data, with outcomes combined to generate frequency-weighted means. RESULTS Twenty-four studies met the inclusion criteria. The frequency-weighted mean age was 61.9 years with 35.4 months' follow-up. The mean improvements in postoperative range of motion in the forward elevation, abduction, external rotation, and internal rotation planes were 58.6°, 66.2°, 16.6°, and 16.1°, respectively, and postoperative abduction strength improved by 3.84 kg. American Shoulder and Elbow Surgeons, University of California-Los Angeles, Constant, Penn, and Oxford scores improved by 39.3, 10.7, 40.8, 34.4, and 17.6, respectively. Augmentation and interposition techniques showed similar improvements in range of motion, strength, and patient-reported outcomes (PROs), whereas xenografts showed less improvement in PROs compared with other graft types. Studies reported improvements in pain and activities of daily living (ADLs), with greater than 90% overall satisfaction, although few patients (13%) were able to return to preinjury activity. Whereas interposition and augmentation techniques showed similar improvements in pain and ADLs, xenografts showed less improvement in ADLs than other graft types. The overall retear rate was 25%, with rates of 34% and 12% for augmentation and interposition, respectively, and rates of 44%, 23%, and 15% for xenografts, allografts, and synthetic grafts, respectively. CONCLUSIONS We report improvements in clinical and functional outcomes, with similar results for augmentation and interposition techniques, whereas xenografts showed less improvement than synthetic grafts and allografts in PROs and ADLs. Retear rates may be lower with the interposition technique or in patients with synthetic grafts or allografts. LEVEL OF EVIDENCE Level IV, systematic review of Level II through IV studies.
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Affiliation(s)
| | - Eric C Makhni
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Brian J Cole
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
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Ryösä A, Laimi K, Äärimaa V, Lehtimäki K, Kukkonen J, Saltychev M. Surgery or conservative treatment for rotator cuff tear: a meta-analysis. Disabil Rehabil 2016; 39:1357-1363. [PMID: 27385156 DOI: 10.1080/09638288.2016.1198431] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Comparative evidence on treating rotator cuff tear is inconclusive. The objective of this review was to evaluate the evidence on effectiveness of tendon repair in reducing pain and improving function of the shoulder when compared with conservative treatment of symptomatic rotator cuff tear. METHOD Search on CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science and Pedro databases. Randomised controlled trials (RCT) comparing surgery and conservative treatment of rotator cuff tear. Study selection and extraction based on the Cochrane Handbook for Systematic reviews of Interventions. Random effects meta-analysis. RESULTS Three identified RCTs involved 252 participants (123 cases and 129 controls). The risk of bias was considered low for all three RCTs. For Constant score, statistically insignificant effect size was 5.6 (95% CI -0.41 to 11.62) points in 1-year follow up favouring surgery and below the level of minimal clinically important difference. The respective difference in pain reduction was -0.93 (95% CI -1.65 to -0.21) cm on a 0-10 pain visual analogue scale favouring surgery. The difference was statistically significant (p = 0.012) in 1-year follow up but below the level of minimal clinically important difference. CONCLUSION There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. Thus, a conservative approach is advocated as the initial treatment modality. Implications for Rehabilitation There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. There was no clinically significant difference between surgery and active physiotherapy in 1-year follow-up in improving Constant score or reducing pain caused by rotator cuff tear. As physiotherapy is less proneness to complications and less expensive than surgery, a conservative approach is advocated as the initial treatment modality to rotator cuff tears.
