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Ueda Y, Sugaya H, Takahashi N, Matsuki K, Tokai M, Hoshika S, Onishi K, Kawashima I. Rotator Cuff Tears are Significantly More Frequent in Recurrent Shoulder Instability Patients With Initial Dislocation at Age 40 or Older. Arthroscopy 2024; 40:1753-1759. [PMID: 38181986 DOI: 10.1016/j.arthro.2023.12.026] [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: 06/16/2023] [Revised: 12/16/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE To investigate and compare the pathologies and clinical outcomes of patients with traumatic anterior shoulder instability who underwent arthroscopic stabilization at 40 years or older between shoulders with initial dislocation before age 40 years and at 40 years or after. METHODS Shoulders that underwent arthroscopic stabilization for recurrent traumatic anterior shoulder instability at 40 years or older with a minimum of 2-year follow-up were included. The subjects were divided into 2 groups according to age at initial dislocation after propensity score matching to reduce potential bias: younger than 40 years (group 1) and 40 years or older (group 2). Radiographic findings, pathologies, clinical outcomes, and complications were compared between the groups. RESULTS Group 1 included 56 shoulders in 56 patients (26 men and 30 women) with a mean age of 51 years (range, 40-77 years). Group 2 included 28 shoulders in 28 patients (13 men and 15 women) with a mean age of 51 years (range, 40-77 years). Glenoid bone loss was greater in group 1 than in group 2 (P = .004). Rotator cuff tears were more frequently observed in group 2 than in group 1 (P < .001). Both groups showed significant improvement in the West Ontario Shoulder Instability Index score (P < .001 for each) and flexion (P < .001 for each). The recurrence rate was 4% in group 1 and 7% in group 2. CONCLUSIONS Rotator cuff tears are significantly more frequent in recurrent shoulder instability patients with initial dislocation at age 40 or older. Arthroscopic stabilization yielded a low recurrence rate and favorable outcomes with a good return-to-sport rate in patients 40 years or older. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic trial.
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Affiliation(s)
- Yusuke Ueda
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan; Yonekura Spine and Joint Hospital, Tokyo, Japan.
| | | | - Norimasa Takahashi
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Keisuke Matsuki
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | | | - Shota Hoshika
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | | | - Itaru Kawashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Yoon TH, Choi JH, Lim JR, Chang HH, Chun YM. Heated Tobacco Products Have Detrimental Effects on Rotator Cuff Healing, Similar to Conventional Cigarettes. J Bone Joint Surg Am 2024; 106:869-878. [PMID: 38507504 DOI: 10.2106/jbjs.23.00804] [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] [Indexed: 03/22/2024]
Abstract
BACKGROUND Cigarette smoking impairs rotator cuff healing, but no study, to our knowledge, has focused on the association between heated tobacco products and rotator cuff tears. METHODS This study retrospectively investigated 1,133 patients who underwent arthroscopic repair of symptomatic rotator cuff tears between March 2011 and April 2021. Patients were grouped on the basis of their smoking patterns as nonsmokers, cigarette smokers, and heated tobacco smokers. Propensity score matching was used to reduce selection bias, and 45 subjects were selected from each group via 1:1:1 matching. Functional scores and active range of motion were compared among the 3 groups preoperatively and at a 2-year follow-up. Postoperative magnetic resonance imaging was performed 6 months after the surgical procedure to assess structural integrity. RESULTS Except for sex, similar baseline characteristics were achieved after propensity score matching. There were no differences in the clinical scores or range of motion between the matched groups either preoperatively or at the 2-year follow-up. However, the retear rate for the matched nonsmoker group was significantly lower (8.9%) than those for the matched cigarette smoker group (31.1%) and the heated tobacco smoker group (28.9%) (p = 0.022). Multivariable logistic regression analysis revealed that the retear rates were 3.403 times higher for the cigarette smoker group and 3.397 times higher for the heated tobacco smoker group than that for the nonsmoker group. CONCLUSIONS Heated tobacco users, like conventional cigarette smokers, have worse clinical outcomes with respect to rotator cuff healing than nonsmokers. Regardless of the type of cigarette, abstinence from smoking is necessary for patients undergoing rotator cuff repair surgery. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tae-Hwan Yoon
- Arthroscopy and Joint Research Institute, Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Yau WP. Smokers Achieved Minimal Clinically Important Difference for Visual Analog Scale and American Shoulder and Elbow Surgeons Scores at a Lower Rate Than Nonsmokers Even When Repaired Supraspinatus Tendons Were Intact on Postoperative Magnetic Resonance Imaging. Arthrosc Sports Med Rehabil 2024; 6:100877. [PMID: 38379600 PMCID: PMC10877171 DOI: 10.1016/j.asmr.2023.100877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/26/2023] [Indexed: 02/22/2024] Open
Abstract
Purpose To investigate the impact of smoking on clinical outcomes after repair of supraspinatus tendon in patients who had an intact repair found on postoperative magnetic resonance imaging. Methods Patients who received primary complete repair of supraspinatus tendon tear between 2014 and 2020 were retrospectively identified. Patients were excluded if a postoperative magnetic resonance imaging scan was not available or if the follow-up was less than 2 years. Visual analog score (VAS), American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion were assessed at the 2-year follow-up. The percentage of patients acquiring minimal clinically important difference (MCID) was reported. Results One hundred primary supraspinatus tendon repairs were included. The healing rate was 77% in smokers and 90% in nonsmokers. Smoking was the independent predictor of a poorer 2-year VAS (P < .001) and ASES (P < .001) scores. Significant improvement in clinical outcomes was observed between preoperation and the 2-year follow-up, regardless of the integrity of the repair or smoking status (P < .001). When the repaired tendon was intact, nonsmokers had a greater chance of achieving MCID in 2-year VAS and ASES scores than smokers. Ninety-nine percent of nonsmokers, compared with 82% of smokers, achieved MCID in VAS at the 2-year follow-up (P = .023). The corresponding figures for ASES were 98% and 71%, respectively (P = .004). Conclusions In this study, smoking was associated with poorer clinical outcomes, including a greater 2-year VAS pain score and a lower 2-year ASES score, when compared with nonsmokers, even in cases in which there was no full-thickness retear of the repaired supraspinatus tendon. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- W P Yau
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Yau WP. Differences in Clinical Outcomes Between Patients With Retear After Supraspinatus Tendon Repair and Those With Intact Repair at 5-Year Follow-up. Am J Sports Med 2024; 52:1040-1052. [PMID: 38385212 DOI: 10.1177/03635465241227643] [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] [Indexed: 02/23/2024]
Abstract
BACKGROUND It is well known that rotator cuff repair is associated with an overall retear rate of 21% to 26%. However, a cuff retear may not necessarily be associated with poor clinical outcomes. HYPOTHESIS There would be no difference in clinical outcomes between patients with a cuff retear and those with an intact repair at a midterm follow-up of 5 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective study was conducted involving patients who received arthroscopic complete repair of the supraspinatus tendon between January 2009 and December 2017. Patients who did not have a postoperative magnetic resonance imaging (MRI) scan or who had a follow-up of <5 years were excluded. Clinical outcomes, including the visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion (FF) of the involved shoulder were assessed at the 2-year and 5-year follow-up points. RESULTS The study group included 105 patients with a mean follow-up of 85 months. MRI scans were performed at a mean of 20 months. Fourteen full-thickness cuff retears and 91 intact repairs were identified using postoperative MRI scans. Significant improvement in VAS score, ASES score, and FF were found between the preoperative assessment and the 2 designated follow-up points (2 years and 5 years) in both the cuff retear and the intact repair groups (P < .001). The VAS and ASES scores at the 2-year follow-up for the intact repair group were 1.8 ± 2.0 and 80.7 ± 18.1, respectively. The corresponding values for the retear group were 2.3 ± 2.2 and 71.9 ± 19.5, respectively. No significant difference was found between the 2 groups in the VAS and ASES scores at the 2-year follow-up. However, patients with an intact repair had a better VAS score (1.4 ± 1.8; P = .049) and ASES score (81.7 ± 17; P = .019) than those with a cuff retear at the 5-year assessment (3.0 ± 2.8 and 67.1 ± 22.9, respectively). In the intact repair group, 91% of patients achieved the minimal clinically important difference for the 5-year VAS score, compared with 54% in the cuff retear group (P < .001). The corresponding values for the 5-year ASES score were 80% and 54%, respectively (P = .044). FF measurements at the 5-year follow-up in patients with intact repair and those with a cuff retear were 161°± 23° and 144°± 37°, respectively (P = .059). Continuous improvement in VAS score and FF between the 2-year and 5-year follow-up was observed in the intact repair group (P = .005 and P = .04, respectively). CONCLUSION The patients with an intact repair had better VAS and ASES scores compared with those who had a cuff retear at a midterm follow-up of 5 years. Between the 2-year and the 5-year follow-up, some further improvement was observed in the VAS score and FF in the intact repair group.
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Affiliation(s)
- W P Yau
- Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of the People's Republic of China
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Zhang Z, Ke C, Zhang Z, Chen Y, Weng H, Dong J, Hao M, Liu B, Zheng M, Li J, Ding S, Dong Y, Peng Z. Re-tear after arthroscopic rotator cuff repair can be predicted using deep learning algorithm. Front Artif Intell 2024; 7:1331853. [PMID: 38487743 PMCID: PMC10938848 DOI: 10.3389/frai.2024.1331853] [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: 11/01/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
The application of artificial intelligence technology in the medical field has become increasingly prevalent, yet there remains significant room for exploration in its deep implementation. Within the field of orthopedics, which integrates closely with AI due to its extensive data requirements, rotator cuff injuries are a commonly encountered condition in joint motion. One of the most severe complications following rotator cuff repair surgery is the recurrence of tears, which has a significant impact on both patients and healthcare professionals. To address this issue, we utilized the innovative EV-GCN algorithm to train a predictive model. We collected medical records of 1,631 patients who underwent rotator cuff repair surgery at a single center over a span of 5 years. In the end, our model successfully predicted postoperative re-tear before the surgery using 62 preoperative variables with an accuracy of 96.93%, and achieved an accuracy of 79.55% on an independent external dataset of 518 cases from other centers. This model outperforms human doctors in predicting outcomes with high accuracy. Through this methodology and research, our aim is to utilize preoperative prediction models to assist in making informed medical decisions during and after surgery, leading to improved treatment effectiveness. This research method and strategy can be applied to other medical fields, and the research findings can assist in making healthcare decisions.
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Affiliation(s)
- Zhewei Zhang
- Ningbo University affiliated Li Huili Hospital, Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
| | - Chunhai Ke
- Ningbo University affiliated Li Huili Hospital, Ningbo University, Ningbo, China
| | - Zhibin Zhang
- Faculty of Electrical Engineering and Computer Science, Ningbo University, Ningbo, China
- Key Laboratory of Mobile Network Application Technology of Zhejiang Province, Ningbo University, Ningbo, China
| | - Yujiong Chen
- Ningbo University affiliated Li Huili Hospital, Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
| | - Hangbin Weng
- Ningbo University affiliated Li Huili Hospital, Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
| | - Jieyang Dong
- Ningbo University affiliated Li Huili Hospital, Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
| | - Mingming Hao
- Ningbo University affiliated Li Huili Hospital, Ningbo University, Ningbo, China
| | - Botao Liu
- Ningbo University affiliated Li Huili Hospital, Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
| | - Minzhe Zheng
- Ningbo University affiliated Li Huili Hospital, Ningbo University, Ningbo, China
| | - Jin Li
- Ningbo University affiliated Li Huili Hospital, Ningbo University, Ningbo, China
| | - Shaohua Ding
- Ningbo University affiliated Li Huili Hospital, Ningbo University, Ningbo, China
| | - Yihong Dong
- Faculty of Electrical Engineering and Computer Science, Ningbo University, Ningbo, China
- Key Laboratory of Mobile Network Application Technology of Zhejiang Province, Ningbo University, Ningbo, China
| | - Zhaoxiang Peng
- Ningbo University affiliated Li Huili Hospital, Ningbo University, Ningbo, China
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Tashjian RZ, Zitnay J, Kazmers NH, Veerabhadraiah SR, Zelada AC, Honeggar M, Chalmers PN, Henninger HB, Jurynec MJ. Estrogen and testosterone supplementation improves tendon healing and functional recovery after rotator cuff repair. J Orthop Res 2024; 42:259-266. [PMID: 37756152 DOI: 10.1002/jor.25695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/21/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Failure of healing after rotator cuff repair (RCR) is common. The purpose of the current study was to evaluate the effect of systemic estrogen or testosterone supplementation on tendon healing after RCR. Seventy-two adult male mice were utilized for all experiments. The supraspinatus tendon was transected and repaired with 6-0 Prolene suture on the left shoulder of 51 animals. Mice were segregated into three groups postoperative: (1) vehicle group (VG; n = 18), (2) estrogen group (EST; n = 17), and (3) testosterone group (TST; n = 16). An unrepaired control group (unrepaired, n = 21) did not have surgery. Utilizing these animals, histological analysis, activity testing, biomechanical testing and RNA sequencing (RNA-seq) was performed. At 8 weeks post-RCR, TST, and EST supplementation improved the overall histologic structure of the repaired enthesis site. No differences in ultimate failure loads or stiffness were detected between VG, EST, and TST groups after biomechanical testing. RCR caused a reduction in wheel activity compared to unrepaired controls and supplementation with TST restored wheel activity. RNA-seq analysis indicated that estrogen and testosterone regulated different pathways associated with enthesis healing, including a suppression of inflammatory signaling. Supplementation with sex hormones improved the structure of the repaired tendon enthesis and significantly regulated expression of diverse pathways regulating multiple biological processes. Testosterone administration following RCR restored wheel activity without having a detrimental impact on biomechanical strength. Future human studies of sex hormone supplementation after RCR are warranted as supplementation in an animal model may improve tendon enthesis healing.
