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For: Thorpe A, Hurworth M, O'Sullivan P, Mitchell T, Smith A. Rising trends in surgery for rotator cuff disease in Western Australia. ANZ J Surg 2016;86:801-804. [DOI: 10.1111/ans.13691] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 04/03/2016] [Accepted: 05/13/2016] [Indexed: 11/28/2022]

For:	Thorpe A, Hurworth M, O'Sullivan P, Mitchell T, Smith A. Rising trends in surgery for rotator cuff disease in Western Australia. ANZ J Surg 2016;86:801-804. [DOI: 10.1111/ans.13691] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 04/03/2016] [Accepted: 05/13/2016] [Indexed: 11/28/2022]

Number

Cited by Other Article(s)

Harris IA, Page RS, Buchbinder R, Äärimaa V, Adie S, Brown G, Cinnadaio N, Damiani M, Descallar J, Ferreira ML, Foster NE, Gill S, Hutchison K, Järvinen T, Khoo O, Lieu D, Maher CG, Naylor JM, Smith G, Spencer L, Toh Y, Whan A, Yeoh T. ARC (Australian Rotator Cuff) trial: study protocol for a randomised placebo-controlled trial comparing rotator cuff repair to no repair during arthroscopic shoulder surgery for people with shoulder pain and non-acute rotator cuff tears. Trials 2025;26:116. [PMID: 40176135 PMCID: PMC11963692 DOI: 10.1186/s13063-025-08822-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 03/20/2025] [Indexed: 04/04/2025] Open

Abstract

BACKGROUND

Degenerative rotator cuff tears are common and are often treated with surgical repair. Randomised trials have not shown a clear advantage to surgery over non-surgical treatment, but there have been no published placebo-controlled trials investigating rotator cuff repair. This study aims to compare arthroscopic shoulder surgery with rotator cuff repair to surgery without rotator cuff repair (placebo) for improving shoulder pain and function in people with shoulder pain and full-thickness degenerative rotator cuff tears.

METHODS

The study is a multicentre two-parallel arm, blinded, individually randomised controlled trial (RCT). Participants will be people aged 40-75 years (inclusive) with more than 6 months of shoulder pain, a degenerative (non-traumatic) full thickness rotator cuff tear 1 to 4 cm in length for whom surgery is recommended and repair of the tear is the main reason for surgery. The intervention is arthroscopic surgery (including-as indicated-bursectomy, debridement, acromioclavicular joint resection, acromioplasty and biceps tenodesis or tenotomy) with rotator cuff repair. The control is the same arthroscopic shoulder surgery without rotator cuff repair. Participants will be randomised to cuff repair or no cuff repair in a 1:1 ratio intra-operatively, after all other surgical procedures have been performed. Participants, follow-up surgeons, physiotherapists, study staff and statisticians will be blinded. Post-surgical rehabilitation will be usual care for rotator cuff repair in both groups. The primary outcome will be shoulder pain and function measured using the Western Ontario Rotator Cuff Index at 6 months post-surgery.

DISCUSSION

The ARC trial will provide low bias evidence on a common surgical procedure: rotator cuff repair for degenerative tears.

TRIAL REGISTRATION

The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000789965) on 5 August 2020 and the WHO International Clinical Trials Registry Platform (universal trial number U1111-1251-6599).

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Affiliation(s)

Ian A Harris Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, Australia. School of Clinical Medicine, Faculty of Medicine & Health, UNSW Sydney, PO Box 1274 Darlinghurst, Liverpool, NSW, 1300, Australia. Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Sydney, NSW, Australia.
Richard S Page B-CORE (Barwon Centre for Orthopaedic Research and Education), IMPACT, School of Medicine, Deakin University, Geelong, VIC, Australia St John of God Hospital & Barwon Health, Geelong, VIC, Australia
Rachelle Buchbinder Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Ville Äärimaa Division of Diseases of the Musculoskeletal System, Turku University Hospital, Turku, Finland
Sam Adie School of Clinical Medicine, UNSW Medicine & Health, St George & Sutherland Clinical Campuses, UNSW Sydney, Sydney, NSW, Australia
Graeme Brown Department of Orthopaedics University Hospital Geelong, Affiliate Senior Lecturer School of Medicine, Deakin University, Geelong, VIC, Australia
Nancy Cinnadaio Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, Australia School of Clinical Medicine, Faculty of Medicine & Health, UNSW Sydney, PO Box 1274 Darlinghurst, Liverpool, NSW, 1300, Australia
Maurizio Damiani School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia
Joseph Descallar Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, Australia
Manuela L Ferreira The George Institute for Global Health, UNSW, Sydney, NSW, Australia
Nadine E Foster STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Herston, Brisbane, QLD, Australia
Stephen Gill B-CORE (Barwon Centre for Orthopaedic Research and Education), IMPACT, School of Medicine, Deakin University, Geelong, VIC, Australia St John of God Hospital & Barwon Health, Geelong, VIC, Australia
Katrina Hutchison Department of Philosophy, Macquarie University, Sydney, Australia
Teppo Järvinen Finnish Centre for Evidence-Based Orthopaedics (FICEBO), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Oliver Khoo Department of Orthopaedics, St Vincent's Hospital Sydney, Sydney, NSW, Australia
David Lieu Orthopaedic Department, Fairfield Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
Christopher G Maher Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Sydney, NSW, Australia
Justine M Naylor Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, Australia School of Clinical Medicine, Faculty of Medicine & Health, UNSW Sydney, PO Box 1274 Darlinghurst, Liverpool, NSW, 1300, Australia
Geoff Smith School of Clinical Medicine, UNSW Medicine & Health, St George & Sutherland Clinical Campuses, UNSW Sydney, Sydney, NSW, Australia
Luke Spencer Ballarat Orthopaedics and Sports Medicine, Novar Musculoskeletal Research institute, Grampian Health - Ballarat Base Hospital, Ballarat, VIC, Australia
Yvana Toh STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Herston, Brisbane, QLD, Australia
Andrew Whan St John of God Hospital & Barwon Health, Geelong, VIC, Australia
Tim Yeoh Department of Orthopaedics, St Vincent's Hospital Sydney, Sydney, NSW, Australia

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Blakeney WG, Sharifa AA, Graham D, Kop A. Dermal Graft Thickness Over 2 mm and Grafts Oriented Parallel to Skin Tension Lines Increased Graft Strength and Suture Retention: A Biomechanical Study. Arthroscopy 2024:S0749-8063(24)01028-4. [PMID: 39672246 DOI: 10.1016/j.arthro.2024.11.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 11/21/2024] [Accepted: 11/21/2024] [Indexed: 12/15/2024]

