Evaluation of arthroscopic rotator cuff repair results in patients with anterior greater tubercle cysts

Clinical efficacy and tendon integrity of patients with subscapularis tear by the technique of arthroscopic single external row repair

Background

With the development of arthroscopic technology and equipment, arthroscopy can effectively repair the tear of the subscapular muscle. However, it is difficult to expose the subscapular muscle and operate it under a microscope. In this study, the SwiveLock® C external row anchor under arthroscopy was applied to repair the tear of the subscapular muscle in a single row, which is relatively easy to operate with reliable suture and fixation, and its efficacy was evaluated.

Purpose

This study aimed to assess the clinical efficacy and the tendon integrity of patients who had subscapularis tears by adopting the single-row repair technique with a SwiveLock® C external row anchor.

Methods

Patients who had the subscapular muscle tear either with or without retraction were included, and their follow-up time was at least 1 year. The degree of tendon injury was examined by magnetic resonance imaging (MRI) and confirmed by arthroscopy. The tendon was repaired in an arthroscopic manner by utilizing the single-row technique at the medial margin of the lesser tuberosity. One double-loaded suture SwiveLock® C anchor was applied to achieve a strong fixation between the footprint and tendon. The range of motion, pain visual simulation score, American Shoulder and Elbow Surgeons (ASES) score, and Constant score of shoulder joint were evaluated for each patient before the operation, 3 months after the operation, and at least 1 year after the operation.

Results

In total, 110 patients, including 31 males and 79 females, with an average age of 68.28 ± 8.73 years were included. Arthroscopic repair of the subscapular tendon with SwiveLock® C external anchor can effectively improve the range of motion of the shoulder joint. At the last follow-up, the forward flexion of the shoulder joint increased from 88.97 ± 26.33° to 138.38 ± 26.48° (P < 0.05), the abduction range increased from 88.86 ± 25.27° to 137.78 ± 25.64° (P < 0.05), the external rotation range increased from 46.37 ± 14.48° to 66.49 ± 14.15° (P < 0.05), and the internal rotation range increased from 40.03 ± 9.01° to 57.55 ± 7.43° (P < 0.05). The clinical effect is obvious. The constant shoulder joint score increased from 40.14 ± 15.07 to 81.75 ± 11.00 (P < 0.05), the ASES score increased from 37.88 ± 13.24 to 82.01 ± 9.65 (P < 0.05), and the visual analog scale score decreased from 5.05 ± 2.11 to 1.01 ± 0.85 (P < 0.05). In the 6th month after the operation, two cases (1.81%) were confirmed to have re-tears via MRI.

Conclusion

In this study, we repaired the subscapularis muscle with a single-row technique fixed by SwiveLock® C anchor and FiberWire® sutures and evaluated its efficacy. The results showed that the clinical effect of single-row arthroscopic repair was satisfactory and that reliable tendon healing could be achieved.

Transosseous repair with a cortical implant for greater tubercle cyst-related rotator cuff tear results in good clinical outcomes, but significant implant migration

PURPOSE

To evaluate whether an arthroscopic transosseous technique (ATO) with cortical implants is effective for rotator cuff tear (RCT) repair in patients with cysts of the greater tuberosity (GTC).

METHODS

Patients treated with the ATO technique between January 2013 and October 2017 were evaluated. Inclusion criteria were patients treated for both cyst-related and non-cyst-related RCTs and patients with a moderate-sized tear (1-3 cm) according to the DeOrio and Cofield classification. A total of 39 patients were separated into two groups: Group 1 (n = 16) patients with cyst-associated RCT, and Group 2 (n = 23) patients with no cyst. Implant pull-out and migration were evaluated radiologically on standard antero-posterior shoulder radiographs and rotator cuff re-tear was assessed on magnetic resonance images at the final follow-up examination. Group 1 patients were separated into two subgroups according to cyst size (cyst < 5 mm and cyst ≥ 5 mm) and subgroup analysis was performed. Clinical assessment was performed using a visual analog scale, the Constant score and Oxford shoulder score.