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Affiliation(s)
- Anssi Ryösä
- a Department of Orthopaedics and Traumatology , Turku University Hospital and University of Turku , Turku , Finland
| | - Katri Laimi
- b Department of Physical and Rehabilitation Medicine , Turku University Hospital and University of Turku , Turku , Finland
| | - Ville Äärimaa
- a Department of Orthopaedics and Traumatology , Turku University Hospital and University of Turku , Turku , Finland
| | - Kaisa Lehtimäki
- a Department of Orthopaedics and Traumatology , Turku University Hospital and University of Turku , Turku , Finland
| | - Juha Kukkonen
- c Department of Surgery , Satakunta Central Hospital , Pori , Finland
| | - Mikhail Saltychev
- b Department of Physical and Rehabilitation Medicine , Turku University Hospital and University of Turku , Turku , Finland
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Hawi N, Dratzidis A, Kraemer M, Suero EM, Liodakis E, Hurschler C, Krettek C, Hawi A, Meller R. Biomechanical evaluation of the simple cinch stitch for arthroscopic rotator cuff repair. Clin Biomech (Bristol, Avon) 2016; 36:21-5. [PMID: 27195737 DOI: 10.1016/j.clinbiomech.2016.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/23/2016] [Accepted: 04/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The tissue-suture interface is described as the most vulnerable and susceptible area in the muscle-tendon-bone construction of arthroscopic rotator cuff repair. Various stitching techniques have been described to enhance the strength, fixation and stability of the repair, but technical and biomechanical challenges remain. Purpose was to examine the biomechanical properties of the simple cinch stitch in comparison to other stitches commonly used for rotator cuff repair. METHODS Infraspinatus tendons were harvested from sheep and split in half. The tendons were randomized into five different stitch configuration groups for biomechanical testing: simple stitch; horizontal stitch; FiberChain®; simple cinch stitch; and modified Mason-Allen stitch. Each specimen was first cyclically loaded on a universal materials testing machine under force control from 5 to 30N at 0.25Hz for twenty cycles. Then, each specimen was loaded to failure under displacement control at a rate of 1mm/s. Cyclic elongation, peak-to-peak displacement and ultimate tensile load were measured. The type of failure was recorded. FINDINGS No differences in cyclic elongation or peak-to-peak displacement were seen between stitch configurations. In the load-to-failure test, the simple cinch stitch demonstrated significantly higher ultimate load than the simple and the horizontal stitch configurations. The comparison to the FiberChain® Suture revealed no statistical significant differences. The FiberChain® Suture demonstrated significantly higher ultimate load than the simple stitch. No statistical significance could be demonstrated in comparison to the horizontal stitch or the simple cinch stitch. The ultimate tensile load of the modified Mason-Allen stitch was significantly higher than that of the other stitch configurations. INTERPRETATION The simple cinch stitch has an ultimate tensile load comparable to the FiberChain® suture and is superior to the simple stitch and the horizontal stitch. The major advantage of the simple cinch technique is that it is possible to perform the stitch entirely arthroscopically, without the need to perforate the tissue a second time or to use special suture materials. STUDY DESIGN Controlled laboratory study.
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Affiliation(s)
- Nael Hawi
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany.
| | | | - Manuel Kraemer
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School (MHH), Hannover, Germany.
| | - Eduardo M Suero
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany.
| | | | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School (MHH), Hannover, Germany.
| | - Christian Krettek
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany.
| | - Ahmed Hawi
- Orthopaedic and Surgical Clinic Braunschweig (OCP), Braunschweig, Germany.
| | - Rupert Meller
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany.
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Cho NS, Cha SW, Shim HS, Juh HS, Rhee YG. Comparison of Clinical and Structural Outcomes of Open and Arthroscopic Repair for Massive Rotator Cuff Tear. Clin Shoulder Elb 2016. [DOI: 10.5397/cise.2016.19.2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Massive Rotator Cuff Repair With All-Arthroscopic Patch Augmentation: A Surgical Technique. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2016. [DOI: 10.1097/bte.0000000000000074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Compared with smaller tears, massive rotator cuff tears present significant clinical management dilemmas for the treating surgeon because they are often fraught with structural failure and poor outcomes. To optimize healing, current surgical methods look to optimize footprint coverage and enhance the biological environment for healing. Double-row techniques have demonstrated clear biomechanical advantages in controlled cadaveric studies, but have yet to demonstrate clear clinical efficacy over more simple repair techniques. When repairs for massive rotator cuff tears fail, options include revision repair or superior capsular reconstruction, an option to bridge the tissue gap with human dermal allograft or fascia lata autograft in hopes of containing the humeral head from superior migration and precluding rotator cuff arthropathy. Although latissimus transfers remain a reasonable option for massive, irreparable rotator cuff tears in appropriately indicated patients, clinical results are often unpredictable. Older patients with chronic, massive rotator cuff tears with pseudoparalysis can achieve predictable, often excellent clinical results with a reverse total shoulder arthroplasty. [Orthopedics. 2016; 39(3):145-151.].