McKay MJ, Weber KA, Wesselink EO, Smith ZA, Abbott R, Anderson DB, Ashton-James CE, Atyeo J, Beach AJ, Burns J, Clarke S, Collins NJ, Coppieters MW, Cornwall J, Crawford RJ, De Martino E, Dunn AG, Eyles JP, Feng HJ, Fortin M, Franettovich Smith MM, Galloway G, Gandomkar Z, Glastras S, Henderson LA, Hides JA, Hiller CE, Hilmer SN, Hoggarth MA, Kim B, Lal N, LaPorta L, Magnussen JS, Maloney S, March L, Nackley AG, O’Leary SP, Peolsson A, Perraton Z, Pool-Goudzwaard AL, Schnitzler M, Seitz AL, Semciw AI, Sheard PW, Smith AC, Snodgrass SJ, Sullivan J, Tran V, Valentin S, Walton DM, Wishart LR, Elliott JM. MuscleMap: An Open-Source, Community-Supported Consortium for Whole-Body Quantitative MRI of Muscle. J Imaging 2024;10:262. [PMID: 39590726 PMCID: PMC11595196 DOI: 10.3390/jimaging10110262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 09/11/2024] [Accepted: 10/18/2024] [Indexed: 11/28/2024] Open

Affiliation(s)

Marnee J. McKay Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Kenneth A. Weber Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford, CA 94304, USA; (K.A.W.II); (E.O.W.)
Evert O. Wesselink Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford, CA 94304, USA; (K.A.W.II); (E.O.W.) Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences—Program Musculoskeletal Health, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
Zachary A. Smith Department of Rehabilitation Medicine, University of Oklahoma, Norman, OK 73019, USA;
Rebecca Abbott Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN 55455, USA;
David B. Anderson Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Claire E. Ashton-James Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
John Atyeo Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Aaron J. Beach Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia; (A.J.B.); (J.S.M.)
Joshua Burns Disability Prevention Program, Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
Stephen Clarke Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Natalie J. Collins School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072 QLD, Australia; (N.J.C.); (M.M.F.S.); (S.P.O.); (L.R.W.)
Michel W. Coppieters School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia; (M.W.C.); (J.A.H.)
Jon Cornwall Otago Medical School, University of Otago, Dunedin 9016, New Zealand; (J.C.); (P.W.S.)
Rebecca J. Crawford Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia;
Enrico De Martino Department of Health Science and Technology, Aalborg University, Gistrup, 9260 North Jutland, Denmark;
Adam G. Dunn Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Jillian P. Eyles Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.) Northern Sydney Local Health District, The Kolling Institute, St Leonards, NSW 2065, Australia
Henry J. Feng Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Maryse Fortin Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada;
Melinda M. Franettovich Smith School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072 QLD, Australia; (N.J.C.); (M.M.F.S.); (S.P.O.); (L.R.W.)
Graham Galloway Herston Imaging Research Facility, University of Queensland, Brisbane, QLD 4072, Australia;
Ziba Gandomkar Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Sarah Glastras Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.) Northern Sydney Local Health District, The Kolling Institute, St Leonards, NSW 2065, Australia
Luke A. Henderson Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Julie A. Hides School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia; (M.W.C.); (J.A.H.)
Claire E. Hiller Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Sarah N. Hilmer Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Mark A. Hoggarth Department of Physical Therapy, North Central College, Naperville, IL 60540, USA;
Brian Kim Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.) Northern Sydney Local Health District, The Kolling Institute, St Leonards, NSW 2065, Australia
Navneet Lal Otago Medical School, University of Otago, Dunedin 9016, New Zealand; (J.C.); (P.W.S.)
Laura LaPorta School of Rehabilitative and Health Sciences, Regis University, Denver, CO 80221, USA;
John S. Magnussen Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia; (A.J.B.); (J.S.M.)
Sarah Maloney Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Lyn March Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Andrea G. Nackley Center for Translational Pain Medicine, Department of Anesthesiology, School of Medicine, Duke University, Durham, NC 27710, USA;
Shaun P. O’Leary School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072 QLD, Australia; (N.J.C.); (M.M.F.S.); (S.P.O.); (L.R.W.)
Anneli Peolsson Occupational and Environmental Medicine Centre, Department of Health Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, 58183 Linköping, Sweden; Department of Health Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, 58183 Linköping, Sweden
Zuzana Perraton School of Allied Health, La Trobe University, Melbourne, VIC 3086, Australia; (Z.P.); (A.I.S.)
Annelies L. Pool-Goudzwaard Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences—Program Musculoskeletal Health, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
Margaret Schnitzler Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Amee L. Seitz Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
Adam I. Semciw School of Allied Health, La Trobe University, Melbourne, VIC 3086, Australia; (Z.P.); (A.I.S.)
Philip W. Sheard Otago Medical School, University of Otago, Dunedin 9016, New Zealand; (J.C.); (P.W.S.)
Andrew C. Smith School of Medicine, University of Colorado, Aurora, CO 80045, USA;
Suzanne J. Snodgrass Discipline of Physiotherapy, University of Newcastle, Callaghan, NSW 2308, Australia;
Justin Sullivan Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
Vienna Tran Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia;
Stephanie Valentin School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland EH11 4BN, UK;
David M. Walton School of Physical Therapy, Western University, London, ON N6A 3K7, Canada;
Laurelie R. Wishart School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072 QLD, Australia; (N.J.C.); (M.M.F.S.); (S.P.O.); (L.R.W.) School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia
James M. Elliott Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.) Northern Sydney Local Health District, The Kolling Institute, St Leonards, NSW 2065, Australia

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Salas M, Zaldivar B, Fierro G, Gonzalez JC, Lievano JR. Incidence and risk factors for shoulder stiffness after open and arthroscopic rotator cuff repair. Arch Orthop Trauma Surg 2024;144:2047-2055. [PMID: 38630250 DOI: 10.1007/s00402-024-05323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/08/2024] [Indexed: 05/16/2024]

Abstract

INTRODUCTION

The aim of this study was to estimate the incidence of stiffness during the first 6 months after rotator cuff repair and to evaluate postoperative stiffness with respect to its risk factors and its influence on the outcome at 6 months postoperatively.

METHODS

In a prospective cohort of 117 patients (69 women, 48 men; average age 59) from our institutional rotator cuff registry, who underwent either arthroscopic (n = 77) or open (n = 40) rotator cuff repair, we measured shoulder range of motion (ROM) at 3 and 6 months post-surgery. We evaluated the incidence of stiffness and analyzed functional outcomes, comparing various preoperative and intraoperative factors in patients with stiffness to those without at the 6-month mark.

RESULTS

Shoulder stiffness was observed in 31% of patients (36/117) at 3 months postoperatively, decreasing to 20% (23/117) at 6 months. No significant link was found between stiffness at 6 months and demographic factors, preoperative stiffness, tear characteristics, or the type of repair. Notably, patients undergoing arthroscopic repair exhibited a 4.3-fold higher risk (OR 4.3; 95% CI 1.2-15.6, p = 0.02) of developing stiffness at 6 months compared to those with mini-open repair. Despite these differences in stiffness rates, no significant variation was seen in the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, or Visual Analog Scale (VAS) scores at 6 months between the groups.

CONCLUSION

The incidence of postoperative shoulder stiffness following rotator cuff repair was substantial at 31% at 3 months, reducing to 20% by 6 months. Mini-open repair was associated with a lower 6-month stiffness incidence than arthroscopic repair, likely due to variations in rehabilitation protocols. However, the presence of stiffness at 6 months post-surgery did not significantly affect functional outcomes or pain levels.