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Affiliation(s)
- Robert Z Tashjian
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jared Zitnay
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Nikolas H Kazmers
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Antonio C Zelada
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Matthew Honeggar
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Heath B Henninger
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Michael J Jurynec
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Alaia MJ, Li ZI, Chalem I, Hurley ET, Vasavada K, Gonzalez-Lomas G, Rokito AS, Jazrawi LM, Kaplan K. Cannabidiol for Postoperative Pain Control After Arthroscopic Rotator Cuff Repair Demonstrates No Deficits in Patient-Reported Outcomes Versus Placebo: 1-Year Follow-up of a Randomized Controlled Trial. Orthop J Sports Med 2024; 12:23259671231222265. [PMID: 38322981 PMCID: PMC10846110 DOI: 10.1177/23259671231222265] [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: 07/28/2023] [Accepted: 08/10/2023] [Indexed: 02/08/2024] Open
Abstract
Background Cannabidiol (CBD) has been shown recently to positively affect patient pain and satisfaction immediately after arthroscopic rotator cuff repair (ARCR). However, it is unclear whether the addition of CBD to a perioperative regimen could affect postoperative outcomes. Purpose To evaluate patient-reported outcomes among patients who underwent ARCR and received buccally absorbed CBD or an identical placebo for early postoperative pain management at 1-year follow-up. Study Design Randomized controlled trial; Level of evidence, 2. Methods Eligible patients had previously participated in a multicenter, placebo-controlled, randomized, double-blinded trial that evaluated the analgesic effects of CBD in the immediate postoperative period after ARCR. The experimental group received 25 mg of CBD 3 times/day if <80 kg and 50 mg of CBD 3 times/day if >80 kg for 14 days, with the control group receiving an identical placebo. The following outcomes were assessed at minimum 1-year follow-up: visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and patient satisfaction. The rates of achievement of the Patient Acceptable Symptom State (PASS) were compared based on ASES at latest follow-up. Continuous and categorical variables were compared with the Mann-Whitney U test and Fisher exact test, respectively. Results Follow-up was obtained from 83 of 99 patients (83.8%) who completed the original trial. There were no significant differences between the CBD and control groups with respect to age, sex, body mass index, rate of concomitant procedures, or number of anchors used intraoperatively. At 1-year follow-up, there were no significant differences between the CBD and control groups in VAS pain (0.8 vs 1.2, P = .38), ASES (93.0 vs 91.1, P = .71), SANE (87.6 vs 90.1, P = .24), or satisfaction (97.4 vs 95.4, P = .41). A majority of patients achieved the PASS (81.0% [CBD] vs 77.5% [control]; P = .79). Conclusion Perioperative use of CBD for pain control among patients undergoing ARCR did not result in any significant deficits in pain, satisfaction, or patient-reported outcomes at 1-year postoperatively compared with a placebo control group. These findings suggest that CBD can be considered in a postoperative multimodal pain management regimen without detrimental effects on outcome. Registration NCT04672252 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Michael J. Alaia
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Zachary I. Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Isabel Chalem
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Eoghan T. Hurley
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Kinjal Vasavada
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Guillem Gonzalez-Lomas
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Andrew S. Rokito
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Laith M. Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Kevin Kaplan
- Department of Orthopedic Surgery, Jacksonville Orthopaedic Institute, Jacksonville, Florida, USA
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Choi JH, Chun YM, Yoon TH. Effect of cigarette smoking on the maintenance of reduction after treatment of acute acromioclavicular joint dislocation with hook plate fixation. Clin Shoulder Elb 2023; 26:373-379. [PMID: 37957882 DOI: 10.5397/cise.2023.00738] [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: 08/17/2023] [Accepted: 09/12/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the association between smoking and clinical outcomes of hook plate fixation for acute acromioclavicular (AC) joint injuries. METHODS This study retrospectively investigated 82 patients who underwent hook plate fixation for acute AC joint dislocation between March 2014 to June 2022. The patients were grouped by smoking status, with 49 in group N (nonsmokers) and 33 in group S (smokers). Functional scores and active range of motion were compared among the groups at the 1-year follow-up. Coracoclavicular distance (CCD) was measured, and difference with the uninjured side was compared at initial injury and 6 months after implant removal. RESULTS No significant differences were observed between the two groups in demographic factors such as age and sex, as well as parameters related to initial injury status, which included time from injury to surgery, the preoperative CCD difference value, and the Rockwood classification. However, the postoperative CCD difference was significantly higher in group S (3.1±2.6 mm) compared to group N (1.7±2.4 mm). Multivariate regression analysis indicated that smoking and the preoperative CCD difference independently contributed to an increase in the postoperative CCD difference. Despite the radiographic differences, the postoperative clinical outcome scores and active range of motion measurements were comparable between the groups. CONCLUSIONS Smoking had a detrimental impact on ligament healing after hook plate fixation for acute AC joint dislocations. This finding emphasizes the importance of smoking cessation to optimize reduction maintenance after AC joint injury. Level of evidence: III.
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Affiliation(s)
- Jee-Hoon Choi
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Min Chun
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hwan Yoon
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Livesey MG, Bains SS, Weir TB, Kolakowski L, Rocca MS, Remily EA, Gilotra MN, Hasan SA. Does timing matter? The effect of preoperative smoking cessation on the risk of infection or revision following rotator cuff repair. J Shoulder Elbow Surg 2023; 32:1937-1944. [PMID: 37030604 DOI: 10.1016/j.jse.2023.03.007] [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: 11/03/2022] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Nicotine in tobacco products is known to impair bone and tendon healing, and smoking has been associated with an increased rate of retear and reoperation following rotator cuff repair (RCR). Although smoking is known to increase the risk of failure following RCR, former smoking status and the timing of preoperative smoking cessation have not previously been investigated. METHODS A national all-payer database was queried for patients undergoing RCR between 2010 and 2020. Patients were stratified into 5 mutually exclusive groups according to smoking history: (1) never smokers (n = 50,000), (2) current smokers (n = 28,291), (3) former smokers with smoking cessation 3-6 months preoperatively (n = 34,513), (4) former smokers with smoking cessation 6-12 months preoperatively (n = 786), and (5) former smokers with smoking cessation >12 months preoperatively (n = 1399). The risks of postoperative infection and revision surgery were assessed at 90 days, 1 year, and 2 years following surgery. Multivariate logistic regressions were used to isolate and evaluate risk factors for postoperative complications. RESULTS The 90-day rate of infection following RCR was 0.28% in never smokers compared with 0.51% in current smokers and 0.52% in former smokers who quit smoking 3-6 months prior to surgery (P < .001). Multivariate logistic regression identified smoking (odds ratio [OR], 1.49; P < .001) and smoking cessation 3-6 months prior to surgery (OR, 1.56; P < .001) as risk factors for 90-day infection. The elevated risk in these groups persisted at 1 and 2 years postoperatively. However, smoking cessation >6 months prior to surgery was not associated with a significant elevation in infection risk. In addition, smoking was associated with an elevated 90-day revision risk (OR, 1.22; P = .038), as was smoking cessation between 3 and 6 months prior to surgery (OR, 1.19; P = .048). The elevated risk in these groups persisted at 1 and 2 years postoperatively. Smoking cessation >6 months prior to surgery was not associated with a statistically significant elevation in revision risk. CONCLUSION Current smokers and former smokers who quit smoking within 6 months of RCR are at an elevated risk of postoperative infection and revision surgery at 90 days, 1 year, and 2 years postoperatively compared with never smokers. Former smokers who quit >6 months prior to RCR are not at a detectably elevated risk of infection or revision surgery compared with those who have never smoked.
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Affiliation(s)
- Michael G Livesey
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Tristan B Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Logan Kolakowski
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael S Rocca
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ethan A Remily
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
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Failla MJ, Mintken PE, McDevitt AW, Michener LA. Trajectory of patient-rated outcomes and association with patient acceptable symptom state in patients with musculoskeletal shoulder pain. J Man Manip Ther 2023; 31:279-286. [PMID: 36300352 PMCID: PMC10324443 DOI: 10.1080/10669817.2022.2137350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Characterize trajectory and predictors of patient acceptable symptom state (PASS) defined recovery at 6 months. METHODS Individuals with musculoskeletal shoulder pain (n = 140) completed patient-reported disability and PASS at baseline, 1 and 6 months. The PASS was categorized into 3 trajectory groups; 1.) Early Recovery (answered yes to PASS at 1 and 6-months), 2.) Delayed Recovery (PASS-yes only at 6-months), and 3.) Unrecovered. Mixed models characterized the trajectory between PASS-groups using SPADI and QDASH disability change scores. Logistic regression identified predictors of Early Recovery versus Delayed+Unrecovered groups. RESULTS PASS-defined recovery rates by group were Early Recovery (58%), Delayed Recovery (22%), and Unrecovered (20%). A group main effect indicated lower disability over time in the Early Recovery versus Unrecovered (QDASH mean difference = 11(2.4); p = 0.001; SPADI mean difference = 12(3); p < 0.001). The odds of an Early Recovery slightly increased with greater change scores on the SPADI (odds ratio = 1.06, 95%CI:1.02,1.11; p = 0.004) and QDASH (odds ratio = 1.08, 95%CI:1.03,1.13; p = 0.003) over the first month of treatment. CONCLUSION Recovery trajectories of patients indicate differing responses to treatment despite overall improvements over the first month of treatment. Incorporating both patient-reported disability (SPADI, QDASH) and acceptable satisfaction (PASS) may aid in determining recovery trajectory, but more evidence is needed to be clinically useful.
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Affiliation(s)
- Mathew J. Failla
- Department of Rehabilitation and Movement Science, University of Vermont 5, Burlington, VT, USA
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, VT, USA
| | - Paul E. Mintken
- Physical Therapy Program, University of Colorado School of Medicine, Colorado, USA
- Wardenburg Health Center, University of Colorado-Boulder, Boulder, Colorad
| | - Amy W. McDevitt
- Physical Therapy Program, University of Colorado School of Medicine, Colorado, USA
- Sports Physical Therapy and Rehabilitation, University of Colorado Health, Denver, Colorad
| | - Lori A. Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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11
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Lee S, Lee N, Shin SJ. Relationship of Missed Statin Therapy and 10-Year Atherosclerotic Cardiovascular Disease Risk Score to Retear Rate After Arthroscopic Rotator Cuff Repair. Am J Sports Med 2023; 51:1988-1996. [PMID: 37259963 DOI: 10.1177/03635465231175476] [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] [Indexed: 06/02/2023]
Abstract
BACKGROUND There is no practical consensus on managing cholesterol in patients with rotator cuff repair despite hyperlipidemia and statin therapy being well-known factors in rotator cuff healing. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk score is a commonly used guideline to determine statin administration for hyperlipidemia. PURPOSE To identify the relationship between retear and preoperative factors, including 10-year ASCVD risk score and statin administration status, and to compare clinical outcomes and retear rates between patients who are taking and not taking statins. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This study enrolled 182 patients with a symptomatic full-thickness rotator cuff tear who underwent arthroscopic repair. Serum lipid profile, 10-year ASCVD risk score, statin eligibility, and statin administration status were assessed. Patients were categorized into 2 groups based on magnetic resonance imaging to evaluate cuff integrity at postoperative 6 months: a healed group and a retear group. Radiographic and intraoperative factors related to retear were analyzed. Multiple regression analysis was performed to evaluate factors related to rotator cuff retear. For the subgroup analysis, patients eligible for statin therapy were divided into 2 subgroups according to administration status. RESULTS There were 149 (81.9%) patients in the healed group and 33 (18.1%) in the retear group. In the multiple regression analysis, missed statin therapy, 10-year ASCVD risk score, and fatty infiltration of the infraspinatus muscle were the independent factors related to retear. The cutoff value for 10-year ASCVD risk score was 11.85%, with a sensitivity of 0.75 and a specificity of 0.62. In the subgroup analysis of 104 patients eligible for statin therapy, 66 (63.5%; group 1) received statin therapy and 38 (36.5%; group 2) missed it. Group 2 showed a significantly higher retear rate than group 1 (36.8% vs 13.6%; P = .006). CONCLUSION Missed statin therapy, 10-year ASCVD risk score, and fatty infiltration of the infraspinatus were the independent factors associated with rotator cuff retear. Patients who missed statin therapy showed a higher retear rate than patients receiving statin therapy. Optimal statin therapy for patients who undergo arthroscopic rotator cuff repair might improve repair integrity.
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Affiliation(s)
- Sanghyeon Lee
- Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
| | - Narea Lee
- Department of Anesthesiology and Pain Medicine, CHA Ilsan Medical Center, CHA University, Goyang, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
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12
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Schanda JE, Eigenschink M, Laky B, Frank JK, Pauzenberger L, Anderl W, Heuberer PR. Comparison of Outcomes After Arthroscopic Superior Capsule Reconstruction Versus Arthroscopic Partial Repair or Arthroscopic Debridement for Irreparable Rotator Cuff Tears. Orthop J Sports Med 2023; 11:23259671231185182. [PMID: 37529527 PMCID: PMC10387798 DOI: 10.1177/23259671231185182] [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: 03/15/2023] [Accepted: 04/13/2023] [Indexed: 08/03/2023] Open
Abstract
Background Arthroscopic superior capsule reconstruction (SCR), arthroscopic partial repair (PR), and arthroscopic debridement (DB) are valid treatment options for irreparable rotator cuff (RC) tears. Purpose/Hypothesis The purpose of this study was to compare clinical, functional, and radiological outcomes of arthroscopic SCR with arthroscopic PR and arthroscopic DB in patients with irreparable posterosuperior RC tears. It was hypothesized that SCR would lead to superior clinical and functional outcomes compared with PR or DB. Study Design Cohort study; Level of evidence, 3. Methods Clinical and functional outcomes of this single-center retrospective study included range of motion, strength, and the age- and sex-adjusted Constant-Murley score. Patient-reported outcome measures (PROMs) involved the quick Disabilities of the Arm, Shoulder and Hand score, the Subjective Shoulder Value, and the visual analog scale for pain. Graft and repaired tendon integrity was evaluated by magnetic resonance imaging (MRI) at 12 months of follow-up. Results In total, 57 patients treated with SCR (n = 20), PR (n = 17), and DB (n = 20) were included. The mean clinical follow-up was 33.8 ± 17.9 months. Preoperative clinical and functional characteristics were comparable among the 3 groups. The range of motion and clinical and functional scores of all 3 groups significantly improved from pre- to postoperatively. Postoperative PROMs showed no differences among all 3 study groups. SCR revealed significantly higher postoperative strength compared with PR (P = .001) and DB (P = .004). Postoperative MRI revealed a rerupture in 4 patients with SCR (20%). Postoperative MRI showed a rerupture in 9 patients with PR ( 53%). Fatty muscle infiltration of the supraspinatus and infraspinatus significantly progressed within all 3 study groups in postoperative MRI scans. No clinical and functional differences were observed between intact and reruptured PR. Conclusion Patients who underwent SCR had better postoperative strength recovery than patients who underwent PR or DB.