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Lu Y, Li Y, Li FL, Li X, Zhuo HW, Jiang CY. Do Different Cyclooxygenase Inhibitors Impair Rotator Cuff Healing in a Rabbit Model? Chin Med J (Engl) 2016; 128:2354-9. [PMID: 26315084 PMCID: PMC4733788 DOI: 10.4103/0366-6999.163379] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: The effect of selective and non-selective cyclooxygenase (COX) inhibitors on tendon healing was variable. The purpose of the study was to evaluate the influence of non-selective COX inhibitor, ibuprofen and flurbiprofen axetil and selective COX-2 inhibitor, celecoxib on the tendon healing process in a rabbit model. Methods: Ninety-six New Zealand rabbits were used as rotator cuff repair models. After surgery, they were divided randomly into four groups: Ibuprofen (10 mg·kg−1·d−1), celecoxib (8 mg·kg−1·d−1), flurbiprofen axetil (2 mg·kg−1·d−1), and control group (blank group). All drugs were provided for 7 days. Rabbits in each group were sacrificed at 3, 6, and 12 weeks after tendon repair. Tendon biomechanical load failure tests were performed. The percentage of type I collagen on the bone tendon insertion was calculated by Picric acid Sirius red staining and image analysis. All data were compared among the four groups at the same time point. All data in each group were also compared across the different time points. Qualitative histological evaluation of the bone tendon insertion was also performed among groups. Results: The load to failure increased significantly with time in each group. There were significantly lower failure loads in the celecoxib group than in the control group at 3 weeks (0.533 vs. 0.700, P = 0.002), 6 weeks (0.607 vs. 0.763, P = 0.01), and 12 weeks (0.660 vs. 0.803, P = 0.002), and significantly lower percentage of type I collagen at 3 weeks (11.5% vs. 27.6%, P = 0.001), 6 weeks (40.5% vs. 66.3%, P = 0.005), and 12 weeks (59.5% vs. 86.3%, P = 0.001). Flurbiprofen axetil showed significant differences at 3 weeks (failure load: 0.600 vs. 0.700, P = 0.024; percentage of type I collagen: 15.6% vs. 27.6%, P = 0.001), but no significant differences at 6 and 12 weeks comparing with control group, whereas the ibuprofen groups did not show any significant difference at each time point. Conclusions: Nonsteroidal anti-inflammatory drugs can delay tendon healing in the early stage after rotator cuff repair. Compared with nonselective COX inhibitors, selective COX-2 inhibitors significantly impact tendon healing.
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Affiliation(s)
| | | | | | | | | | - Chun-Yan Jiang
- Department of Sports Medicine Service, Beijing Jishuitan Hospital, Beijing 100035, China
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Lim CO, Park KJ. Biomechanical Test for Repair Technique of Full-thickness Rotator Cuff Tear. Clin Shoulder Elb 2016. [DOI: 10.5397/cise.2016.19.1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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48
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Nagura I, Kokubu T, Mifune Y, Inui A, Takase F, Ueda Y, Kataoka T, Kurosaka M. Characterization of progenitor cells derived from torn human rotator cuff tendons by gene expression patterns of chondrogenesis, osteogenesis, and adipogenesis. J Orthop Surg Res 2016; 11:40. [PMID: 27036202 PMCID: PMC4818483 DOI: 10.1186/s13018-016-0373-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/22/2016] [Indexed: 01/08/2023] Open
Abstract
Background It is important to regenerate the tendon-to-bone interface after rotator cuff repair to prevent re-tears. The cells from torn human rotator cuff were targeted, and their capacity for multilineage differentiation was investigated. Methods The edges of the rotator cuff were harvested during arthroscopic rotator cuff repair from nine patients, minced into pieces, and cultured on dishes. Adherent cells were cultured, phenotypically characterized. Then expandability, differentiation potential and gene expression were analyzed. Results Flow cytometry revealed that the mesenchymal stem cells (MSC)-related markers CD29, CD44, CD105, and CD166 were positive. However, CD14, CD34, and CD45 were negative. On RT-PCR analyses, the cells showed osteogenic, adipogenic, and chondrogenic potential after 3 weeks of culture under the respective differentiation conditions. In addition, SOX9, type II collagen, and type X collagen expression patterns during chondrogenesis were similar to those of endochondral ossification at the enthesis. Conclusions The cells derived from torn human rotator cuff are multipotent mesenchymal stem cells with the ability to undergo multilineage differentiation, suggesting that MSCs form this tissue could be regenerative capacity for potential self-repair.