RESULTS

The mean follow-up time was 33.7 ± 11.7 months. The mean cyst size was 5.4 ± 1.5 mm. There was no significant difference in re-tear rates between the cystic and non-cystic groups. The mean implant migration distance was 3.0 ± 2.2 mm in patients with a RCT -related cyst and 0.7 ± 0.8 mm in those without a cyst. A statistically significant difference was found between the groups (p = 0.002). There was no statistically significant difference between the groups in respect of clinical scores. No implant failure was observed.

CONCLUSION

The ATO method performed with a cortical implant in RCTs resulted in satisfactory recovery and clinical outcomes in the short to medium term with low failure rates. While no implant failures were observed, implant migration was associated with cyst presence. Therefore, judicious use is advocated in the choice of transosseous fixation for cyst-related RCTs and patients should be informed of the possibility of implant migration.

LEVEL OF EVIDENCE

III.

Compound betamethasone in the treatment of pain after supraspinatus tendon repair

Objective

To investigate the effect of compound betamethasone on pain points of the supraspinatus tendon by local blocking therapy after repair surgery.

Methods

This non-randomised controlled trial included patients who underwent arthroscopic repair of supraspinatus tendon tears and who had long-term pain. At 3 months following surgery, patients were assigned to an experimental group, whose pain points were treated with compound betamethasone, or a control group who did not receive compound betamethasone. Visual analogue scale (VAS) score, Pittsburgh Sleep Quality Index (PSQI) and Constant shoulder score for pain were determined at 3, 4, 5 and 6 months following surgery and analysed retrospectively.

Results

Of 38 included patients, there were no statistically significant between-group differences in VAS score, PSQI or Constant shoulder scores at 3 months following surgery. At 4, 5 and 6 months after surgery, the VAS score and PSQI were significantly lower, and the Constant shoulder score was significantly higher, in the experimental group versus controls.

Conclusions

Using compound betamethasone to locally block pain points after supraspinatus tendon repair surgery may significantly alleviate pain, improve sleep quality, facilitate functional shoulder exercise and achieve good shoulder function.

The correlation between shoulder pathologies and sleep disorders

OBJECTIVE

To assess and characterize the correlation between shoulder pathologies and sleep disturbances.

METHODS

Participants enrolled into this case-control study were divided into two groups: patients with an established clinical diagnosis of active shoulder pathology (study group), and patients without any shoulder pathology (control group). All patients completed the Insomnia Severity Index (ISI) questionnaire, in addition to questions related to participant demographics, health status, medication, and other known insomnia risk factors.

RESULTS

A total of 98 patients were included (46 in the study group and 52 controls). Mean ISI score was significantly higher (indicating more severe insomnia) in the study group versus control group (t[96] = -9.67), even after correcting for confounders (t[53.1] = -8.61). Additionally, in patients with shoulder pathology, those with comorbidities experienced more sleep disturbances than those without comorbidities (β = 0.36). Lastly, the shoulder pathology group was at a higher risk of having sleep disturbances compared with controls (relative risk 4.86, 95% confidence interval 2.24, 10.55).

CONCLUSIONS

Sleep disturbances are more common among patients with shoulder pathologies. Comorbidities and a shorter duration of pathology may predict more severe sleep disturbances.

Periimplant osteolysis does not affect the outcome of rotator cuff repair: a systematic review and meta-analysis

PURPOSE

The goal of this study was to perform a systematic review and meta-analysis to compare the clinical and radiologic outcomes of rotator cuff repair, depending on the presence of developed periimplant osteolysis (PIO) after using suture anchors.

METHODS

The electronic databases of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for articles published up until October 2019 to find relevant articles comparing the outcomes of rotator cuff repair between the periimplant osteolysis group and non-periimplant osteolysis group. Data searching, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines. The results are presented as risk ratio (RR) for binary outcomes and standardised mean difference (SMD) for continuous outcomes with 95% confidence intervals (CI).