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Dannaway J, Sharma G, Raniga S, Graham P, Bokor D. Is preoperative elevated glycated hemoglobin (HbA1c) a risk factor for postoperative shoulder stiffness after posterior-superior rotator cuff repair? JSES Int 2024;8:47-52. [PMID: 38312295 PMCID: PMC10837722 DOI: 10.1016/j.jseint.2023.09.006] [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: 02/06/2024] Open

Abstract

Background

Postoperative shoulder stiffness (POSS) affects a large number of patients undergoing rotator cuff repair (RCR). Diabetes may increase the risk of POSS. Preoperative glycated hemoglobin (HbA1c) is a convenient measure of glucose control in this group. The aim of the present study was to determine a relationship between preoperative HbA1c and POSS in patients undergoing postero-superior RCR.

Methods

Two hundred fifty patients with full-thickness postero-superior rotator cuffs who underwent RCR were followed for 6 months. Pre- and post-operative external rotation with arm by the side at 3 and 6 months were measured. Patient demographics, tear characteristics, preoperative HbA1c level, and surgical details were recorded. Patients with subscapularis tears, concomitant instability, partial thickness tears, arthritis, and irreparable rotator cuff tears were excluded. Univariate and multivariate logistic regression were used to determine the association between patient characteristics and POSS at 6 months.

Results

At the end of 6 months, 16% (41/250) of patients had POSS. Multivariate analysis demonstrated an elevated preoperative HbA1c level was a statistically significant predictor of POSS at 6 months (odds ratio 7.04, P < .01) after posterior superior RCR. Lower preoperative external rotation (P = .02) and female sex (P < .01) were also risk factors associated with POSS. Age, hand dominance, worker's compensation claim status, etiology, and size of the tear, surgical technique, and additional treatments were not statistically significant predictors.

Conclusion

Elevated preoperative HbA1c level is associated with POSS after RCR. Measuring HbA1c preoperatively may assist clinicians to identify patients at risk of POSS. HbA1c is a modifiable parameter that could then be optimized preoperatively in order to improve outcomes.

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Geurkink TH, Marang-van de Mheen PJ, Nagels J, Wessel RN, Poolman RW, Nelissen RG, van Bodegom-Vos L. Substantial Variation in Decision Making to Perform Subacromial Decompression Surgery for Subacromial Pain Syndrome Between Orthopaedic Shoulder Surgeons for Identical Clinical Scenarios: A Case-Vignette Study. Arthrosc Sports Med Rehabil 2023;5:100819. [PMID: 38023445 PMCID: PMC10661501 DOI: 10.1016/j.asmr.2023.100819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open

Abstract

Purpose

To provide further insight into the variation in decision making to perform subacromial decompression (SAD) surgery in patients with subacromial pain syndrome (SAPS) and its influencing factors.

Methods

Between November 2021 and February 2022, we invited 202 Dutch Shoulder and Elbow Society members to participate in a cross-sectional Web-based survey including 4 clinical scenarios of SAPS patients. Scenarios varied in patient characteristics, clinical presentation, and other contextual factors. For each scenario, respondents were asked (1) to indicate whether they would perform SAD surgery, (2) to indicate the probability of benefit of SAD surgery (i.e., pain reduction), (3) to indicate the probability of harm (i.e., complications), and (4) to rank the 5 most important factors influencing their treatment decision.

Results

A total of 78 respondents (39%) participated. The percentage of respondents who would perform SAD surgery ranged from 4% to 25% among scenarios. The median probability of perceived benefit ranged between 70% and 79% across scenarios for respondents indicating to perform surgery compared with 15% to 29% for those indicating not to perform surgery. The difference in the median probability of perceived harm ranged from 3% to 9% for those indicating to perform surgery compared with 8% to 13% for those indicating not to perform surgery. Surgeons who would perform surgery mainly reported patient-related factors (e.g., complaint duration and response to physical therapy) as the most important factors to perform SAD surgery, whereas surgeons who would not perform surgery mainly reported guideline-related factors.

Conclusions

Overall, Dutch orthopaedic shoulder surgeons are reluctant to perform SAD surgery in SAPS patients. There is substantial variation among orthopaedic surgeons regarding decisions to perform SAD surgery for SAPS even when evaluating identical scenarios, where particularly the perceived benefit of surgery differed between those who would perform surgery and those who would not. Surgeons who would not perform SAD surgery mainly referred to guideline-related factors as influential factors for their decision, whereas those who would perform SAD surgery considered patient-related factors more important.

Clinical Relevance

There is substantial variation in decision making to perform SAD surgery for SAPS between individual orthopaedic surgeons for identical case scenarios.

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Geurkink TH, van Bodegom-Vos L, Nagels J, Liew S, Stijnen P, Nelissen RGHH, Marang-van de Mheen PJ. The relationship between publication of high-quality evidence and changes in the volume and trend of subacromial decompression surgery for patients with subacromial pain syndrome in hospitals across Australia, Europe and the United States: a controlled interrupted time series analysis. BMC Musculoskelet Disord 2023;24:456. [PMID: 37270498 DOI: 10.1186/s12891-023-06577-6] [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: 08/16/2022] [Accepted: 05/27/2023] [Indexed: 06/05/2023] Open

Abstract

AIMS

To evaluate the extent to which publication of high-quality randomised controlled trials(RCTs) in 2018 was associated with a change in volume or trend of subacromial decompression(SAD) surgery in patients with subacromial pain syndrome(SAPS) treated in hospitals across various countries.

METHODS

Routinely collected administrative data of the Global Health Data@work collaborative were used to identify SAPS patients who underwent SAD surgery in six hospitals from five countries (Australia, Belgium, Netherlands, United Kingdom, United States) between 01/2016 and 02/2020. Following a controlled interrupted time series design, segmented Poisson regression was used to compare trends in monthly SAD surgeries before(01/2016-01/2018) and after(02/2018-02/2020) publication of the RCTs. The control group consisted of musculoskeletal patients undergoing other procedures.

RESULTS

A total of 3.046 SAD surgeries were performed among SAPS patients treated in five hospitals; one hospital did not perform any SAD surgeries. Overall, publication of trial results was associated with a significant reduction in the trend to use SAD surgery of 2% per month (Incidence rate ratio (IRR) 0.984[0.971-0.998]; P = 0.021), but with large variation between hospitals. No changes in the control group were observed. However, publication of trial results was also associated with a 2% monthly increased trend (IRR 1.019[1.004-1.034]; P = 0.014) towards other procedures performed in SAPS patients.

CONCLUSION

Publication of RCT results was associated with a significantly decreased trend in SAD surgery for SAPS patients, although large variation between participating hospitals existed and a possible shift in coding practices cannot be ruled out. This highlights the complexities of implementing recommendations to change routine clinical practice even if based on high-quality evidence.

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Verweij LPE, Doornberg JN, van den Bekerom MPJ. Early Treatment of Shoulder Pathology May Be Necessary, but Let Us First Improve Patient Risk Stratification to Prevent Overtreatment. Arthroscopy 2023;39:1123-1125. [PMID: 37019526 DOI: 10.1016/j.arthro.2023.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/28/2023] [Indexed: 04/07/2023]

Williams TG, Hackett LM, Lam PH, Stitz DJ, Al-Housni H, Murrell DF, Murrell GAC. Fibrillar matrix, Echogenicity, Contour, Thickness, and Suture (FECTS) vs. Global: A comparison of 2 scales developed to assess ultrasound images post rotator cuff repair. J Shoulder Elbow Surg 2023;32:713-728. [PMID: 36481456 DOI: 10.1016/j.jse.2022.10.035] [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: 05/01/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022]

Abstract

BACKGROUND

Ultrasound is commonly used to assess rotator cuff repair (RCR), but no standardized criterion exists to characterize the tendon.