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Affiliation(s)
- Issei Nagura
- Department of Orthopaedic Surgery, Kobe Rosai Hospital, 4-1-23 Kagoike-dori, Chuo-ku, Kobe, 651-0053, Japan. .,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Takeshi Kokubu
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Fumiaki Takase
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yasuhiro Ueda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takeshi Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Thigpen CA, Shaffer MA, Kissenberth MJ. Knowing the speed limit: weighing the benefits and risks of rehabilitation progression after arthroscopic rotator cuff repair. Clin Sports Med 2015; 34:233-46. [PMID: 25818711 DOI: 10.1016/j.csm.2014.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Rotator cuff repairs have increased. Although clinical trials have examined the effect of immobilization and timing of passive range of motion (ROM) on patient outcomes and structural integrity, there is controversy as to the timing and progression for therapy. Primary goals are restoring function while maintaining the structural integrity of the repair. We advocate for a protocol of 4 to 6 weeks of immobilization, followed by protected passive ROM, which is followed by a gradual progression to active ROM and then appropriate resistance exercise program for most all rotator cuff repairs. The rate of progression should be adjusted individually.
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Affiliation(s)
- Charles A Thigpen
- Proaxis Therapy, 200 Patewood Drive, Suite 150 C, Greenville, SC, USA; Center for Rehabilitation and Reconstruction Sciences, Greenville, SC, USA.
| | - Michael A Shaffer
- Department of Rehabilitation Therapies, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael J Kissenberth
- Department of Orthopedics, Steadman-Hawkins Clinics of the Carolinas, Greenville Health System, Greenville, SC, USA
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Guity MR, Eraghi AS. Open Rotator Cuff Tear Repair Using Deltopectoral Approach. Med Arch 2015; 69:298-301. [PMID: 26622080 PMCID: PMC4639353 DOI: 10.5455/medarh.2015.69.298-301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/05/2015] [Indexed: 12/16/2022] Open
Abstract
Background: The goal of this study was to evaluate the outcome of the open repair of rotator cuff tears via the deltopectoral approach in patients unable to afford arthroscopic repair costs. Methods: We evaluated 80 consecutive patients who were treated for full-thickness rotator cuff tears by open repair through the deltopectoral approach. There were 48 men and 32 women at a mean age of 60.1 years (range, 35-80 years). Preoperative and postoperative clinical assessments were performed with the Constant score, American Shoulder and Elbow Surgeons (ASES) score, modified University of California Los Angeles (UCLA) score, and pain visual analog scale. Results: The mean follow-up period was 30.6 months (range, 18-48 months). At final follow-up visits, the ASES, Constant score, and modified UCLA score were found to have improved significantly from 33.56, 39.24, and 13.0 to 85.64, 81.46, and 32.2, respectively (P <0.01). Pain, as measured on a visual analog scale, was improved significantly (P <0.01). The mean time for recovering the full range of motion was 2.5 months. Postoperative pain at 48 hours and at 6 weeks was relatively low. There were no cases of intractable stiffness. Conclusion: The deltopectoral approach for open rotator cuff repair produced satisfactory results and reduces rate of shoulder stiffness and postoperative pain.
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Affiliation(s)
- Mohammad Reza Guity
- Orthopaedics Department, Imam Khomeini Hospital, Tehran University of Medical sciences, Tehran, Iran
| | - Amir Sobhani Eraghi
- Orthopaedics Department, Rasoul Akram Hospital, Iran University of Medical sciences, Tehran, Iran
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