RESULTS

Six clinical studies were included. No significant differences were found between the group with periimplant osteolysis and the group without periimplant osteolysis regarding retear rate (RR = 1.34; 95% CI 0.93-1.94; I² = 28%), postoperative clinical scores (SMD = 0.29; 95% CI - 0.26 to 0.83; I² = 80%) and range of motion (ROM); forward flexion (SMD = 0.39; 95% CI - 0.16 to 0.93; I² = 0%), external rotation (SMD = - 0.10; 95% CI - 0.64 to 0.45; I² = 0%) and internal rotation (SMD = - 0.37; 95% CI - 0.92 to 0.17; I² = 0%).

CONCLUSION

The presence of periimplant osteolysis after rotator cuff repair with suture anchor does not affect the clinical outcomes such as retear rate, clinical scoring, and ROM. However, as there was no standard consensus on the criteria for evaluating periimplant osteolysis, this result may not fully reflect the effect of periimplant osteolysis depending on its severity.

LEVEL OF EVIDENCE

Level IV.

The analgesic efficacy of pregabalin for shoulder arthroscopy: A meta-analysis of randomized controlled trials

INTRODUCTION

The efficacy of pregabalin for pain management of shoulder arthroscopy remains controversial. We conduct this meta-analysis to explore the influence of pregabalin versus placebo on the postoperative pain intensity of shoulder arthroscopy.

METHODS

We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through November 2019 for randomized controlled trials assessing the effect of pregabalin versus placebo on pain control of shoulder arthroscopy. This meta-analysis was performed using the random-effect model.

RESULTS

Three randomized controlled trials were included in the meta-analysis. Overall, compared with control group for shoulder arthroscopy, pregabalin remarkably decreased pain scores at 0 to 1 hour (Std. MD = -0.57; 95% CI = -1.04 to -0.09; P = .02) and 12 hours (Std. MD = -0.37; 95% CI = -0.72 to -0.02; P = .04), as well as analgesic consumption (Std. MD = -1.84; 95% CI = -2.24 to -1.44; P < .00001), but showed no notable influence on pain scores at 24 hours (Std. MD = -0.54; 95% CI = -1.47 to 0.38; P = .25), nausea or vomiting (RR = 0.84; 95% CI = 0.53-1.33; P = .45), dizziness (RR = 1.14; 95% CI = 0.89-1.47; P = .30).

CONCLUSIONS

Pregabalin may benefit to pain control after shoulder arthroscopy.

Comparison of surgical outcomes between rotator cuff repair with and without rotator interval capsular release for rotator cuff tears to prevent and improve postoperative stiffness: a meta-analysis

BACKGROUND

A common complication of rotator cuff (RC) repair is a postoperative stiffness. Postoperative stiffness may develop and lead to inferior functional outcomes. Rotator cuff repair with additional rotator interval (RI) capsular release can be done to prevent postoperative stiffness in rotator cuff tears. However, routine rotator interval capsular release in rotator cuff repair is controversial. Therefore, we conducted a systematic review and meta-analysis to compare the postoperative outcomes between RC repair with and without RI capsular release for RC tears with and without concomitant stiffness.

METHOD

We searched all comparative studies that compared postoperative outcomes (VAS, CS, ASES, complications and ROM at 3, 6 and 12 months) of RC repair with and without RI capsular release for RC tears with and without concomitant stiffness from PubMed and Scopus databases from inception to the February 1, 2020.

RESULTS

Seven of 255 studies (six comparative studies and one RCT) (N = 803 patients) were eligible; 2 and 5 studies were included in the pooling of RC repair and RI release without concomitant stiffness and stiffness, respectively; 2, 6, 3, 6, 3, 5, 7, 7, and 7 studies were included in pooling of VAS, CS, ASES at 6 and 12 months and range of motion (internal, external rotation and forward flexion) at 3, 6 and 12 months, respectively. The UMD of VAS, CS and ASES scores at 6- and 12-month follow-up for the RC repair and RI release group was 0.48 (95% CI: 0.05, 0.90), 0.93 (-1.70, 3.56), -2.27 (-5.30, 0.76), -0.04 (-0.24, 0.15), 1.66 (0.77, 2.55) and 1.58 (0.21, 2.96) scores when compared to RC repair alone with and without concomitant stiffness. In terms of ROM, forward flexion for the RC repair and RI release group was -4.60 (-10.61, 1.41), -7.11 (-15.47, 1.25) and -0.70 (-2.51, -1.11) degrees at 3, 6 and 12 months, respectively, when compared to RC repair alone. For external rotation, RC repair and RI release were -0.12 (-8.27, 8.03), -3.98 (-12.09, 4.14) and -2.65 (-5.35, 0.04) degrees at 3, 6 and 12 months, respectively, when compared to RC repair alone. For internal rotation in RC repair and RI release, the values were -1.22 (-1.97, - 0.48), -1.01 (-1.79, -0.23) and -0.19 (-1.13, 0.74) degrees at 3, 6 and 12 months, respectively, when compared to RC repair alone. There were no differences with a RR of 0.92 (0.46, 1.84) between the two groups in terms of complications. After subgroup analysis, RC repair with RI release had no clinically significant differences for pain, function and ROM when compared to RC repair alone in RC tear patients with and without preoperative stiffness.