PURPOSE

The aims of this study were to (1) develop content validity for ultrasound specific criteria to grade the postoperative appearance of a tendon after RCR, (2) assess the reliability of the criteria, and (3) assess the feasibility to use these assessments.

METHODOLOGY

Following expert consultation and literature review for content validity, 2 scales were created: 1) the Fibrillar matrix, Echogenicity, Contour, Thickness, and Suture (FECTS) scale and 2) the Rotator Cuff Repair-Investigator Global Assessment (RCR-IGA). A prospective cohort study was undertaken on patients who had received a RCR and serial B-mode ultrasound images. Four raters assessed the 64-ultrasound images using the scales created in a blinded fashion using intraclass correlation coefficients.

RESULTS

The FECTS scale was a composite score with 5 key parameters and the RCR-IGA scale was a 5-point global score. The intrarater reliability for the FECTS scale was excellent for the most experienced rater (0.92) and fair for the rater with no experience (0.72). The intrarater reliability for the RCR-IGA scale was excellent for 3 of the 4 raters (0.80-0.87) and fair when used by the least experienced rater (0.56). Inter-rater testing for all the FECTS scale parameters had excellent reliability (0.82-0.92) except for Fibrillar matrix (0.73). The average time to complete the FECTS scale per image was 23 seconds and 11 seconds for the RCR-IGA scale.

CONCLUSION

The FECTS scale and the RCR-IGA scale are reliable tools to assess the ultrasonic appearance of the repaired rotator cuff tendon. The FECTS scale was more reliable for less experienced assessors. The RCR-IGA scale was easier, more time efficient and reliable for those with experience.

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McKenzie BJ, Haas R, Ferreira GE, Maher CG, Buchbinder R. The environmental impact of health care for musculoskeletal conditions: A scoping review. PLoS One 2022;17:e0276685. [PMID: 36441677 PMCID: PMC9704655 DOI: 10.1371/journal.pone.0276685] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open

Abstract

BACKGROUND

Health care has significant environmental impact. We performed a scoping review to map what is known about the environmental impact of health care for musculoskeletal conditions.

METHODS

We included published papers of any design that measured or discussed environmental impact of health care or health support services for any musculoskeletal condition in terms of climate change or global warming (e.g., greenhouse gas emissions it produces). We searched MEDLINE and Embase from inception to 2 May 2022 using keywords for environmental health and musculoskeletal conditions, and performed keyword searches using Google and Google Scholar. Two independent reviewers screened studies. One author independently charted data, verified by a second author. A narrative synthesis was performed.

RESULTS

Of 12,302 publications screened and 73 identified from other searches, 122 full-text articles were assessed for eligibility, and 49 were included (published 1994 to 2022). Of 24 original research studies, 11 measured environmental impact relating to climate change in orthopaedics (n = 10), and medical aids for the knee (n = 1), one measured energy expenditure of laminar versus turbulent airflow ventilation systems in operating rooms during simulated hip replacements and 12 measured waste associated with orthopaedic surgery but did not relate waste to greenhouse gas emissions or environmental effects. Twenty-one editorials described a need to reduce environmental impact of orthopaedic surgery (n = 9), physiotherapy (n = 9), podiatry (n = 2) or occupational therapy (n = 1). Four narrative reviews discussed sustainability relating to hand surgery (n = 2), orthopaedic surgery (n = 1) and orthopaedic implants (n = 1).

CONCLUSION

Despite an established link between health care and greenhouse gas emissions we found limited empirical data estimating the impact of musculoskeletal health care on the environment. These data are needed to determine whether actions to lower the carbon footprint of musculoskeletal health care should be a priority and to identify those aspects of care that should be prioritised.

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Zadro JR, O'Keeffe M, Ferreira GE, Traeger AC, Gamble AR, Page R, Herbert RD, Harris IA, Maher CG. Diagnostic labels and advice for rotator cuff disease influence perceived need for shoulder surgery: an online randomised experiment. J Physiother 2022;68:269-276. [PMID: 36257876 DOI: 10.1016/j.jphys.2022.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/05/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open

Abstract

QUESTION

What are the effects of diagnostic labels and advice, and interactions between labels and advice, on perceived need for shoulder surgery for rotator cuff disease?

DESIGN

2×2 factorial online randomised experiment.

PARTICIPANTS

People with shoulder pain.

INTERVENTION

Participants read a scenario describing a patient with rotator cuff disease and were randomised to bursitis label plus guideline-based advice, bursitis label plus treatment recommendation, rotator cuff tear label plus guideline-based advice, and rotator cuff tear label plus treatment recommendation. Guideline-based advice included encouragement to stay active and positive prognostic information. Treatment recommendation stressed that treatment is needed for recovery.

OUTCOME MEASURES

Perceived need for surgery (primary outcome), imaging, an injection, a second opinion and to see a specialist; and perceived seriousness of the condition, recovery expectations, impact on work performance and need to avoid work.

RESULTS

A total of 2,024 responses (99.8% of 2,028 randomised) were analysed. Labelling as bursitis (versus rotator cuff tear) decreased perceived need for surgery (mean effect -0.5 on a 0-to-10 scale, 98.3% CI -0.7 to -0.2), imaging and to see a specialist, and perceived seriousness of the condition and need to avoid work. Guideline-based advice (versus treatment recommendation) decreased perceived need for surgery (mean effect -1.0, 98.3% CI -1.3 to -0.7), imaging, an injection, a second opinion and to see a specialist, and perceived seriousness of the condition and recovery expectations. There was little to no evidence of an advice label interaction for any outcome.

CONCLUSION

Labels and advice influenced perceived need for surgery and other secondary outcomes in people with rotator cuff disease, with larger effects for advice. There was evidence of little or no interaction between labels and advice for any outcome, but the additive effect of labels and advice appeared large for some outcomes (eg, perceived need for imaging and perceived seriousness of the condition).

TRIAL REGISTRATION

ACTRN12621001370897.