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Affiliation(s)
- Jakob E. Schanda
- Department for Trauma Surgery, AUVA Trauma Center Vienna-Meidling, Vienna, Austria
- Ludwig Boltzmann Institute for Traumatology–The Research Center in Cooperation with AUVA, Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Martin Eigenschink
- Department for Trauma Surgery, AUVA Trauma Center Vienna-Meidling, Vienna, Austria
- Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
| | - Brenda Laky
- Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
- Austrian Society for Regenerative Medicine, Vienna, Austria
| | - Julia K. Frank
- II Orthopedic Department, Sacred Heart Hospital of Jesus, Vienna, Austria
| | - Leo Pauzenberger
- II Orthopedic Department, Sacred Heart Hospital of Jesus, Vienna, Austria
- healthPi Medical Center, Vienna, Austria
| | - Werner Anderl
- Austrian Society for Regenerative Medicine, Vienna, Austria
| | - Philipp R. Heuberer
- Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
- healthPi Medical Center, Vienna, Austria
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13
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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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14
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Failed and Revision Rotator Cuff Repair. Clin Sports Med 2023; 42:141-155. [DOI: 10.1016/j.csm.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Surgery and Rotator Cuff Disease. Clin Sports Med 2023; 42:1-24. [DOI: 10.1016/j.csm.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Raso J, Althoff A, Brunette C, Kamalapathy P, Arney M, Werner BC. Preoperative Substance Use Disorder Is Associated With an Increase in 90-Day Postoperative Complications, 1-Year Revisions and Conversion to Arthroplasty Following Arthroscopic Rotator Cuff Repair: Substance Use Disorder on the Rise. Arthroscopy 2022; 39:1386-1393.e4. [PMID: 36586469 DOI: 10.1016/j.arthro.2022.12.026] [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: 06/14/2022] [Revised: 12/03/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of the current study was to use a nationwide administrative-claims database to characterize the substance use disorder trends of patients undergoing arthroscopic rotator cuff repair (RCR). Additionally, we sought to evaluate the influence of preoperative substance use disorder on postoperative outcomes following arthroscopic RCR. METHODS The Mariner database was used to identify patients undergoing RCR using CPT codes, ages 18-84 years old, from 2010 to 2019. Patients were stratified by substance use, including cannabis, cocaine, nicotine, alcohol, opioids, stimulants, or sedative, as defined by International Classification of Diseases (ICD) codes. Substance use disorders trends were reported. Postoperative outcomes assessed consisted of major complications, minor complications, infections, readmissions, and Emergency Department visits within 90 days of surgery. Additionally, postoperative stiffness, revision surgery, and conversion to arthroplasty within 1 year were evaluated. Multivariate logistic regressions were used to control for demographic and comorbid factors. RESULTS Substance use trends from 2010 to 2019 show an increase in documentation of substance use in patients undergoing RCR. Individuals with a history of substance use disorder had an increased risk of adverse outcomes, most notably major medical complications (odds ratio [OR]: 1.63; 95% confidence interval [CI]: 1.44-1.86; P < .001), revision surgery (OR: 1.43; 95% CI: 1.30-1.56; P < .001), and conversion to arthroplasty (OR: 1.40; 95% CI: 1.08-1.80; P = .009). Subgroup analysis demonstrated that cannabis users were at higher risk for major medical complications (OR: 1.75; 95% CI: 1.15-2.56; P < .001), conversion to arthroplasty (OR: 3.54; 95% CI: 1.77-6.4; P < .001), and revision (OR: 1.53; 95% CI: 1.12-2.04; P < .05) compared to controls. Additionally, substance use was associated with higher medical costs in terms of procedural cost (β; $3634: $3,490-3,777) and 90-day postoperative costs (β: $436; $375-$498). CONCLUSION Documentation of substance use disorder is increasing in individuals undergoing arthroscopic rotator cuff repair. Substance use is associated with higher rates of postoperative complications, overall costs, and revision surgery following arthroscopic RCR. Nicotine and cannabis use were most commonly associated with increased rates of postoperative complications and treatment failure. LEVEL OF EVIDENCE IV, retrospective therapeutic case series.
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Affiliation(s)
- Jon Raso
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Alyssa Althoff
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Colby Brunette
- University of Virginia, School of Medicine, Charlottesville, Virginia, U.S.A
| | - Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Monica Arney
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
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17
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Yu XN, Xu LM, Bin YW, Yuan Y, Tian SB, Cai B, Tao KX, Wang L, Wang GB, Wang Z. Risk Factors of Anastomotic Leakage After Anterior Resection for Rectal Cancer Patients. Curr Med Sci 2022; 42:1256-1266. [PMID: 36544033 DOI: 10.1007/s11596-022-2616-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 01/17/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Anastomotic leakage (AL) is one of the serious complications after anterior resection for rectal cancer. Defunctioning stoma (DS) is one of the most widely used approaches to prevent it; however, the effect of DS on the occurrence of AL remains controversial. This study aimed to investigate risk factors of AL and assess the effect of DS after anterior resection for rectal cancer patients. METHODS A retrospective analysis was conducted for the data of 1840 patients who underwent anterior resection for rectal cancer from January 2014 to December 2019. RESULTS The results showed the overall AL incidence was 7.5%. Multivariate analyses revealed that males [odds ratio (OR) 1.562] and T3-T4 stage (OR 1.729) were independent risk factors for all patients. After propensity score matching analysis, the AL incidence was 14.1% in the group with no DS and 6.4% in the DS group (P<0.001). The clinical AL (grade B + grade C) incidence was 12.4% in no DS group and 4.6% in the DS group (P<0.001). CONCLUSION The study suggested that males and T3-T4 stage were independent risk factors of AL. In addition, DS could reduce the rate of symptomatic AL.
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Affiliation(s)
- Xiang-Nan Yu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lu-Ming Xu
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ya-Wen Bin
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ye Yuan
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shao-Bo Tian
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bo Cai
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Kai-Xiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lin Wang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Guo-Bin Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Zheng Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Furuhata R, Matsumura N, Matsuo T, Kimura H, Suzuki T, Nakamura M, Iwamoto T. Evaluation of Radiographic Changes 5 Years After Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2022; 10:23259671221126095. [PMID: 36199829 PMCID: PMC9528035 DOI: 10.1177/23259671221126095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Radiographic changes in the glenohumeral joint often occur after rotator cuff repair; however, the details of the progression and underlying causes remain unknown. Purpose: To retrospectively evaluate the timing and frequency of radiographic changes after arthroscopic rotator cuff repair and to clarify the predictive factors that affect the onset of such changes using multivariate analysis. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed 100 patients with 5 years of follow-up after arthroscopic rotator cuff repair and evaluated the postoperative shift in radiographic findings on plain radiographs every year during follow-up. Factors related to osteoarthritis, acromial spur re-formation, and greater tuberosity resorption at 5 years after surgery were evaluated using logistic regression analyses. Explanatory variables included preoperative factors, intraoperative factors, and postoperative retear. Baseline variables significant in the univariate analyses were included in the multivariate models. Results: Of the 100 patients, 12 developed osteoarthritis, 26 developed acromial spur formation, and 16 developed greater tuberosity resorption at 5 years after surgery. The incidence and grade of osteoarthritis and acromial spur gradually increased over time postoperatively. On the other hand, greater tuberosity resorption developed within 2 years after surgery but did not progress later. Multivariate analysis showed that a larger anteroposterior tear size (odds ratio [OR], 1.09; 95% CI, 1.01-1.17; P = .037) was a risk factor for postoperative osteoarthritis. Early retear (OR, 10.26; 95% CI, 1.03-102.40; P = .047) was a risk factor for acromial spur re-formation. Roughness of the greater tuberosity (OR, 9.07; 95% CI, 1.13-72.82; P = .038) and larger number of suture anchors (OR, 3.34; 95% CI, 1.66-6.74; P = .001) were risk factors for greater tuberosity resorption. Conclusion: Our study showed that radiographic changes occurred in 40% of patients within 5 years after arthroscopic rotator cuff repair. While the osteoarthritic changes and acromial spur re-formation gradually progressed postoperatively, the greater tuberosity resorption stopped within 2 years after surgery. Tear size, morphology of the greater tuberosity, and the number of suture anchors can affect radiographic changes. Furthermore, this study suggested that acromial spur re-formation may be an indicator of early retears.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Tomoki Matsuo
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Alaia MJ, Hurley ET, Vasavada K, Markus DH, Britton B, Gonzalez-Lomas G, Rokito AS, Jazrawi LM, Kaplan K. Buccally Absorbed Cannabidiol Shows Significantly Superior Pain Control and Improved Satisfaction Immediately After Arthroscopic Rotator Cuff Repair: A Placebo-Controlled, Double-Blinded, Randomized Trial. Am J Sports Med 2022; 50:3056-3063. [PMID: 35905305 DOI: 10.1177/03635465221109573] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite the widespread use and sales of cannabidiol (CBD) products in the United States, there is a paucity of literature to evaluate its effectiveness, safety, or ideal route of administration for postoperative pain. PURPOSE To evaluate the potential analgesic effects of buccally absorbed CBD in patients who have undergone arthroscopic rotator cuff repair (ARCR). STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This was a US Food and Drug Administration-sanctioned, multicenter, placebo-controlled, randomized, double-blinded trial conducted in patients undergoing ARCR. Patients aged from 18 to 75 years undergoing ARCR were prospectively enrolled and randomized to the control and experimental groups. The experimental group received an oral, buccally absorbed tablet containing 25 mg of CBD 3 times a day if <80 kg, or 50 mg of CBD 3 times a day if >80 kg, for 14 days postoperatively, while the control group received an identical placebo. Patients were followed up on days 1, 2, 7, and 14, and visual analog scale (VAS) for pain scores, opioid consumption, and satisfaction with pain control were recorded. Additionally, liver function tests were conducted on days 7 and 14 to assess safety, and nausea was monitored. P < .05 was considered to be statistically significant. RESULTS Overall, 100 patients were recruited, with 1 patient being excluded, for a total of 99 patients. There were no significant differences in patient demographics between the 2 groups. On day 1, the VAS pain score was significantly lower in the CBD group than in the control group (4.4 ± 3.1 vs 5.7 ± 3.2, respectively; P = .04), although this difference was no longer present on day 2 (4.7 ± 2.8 vs 5.3 ± 2.6, respectively; P = .32). On both days 1 and 2, patient satisfaction with pain control was significantly higher in the CBD group than in the control group (day 1: 7.0 ± 3.0 vs 5.6 ± 3.7, respectively [P = .04]; day 2: 7.3 ± 2.5 vs 6.0 ± 3.3, respectively [P = .03]). The quantity of opioids consumed was low in both groups, and there were no statistically significant differences in opioid consumption (P > .05). On days 7 and 14, there were no statistically significant differences in VAS scores, opioid consumption, or patient satisfaction with pain control between the CBD and control groups (P > .05 for all). There were no significant differences in liver function test results postoperatively (P > .05). CONCLUSION Buccally absorbed CBD demonstrated an acceptable safety profile and showed significant promise in the reduction of pain in the immediate perioperative period after ARCR compared with the control. Further studies are currently ongoing to confirm dosing and effectiveness in other orthopaedic conditions. REGISTRATION NCT04672252 (ClinicalTrials.gov identifier).
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Affiliation(s)
| | | | | | | | - Briana Britton
- Jacksonville Orthopaedic Institute, Jacksonville, Florida, USA
| | | | | | | | - Kevin Kaplan
- Jacksonville Orthopaedic Institute, Jacksonville, Florida, USA
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20
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Duijn EAHD, Roy van S, Karel YHJM, Provyn S, Pouliart N. An interexaminer agreement and reliability study on cadavers with musculoskeletal ultrasound of the shoulder performed by physiotherapists and radiologists compared with dissection. Musculoskelet Sci Pract 2022; 60:102569. [PMID: 35533597 DOI: 10.1016/j.msksp.2022.102569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A cross-sectional inter-examiner agreement and reliability study on fresh frozen cadaver shoulders. BACKGROUND Musculoskeletal ultrasound (MSU) is frequently used by physical therapists and radiologists to improve specific diagnosis in rotator cuff related pathology. The evaluation of the rotator cable seems to be important as stabilizing structure when cuff tears occur. OBJECTIVES To evaluate the inter-examiner agreement and reliability of MSU of the shoulder to detect rotator cuff-pathology and the involvement of the rotator cable in comparison to "dissection". METHODS Physical therapists, a radiologist and an orthopedic surgeon (dissection) investigated 40 fresh frozen cadaver shoulders in order to detect shoulder pathology including rotator cable involvement. Examiners were blinded to each other's findings. RESULTS We found a strong and significant agreement between the raters: PTs, the radiologist and the dissector in this cadaver study for all rotator cuff, the long head of the biceps pathologies and in detecting abnormalities of the rotator cable. The kappa value was substantial to (almost) perfect agreement for all diagnostic outcome categories. CONCLUSIONS This study shows that among a limited group of physical therapists, one radiologist and a dissector a strong level of agreement with kappa values from substantial to (almost) perfect in finding subacromial pathology.