CONCLUSIONS

RC repair with RI release in patients with and without preoperative stiffness had no statistically significant differences for pain, function (CS and ASES) and range of motion (FF, ER and IR) when compared to RC repair alone in RC injury patients.

LEVEL OF EVIDENCE

II.

Comparison of arthroscopic suture-bridge technique and double-row technique for treating rotator cuff tears: A PRISMA meta-analysis

BACKGROUND

Rotator cuff tear is a common shoulder disorder in the elderly. Either arthroscopic double-row (DR) or suture-bridge (SB) technique for rotator cuff tear patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical outcomes of arthroscopic SB versus DR intervention.

METHODS

The 7 studies were acquired from PubMed, Medline, Embase, CNKI, Google, and Cochrane Library. The data were extracted by 2 of the co-authors independently and were analyzed by RevMan5.3. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa scale were used to assess risk of bias.

RESULTS

Seven studies including 1 randomized controlled trial and 6 observational studies were assessed. The methodological quality of the trials ranged from low to moderate. The pooled results of American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, and range of motion showed that the differences were not statistically significant between the 2 interventions. The difference of University of California at Los Angeles (UCLA) score was statistically significant between SB and DR intervention, and SB treatment was more effective (MD = -0.95, 95% CI = -1.70 to -0.20, P = .01). The difference of re-tear rate was statistically significant and SB treatment achieved better result than DR treatment (OR = 0.31, 95% CI = 0.15-0.64, P = .001). Sensitivity analysis proved the stability of the pooled results and the publication bias was not apparent.

CONCLUSIONS

Both arthroscopic SB and DR interventions had benefits in rotator cuff tear. SB treatment was more effective in UCLA score and had lower re-tear rate than DR treatment. The arthroscopic SB technique is recommended as the optical choice for rotator cuff tear.

Efficacy of ultrasound-guided percutaneous lavage for rotator cuff calcific tendinopathy: A systematic review and meta-analysis

BACKGROUND

Rotator cuff calcific tendinopathy (RCCT) is frequently diagnosed in patients with shoulder pain, but there is no consensus on its treatment such as rest, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, subacromial corticosteroid injection (SAI), extracorporeal shock wave therapy (ESWT), and ultrasound-guided percutaneous lavage (UGPL). The aim of the study was to compare the effectiveness of UGPL with other techniques in the treatment of RCCT.

METHODS

Literature searches of PubMed, EMBASE, OVID, Cochrane Library, Web of Science, Chinese Biomedical Literature, Wanfang, Weipu Journal, and CNKI databases were performed up to August 2018. Only randomized controlled trials (RCTs) comparing UGPL vs other methods for RCCT were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards.

RESULTS

Eight RCTs were included with 617 cases in all. The result of meta-analysis showed that: there were significant differences between the UGPL and ESWT group in 12-month follow-up VAS, constant shoulder score (CSS), the average particle size of the calcium deposition, and the calcification disappearance rate. However, there was no significant difference in complication between 2 groups.

CONCLUSION

The present meta-analysis indicates that UGPL has certain clinical effect for calcifying tendinitis of rotator cuff. Compared with ESWT, UGPL may be superior in clinical pain relief and calcification clearance. However, owing to the limited quality and quantity of the included studies, additional high-quality RCTs are needed to confirm these findings.