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Zadro JR, Karunaratne S, Harris IA, Jones CM, O'Keeffe M, Ferreira GE, Buchbinder R, McCaffery K, Thompson R, Maher CG, Hoffmann T. The impact of a patient decision aid on intention to undergo surgery for subacromial pain syndrome: An online randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2022;105:2951-2961. [PMID: 35589459 DOI: 10.1016/j.pec.2022.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/08/2022] [Accepted: 05/07/2022] [Indexed: 06/15/2023]

Affiliation(s)

Joshua R Zadro Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia.
Sascha Karunaratne Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, New South Wales, Australia
Ian A Harris Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia; Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, New South Wales, Australia
Caitlin Mp Jones Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia
Mary O'Keeffe Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia
Giovanni E Ferreira Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia
Rachelle Buchbinder Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Monash Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Victoria, Australia
Kirsten McCaffery Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
Rachel Thompson School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
Christopher G Maher Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia
Tammy Hoffmann Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia

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Lo CN, Leung BPL, Ngai SPC. The Usefulness of Serological Inflammatory Markers in Patients with Rotator Cuff Disease-A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022;58:301. [PMID: 35208624 PMCID: PMC8875154 DOI: 10.3390/medicina58020301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/01/2022] [Accepted: 02/13/2022] [Indexed: 11/16/2022]

Abstract

Background and Objectives: Rotator cuff disease (RCD) is a prominent musculoskeletal pain condition that spans a variety of pathologies. The etiology and precise diagnostic criteria of this condition remain unclear. The current practice of investigating the biochemical status of RCD is by conducting biopsy studies but their invasiveness is a major limitation. Recent biochemical studies on RCD demonstrate the potential application of serological tests for evaluating the disease which may benefit future clinical applications and research. This systematic review is to summarize the results of available studies on serological biochemical investigations in patients with RCD. Methods: An electronic search on databases PubMed and Virtual Health Library was conducted from inception to 1 September 2021. The inclusion criteria were case-control, cross-sectional, and cohort studies with serological biochemical investigations on humans with RCD. Methodological quality was assessed using the Study Quality Assessment Tool for Observational Cohort and Cross-sectional studies from the National Heart, Lung, and Blood Institute. Results: A total of 6008 records were found in the databases; of these, 163 full-text studies were checked for inclusion and exclusion criteria. Nine eligible studies involving 984 subjects with RCD emerged from this systematic review. The quality of the studies found ranged from poor to moderate. In summarizing all the studies, several fatty acids, nonprotein nitrogen, interleukin-1 β, interleukin-8, and vascular endothelial growth factor were found to be significantly higher in blood samples of patients with RCD than with control group patients, while Omega-3 Intex, vitamin B12, vitamin D, phosphorus, interleukin-10, and angiogenin were observed to be significantly lower. Conclusions: This is the first systematic review to summarize current serological studies in patients with RCD. Results of the studies reflect several systemic physiological changes in patients with RCD, which may prove helpful to better understand the complex pathology of RCD. In addition, the results also indicate the possibility of using serological tests in order to evaluate RCD; however, further longitudinal studies are required.

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Vidal C, Lira MJ, de Marinis R, Liendo R, Contreras JJ. Increasing incidence of rotator cuff surgery: A nationwide registry study in Chile. BMC Musculoskelet Disord 2021;22:1052. [PMID: 34930197 PMCID: PMC8690465 DOI: 10.1186/s12891-021-04938-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open

Abstract

BACKGROUND

The rotator cuff surgery (RCS) incidence is rising rapidly in North America, Europe, Asia, and Australia. Despite this, multiple factors limit patients' access to surgery. In Latin America, barriers to orthopedic surgery have been largely ignored. The purpose of this study was to calculate the rate of RCS in Chile between 2008 and 2018, investigating possible associated factors to access such as age, sex, and the health insurance.

METHODS

An ecological study was carried out with nationwide data obtained from the Database of Hospital Discharges of the Department of Statistics. All Chilean inhabitants aged 25 years or more were included. We used the ICD-10 codes M751, M754, and S460. The annual incidence rate of surgeries and the incidence rate for the period studied per 100,000 inhabitants were calculated. Data were analyzed stratified by age, sex, year of study, and the health insurance. Negative binomial regression was used to compare rates. Statistical analyzes were performed with Stata v.14 software.

RESULTS

39,366 RCSs were performed, with a total rate for the period of 32.36 per 100,000 inhabitants. The annual rate of surgeries from 2008 to 2018 increased from 24.55 to 49.11 per 100,000/year. When adjusting for year, an annual increase in surgery rates of 8.19% (95% CI 6.7-9.6) and 101% growth between 2008 and 2018 (95% CI 90-109%, p < 0.001) was observed. When comparing the global rates according to the health insurance, the public system corresponds to 21.3 per 100,000 and the private system to 72 per 100,000, the latter being 3.4-times higher (95% CI 2.7-4.4; p < 0.001).

CONCLUSION

RCS rates are increasing in Chile concordantly with previous reports of other western countries. The most important factor associated with RCS rate found was the patients' health insurance, with higher rates observed for the private sector.

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Hodgetts C, Walker B. Epidemiology, common diagnoses, treatments and prognosis of shoulder pain: A narrative review. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]

Curtis DM, Bradley AT, Lin Y, Baker HP, Shi LL, Strelzow JA, Athiviraham A. National Trends Show Declining Use of Arthroscopic Subacromial Decompression Without Rotator Cuff Repair. Arthroscopy 2021;37:3397-3404. [PMID: 34052380 DOI: 10.1016/j.arthro.2021.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 02/02/2023]

Taylor K, Baxter GD, Tumilty S. Clinical decision-making for shoulder surgery referral: An art or a science? J Eval Clin Pract 2021;27:1159-1163. [PMID: 32941698 DOI: 10.1111/jep.13473] [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: 03/24/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]

Robertson A, Birch M, Harris IA, Buchbinder R, Ferreira G, O'Keeffe M, Maher CG, Zadro JR. Online Information About the Effectiveness of Shoulder Surgery Is Not Based on the Best Available Evidence: A Content Analysis. Arch Phys Med Rehabil 2021;102:2141-2149.e2. [PMID: 34129832 DOI: 10.1016/j.apmr.2021.03.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/22/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]

Abstract

OBJECTIVE

To summarize the proportion of consumer webpages on subacromial decompression and rotator cuff repair surgery that make an accurate portrayal of the evidence for these operations (primary outcome), mention the benefits and harms of surgery, outline alternatives to surgery, and make various surgical recommendations.

DESIGN

Content analysis.

SETTING

Online consumer information about subacromial decompression and rotator cuff repair surgery. Webpages were identified through (1) Google searches using terms synonymous with "shoulder pain" and "shoulder surgery" and searching "orthopedic surgeon" linked to each Australian capital city and (2) websites of relevant professional associations (eg, Australian Orthopaedic Association). Two reviewers independently identified webpages and extracted data.

PARTICIPANTS

Not applicable.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Whether the webpage made an accurate portrayal of the evidence for subacromial decompression or rotator cuff repair surgery (primary outcome), mentioned benefits and harms of surgery, outlined alternatives to surgery, and made various surgical recommendations (eg, delay surgery). Outcome data were summarized using counts and percentages.

RESULTS

A total of 155 webpages were analyzed (n=89 on subacromial decompression, n=90 on rotator cuff repair, n=24 on both). Only 18% (n=16) and 4% (n=4) of webpages made an accurate portrayal of the evidence for subacromial decompression and rotator cuff repair surgery, respectively. For subacromial decompression and rotator cuff repair, respectively, 85% (n=76) and 80% (n=72) of webpages mentioned benefits, 38% (n=34) and 47% (n=42) mentioned harms, 94% (n=84) and 92% (n=83) provided alternatives to surgery, and 63% (n=56) and 62% (n=56) recommended delayed surgery (the most common recommendation).

CONCLUSIONS

Most online information about subacromial decompression and rotator cuff repair surgery does not accurately portray the best available evidence for surgery and may be inadequate to inform patient decision making.