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Affiliation(s)
- E A H D Duijn
- Basic (bio) Medical Sciences (BMWE), Vrije Universiteit Brussel, Brussels, Belgium.
| | - S Roy van
- Vrije Universiteit van Brussel, Brussels, Belgium
| | - Y H J M Karel
- Research Group Life in Motion, Avans University of Applied Sciences, Breda, the Netherlands
| | - S Provyn
- Basic (bio) Medical Sciences (BMWE), Vrije Universiteit Brussel, Brussels, Belgium; Anatomical Research and Clinical Studies (ARCS) Vrije Universiteit Brussel, Brussels, Belgium
| | - N Pouliart
- Basic (bio) Medical Sciences (BMWE), Vrije Universiteit Brussel, Brussels, Belgium; Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel) Brussels, Belgium
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Risk factors for failure to achieve minimal clinically important difference and significant clinical benefit in PROMIS computer adaptive test domains in patients undergoing rotator cuff repair. J Shoulder Elbow Surg 2022; 31:1416-1425. [PMID: 35172206 DOI: 10.1016/j.jse.2022.01.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/29/2021] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) has emerged as a valid and efficient means of collecting outcomes in patients with rotator cuff tears. The purpose of this study was to establish threshold score changes to determine minimal clinically important difference (MCID) and substantial clinical benefit (SCB) in PROMIS computer adaptive test (CAT) scores following rotator cuff repair (RCR). Additionally, we sought to identify potential risk factors for failing to achieve MCID and SCB. METHODS Patients undergoing arthroscopic RCR were identified over a 24-month period. Only patients who completed both preoperative and postoperative PROMIS CAT assessments were included in this cohort. PROMIS CAT forms for upper extremity physical function (PROMIS-UE), pain interference (PROMIS-PI), and depression (PROMIS-D) were used with a minimum of 1.5-year follow-up. Statistical analysis was performed to determine threshold score changes to determine anchor-based MCID and SCB, as well as risk factors for failure to achieve significant clinical improvement following surgery. RESULTS Of 198 eligible patients, 168 (84.8%) were included in analysis. ΔPROMIS-UE values of 5.8 and 9.7 (area under the curve [AUC] = 0.906 and 0.949, respectively) and ΔPROMIS-PI values of -11.4 and -12.9 (AUC = 0.875 and 0.938, respectively) were identified as threshold predictors of MCID and SCB achievement. On average, 81%, 65%, and 55% of patients achieved MCID for PROMIS-UE, PROMIS-PI, and PROMIS-D whereas 71%, 61%, and 38% of patients in the cohort, respectively, achieved SCB. MCID achievement in PROMIS-UE significantly differed according to risk factors, including smoking status (likelihood ratio [LR]: 9.8, P = .037), tear size (LR: 10.4, P < .001), distal clavicle excision (LR: 6.1, P = .005), and prior shoulder surgery (LR: 19.2, P < .001). Factors influencing SCB achievement for PROMIS-UE were smoking status (LR: 9.3, P = .022), tear size (LR: 8.0, P = .039), and prior shoulder surgery (11.9, P < .001). Significantly different rates of MCID and SCB achievement in PROMIS-PI for smoking status (LR: 7.0, P = .030, and LR: 5.2, P = .045) and prior shoulder surgery (LR: 9.1, P = .002, and LR: 7.4, P = .006) were also identified. DISCUSSION AND CONCLUSION The majority of patients showed clinically significant improvements that exceeded the established MCID for PROMIS-UE and PROMIS-PI following RCR. Patients with larger tear sizes, a history of prior shoulder surgery, tobacco users, and those who received concomitant distal clavicle excision were at risk for failing to achieve MCID in PROMIS-UE. Additionally, smokers and patients who underwent prior shoulder surgery demonstrated significantly lower improvements in pain scores following surgery.
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22
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Selective Serotonin Reuptake Inhibitor Promotes Bone-Tendon Interface Healing in a Rotator Cuff Tear Rat Model. Tissue Eng Regen Med 2022; 19:853-860. [PMID: 35438456 PMCID: PMC9294099 DOI: 10.1007/s13770-022-00444-6] [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: 12/25/2021] [Revised: 02/12/2022] [Accepted: 02/18/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Selective serotonin reuptake inhibitor (SSRI) is believed to accelerate wound healing, and thus expected to have a positive effect on rotator cuff repair. We hypothesized that SSRI has a positive effect on the healing of the bone-tendon interface (BTI), and improved rotator cuff tear healing would be confirmed by mechanical strength measurements and histological assessment of the restored tendon. METHODS The study used 40 adult male Sprague-Dawley wild-type rats. The animals were divided into two groups: group-SSRI, the supraspinatus repair with SSRI injection group, and group-C, conventional supraspinatus repair only without SSRI. Biomechanical and histological analyses were performed 8 weeks after index rotator cuff surgery. RESULTS The ultimate load (N) was significantly higher in group-SSRI than in group-C (54.8 ± 56.9 Vs 25.1 ± 11.1, p = .031). In the histological evaluation, the Bonar score confirmed significant differences in collagen fiber density (group-C: 0.6 ± 0.5, group-SSRI: 1.1 ± 0.6, p = .024), vascularity (group-C: 0.1 ± 0.2, group-SSRI: 0.3 ± 0.4, p = .024) and cellularity (group-C: 1.7 ± 0.4, group-SSRI: 2.0 ± 0.0, p = .023) between the groups. Based on the total score, group-SSRI was significantly better compared with group-C (6.3 ± 2.7 Vs 4.3 ± 1.9, p = .019). CONCLUSION Our study demonstrated that SSRI could facilitate improved biomechanical and histological outcomes 8 weeks after rotator cuff repair in a rat model. Consequently, SSRI may improve healing after rotator cuff repair.
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Ozcamdalli M, Eken G, Misir A, Oguzkaya S, Uzun E. The effect of watching shoulder ROM changes on functional outcome and quality of life following arthroscopic rotator cuff repair. J Orthop Surg (Hong Kong) 2022; 30:23094990211069693. [PMID: 35086382 DOI: 10.1177/23094990211069693] [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] [Indexed: 11/17/2022] Open
Abstract
PurposeThis study aimed to evaluate the effectiveness of watching video records of their shoulder motion changes on functional outcomes and quality of life after arthroscopic rotator cuff repair (ARCR). Methods The patients were divided into two groups. In Group 1, video records of pre- and postoperative shoulder motions were recorded and showed. In Group 2, no video was showed to the patients. In Group 1, the first postoperative evaluation was done before video watching, and the second evaluation was done just after watching video records. In Group 2, the first and second postoperative measurements were performed with 10-20 days interval. The Constant Murley score (CS), the American Shoulder and Elbow Surgeons score (ASES), the Short-Form 36 (SF-36) score, and active shoulder range of motion (ROM) values were used as an outcome tool. Results A total of 196 patients (Group 1; 76 patients and Group 2; 120 patients) with a mean age of 62.06 ± 7.17 years were included. There was a significant improvement in postoperative scores of SF-36 subscales (except emotional well-being and energy/fatigue), ASES, CM scores, and joint ROM values when compared to preoperative values for both groups (p < .001). The first postoperative outcomes were similar between groups (p > .05). In the second postoperative evaluation, emotional role functioning, energy/fatigue, emotional well-being, health change subscales of SF-36, and ASES scores were significantly higher in Group 1 compared with Group 2 (p < .05). Conclusion When patients watch the pre- and postoperative video records of their shoulder ROM after ARCR, patients' satisfaction and well-being perception increase in the short-term despite unchanged shoulder ROM.
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Affiliation(s)
- Mustafa Ozcamdalli
- Department of Orthopaedics and Traumatology, 317030Basaksehir Pine and Sakura City Hospital, Istanbul, Turkey
| | - Gokay Eken
- Department of Orthopaedics and Traumatology, 147020Uludag University Faculty of Medicine, Bursa, Turkey
| | - Abdulhamit Misir
- Department of Orthopaedics and Traumatology, 317030Basaksehir Pine and Sakura City Hospital, Istanbul, Turkey
| | - Sinan Oguzkaya
- Department of Orthopaedics and Traumatology, 472606Sarkisla State Hospital, Sivas, Turkey
| | - Erdal Uzun
- Department of Orthopaedics and Traumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
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Lu Y, Agarwalla A, Lavoie-Gagne O, Patel BH, Beletsky A, Nwachukwu BU, Verma NN, Cole BJ, Forsythe B. How Long Does It Take to Achieve Clinically Significant Outcomes After Isolated Biceps Tenodesis? Orthop J Sports Med 2022; 10:23259671221070857. [PMID: 35284582 PMCID: PMC8908395 DOI: 10.1177/23259671221070857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/02/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Clinically significant outcomes (CSOs) connect patient-reported outcome measures data to patient-perceived benefit. Although investigators have established threshold values for various CSOs, the timeline to achieve these outcomes after isolated biceps tenodesis (BT) has yet to be defined. Purpose: To define the time-dependent nature of minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) achievement after isolated BT. Study Design: Case series; Level of evidence, 4. Methods: The American Shoulder and Elbow Surgeons score (ASES), the Single Assessment Numeric Evaluation, and the Constant-Murley score (CMS) were administered preoperatively and at 6 and 12 months postoperatively to patients undergoing isolated BT between 2014 and 2018 at our institution. Cumulative probabilities for achieving MCID, SCB, and PASS were calculated using Kaplan-Meier survival analysis. Weibull parametric regression evaluated the hazard ratios (HRs) of achieving earlier MCID, SCB, and PASS. Results: Overall cohort (N = 190) achievement rates ranged between 77.8% and 83.2% for MCID, between 42.2% and 80.2% for SCB, and between 59.7% and 62.9% for PASS. Median achievement time was 5.3 to 6.1 months for MCID, 5.9 to 6.4 months for SCB, and 6.07 to 6.1 months for PASS. Multivariate Weibull parametric regression identified older age, male sex, higher body mass index, preoperative thyroid disease, smoking history, and higher preoperative CMS as predictors of delayed CSO achievement (HR, 1.01-6.41), whereas normal tendon on arthroscopy, defined as absence of tenosynovitis or tendon tear on arthroscopy, predicted earlier CSO achievement (HR, 0.19-0.46). Location of tenodesis and worker compensation status did not significantly predict the time to achieve CSOs on multivariate analysis. Conclusion: After isolated BT, patients can expect to attain CSO by 13 months postoperatively, with most patients achieving this between 5 and 8 months. Patients tend to take longer to achieve PASS than MCID and SCB.
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Affiliation(s)
- Yining Lu
- Department of Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Ophelie Lavoie-Gagne
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bhavik H. Patel
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Benedict U. Nwachukwu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Nikhil N. Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J. Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Vervaecke AJ, Carbone AD, Zubizarreta N, Poeran J, Parsons BO, Verborgt O, Galatz LM, Cagle PJ. Reverse shoulder arthroplasty for rotator cuff tears with and without prior failed rotator cuff repair: A large-scale comparative analysis. J Orthop 2022; 31:1-5. [PMID: 35299693 PMCID: PMC8920866 DOI: 10.1016/j.jor.2022.03.002] [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: 12/28/2021] [Accepted: 03/06/2022] [Indexed: 10/18/2022] Open
Abstract
Background Large-scale data assessing the effect of a prior failed rotator cuff repair (RCR) on the outcome of reverse shoulder arthroplasty (RSA) is currently lacking. Therefore, this study aimed (1) to assess the course of patients undergoing RCR, specifically focusing on the need for conversion to RSA within two years, and (2) to compare outcomes following RSA performed for rotator cuff tears (RCTs) with and without prior RCR. Methods This retrospective cohort study included data from the CMS Data Set (2016-2018). For the first study objective, we included patients undergoing an RCR; these were followed for 24 months to identify a conversion to RSA. For the second study objective, we included RSAs for RCTs, stratified by those with and without a prior RCR (preceding 24 months). Outcomes (hospitalization cost, institutional post-acute care discharge, 90-day readmission and health resource utilization up to 6 months post-RSA) were compared between propensity score-matched groups. Results Out of 33,244 RCRs, 433 (1.3%) patients underwent RSA conversion within two years. Among 7534 RSA cases for RCTs, 245 (3.3%) had an RCR in the preceding two years. In the propensity score analysis, except for a minimal increase in the number of physical rehabilitation visits (RR 1.10; p = 0.0009), no differences were observed between those with and without prior RCR in terms of other RSA outcomes. These included hospitalization cost, discharge to institutional post-acute care facility, 90-day readmission and 6-month post-op cost. Conclusion Rotator cuff repair in elderly patients, when utilizing currently employed indication criteria, results in low conversion rates to RSA within 2 years postoperatively. Furthermore, large dataset outcomes after RSA for RCT such as cost, post-acute care discharge, physical rehabilitation, and readmission rates appear not to be negatively affected by the presence of a prior RCR. Level of evidence Level 3 evidence; Retrospective cohort study.
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Fan N, Yuan S, Du P, Wu Q, Li J, Kong X, Zhu W, Hong G, Zang L. The effects of smoking on clinical and structural outcomes after rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:656-667. [PMID: 34813890 DOI: 10.1016/j.jse.2021.10.026] [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: 08/12/2021] [Revised: 10/06/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several factors have been reported to adversely affect clinical and structural outcomes after rotator cuff repair (RCR). However, the effects of smoking on rotator cuff healing and clinical outcomes remain controversial. The purpose of this study was to compare the clinical and structural outcomes after RCR between smokers and nonsmokers. We hypothesized that there would be no significant difference in the clinical scores after RCR and that smoking would be associated with a significantly increased risk of retear and reoperation. METHODS This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using the PubMed, Cochrane Library, and Embase databases. We included only articles in which patients underwent arthroscopic and open RCR, the clinical outcome scores were reported for smokers and nonsmokers, and the number of rotator cuff retears and reoperations were reported. Data relevant to this study were extracted and statistically analyzed. We used the Newcastle-Ottawa Scale to assess the risk of bias in each study and calculated the I2 value to quantify the effect of heterogeneity. RESULTS Fourteen eligible articles were identified, with 73,817 participants (8553 smokers and 65,264 nonsmokers). The meta-analysis demonstrated that there were no significant differences in the American Shoulder and Elbow Surgeons score (P = .10), Simple Shoulder Test score (P = .19), University of California-Los Angeles score (P = .09), or visual analog scale score (P = .19) between smokers and nonsmokers after surgery, but the Constant score was significantly lower (P = .005) for smokers. Smoking was significantly associated with an increased risk of retear (P = .002; risk ratio, 2.06 [95% confidence interval, 1.30-3.28]; I2 = 31%) and reoperation (P < .001; risk ratio, 1.29 [95% confidence interval, 1.20-1.40]; I2 = 36%) in patients after RCR. CONCLUSION Besides the Constant score, which was lower in smokers, there were no significant differences in the clinical scores after RCR between smokers and nonsmokers. However, smoking was associated with a significantly increased risk of retear and reoperation.
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Affiliation(s)
- Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jian Li
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Kong
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenyi Zhu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Gang Hong
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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Thangarajah T, Tsuchiya S, Lukenchuk J, Lo IK. Arthroscopic Revision Rotator Cuff Repair of Large and Massive Retears using an Interpositional Bridging Dermal Allograft. JSES Int 2022; 6:643-648. [PMID: 35813153 PMCID: PMC9264011 DOI: 10.1016/j.jseint.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Jimenez AE, Lee MS, George T, Owens JS, Maldonado DR, Saks BR, Lall AC, Domb BG. Effect of Cigarette Smoking on Outcomes in Patients Undergoing Primary Hip Arthroscopy and Labral Reconstruction: A Propensity-Matched Controlled Study With Minimum 2-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221075642. [PMID: 35237697 PMCID: PMC8882953 DOI: 10.1177/23259671221075642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: There is a paucity of literature evaluating the effect of cigarette smoking
on outcomes in patients undergoing hip arthroscopy and labral
reconstruction. Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores for
patients who smoke cigarettes and underwent primary hip arthroscopic labral
reconstruction and (2) to compare these results with those of a
propensity-matched control group of patients who have never smoked. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected for all patients who underwent primary hip arthroscopy
for labral reconstruction between January 2011 and January 2019. Patients
were eligible for the study if they indicated that they smoked cigarettes
within 1 month of surgery and had minimum 2-year postoperative outcome
scores for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score
(NAHS), and the visual analog scale (VAS) for pain. The percentage of
patients achieving the minimal clinically important difference (MCID) and
patient-acceptable symptom state (PASS) was recorded. Rates of revision
surgery were also documented. These patients were then propensity matched in
a 1:3 ratio to patients who had never smoked (controls) for comparison. Results: A total of 20 patients (20 hips) were included with a mean follow-up of 39.9
± 13.0 months and mean age of 41.4 ± 10.4 years. These patients demonstrated
significant improvement from preoperatively to the minimum 2-year follow-up
for mHHS, NAHS, and VAS (P < .05). They also achieved
MCID for mHHS and VAS at acceptable rates, 70% for both. When outcomes were
compared with those of 60 control patients (60 hips), patients who smoke
demonstrated lower preoperative PRO scores but similar minimum 2-year
postoperative PRO scores for mHHS and NAHS. Patients who smoke demonstrated
lower rates of achieving PASS for mHHS (55% vs 75%) and NAHS (40% vs 61.7%)
compared with controls; however, these findings were not statistically
significant. Rates of secondary surgery were statistically significantly
higher in the smoking group compared with controls (25% vs 5%;
P = .031). Survivorship for the smoking patients was
80% and 98.3% for the control group. At the two-year mark survivorship was
90% for the smoking group and 100% for the control group (P
= .06) Conclusion: While smokers can still derive significant improvement from hip arthroscopy,
their ultimate functional outcome and rate of secondary surgeries are
inferior to those of nonsmokers. As smoking is a significant and modifiable
risk factor, we should continue to counsel smokers on smoking cessation
prior to and after surgery
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Affiliation(s)
| | - Michael S. Lee
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Tom George
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S. Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Benjamin R. Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C. Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
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van der List JP, Kok LM, Alta TDW, van der List MPJ, van Noort A. Role of Delay Between Injury and Surgery on the Outcomes of Rotator Cuff Repair: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 51:1328-1339. [PMID: 35099309 DOI: 10.1177/03635465211069560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Outcomes of rotator cuff repair (RCR) are influenced by several well-described factors, but the role of delay from injury to surgery on the outcomes is not clear. PURPOSE To assess the role of delay to surgery on the outcomes of RCR in the literature. STUDY DESIGN Systematic review with meta-analysis; Level of evidence, 4. METHODS PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. All studies assessing outcomes after RCR-either retear rates or patient-reported outcome measures (PROMs)-and reporting delay to surgery were identified through June 2021 in PubMed, Embase, and Cochrane. Inclusion criteria consisted of traumatic injuries, mean age <65 years, minimum 6-month follow-up, and assessment of retear rates with radiologic examination or reporting of PROMs. Random-effect models were used to assess outcomes, reported in odds ratio (OR) or mean difference (MD) with 95% CIs. RESULTS A total of 8118 patients were included from 33 studies, with a mean age of 59 years (range, 53-64) and mean follow-up of 3.0 years (range, 0.5-8.2), among whom 53% were male and 74% had dominant-side injury. Patients undergoing surgery >3 months after injury did not have significantly higher retear rates (OR, 1.1 [95% CI, 0.5 to 3.1]; P = .700), lower Constant-Murley score (MD, -6.2 [95% CI, -16.4 to 4.1]; P = .240), or lower ASES score (American Shoulder and Elbow Surgeons; MD, -12.9 [95% CI, -26.0 to -0.2]; P = .050) compared with those having surgery within 3 months. Similarly, delaying surgery for 6 months did not result in higher retear rates (OR, 1.7 [95% CI, 0.8 to 3.7]; P = .190) or lower PROMs. Delaying surgery for 1 year, however, led to an increased likelihood of retear when compared with <1 year (OR, 2.9 [95% CI, 2.1 to 4.0]; P < .001), and this was similar for the 2-year cutoff (OR, 5.9 [95% CI, 1.1 to 32.1]; P = .040). It was also noted that patients with an intact cuff at follow-up had a mean 3.9 months' shorter time from injury to surgery than patients with retear (95% CI, 1.0-6.8 months; P = .009). CONCLUSION This systematic review with meta-analysis found that delaying rotator cuff surgery for 3 to 6 months did not lead to higher retear rates or inferior PROMs as compared with undergoing earlier surgery. However, delaying surgery for ≥1 year clearly resulted in higher retear rates after RCR. This study is limited by relying on retrospective studies, and larger prospective studies are needed to confirm these findings. REGISTRATION CRD42021240720 (PROSPERO).
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Affiliation(s)
- Jelle P van der List
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands.,Department of Orthopaedic Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Laura M Kok
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Tjarco D W Alta
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | | | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
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Furuhata R, Matsumura N, Oki S, Kimura H, Suzuki T, Iwamoto T, Matsumoto M, Nakamura M. Risk Factors for Loss of Active Shoulder Range of Motion in Massive Rotator Cuff Tears. Orthop J Sports Med 2022; 10:23259671211071077. [PMID: 35097147 PMCID: PMC8796088 DOI: 10.1177/23259671211071077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Patients with massive rotator cuff tears often exhibit loss of active range of shoulder motion, which can interfere with activities of daily living. The risk factors for loss of motion remain largely unknown. Purpose: To clarify the predictive factors that affect the range of motion in chronic massive rotator cuff tears using multivariate analyses. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively reviewed 204 consecutive patients who were evaluated at their institution with chronic massive rotator cuff tears. In this study, the dependent variable was determined to be active anterior elevation limited to ≤90° or external rotation (ER) with the arm at the side limited to ≤0°. Explanatory variables included age; sex; affected side; duration of symptoms; smoking history; existence of diabetes, hypertension, or rheumatoid arthritis; involved tendons; presence of a 3-tendon tear; rupture of the long head of biceps tendon; superior migration of the humeral head; and cuff tear arthropathy. Baseline variables that were observed to be significant in the univariate analyses were included in multivariate models, which used logistic regression to identify independent predictors of loss of motion. Results: Overall, 73 patients (35.8%) exhibited limited anterior elevation, and 27 (13.2%) exhibited limited ER. Multivariate analyses showed that inferior subscapularis tear (odds ratio [OR], 14.66; 95% CI, 2.95-72.93; P = .001), smoking (OR, 4.13; 95% CI, 1.94-8.79; P < .001), superior migration of humeral head (OR, 3.92; 95% CI, 1.80-8.53; P = .001), and 3-tendon tear (OR, 3.29; 95% CI, 1.32-8.20; P = .011) were significantly associated with the loss of anterior elevation. Teres minor tear (OR, 73.37; 95% CI, 9.54-564.28; P < .001) and superior migration of the humeral head (OR, 3.55; 95% CI, 1.04-12.19; P = .044) were significantly associated with loss of ER. Conclusion: In the current study, a history of smoking, type of torn tendons, and superior migration of the humeral head were associated with loss of active shoulder motion. In particular, the status of inferior subscapularis or teres minor contributed to the onset of pseudoparalysis in massive rotator cuff tears.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopaedic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya-shi, Tochigi, Japan
| | - Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Song HE, Oh KS, Yoon JP, Lee DR, Baek S, Chung SW. Improvement in scapular dyskinesis after rotator cuff repair and subacromial decompression. Knee Surg Sports Traumatol Arthrosc 2021; 29:3961-3970. [PMID: 34312711 DOI: 10.1007/s00167-021-06681-x] [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: 02/15/2021] [Accepted: 07/22/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the incidence of scapular dyskinesis (SD) in patients with rotator cuff tears using pre- and postoperative 3D computed tomography, analyze the changes in scapular kinematics that occur after arthroscopic rotator cuff repair, and identify the contributing clinical factors. METHODS Thirty-five patients (mean age, 62.5 ± 8.4 years) were included. Four scapular angles (upward rotation, internal rotation, protraction, and posterior tilt) were measured. The patients were categorized into three pre-existing SD types according to the difference in measured scapular angles between the affected and unaffected sides (type 1 SD, posterior tilt angle difference < - 5°; type 2 SD, internal rotation angle difference > 5°; and type 3 SD, upward rotation angle difference > 5°). The prevalence, factors influencing SD, and outcomes were compared between the improved and sustained SD groups. RESULTS Twenty three of the 35 patients (65.7%) with rotator cuff tears had SD (type 1, 11; type 2, six; type 3, six). Of the 23 preoperative SD patients, 12 (52.1%) showed improved SD postoperatively. Most of the patients with improved SD (9/12) had type 1 SD (p = 0.021) and a significantly improved posterior tilt angle (p = 0.043). The improvement in SD was correlated with a higher range of motion of forward flexion and higher Constant scores (all p < 0.05). No healing failure occurred in the improved SD group (p = 0.037). CONCLUSION The prevalence of SD was high in patients with degenerative rotator cuff tears. More than half of the SD cases, especially type 1 SD, improved postoperatively. SD recovery correlated with better function and successful rotator cuff healing. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Han Eui Song
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, College of Medicine, Kyungpook University, Daegu, Korea
| | - Dong Ryun Lee
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea
| | - Samuel Baek
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea.
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Kennedy P, Saloky K, Yadavalli A, Barlow E, Aynardi M, Garner M, Bible J, Lewis GS, Dhawan A. Nicotine Exposure Via Electronic Cigarettes Significantly Impedes Biomechanical Healing Properties of Tendon Healing in a Rat Model. Arthroscopy 2021; 37:3170-3176. [PMID: 33940121 DOI: 10.1016/j.arthro.2021.03.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the biomechanical and histologic effects on Achilles tendon repair of inhaled combusted tobacco versus nicotine exposure via electronic cigarette versus a control group in a small-animal model (Sprague-Dawley rat). METHODS Fifty-four Sprague-Dawley rats were randomized into 3 groups: combusted tobacco, e-cigarettes, or control. Experimental rats were exposed to research cigarettes or e-cigarette vapor in a smoking chamber for 4 weeks. Surgical transection and repair of the Achilles tendon were then completed, followed by 2 additional weeks of exposure. Achilles tendons were harvested, and biomechanical tensile testing was performed. Histologic evaluation was completed, including hematoxylin-eosin staining, trichrome staining, and immunohistochemistry analysis for type I and type III collagen. RESULTS The control group showed the highest mean tensile load to failure, at 41.0 ± 10.4 N (range, 18.3-55.1 N); the cigarette cohort had the second highest mean, at 37.3 ± 11.1 N (range, 14.0-54.7 N); and finally, the vaping group had the lowest mean, at 32.3 ± 8.4 N (range, 17.8-45.1 N). One-way analysis of variance showed a significant difference in load to failure when comparing the control group with the e-cigarette group (P = .026). No statistical difference was detected between the control group and cigarette group (P = .35) or between the e-cigarette group and cigarette group (P = .23). Stiffness and qualitative histologic analysis showed no difference among groups. CONCLUSIONS This investigation shows that in a rat model, nicotine exposure via e-cigarette significantly impedes the biomechanical healing properties of Achilles tendon surgical repair. CLINICAL RELEVANCE The results indicate that although e-cigarettes are often used as a perceived "safer" alternative to smoking, their use may have a detrimental effect on tendon load to failure.
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Affiliation(s)
- Patrick Kennedy
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A..
| | - Kaitlin Saloky
- Geisinger Commonwealth School of Medicine, Geisinger Health System, Scranton, Pennsylvania, U.S.A
| | - Aditya Yadavalli
- Department of Anesthesia and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A. (d)Department of Emergency Medicine, Zucker School of Medicine, Northwell Southside Hospital, Bay Shore, New York, U.S.A
| | - Erin Barlow
- Department of Anesthesia and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A. (d)Department of Emergency Medicine, Zucker School of Medicine, Northwell Southside Hospital, Bay Shore, New York, U.S.A
| | - Michael Aynardi
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Matthew Garner
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Jesse Bible
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Gregory S Lewis
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Aman Dhawan
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
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Morikawa D, Hawthorne BC, McCarthy MBR, Bellas N, Johnson JD, Trudeau MT, Murphy KV, Mancini MR, LeVasseur MR, Cote MP, Mazzocca AD. Analysis of Patient Factors Affecting In Vitro Characteristics of Subacromial Bursal Connective Tissue Progenitor Cells during Rotator Cuff Repair. J Clin Med 2021; 10:jcm10174006. [PMID: 34501453 PMCID: PMC8432549 DOI: 10.3390/jcm10174006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 02/04/2023] Open
Abstract
Unsatisfactory failure rates following rotator cuff (RC) repair have led orthopaedic surgeons to explore biological augmentation of the healing enthesis. The subacromial bursa (SB) contains abundant connective tissue progenitor cells (CTPs) that may aid in this process. The purpose of the study was to investigate the influence of patient demographics and tear characteristics on the number of colony-forming units (CFUs) and nucleated cell count (NCC) of SB-derived CTPs. In this study, we harvested SB tissue over the supraspinatus tendon and muscle in 19 patients during arthroscopic RC repair. NCC of each sample was analyzed on the day of the procedure. After 14 days, CFUs were evaluated under a microscope. Spearman’s rank correlation coefficient was then used to determine the relationship between CFUs or NCC and patient demographics or tear characteristics. The study found no significant correlation between patient demographics and the number of CFUs or NCC of CTPs derived from the SB (p > 0.05). The study did significantly observe that increased tear size was negatively correlated with the number of CFUs (p < 0.05). These results indicated that increased tear size, but not patient demographics, may influence the viability of CTPs and should be considered when augmenting RCrepairs with SB.