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Maxwell C, Robinson K, McCreesh K. Understanding Shoulder Pain: A Qualitative Evidence Synthesis Exploring the Patient Experience. Phys Ther 2021;101:6054190. [PMID: 33373455 DOI: 10.1093/ptj/pzaa229] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 11/14/2022]

Abstract

OBJECTIVE

The objective of this study was to review and synthesize qualitative research studies exploring the experiences of individuals living with shoulder pain to enhance understanding of the experiences of these individuals as well as facilitate health care developments.

METHODS

A meta-ethnographic approach was adopted to review and synthesize eligible published qualitative research studies. The findings from each included study were translated into one another using the Noblit and Hares 7-stage process. A systematic search of 11 electronic databases was conducted in March 2020. Methodological quality was assessed using the Critical Appraisal Skills Programme appraisal tool.

RESULTS

Nineteen studies were included in the meta-synthesis. Included articles explored the lived experiences as well as treatment-related experiences of participants. All of the included articles were deemed to be of high methodological quality. Three themes were identified: (1) negative emotional, social, and activity impact ("It has been a big upheaval"); (2) developing an understanding ("Why is it hurting so much?"); and (3) exercise ("Am I going to go through a lot of pain in moving it…?"). Across the included studies, the severe emotional and physical impact of shoulder pain was a core finding. Many people sought a "permanent" solution involving surgery. Openness to other treatment options was influenced by factors including understanding of pain, prior experiences, and treatment expectations.

CONCLUSION

These findings deepen our understanding of the impact of shoulder pain on peoples' lives and provide novel insight into the experience of treatment. Enhanced awareness of people's experiences of shoulder pain and treatment is crucial for clinicians when planning and implementing evidence-based recommendation.

IMPACT

To the knowledge of the authors, this is the first qualitative evidence synthesis to explore the treatment-related experiences of individuals with shoulder pain. Shoulder surgery was considered by many as the only means to achieve a more permeant resolution of symptoms.

LAY SUMMARY

Shoulder pain causes emotional and physical turmoil that can permeate every facet of life. People's understanding of their shoulder pain appears to be deeply rooted in a biomechanical view of pain, which influences their expectations relating to diagnosis and treatment.

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Malliaras P, Rathi S, Burstein F, Watt L, Ridgway J, King C, Warren N. 'Physio's not going to repair a torn tendon': patient decision-making related to surgery for rotator cuff related shoulder pain. Disabil Rehabil 2021;44:3686-3693. [PMID: 33577359 DOI: 10.1080/09638288.2021.1879945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]

Abstract

BACKGROUND

Rotator cuff related shoulder pain (RCRSP) is a common and disabling shoulder condition and surgical management is becoming more common. The rates and costs of surgical interventions have been on the rise. Understanding decision-making related to surgery and providing adequate information to people with RCRSP may improve patient-centred care and potentially reduce rates of surgery.

OBJECTIVES

To explore the decision-making processors of people who have undertaken surgery for RCRSP.

DESIGN

An in-depth thematic analysis.

METHOD

Interviews were conducted with patients from Melbourne who had had surgical management for RCRSP. Data were analysed using an inductive thematic approach.

RESULTS

Fifteen participants were recruited. Six key themes emerged: (1) Needing to get it done: "It was necessary to remedy the dire situation"; (2) Non-surgical treatment experience:" I knew that I'd done all I could"; (3) Mechanical problem:" Physio's not going to repair a torn tendon"; (4) Trust in medical professionals "If they told me that I needed to swallow a thousand spiders, I would have done it."; (5) Varied information sources "Dr Google played a big part in it"; (6) Organisational barriers "It was absolutely useless, my insurance."

CONCLUSION

Surgery appears to be commonly precipitated by unremitted severe symptoms and failed non-surgical treatment. While there was strong trust in highly trained surgeons, decision to undergo surgery also drew on questionable pathoanatomical beliefs and instances of inadequate patient information about treatment choices and risks that may be addressed by adopting a more patient-centred care approach.IMPLICATIONS FOR REHABILITATIONUnderstanding decision-making related to surgery and providing adequate information to people with rotator cuff related shoulder pain may improve patient-centred care.Surgery appears to be commonly precipitated by unremitted severe symptoms and failed non-surgical treatment.Decision to undergo surgery sometimes drew on questionable pathoanatomical beliefs.There was strong trust in highly trained surgeons but there were instances of inadequate patient information about treatment choices and risks.

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Smythe A, Rathi S, Pavlova N, Littlewood C, Connell D, Haines T, Malliaras P. Self-reported management among people with rotator cuff related shoulder pain: An observational study. Musculoskelet Sci Pract 2021;51:102305. [PMID: 33249362 DOI: 10.1016/j.msksp.2020.102305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 11/26/2022]

Cridland K, Pritchard S, Rathi S, Malliaras P. 'He explains it in a way that I have confidence he knows what he is doing': A qualitative study of patients' experiences and perspectives of rotator-cuff-related shoulder pain education. Musculoskeletal Care 2020;19:217-231. [PMID: 33258225 DOI: 10.1002/msc.1528] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 01/28/2023]

Abstract

BACKGROUND

Patient education is recommended in clinical practice guidelines for rotator-cuff-related shoulder pain (RCRSP), yet there are no guidelines for clinicians. A gap in the current literature relates to patients' perspectives.

AIMS

The aim of this study was to explore the experiences and perspectives of people with RCRSP about education for their condition.

MATERIALS AND METHODS

An inductive qualitative design was adopted. Eight participants with RCRSP participated in individual telephone interviews that were audio-recorded, transcribed and de-identified. Four researchers completed inductive thematic analysis. Institutional ethics approval was obtained.

RESULTS

Results are detailed as a thematic analysis from the interview responses. Three primary themes were identified: (1) a therapeutic alliance leads to trust of education; (2) education of RCRSP should be individualized and practical; and (3) delivery of educational interventions should be varied and multi-modal.

DISCUSSION

The results demonstrated that trust in the health professional providing the education facilitates adherence and increases belief that the condition is being effectively treated. Participants believed imaging were necessary for an individual diagnosis despite clinical practice guidelines not recommending imaging for the first 6-12 weeks of initial presentation. There was a general caution about generic online information which may adversely impact the value of exclusively online educational intervention in the future. Participants preferred clear and practical education about RCRSP, including activity modification, timeframes for recovery and potential detriments to their recovery. There was consensus that education is best delivered early in the rehabilitation process, however there were mixed preferences for delivery method between written, video and face-to-face which perhaps reflects different learning styles and indicates that a 'one size fits all' approach is not effective in adult education in this condition.

CONCLUSION

People with RCRSP believe education about their condition is important and is best delivered by a trusted source early in their rehabilitation. There is a belief that scans are necessary to provide an individualized diagnosis and assists in their understanding of the condition. There is an opportunity for online education; however, this may best be utilised as an adjunct method to face-to-face care.

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Malliaras P, Cridland K, Hopmans R, Ashton S, Littlewood C, Page R, Harris I, Skouteris H, Haines T. Internet and Telerehabilitation-Delivered Management of Rotator Cuff-Related Shoulder Pain (INTEL Trial): Randomized Controlled Pilot and Feasibility Trial. JMIR Mhealth Uhealth 2020;8:e24311. [PMID: 33206059 PMCID: PMC7710452 DOI: 10.2196/24311] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022] Open

Abstract

BACKGROUND

Rotator cuff-related shoulder pain (RCRSP) is a common and disabling musculoskeletal condition. Internet-based and telerehabilitation delivery of recommended care may improve access to care and improve adherence and outcomes.