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Affiliation(s)
- Daichi Morikawa
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu 279-0021, Japan
- Correspondence: (D.M.); (A.D.M.)
| | - Benjamin C. Hawthorne
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Mary Beth R. McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Nicholas Bellas
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Jeremiah D. Johnson
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Maxwell T. Trudeau
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Kyle V. Murphy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Michael R. Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Matthew R. LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Mark P. Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA; (B.C.H.); (M.B.R.M.); (N.B.); (J.D.J.); (M.T.T.); (K.V.M.); (M.R.M.); (M.R.L.); (M.P.C.)
- Correspondence: (D.M.); (A.D.M.)
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Silva CMM, Mourão NM, da Rocha LN, Landim JIVD, Rocha HAL, Lacerda MAA, Rocha FAC, Leite JAD. Surgical outcome following rotator cuff tear repair in a low-income population. Impact of obesity and smoking. BMC Musculoskelet Disord 2021; 22:714. [PMID: 34419023 PMCID: PMC8380319 DOI: 10.1186/s12891-021-04599-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022] Open
Abstract
Background Comorbidities and socioeconomic issues impact outcome of rotator cuff tear (RCT) repair. There are no data on RCT repair outcome from developing regions. We determined the impact of obesity and smoking following RCT repair in a low-income population. Methods This is a retrospective case series. Forty-seven shoulders of 42 patients subjected to open or arthroscopic repair of a RCT with a minimum of 2 years follow-up were cross-sectionally evaluated. Patients were seen in the Orthopaedic Service of the Hospital Geral de Fortaleza-CE, Brazil between March and September 2018. RCT were classified as partial or full-thickness lesions. Fatty infiltration (Goutallier) and tendon retraction (Patte) were recorded as well as obesity (BMI > 30), literacy [>/≤ 8 school years (SY)] and smoking status 6 months prior to surgery (present/absent). Outcomes included pain (visual analogue scale; VAS, 0–10 cm), range of motion [active forward flexion and external rotation (ER)], UCLA and ASES scoring. Results Patients were 59.9 ± 7.4 years-old, 35(74.4%) female with 19 (17.1–30.2 IQR) median of months from diagnosis to surgery and 25 median months of follow-up (26.9–34.0 IQR); over 90% declared < 900.00 US$ monthly family income and two-thirds had ≤8 SY. Forty patients (85.1%) had full-thickness tears, 7 (14.9%) had Goutallier ≥3 and over 80% had < Patte III stage. Outcomes were similar regardless of fatty infiltration or tendon retraction staging. There were 17 (36.1%) smokers and 13 (27.6%) obese patients. Outcome was similar when comparing obese vs non-obese patients. Smokers had more pain (P = 0.043) and less ER (P = 0.029) with a trend towards worse UCLA and ASES scores as compared to non-smokers though differences did not achieve minimal clinically important difference (MCID) proposed for surgical RCT treatment. After adjusting for obesity, VAS and ER values in smokers were no longer significant (P = 0.2474 and 0.4872, respectively). Conclusions Our data document outcomes following RCT repair in a low-income population. Smoking status but not obesity impacted RCT repair outcome though not reaching MCID for surgical treatment.
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Affiliation(s)
- Christine M M Silva
- Postgraduating Program in Surgery, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, Brazil.,Orthopaedic Service - Shoulder and Elbow Group - Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Natália M Mourão
- Orthopaedic Service - Shoulder and Elbow Group - Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Leila N da Rocha
- Department of Internal Medicine, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, Brazil
| | - Joaquim I V D Landim
- Department of Internal Medicine, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, Brazil
| | - Hermano A L Rocha
- Department of Maternal and Child Health, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil.,Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Marco A A Lacerda
- Orthopaedic Service - Shoulder and Elbow Group - Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Francisco A C Rocha
- Department of Internal Medicine, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, Brazil. .,Instituto de Biomedicina - Laboratório de Investigação em Osteoartropatias, Rua Cel. Nunes de Melo, 1315 - 1°. Andar, Rodolfo Teófilo -, Fortaleza, CE, 60430-270, Brazil.
| | - José A D Leite
- Department of Surgery, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, Brazil
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35
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Rohman ML, Snow M. Use of biologics in rotator cuff disorders: Current concept review. J Clin Orthop Trauma 2021; 19:81-88. [PMID: 34099971 PMCID: PMC8165426 DOI: 10.1016/j.jcot.2021.05.005] [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: 02/28/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 01/08/2023] Open
Abstract
Poor tendon to bone healing following rotator cuff repair has led to the continued interest and investigation into biological augmentation. The biology of tendinopathy is not fully understood and consequently the availability of disease modifying therapeutic targets is limited. A ceiling of benefit has been reached by mechanical optimisation of rotator cuff repair and thus, in order to improve healing rates, a biological solution is required. This review focuses on the strategies to biologically augment rotator cuff disorders with an emphasis on rotator cuff repair. Leucocyte rich platelet rich plasma has been shown to improve healing rates without clinically relevant improvements in outcome scores. Similarly, improved healing rates have also been reported with bone marrow stimulation and in long-term follow-up with bone marrow concentrate. Extracellular matrix (ECM) and synthetic scaffolds can increase healing through mechanical and or biological augmentation. A potential third category of scaffold is bio-inductive and has no mechanical support. Studies involving various scaffolds have shown promising results for augmentation of large to massive tears and is likely to be most beneficial when tendon quality is poor, however level I evidence is limited.
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Affiliation(s)
| | - Martyn Snow
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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36
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Duong JKH, Lam PH, Murrell GAC. Anteroposterior tear size, age, hospital, and case number are important predictors of repair integrity: an analysis of 1962 consecutive arthroscopic single-row rotator cuff repairs. J Shoulder Elbow Surg 2021; 30:1907-1914. [PMID: 33160028 DOI: 10.1016/j.jse.2020.09.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/20/2020] [Accepted: 09/29/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Retear or nonhealing of a surgically repaired rotator cuff is common, but the determinants of retear are poorly understood. We aimed to determine the relationship between preoperative and intraoperative factors and retear rate following rotator cuff repair and to formulate a predictive model based on this relationship, including any interaction effects between tear size, patient age, and surgical experience in contributing to the retear rate. METHODS We performed a post hoc analysis of prospectively collected data from 1962 consecutive patients who underwent a primary arthroscopic single-row rotator cuff repair performed by the senior author from 2007 through 2018 and postoperatively returned for 6-month follow-up ultrasonography. RESULTS Multiple logistic regression analysis revealed anteroposterior tear length to be the most important independent predictor of retear (Wald statistic, 90; P < .001). Other independent predictors included case number (Wald statistic, 59; P < .001), patient age at surgery (Wald statistic, 30; P < .001), and type of hospital (public vs. private) (Wald statistic, 17; P < .001). The data indicated that following rotator cuff repair, there was a 4-fold increase in the retear rate as the anteroposterior tear size increased from 1 cm to 3 cm; a 8-fold decrease when comparing case number 1000 with case number 3000; a 2-fold increase as patient age increased from 50 years to 70 years; and a 3-fold increase when comparing surgery performed in a public hospital vs. a private hospital. The area under the receiver operating characteristic curve was 0.81 (95% confidence interval, 0.78-0.84), indicating that our equation could predict 81% of retears. CONCLUSIONS Anteroposterior tear length was the most important independent predictor of retear or nonhealing. Other predictive factors included case number, patient age at surgery, and hospital type. The predictive effect of anteroposterior tear length, patient age, and case number in contributing to retear was additive. Our regression equation may be used to calculate patient rotator cuff retear risk at 6 months after repair.
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Affiliation(s)
- Julian K H Duong
- Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Patrick H Lam
- Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, NSW, Australia.
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37
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Factors Influencing Press Ganey Ambulatory Surgery Scores in Patients Undergoing Upper Extremity Procedures. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202106000-00001. [PMID: 34077402 PMCID: PMC8174545 DOI: 10.5435/jaaosglobal-d-20-00209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/08/2021] [Indexed: 11/18/2022]
Abstract
We sought to determine whether patient and surgical factors are associated with
the Press Ganey Ambulatory Surgery Survey (PGAS) satisfaction scores in patients
undergoing outpatient upper extremity procedures.
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38
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Kim DM, Jeon IH, Yang HS, Shin MJ, Park JH, Kholinne E, Kim H, Park D, Koh KH. Poor Prognostic Factors in Patients With Rotator Cuff Retear. Orthop J Sports Med 2021; 9:2325967121992154. [PMID: 33869644 PMCID: PMC8020255 DOI: 10.1177/2325967121992154] [Citation(s) in RCA: 13] [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: 09/29/2020] [Accepted: 11/05/2020] [Indexed: 01/08/2023] Open
Abstract
Background: The treatment for retears after arthroscopic rotator cuff repair (ARCR) has
long been a challenge. Purpose: This study aimed to (1) summarize the characteristics of patients with a
retear after primary ARCR and (2) determine the risk factors for poor
clinical outcomes after a retear. Study Design: Case-control study; Level of evidence, 3. Methods: We collected the data of patients with a retear after primary ARCR between
January 2011 and December 2016. There were 45 patients with retears included
(19 men [42.2%] and 26 women [57.8%]; mean ± SD age, 63.11 ± 8.87 years).
Initially, the demographic and outcome data of patients with a retear were
analyzed. Patients were classified into good and poor outcome groups
according to their overall satisfaction at final follow-up. Univariable and
multivariable logistic regression analyses were performed to determine the
factors for poor clinical outcomes after a retear. Results: A total of 31 patients were classified into the good outcome group, and 14
patients were classified into the poor outcome group. Both the good and the
poor outcome groups showed that clinical scores significantly improved at
the time of the retear diagnosis, but the final scores were maintained or
worse compared with scores at the time of the retear diagnosis. Final range
of motion (ROM), except external rotation in the good outcome group, was
worse or had no significant change compared with ROM at the time of the
retear diagnosis. On multivariable logistic regression analysis, current
smoking (odds ratio [OR], 45.580 [95% CI, 3.014-689.274]; P
= .006), female sex (OR, 32.774 [95% CI, 2.433-441.575]; P
= .009), and retears of the same or larger size than the initial tear (OR,
10.261 [95% CI, 1.544-68.202]; P = .016) showed a higher OR
for poor clinical outcomes after a retear. Conclusion: Smoking, female sex, and retears of the same or larger size than the initial
tear were independent risk factors for poor clinical outcomes after a
rotator cuff retear. Final clinical scores and ROM were similar or worse
compared with the scores and ROM at the time of the retear diagnosis.
Therefore, revision surgery should be actively considered in female patients
or those who smoke with poor clinical outcomes and a larger retear size than
the preoperative tear size at the time of the retear diagnosis.
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Affiliation(s)
- Dong Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Sarang Plus Hospital, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ha-Sol Yang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung Jin Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, St Carolus Hospital, Faculty of Medicine, Trisakti University, Jakarta, Indonesia
| | - Hyojune Kim
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Dongjun Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Morris TM, Marlborough FJ, Montgomery RJ, Allison KP, Eardley WGP. Smoking and the patient with a complex lower limb injury. Injury 2021; 52:814-824. [PMID: 33495022 DOI: 10.1016/j.injury.2020.12.025] [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: 07/27/2020] [Revised: 11/11/2020] [Accepted: 12/23/2020] [Indexed: 02/02/2023]
Abstract
Smoking is known to increase the risk of peri-operative complications in Orthoplastic surgery by impairing bone and wound healing. The effects of nicotine replacement therapies (NRTs) and electronic cigarettes (e-cigarettes) has been less well established. Previous reviews have examined the relationship between smoking and bone and wound healing separately. This review provides surgeons with a comprehensive and contemporaneous account of how smoking in all forms interacts with all aspects of complex lower limb trauma. We provide a guide for surgeons to refer to during the consent process to enable them to tailor information towards smokers in such a way that the patient may understand the risks involved with their surgical treatment. We update the literature with recently discovered methods of monitoring and treating the troublesome complications that occur more commonly in smokers effected by trauma.
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Affiliation(s)
- Timothy M Morris
- Orthoplastic Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough, England, TS4 3BW.
| | - Fergal J Marlborough
- Orthoplastic Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough, England, TS4 3BW
| | - Richard J Montgomery
- Orthoplastic Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough, England, TS4 3BW
| | - Keith P Allison
- Orthoplastic Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough, England, TS4 3BW
| | - William G P Eardley
- Orthoplastic Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough, England, TS4 3BW
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Emara AK, Grits D, Samuel LT, Acuña AJ, Rosneck JT, Kamath AF. Hip Arthroscopy in Smokers: A Systematic Review of Patient-Reported Outcomes and Complications in 18,585 Cases. Am J Sports Med 2021; 49:1101-1108. [PMID: 32628512 DOI: 10.1177/0363546520922854] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although the negative effects of smoking have been documented for other types of arthroscopic procedures, there is limited information regarding its influence on hip arthroscopy outcomes. PURPOSE To examine the effect of smoking on the following outcomes after hip arthroscopy: patient-reported outcomes (PROs), the degree of improvement in PROs relative to baseline, complication rates, and rates of revision arthroscopy and/or conversion to total hip arthroplasty (THA). STUDY DESIGN Systematic review. METHODS The PubMed, Embase, and Cochrane Library databases were queried for studies published between January 1, 1985, and January 14, 2020, comparing the outcomes of hip arthroscopy between smokers and nonsmokers. Case reports, basic science studies, and studies investigating pediatric patients or lacking a description of outcomes were excluded. Included outcome tools were the modified Harris Hip Score, the visual analog scale (VAS) for pain and satisfaction, and the Hip Outcome Score (HOS)-Sports Specific and HOS-Activities of Daily Living. Preoperative characteristics and operative indications were also recorded. RESULTS Postoperative combined means (± SD) were better in nonsmokers versus smokers for the modified Harris Hip Score (75.67 ± 20.88 vs 82.32 ± 15.5; P = .001), the VAS pain (3.13 ± 2.79 vs 2.13 ± 2.21; P < .001), and the HOS-Sports Specific (62.54 ± 25.38 vs 71.7 ± 23.3; P < .001). There was no difference between groups in VAS satisfaction (P = .23) or HOS-Activities of Daily Living (P = .13). The extent of PRO score improvement relative to baseline values was similar in smokers and nonsmokers in all PRO measures (P > .05 for all). Smokers demonstrated higher rates of postoperative thromboembolic (P = .0177) and infectious (P = .006) complications. There was no difference between rates of revision arthroscopy (P = .47) and THA conversion (P = .31). CONCLUSION Smoking adversely affects certain postoperative PROs and is associated with higher postoperative complication rates. Further studies are required investigating the degree of PRO improvement and long-term arthroscopy revision and THA conversion rates.
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Affiliation(s)
- Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daniel Grits
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Alexander J Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - James T Rosneck
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Zabrzyński J, Gagat M, Łapaj Ł, Paczesny Ł, Yataganbaba A, Szwedowski D, Huri G. Relationship between long head of the biceps tendon histopathology and long-term functional results in smokers. A time to reevaluate the Bonar score? Ther Adv Chronic Dis 2021; 12:2040622321990262. [PMID: 33708369 PMCID: PMC7907713 DOI: 10.1177/2040622321990262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/05/2021] [Indexed: 12/22/2022] Open
Abstract
Aim The purpose of this study was to investigate whether there is an association between smoking, the extent of the degeneration process in the biceps tendinopathy, including cells and extracellular matrix (ECM) alterations, and long-term surgical results. Methods This study comprised 40 consecutive patients admitted for shoulder arthroscopy due to symptomatic biceps tendinopathy and classified into three groups based on smoking status: active smokers, former smokers, and non-smokers. According to the classical Bonar score criteria, the histopathologic evaluation of the harvested intra-articular portion of the tendon was done. The follow-up examination was based on the American Shoulder and Elbow Surgeons Score (ASES). Results A cohort of 32 patients was enrolled in the final follow-up examination; mean 37.56 months. Histopathological evaluation according to the classical Bonar score revealed degeneration of the tendinous tissue in each group but there was no correlation between the extent of degeneration, smoking indexes and the ASES. After revision of Bonar scale within the vascularity criterion, we found a correlation between the extent of degeneration of tendinous tissue, smoking data, ASES score, and the severity of rotator cuff injury. Conclusion In this paper, we indicate the ambiguous role of the neovascularization in the biceps tendinopathy, and it was used for modification of the classical Bonar score. Consequently, recalculated, modified Bonar score was correlated positively with smoking indexes and functional outcomes. Furthermore, the morphological alterations of rotator cuff tendons also correlated positively with the extent of biceps tendon degeneration, measured according to the modified scoring system.
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Affiliation(s)
- Jan Zabrzyński
- Department of General Orthopedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, Poznan, Poland; Department of Orthopedics, Orvit Clinic, Citomed Healthcare Center, Torun, Poland
| | - Maciej Gagat
- Department of Histology and Embryology, Faculty of Medicine, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Torun, Poland
| | - Łukasz Łapaj
- Department of General Orthopedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, Poznan, Poland
| | - Łukasz Paczesny
- Department of Orthopedics, Orvit Clinic, Citomed Healthcare Center, Torun, Poland
| | - Alper Yataganbaba
- Orthopedics and Traumatology Department, Hacettepe Universitesi, Ankara, Turkey
| | - Dawid Szwedowski
- Department of Orthopedics, Orvit Clinic, Citomed Healthcare Center, Torun, Poland Orthopedic Arthroscopic Surgery International (OASI) Bioresearch Foundation Milan, Italy
| | - Gazi Huri
- Orthopedics and Traumatology Department, Hacettepe Universitesi, Ankara, Turkey
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Kashanchi KI, Nazemi AK, Komatsu DE, Wang ED. Smoking as a risk factor for complications following arthroscopic rotator cuff repair. JSES Int 2021; 5:83-87. [PMID: 33554170 PMCID: PMC7846693 DOI: 10.1016/j.jseint.2020.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The purpose of this study was to investigate the association between smoking status and postoperative complications within 30 days of arthroscopic rotator cuff repair (ARCR). Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify all patients who underwent ARCR from 2015 to 2017. Smokers were defined as patients who reported smoking cigarettes in the year prior to rotator cuff repair. Patients who used chewing tobacco, cigars, or electronic cigarettes were not included in the smoking cohort. Postoperative complications were reported within 30 days of the procedure. Multivariate logistic regression was performed to investigate the relationship between smoking status and postoperative complications. Results There were 18,594 patients included in this study. Of these patients, 2834 (15.2%) were current smokers. Smokers were more likely to be men, to be aged < 65 years, and to have a body mass index < 30. Smokers were also more likely to have chronic obstructive pulmonary disease, to be functionally dependent, and to have an American Society of Anesthesiologists (ASA) class ≥ 3. After adjustment for all significantly associated patient demographic characteristics and comorbidities, smoking was identified as a significant predictor of surgical complications (odds ratio [OR], 1.955; P = .022), return to the operating room (OR, 2.547; P = .003), readmission (OR, 1.570; P = .014), and sepsis or septic shock (OR, 4.737; P = .021). Smoking was not a significant predictor of medical complications (OR, 1.105; P = .687) or surgical-site infections (OR, 1.216; P = .713). Conclusion Smoking may be a risk factor for surgical complications, readmission, and sepsis or septic shock within 30 days of ARCR.
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Affiliation(s)
- Kevin I Kashanchi
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Alireza K Nazemi
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - David E Komatsu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Edward D Wang
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
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Zabrzyński J, Huri G, Gagat M, Łapaj Ł, Yataganbaba A, Szwedowski D, Askin M, Paczesny Ł. The Impact of Smoking on Clinical Results Following the Rotator Cuff and Biceps Tendon Complex Arthroscopic Surgery. J Clin Med 2021; 10:599. [PMID: 33562734 PMCID: PMC7915659 DOI: 10.3390/jcm10040599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 12/18/2022] Open
Abstract
The purpose of this study was to investigate the association of smoking and functional outcomes after arthroscopic treatment of complex shoulder injuries: rotator cuff tears (RCTs) with biceps tendon (LHBT) tears. This retrospective case-control study has been conducted on a cohort of patients who underwent shoulder arthroscopy between 2015 and 2017 due to complex injury treatment. The outcomes were assessed using the American Shoulder and Elbow Surgeons Score (ASES), the University of California at Los Angeles (UCLA) Shoulder Score, need for non-steroid anti-inflammatory drugs (NSAIDs) consumption and the visual analog scale (VAS). Complications and changes in smoking status were also noted. A cohort of 59 patients underwent shoulder arthroscopy, due to complex LHBT pathology and RCTs, and were enrolled in the final follow-up examination; with mean duration of 26.03 months. According to smoking status, 27 of patients were classified as smokers, and the remaining 32 were non-smokers. In the examined cohort, 36 patients underwent the LHBT tenotomy and 23 tenodesis. We observed a relationship between smoking status and distribution of various RCTs (p < 0.0001). The mean postoperative ASES and UCLA scores were 80.81 and 30.18 in the smoker's group and 84.06 and 30.93 in the non-smoker's group, respectively. There were no statistically significant differences in pre/postoperative ASES and postoperative UCLA scores between smokers and non-smokers (p > 0.05). The VAS was significantly lower in the non-smokers' group (p = 0.0021). Multi-tendon injuries of the shoulder are a serious challenge for surgeons, and to obtain an excellent functional outcome, we need to limit the negative risk factors, including smoking. Furthermore, there is a significant association between smoking and the occurrence of massive rotator cuff tears, and the pain level measured by the VAS. Simultaneous surgical treatment of RC and LHBT lesions in the smoker population allowed us to obtain the functional outcomes approximated to non-smokers in the long-term follow-up. Of course, we cannot assert that smoking is the real cause of all complications, however, we may assume that this is a very important, negative factor in shoulder arthroscopy.
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Affiliation(s)
- Jan Zabrzyński
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, 61-701 Poznan, Poland;
- Department of Orthopaedics, Orvit Clinic, Citomed Healthcare Center, 87-100 Torun, Poland;
- Department of Pathology, Faculty of Medicine, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland
| | - Gazi Huri
- Orthopaedics and Traumatology Department, Hacettepe Universitesi, Ankara 06-532, Turkey; (G.H.); (A.Y.); (M.A.)
| | - Maciej Gagat
- Department of Histology and Embryology, Faculty of Medicine, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland;
| | - Łukasz Łapaj
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, 61-701 Poznan, Poland;
| | - Alper Yataganbaba
- Orthopaedics and Traumatology Department, Hacettepe Universitesi, Ankara 06-532, Turkey; (G.H.); (A.Y.); (M.A.)
| | - Dawid Szwedowski
- Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, 20-133 Milan, Italy;
| | - Mehmet Askin
- Orthopaedics and Traumatology Department, Hacettepe Universitesi, Ankara 06-532, Turkey; (G.H.); (A.Y.); (M.A.)
| | - Łukasz Paczesny
- Department of Orthopaedics, Orvit Clinic, Citomed Healthcare Center, 87-100 Torun, Poland;
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Ozcamdalli M, Kizkapan TB, Misir A, Oguzkaya S. Effect of Smoking on Postoperative Function and Quality of Life After Full Thickness Arthroscopic Rotator Cuff Repair: A Retrospective Analysis. Indian J Orthop 2021; 55:464-470. [PMID: 33927826 PMCID: PMC8046883 DOI: 10.1007/s43465-020-00339-5] [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: 09/06/2020] [Accepted: 12/24/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The effect of smoking on preoperative and postoperative outcome scores as well as quality of life measurements after arthroscopic rotator cuff repair (ARCR) has not been fully understood, and studies regarding this are lacking in the literature. This study aimed to evaluate the effect of smoking on function and quality of life after ARCR. METHODS Two-hundred patients who underwent full-thickness ARCR with a minimum 1-year follow-up period were included and evaluated retrospectively. The patients were divided into two groups: smokers (Group 1, 59 patients) and nonsmokers (Group 2, 141 patients). Pre- and postoperative Constant Murley (CM) scores, American Shoulder and Elbow Surgeons (ASES) scores, visual analogue scale scores (VASs), and Short-Form 36 health survey (SF-36) scores were used to evaluate functional and quality of life outcomes. The correlation between the smoking amount (pack-years) and outcomes was evaluated. RESULTS A total of 200 patients included into study (90 male and 110 female) with mean age of 62.68 ± 3.98. There was no statistically significant difference between the two groups regarding preoperative scores, except in the ASES score (P = 0.021 ) Additionally, there was a statistically significant difference between the groups regarding postoperative CM score, ASES score, and VAS, and in physical functioning and role limitations due to physical health domains of the SF-36 (P = 0.029, P = 0.038, P = 0.021 and P = 0.020, respectively). There were small to moderate negative correlations between amount of smoking and preoperative physical functioning, role limitations from emotional problems, energy/fatigue, emotional well-being, and pain domains of the SF-36. However, there were moderate to strong negative correlations between amount of smoking and postoperative SF-36 domains. CONCLUSION Preoperative and postoperative functional outcome scores, and quality of life measurements are negatively affected from smoking. As the amount of smoking increases, postoperative results are negatively affected. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Mustafa Ozcamdalli
- grid.411224.00000 0004 0399 5752Department of Orthopedics and Traumatology, Ahi Evran University, Kirsehir, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopedics and Traumatology, Cekirge State Hospital, Bursa, Turkey
| | - Abdulhamit Misir
- grid.414850.c0000 0004 0642 8921Department of Orthopedics and Traumatology, Istanbul Basaksehir Pine and Sakura City Training and Research Hospital, Istanbul, Turkey
| | - Sinan Oguzkaya
- Department of Orthopedics and Traumatology, Sarkisla State Hospital, Yildirim Mah. Alper Tunga Cad. Kalecity evleri B blok No:6, 58400 Sivas, Turkey
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Harada N, Gotoh M, Ishitani E, Kakuma T, Yano Y, Tatara D, Kawakami J, Imai T, Karasuyama M, Kudoh Y, Shiba N. Combination of risk factors affecting retear after arthroscopic rotator cuff repair: a decision tree analysis. J Shoulder Elbow Surg 2021; 30:9-15. [PMID: 32838953 DOI: 10.1016/j.jse.2020.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several risk factors for postoperative retear after arthroscopic rotator cuff repair (ARCR) have been cited in a large number of reports; various combinations of these seem to be present in the clinical setting. PURPOSE Using a combination model for decision tree analysis, we aimed to investigate the combination of risk factors that affect postoperative retear the most. METHODS A total of 286 patients who underwent magnetic resonance (MR) imaging at 6 months after surgery were included in this study. Based on the structural integrity of the MR images taken 6 months after surgery, the patients were divided into a healed group (intact tendon, 254 patients) and a retear group (ruptured tendon, 32 patients). Using univariate and decision tree analyses, we selected a combination of 11 risk factors that drastically affected postoperative retear. RESULTS The mean age was 64.9 ± 7.1 years, and the mean symptom duration was 9.7 ± 11.6 months. The tear was small/medium in 177 patients and large/massive in 109 patients. The technique for surgical repair was single row in 42 patients, double row in 60 patients, and suture bridging in 216 patients. On univariate analysis, both groups had significant differences in the anteroposterior (AP) tear size (P < .0001), mediolateral tear size (P < .0001), hyperlipidemia (P = .0178), global fatty degeneration index (P < .0001), supraspinatus fatty degeneration stage (P < .0001), and critical shoulder angle (CSA) (P = .0015). All of these 5 risk factors, except for mediolateral tear size, were selected as candidates for the decision tree analysis. Eight combination patterns were determined to have prediction probabilities that ranged from 4.3% to 86.1%. In particular, the combination of an AP tear size of ≥40 mm, hyperlipidemia, and a CSA of ≥37° affected retear after ARCR the most. CONCLUSIONS Decision tree analysis lead to the extraction of different retear factor combinations, which were divided into 5 retear groups. The worst combination was of AP tear size ≥40 mm, hyperlipidemia, and CSA ≥37°, and the prediction probability of this combination was 86.2%. Therefore, our data may offer a new index for the prediction of retear after ARCR.