OBJECTIVE

The primary aim of this pilot randomized controlled trial was to assess the feasibility of a 12-week internet-delivered intervention for RCRSP comparing advice only, recommended care, and recommended care with group-based telerehabilitation.

METHODS

Reporting was in accordance with the Consolidated Standards of Reporting Trials (CONSORT) checklist for pilot and feasibility trials. People with a primary complaint of RCRSP for 3 months or longer were identified via a paid Facebook strategy. Screening involved an online questionnaire followed by a 20-minute telehealth assessment. Participants were randomly allocated (via a Zelen design) to receive (1) advice only, (2) recommended care (internet-delivered evidence-based exercise and education), or (3) recommended care and telerehabilitation (including a weekly group teleconference session). Progression criteria for a full-scale trial included (1) recruitment of 20% or greater of eligible participants, (2) acceptable adherence (two or more of the three prescribed weekly sessions) among 70% or greater of participants, (3) 80% or greater retention of participants, (4) absence of intervention-related serious adverse events, and (5) 80% or greater response rates to questionnaires. Secondary clinical and patient knowledge outcomes were collected (via email or text) at baseline, six weeks, and 12 weeks (for clinical and patient knowledge), and within-group change was reported descriptively.

RESULTS

We enrolled 36 of 38 (95%) eligible participants and all participants were recruited within a 3-week period. Of the 36 participants, 12 participants were allocated to each of the three trial arms. The mean age of participants was between 51 and 56 years, and 83% (10/12) to 92% (11/12) were female. Retention at the 12-week endpoint was 94% (34/36) and response to email questionnaires at other time points was 83% or greater. We found acceptable adherence (defined as greater than 70% of participants performing exercise 2 or 3 times/week) in the recommended care group with telerehabilitation but not in the recommended care group without telerehabilitation. There was a total of 24 adverse events over 108 person-months of observation. All adverse events were mild or moderate (mainly muscle and shoulder symptoms), with the exception of one instance of elective surgery (unrelated to the person's shoulder condition).

CONCLUSIONS

Our prespecified success criteria were met or exceeded, but there was a gender imbalance toward women. It is feasible to progress to a fully powered trial, but strategies to address the gender imbalance need to be implemented.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12620000248965); https://tinyurl.com/yy6eztf5.

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Karppi P, Ryösä A, Kukkonen J, Kauko T, Äärimaa V. Effectiveness of supervised physiotherapy after arthroscopic rotator cuff reconstruction: a randomized controlled trial. J Shoulder Elbow Surg 2020;29:1765-1774. [PMID: 32815806 DOI: 10.1016/j.jse.2020.04.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 02/01/2023]

Meehan K, Wassinger C, Roy JS, Sole G. Seven Key Themes in Physical Therapy Advice for Patients Living With Subacromial Shoulder Pain: A Scoping Review. J Orthop Sports Phys Ther 2020;50:285-a12. [PMID: 32476583 DOI: 10.2519/jospt.2020.9152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Cochrane in CORR®: Surgery for Rotator Cuff Tears. Clin Orthop Relat Res 2020;478:947-953. [PMID: 32282464 PMCID: PMC7170705 DOI: 10.1097/corr.0000000000001235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]

Naunton J, Harrison C, Britt H, Haines T, Malliaras P. General practice management of rotator cuff related shoulder pain: A reliance on ultrasound and injection guided care. PLoS One 2020;15:e0227688. [PMID: 31929588 PMCID: PMC6957186 DOI: 10.1371/journal.pone.0227688] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/26/2019] [Indexed: 12/22/2022] Open

Abstract

OBJECTIVE

To describe general practitioner's (GP's) current management of rotator cuff related shoulder pain (RCRP) in Australia and identify if this is consistent with recommended care and best available evidence. The secondary aim was to determine if GP management of RCRP changed over time.

METHODS

Data about management of RCRP by Australian GPs was extracted from the Bettering the Evaluation of Care of Health program database over its final five years (April 2011-March 2016). Patient and GP characteristics and encounter management data were extracted. Results are reported using descriptive statistics with point estimates and 95% confidence intervals. A secondary analysis over a 16 year period (2000-2016) examined management data for RCRP in four year periods.

RESULTS

RCRP was the most common shoulder condition managed by GPs at 5.12 per 1,000 encounters; and at an estimated 732,000 times nationally in 2015-2016. Management rate was higher among male patients (5.5 per 1000 encounters c.f. 4.8 for female patients) and was highest in the 45-64 year old age group (8.6 per 1000). RCRP was most frequently managed with medications (54.7%), steroid injection (19.5%) followed by non-steroidal anti-inflammatory drugs (NSAIDs) (19.1%). Imaging was ordered for 43.4% (ultrasound 41.2% and x-ray 11.6%) of all RCRP presentations (new and returning). Over half (53.0%) of new RCRP presentations were referred for ultrasound imaging. In the 16 year period 2000-16 ultrasound imaging more than doubled from 19.1% to 41.9% of management occasions. In parallel, prescribed steroid injection increased from 9.8% to 19.7%.

CONCLUSION

The usual care provided by GPs for RCRP relies on the use of ultrasound and steroid injection. This is not consistent with recommended care and clinical guidelines that recommend these are delayed until after 6-12 weeks of NSAID medication, exercise and activity modification. There has been a significant increase in the rate of steroid injection and ultrasound imaging, which may be due in part to policy change.

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Jones T, Carr AJ, Beard D, Linton MJ, Rooshenas L, Donovan J, Hollingworth W. Longitudinal study of use and cost of subacromial decompression surgery: the need for effective evaluation of surgical procedures to prevent overtreatment and wasted resources. BMJ Open 2019;9:e030229. [PMID: 31467054 PMCID: PMC6719759 DOI: 10.1136/bmjopen-2019-030229] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open

Abstract

OBJECTIVES

To illustrate the need for better evaluation of surgical procedures, we investigated the use and cost of subacromial decompression in England over the last decade compared with other countries and explored how this related to the conduct and outcomes of randomised, placebo-controlled clinical trials.

DESIGN

Longitudinal observational study using Hospital Episode Statistics linked to Payment by Results tariffs in England, 2007/2008 to 2016/2017.

SETTING

Hospital care in England; Finland; New York State, USA; Florida State, USA and Western Australia.

PARTICIPANTS

Patients with subacromial shoulder pain.

INTERVENTIONS

Subacromial decompression.

MAIN OUTCOME MEASURES

National procedure rates, costs and variation between clinical commissioning groups in England.

RESULTS

Without robust clinical evidence, the use of subacromial decompression in England increased by 91% from 15 112 procedures (30 per 100 000 population) in 2007/2008, to 28 802 procedures (52 per 100 000 population) in 2016/2017, costing over £125 million per year. Rates of use of subacromial decompression are even higher internationally: Finland (131 per 100 000 in 2011), Florida State (130 per 100 000 in 2007), Western Australia (115 per 100 000 in 2013) and New York State (102 per 100 000 in 2006). Two randomised placebo-controlled trials have recently (2018) shown the procedure to be no more effective than placebo or conservative approaches. Health systems appear unable to avoid the rapid widespread use of procedures of unknown effectiveness, and methods for ceasing ineffective treatments are under-developed.