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Affiliation(s)
- Nobuya Harada
- Department of Rehabilitation, Fukuoka Shion Hospital, Fukuoka, Japan; Kurume University School of Medicine Graduate School, Fukuoka, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan.
| | - Eiichi Ishitani
- Department of Orthopedic Surgery, Fukuoka Shion Hospital, Fukuoka, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatistics, Kurume University School of Medicine, Fukuoka, Japan
| | - Yuka Yano
- Department of Rehabilitation, Fukuoka Shion Hospital, Fukuoka, Japan
| | - Daisuke Tatara
- Department of Rehabilitation, Fukuoka Shion Hospital, Fukuoka, Japan
| | - Junichi Kawakami
- Department of Physical Therapy, Kyushu Nutrition Welfare University, Fukuoka, Japan
| | - Takaki Imai
- Department of Rehabilitation, Keishinkai Hopital, Saga, Japan
| | - Masaki Karasuyama
- Department of Physical Therapy, Kyushu Nutrition Welfare University, Fukuoka, Japan
| | - Yu Kudoh
- Kurume University School of Medicine Graduate School, Fukuoka, Japan
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University, Fukuoka, Japan
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Burns KA, Robbins LM, LeMarr AR, Childress AL, Morton DJ, Wilson ML. Healing rates after rotator cuff repair for patients taking either celecoxib or placebo: a double-blind randomized controlled trial. JSES Int 2020; 5:247-253. [PMID: 33681844 PMCID: PMC7910746 DOI: 10.1016/j.jseint.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Use of anti-inflammatory medications (NSAIDs) is an important component of multimodal pain control after orthopedic procedures to avoid opioid overutilization and abuse. However, the deleterious effects of NSAIDs on tendon healing are of particular concern in rotator cuff repair (RCR). The purpose of this study was to evaluate the effect of celecoxib or placebo on healing rates after RCR when administered in the perioperative and immediate postoperative period using MRI evaluation at one year postoperatively. A secondary aim was to determine whether clinical differences existed between patients with intact or non-intact repairs. Methods Patients aged ≤65 years with partial- or full-thickness rotator cuff tear (<25x25 mm) were randomized to receive celecoxib 400 mg or placebo 1 hour before the procedure and 200mg bid for 3 weeks postoperatively. All patients were treated as clinically indicated at the time of surgery and followed standard postoperative protocol. Repair integrity was evaluated with MRI using the Sugaya classification for repair integrity. Data were analyzed using multivariable logistic regression by intent to treat. Results Seventy-nine patients were enrolled; 21 were lost to follow-up, 6 did not have cuff repair, 5 were revised, and 2 declined follow-up, leaving 45 patients with one-year follow-up. Five of these patients did not complete MRI, leaving 40 patients for review. Eighteen of 20 patients (90%) who received celecoxib completed all doses of study medication as did 15 of 20 patients (75%) who received placebo. The patient groups were similar for demographics, clinical results, and healing rate. After adjusting for tear size, no statistically significant difference in healing rate was found between groups, with 10 of 20 celecoxib patients (50%) having intact repair at 1 year compared with 14 of 20 placebo patients (70%) (OR = 0.53, 95% CI: 0.14, 2.08, P = 0.35). Conclusion Half of the patients who received celecoxib had an intact repair compared with 70% intact repair for patients receiving placebo. Although not statistically significant in this small study, larger studies are needed to clarify this important clinical concern. The authors do not recommend use of celecoxib for postoperative pain control after RCR.
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Affiliation(s)
- Katherine A Burns
- SSM Health Orthopedics, SSM Health DePaul Hospital, St. Louis, MO, USA
| | - Lynn M Robbins
- SSM Health Orthopedics, SSM Health DePaul Hospital, St. Louis, MO, USA
| | - Angela R LeMarr
- SSM Health Orthopedics, SSM Health DePaul Hospital, St. Louis, MO, USA
| | - Amber L Childress
- SSM Health Orthopedics, SSM Health DePaul Hospital, St. Louis, MO, USA
| | - Diane J Morton
- SSM Health Orthopedics, SSM Health DePaul Hospital, St. Louis, MO, USA
| | - Melissa L Wilson
- University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA, USA
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Hong CK, Chang CJ, Kuan FC, Hsu KL, Chen Y, Chiang CH, Su WR. Patients With Diabetes Mellitus Have a Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair: A Meta-analysis. Orthop J Sports Med 2020; 8:2325967120961406. [PMID: 33225006 PMCID: PMC7653299 DOI: 10.1177/2325967120961406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023] Open
Abstract
Background Retear of a repaired rotator cuff tendon is a major issue for shoulder surgeons. It is possible that diabetes mellitus (DM) is associated with a greater risk of tendon retear after arthroscopic rotator cuff repair. Purpose To determine whether patients with DM have a higher tendon retear risk after arthroscopic rotator cuff repair. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the Web of Science, PubMed, and Embase databases. Inclusion criteria were articles written in the English language that included patients undergoing arthroscopic rotator cuff repair surgeries, reported the numbers of patients with and those without DM, and reported the number of rotator cuff retears. Data relevant to this study were extracted and statistically analyzed. Random-effects models were used to generate pooled odds ratio estimates and CIs. Results A total of 160 studies were identified from the initial search, and 5 of them met the inclusion criteria. A total of 1065 patients (207 patients with DM and 858 patients without DM) were included. The pooled results showed that the patients in the DM group had a significantly higher tendon retear risk than did those in the non-DM group (relative risk, 2.25; 95% CI, 1.14-4.45; P = .02). Conclusion Patients with DM have a 2.25 times higher risk of tendon retear after arthroscopic rotator cuff repair compared with patients without DM.
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Affiliation(s)
- Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Jui Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Hospital, Tainan, Taiwan
| | - Chen-Hao Chiang
- Department of Orthopaedic Surgery, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
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Best MJ, Aziz KT, Nayar SK, Patten IS, Bansal A, Huish E, Srikumaran U. Smoking is an independent risk factor for complications following open rotator cuff repair. PHYSICIAN SPORTSMED 2020; 48:469-472. [PMID: 32266846 DOI: 10.1080/00913847.2020.1753482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives: Smoking has been associated with poor cuff healing and worse long-term outcomes in patients undergoing rotator cuff repair. The effects of smoking on short-term complications following open rotator cuff repair are not well defined. The purpose of this study is to analyze the effects of smoking on 30-day outcomes following open rotator cuff repair. Methods: The American College of Surgeons National Surgical Quality Improvement Program was used to identify patients who underwent open rotator cuff repair from 2011 to 2016. Patients who were current smokers (within 1 year prior to surgery) were identified and compared with nonsmokers. Demographic data and postoperative complications within 30 days were analyzed. Multivariable logistic regression was used to isolate the effect of smoking on complications after surgery. Results: We identified 5,157 patients who underwent open rotator cuff repair, of which 18% (946 patients) were current smokers (within 1 year of surgery). Smokers were younger (54.4 years versus 61.5 years, P < 0.001) and were more likely to be male (60.8% versus 56.9%, P = 0.03). Compared with nonsmokers, smokers had a similar rate of comorbidities (P = 0.35) and similar preoperative functional status (P = 0.53), but had higher mean American Society of Anesthesiologists (ASA) class (P < 0.001). Logistic regression revealed that smoking was an independent predictor for any complication (OR 1.9, P = 0.03), any venous thromboembolic event (OR 4.6, P = 0.01), and pulmonary embolism (OR 6.4, P = 0.02). Conclusion: Patients who smoke are at increased risk for short-term complications after open rotator cuff repair. Smoking is independently associated with increased rate of postoperative venous thromboembolic events such as pulmonary embolism. This further highlights the importance of preoperative smoking cessation in patients undergoing open rotator cuff repair.
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Affiliation(s)
- Matthew J Best
- Department of Orthopaedic Surgery, Johns Hopkins University , Baltimore, MD, USA
| | - Keith T Aziz
- Department of Orthopaedic Surgery, Johns Hopkins University , Baltimore, MD, USA
| | - Suresh K Nayar
- Department of Orthopaedic Surgery, Johns Hopkins University , Baltimore, MD, USA
| | - Ian S Patten
- Department of Orthopaedic Surgery, Johns Hopkins University , Baltimore, MD, USA
| | - Ankit Bansal
- Department of Orthopaedic Surgery, Johns Hopkins University , Baltimore, MD, USA
| | - Eric Huish
- Department of Orthopaedic Surgery, Johns Hopkins University , Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins University , Baltimore, MD, USA
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Weir TB, Gilotra MN, Foster MJ, Santos J, Sykes JB, Kuntz AF, Huffman GR, Glaser DL. Preoperative tendon retraction, not smoking, is a risk factor for failure with continuity after rotator cuff repair. J Clin Orthop Trauma 2020; 15:76-82. [PMID: 33680825 PMCID: PMC7919958 DOI: 10.1016/j.jcot.2020.10.031] [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: 06/23/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Smoking is a poor prognostic factor for healing after rotator cuff repair and is associated with inferior results. We hypothesized that smokers would have higher recurrent tear rates and more postoperative myotendinous junction (MTJ) retraction in healed repairs than nonsmokers three months postoperatively. METHODS Rotator cuff repairs (RCRs) were retrospectively reviewed over a 2-year period. Patients underwent magnetic resonance imaging (MRI) within 6 months prior to surgery and again at 3 months postoperatively. Seventy-nine patients were included and stratified by smokers versus nonsmokers. Baseline patient demographics, tear characteristics, and surgical factors were collected. Preoperative and postoperative MRIs were assessed to quantify the MTJ position and to establish the recurrent tear rate. RESULTS For the total cohort (nonsmokers, n = 56; smokers, n = 23), significant differences in age, race, and traumatic onset of injury existed between groups. There were no significant differences in recurrent tear between smokers (26%) and nonsmokers (27%), but nonsmokers were more satisfied. For patients with healed RCRs (nonsmokers, n = 41; smokers, n = 17), there were significant differences in race. On univariate analysis, nonsmokers had a significantly more lateral MTJ postoperatively (P = 0.05). On multivariable regression analysis, medialized postoperative MTJ position in healed cuffs was driven only by greater preoperative rotator cuff retraction preoperatively. There were no significant differences in MTJ position based on smoking status for patients with healed RCRs. CONCLUSION Smoking does not appear to be an independent risk factor for postoperative MTJ retraction in healed RCRs, also known as failure in continuity. Preoperative tear size and retraction play the biggest roles in predicting postoperative MTJ position, regardless of smoking status. There are no significant differences in patient-reported outcomes for patients with healed RCRs, but nonsmokers had more satisfaction following RCR in the total cohort. LEVEL OF EVIDENCE Level III; Retrospective cohort study; Diagnostic study.
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Key Words
- ASES, American Shoulder and Elbow Surgeons Score
- CI, confidence interval
- FS, fat suppression
- Failure with continuity
- ICC, intraclass correlation coefficient
- MRI, magnetic resonance imaging
- MTJ, myotendinous junction
- Myotendinous junction
- NRS, numeric rating scale
- PD, proton density
- Penn, Penn Shoulder Score
- RCR, rotator cuff repair
- Rotator cuff
- Smoking
- mAC, medial aspect of the acromion
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Affiliation(s)
- Tristan B. Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit N. Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael J. Foster
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jessica Santos
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua B. Sykes
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew F. Kuntz
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - G. Russell Huffman
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - David L. Glaser
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Corresponding author. Penn Musculoskeletal Center, Penn Medicine University City, 8th Floor, 3737 Market Street, Philadelphia, PA, 19104, USA.
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Zabrzynski J, Gagat M, Paczesny L, Grzanka D, Huri G. Correlation between smoking and neovascularization in biceps tendinopathy: a functional preoperative and immunohistochemical study. Ther Adv Chronic Dis 2020; 11:2040622320956418. [PMID: 33101619 PMCID: PMC7549321 DOI: 10.1177/2040622320956418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/10/2020] [Indexed: 12/31/2022] Open
Abstract
Aims The purpose of this study was to investigate whether smoking is associated with neovascularization in the tendinopathy of the long head of the biceps tendon (LHBT). Methods The study included 40 consecutive patients who underwent arthroscopic biceps tenotomy/tenodesis due to chronic biceps tendinopathy and divided into three groups: (1) non-smokers, (2) former smokers, (3) smokers. LHBT tissue samples were stained with H&E, Alcian blue and Trichrome staining. Immunohistochemical examination was performed using anti-CD31 and anti-CD34. The neovessel density score (NDS) was scored by Bonar criteria. Results The mean period of smoking was 15.50 years with an average number of 24 cigarettes/day in the former smokers and 21.69 years with an average number of 15 cigarettes/day in the active smokers. The mean NDS was 2.23/3 in non-smokers, whereas it was 1.60/3 in former smokers and 1.31/3 in active smokers. The mean American Shoulder and Elbow Surgeons score equaled 46 in never smoked patients, 43.60 in former smokers, and 41.46 in active smokers. In the patients with smoking history, the disorganized tendinous tissue islands were avascular and composed of compact acidic polysaccharides and mucopolysaccharides. We observed negative correlation between the NDS and the smoking indexes, including cigarettes per day (p = 0.0150), smoking years (p = 0.0140), pack-years (p = 0.0088). Conclusion In conclusion, the present study revealed that smoking impairs the vascularization of the biceps tendon in chronic tendinopathy. Clinically, we observed a negative correlation between smoking and neovascularization. Furthermore, there was no correlation between neovascularization and functional preoperative status.
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Affiliation(s)
- Jan Zabrzynski
- Department of Orthopedics, Orvit Clinic, Citomed Healthcare Center, Torun, Poland
| | - Maciej Gagat
- Department of Histology and Embryology, Faculty of Medicine, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Torun, Poland
| | - Lukasz Paczesny
- Department of Orthopedics, Orvit Clinic, Citomed Healthcare Center, Torun, Poland
| | - Dariusz Grzanka
- Department of Pathology, Faculty of Medicine, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Torun, Poland
| | - Gazi Huri
- Orthopedics and Traumatology Department, Hacettepe Universitesi, Ankara, Turkey
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