CONCLUSIONS

Without good evidence, nearly 30 000 subacromial decompression procedures have been commissioned each year in England, costing over £1 billion since 2007/2008. Even higher rates of procedures are carried out in countries with less regulated health systems. High quality randomised trials need to be initiated before widespread adoption of promising operative procedures to avoid overtreatment and wasted resources, and methods to prevent or desist the use of ineffective procedures need to be expedited.

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Veen EJD, Stevens M, Koorevaar CT, Diercks RL. Appropriate care for orthopedic patients: effect of implementation of the Clinical Practice Guideline for Diagnosis and Treatment of Subacromial Pain Syndrome in the Netherlands. Acta Orthop 2019;90:191-195. [PMID: 30931669 PMCID: PMC6534224 DOI: 10.1080/17453674.2019.1593641] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open

Khan M, Alolabi B, Horner N, Bedi A, Ayeni OR, Bhandari M. Surgery for shoulder impingement: a systematic review and meta-analysis of controlled clinical trials. CMAJ Open 2019;7:E149-E158. [PMID: 30846616 PMCID: PMC6411477 DOI: 10.9778/cmajo.20180179] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open

Abstract

BACKGROUND

Shoulder impingement is one of the most common nontraumatic upper limb causes of disability in adults. Our aim was to evaluate the efficacy of surgical intervention in comparison with nonoperative or sham treatments in patients with shoulder impingement in terms of both pain and functional outcomes.

METHODS

We conducted a systematic review and meta-analysis of randomized controlled trials. Two reviewers independently screened MEDLINE, Embase, PubMed and Cochrane databases for randomized controlled trials published from 1946 to July 19, 2018. A risk-of-bias assessment was conducted for all included studies, and outcomes were pooled using a random effects model. The primary outcome was improvement in pain up to 2 years. Secondary outcomes were functional outcome scores reported in the short term (≤ 1 yr) and long term (≥ 2 yr). Heterogeneity was assessed using the I ² statistic. Functional outcome scores were presented along with minimal clinically important differences to provide clinical context for findings.

RESULTS

Thirteen randomized controlled trials (n = 1062 patients) were included in this review. Eligible patients had a mean age of 48 (standard deviation ± 4) years and 45% were men. The pooled treatment effect of surgical intervention for shoulder impingement did not demonstrate any benefit to surgery with respect to pain relief (mean difference -0.07, 95% CI -0.40 to 0.26) or short-term functional outcomes (standardized mean difference -0.09, 95% confidence interval [CI] -0.27 to 0.08). Surgical intervention did result in a small statistically significant but clinically unimportant improvement in long-term functional outcomes (standardized mean difference 0.23, 95% CI 0.06 to 0.41).

INTERPRETATION

Evidence suggests surgical intervention has little, if any, benefit for impingement pathology in the middle-aged patient. Further research is required to identify those patients who will reliably benefit from surgical intervention as well as optimal conservative treatment strategies.

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Affiliation(s)

Moin Khan Division of Orthopaedic Surgery, Department of Surgery (Khan, Alolabi, Horner, Ayeni, Bhandari), McMaster University, Hamilton, Ont.; MedSport (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.
Bashar Alolabi Division of Orthopaedic Surgery, Department of Surgery (Khan, Alolabi, Horner, Ayeni, Bhandari), McMaster University, Hamilton, Ont.; MedSport (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont
Nolan Horner Division of Orthopaedic Surgery, Department of Surgery (Khan, Alolabi, Horner, Ayeni, Bhandari), McMaster University, Hamilton, Ont.; MedSport (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont
Asheesh Bedi Division of Orthopaedic Surgery, Department of Surgery (Khan, Alolabi, Horner, Ayeni, Bhandari), McMaster University, Hamilton, Ont.; MedSport (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont
Olufemi R Ayeni Division of Orthopaedic Surgery, Department of Surgery (Khan, Alolabi, Horner, Ayeni, Bhandari), McMaster University, Hamilton, Ont.; MedSport (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont
Mohit Bhandari Division of Orthopaedic Surgery, Department of Surgery (Khan, Alolabi, Horner, Ayeni, Bhandari), McMaster University, Hamilton, Ont.; MedSport (Bedi), University of Michigan, Ann Arbor, Mich.; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont

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Kjær BH, Magnusson SP, Warming S, Henriksen M, Krogsgaard MR, Juul-Kristensen B. Progressive early passive and active exercise therapy after surgical rotator cuff repair - study protocol for a randomized controlled trial (the CUT-N-MOVE trial). Trials 2018;19:470. [PMID: 30176943 PMCID: PMC6122575 DOI: 10.1186/s13063-018-2839-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/04/2018] [Indexed: 01/08/2023] Open

Abstract

Background

Rotator cuff tear is a common cause of shoulder disability and results in patients predominantly complaining of pain and loss of motion and strength. Traumatic rotator cuff tears are typically managed surgically followed by ~ 20 weeks of rehabilitation. However, the timing and intensity of the postoperative rehabilitation strategy required to reach an optimal clinical outcome is unknown. Early controlled and gradually increased tendon loading has been suggested to positively influence tendon healing and recovery. The aim of this trial is therefore to examine the effect of a progressive rehabilitation strategy on pain, physical function and quality of life compared to usual care (that limits tendon loading in the early postoperative phase) in patients who have a rotator cuff repair of a traumatic tear.

Methods

The current study is a randomized, controlled, outcome-assessor blinded, multicenter, superiority trial with a two-group paralleled design. A total of 100 patients with surgically repaired traumatic rotator cuff tears will be recruited from up to three orthopedic departments in Denmark, and randomized to either a progressive early passive and active movement program or a limited early passive movement program (usual care). The primary outcome measure will be the change from pre-surgery to 12 weeks post-surgery in the Western Ontario Rotator Cuff Index questionnaire. Secondary outcomes include the Disabilities Arm, Shoulder and Hand questionnaire (DASH), range of motion, strength and tendon healing characteristics from ultrasound measurements at 12 months follow up.

Discussion

We hypothesized that patients who receive the progressive rehabilitation strategy will benefit more with respect to pain reduction, physical function and quality of life than those who receive care as usual. If this is confirmed our study can be used clinically to enhance the recovery of patients with traumatic rotator cuff tear.

Trial registration

ClinicalTrials.gov, NCT02969135. Registered on 15 November 2016.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2839-5) contains supplementary material, which is available to authorized users.

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Nganga M, Lizarondo L, Krishnan J, Stephenson M. Management of full thickness rotator cuff tears in the elderly: a systematic review protocol. ACTA ACUST UNITED AC 2018;16:1628-1633. [PMID: 30113547 DOI: 10.11124/jbisrir-2017-003596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]

Lin I, Wiles LK, Waller R, Goucke R, Nagree Y, Gibberd M, Straker L, Maher CG, O’Sullivan PPB. Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review. Br J Sports Med 2017;52:337-343. [DOI: 10.1136/bjsports-2017-098375] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 12/31/2022]