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Oca Pernas R, Fernández Cantón G. Direct MR arthrography without image guidance: a practical guide, joint-by-joint. Skeletal Radiol 2024:10.1007/s00256-024-04709-0. [PMID: 38801542 DOI: 10.1007/s00256-024-04709-0] [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: 04/24/2024] [Revised: 05/10/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
Direct MR arthrography (dMRA) is a fundamental technique in diagnosing pathology in major peripheral joints, allowing for precise evaluation of intra-articular structures. Although injection guidance is typically performed using imaging techniques such as ultrasound or fluoroscopy, puncture via anatomical landmarks may be useful in certain circumstances where it has been proven to be a safe and effective procedure. This paper describes the indications and injection technique of dMRA, joint by joint, focusing on the different technical details, from the most common locations, like the shoulder or hip, to those with more restricted clinical indications, such as the wrist, knee, elbow, or ankle. The most relevant anatomical landmarks are detailed for each joint, aiding in the intra-articular introduction of diluted contrast, highlighting the most accessible trajectories and structures to avoid when inserting the needle. Additionally, tips are provided to facilitate proper joint distension. With all this information, this paper aims to serve as a suitable reference guide for performing dMRA without image guidance if needed.
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Affiliation(s)
- Roque Oca Pernas
- Osakidetza - Basque Health Service, MRI Department, OSATEK, Osatek Deusto, Luis Power, 18, 48014, Bilbao, Spain.
- Department of Radiology, Mutualia, Bilbao, Spain.
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Wang X, Zhang W, Dong J, Li L, Xiao Y, Liu F. Three-dimensional sonography has satisfied accuracy for detecting rotator cuff tears. Front Surg 2024; 11:1411816. [PMID: 38812755 PMCID: PMC11133732 DOI: 10.3389/fsurg.2024.1411816] [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: 04/03/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024] Open
Abstract
Background Rotator cuff injuries and tears are common causes of shoulder pain and dysfunction, necessitating accurate diagnostic methods to guide clinical decision-making. This study evaluates the diagnostic utility of three-dimensional (3D) shoulder sonography in identifying rotator cuff injury and tear patterns. Methods A comprehensive search across seven electronic databases, which included Cochrane Library, Embase, PubMed, Cochrane Library, China Biology Medicine (CBM) database, CNKI, Wanfang, and VIP database. These databases were utilized to retrieve articles that assess the diagnostic value of 3D shoulder sonography for identifying rotator cuff injuries and tear patterns. The effectiveness of 3D shoulder sonography was assessed in terms of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). For each parameter, the 95% confidence intervals were calculated. Additionally, summary receiver operating characteristic curves (SROCs) were constructed, allowing for a comprehensive evaluation of diagnostic accuracy, which is reflected in the area under the SROC curve (AUC). Results Screening of 8,508 identified nine literatures eligible for inclusion in the meta-analysis, encompassing a total of 366 patients. The analysis of detecting any rotator cuff tear revealed a sensitivity of 0.97 and specificity of 0.87, yielding a DOR of 90.03 and an AUC of 0.98. Furthermore, 3D shoulder sonography demonstrated satisfactory accuracy in detecting both full and partial-thickness rotator cuff tears (Sensitivity: 0.92 vs. 0.83, specificity: 0.94 vs. 097, and AUC: 0.96 vs. 0.95). Conclusion This study indicates that three-dimensional sonography has satisfied accuracy for detecting rotator cuff tears.
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Affiliation(s)
- Xin Wang
- Department of Anesthesia Operating Room, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Wei Zhang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Lianxin Li
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yuzhi Xiao
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Toh Y. Ultrasound Versus Magnetic Resonance Imaging as First-Line Imaging Strategies for Rotator Cuff Pathologies: A Comprehensive Analysis of Clinical Practices, Economic Efficiency, and Future Perspectives. Cureus 2024; 16:e59231. [PMID: 38813323 PMCID: PMC11132969 DOI: 10.7759/cureus.59231] [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] [Accepted: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
Rotator cuff injuries are a prevalent cause of atraumatic chronic shoulder pain, imposing a significant healthcare burden. This article reviews the clinical presentation, diagnostic imaging modalities, practice variations, and economic efficiency considerations in the evaluation of rotator cuff pathologies. Ultrasound (US) and magnetic resonance imaging (MRI) are the primary imaging methods for diagnosing rotator cuff injuries. US provides real-time visualization but has limited tissue penetration, while MRI offers detailed anatomical information but is not a dynamic process. Studies show that MRI is superior to US with higher sensitivity and specificity. MRI is the gold standard, particularly for surgical planning, but US remains relevant when MRI is not feasible. Both require standardized protocols for evaluating tear dimensions and muscle atrophy. With the operator-dependent nature of US, MRI offers a more comprehensive assessment of rotator cuff tears and predictive insights for clinical outcomes. Practice variations exist in the management of rotator cuff pathologies, with some countries favoring US as the primary imaging modality and others relying more on MRI. These variations are influenced by factors like resource availability and healthcare system nuances. In Australia, current guidelines lean toward conservative management, potentially leading to delayed diagnoses and increased costs. The United States often favors MRI, while Canada advocates for US as the initial choice. Economic considerations play a significant role in selecting imaging modalities. While US is cost-effective, it may necessitate subsequent MRI examinations, contributing to inefficiencies in the diagnostic process. Studies suggest that a combined approach of US and MRI is less efficient and cost-effective than MRI alone. However, the use of both modalities rather than MRI alone is common in clinical practice, adding to healthcare expenses. In conclusion, the choice of imaging modality for rotator cuff pathologies should consider factors such as diagnostic efficacy, cost-effectiveness, and resource availability. Radiologists play a pivotal role in guiding this selection and ensuring comprehensive evaluations. Future considerations should include the revision of management guidelines and the potential inclusion of shoulder pathologies in healthcare coverage to optimize patient care and healthcare expenditure.
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Affiliation(s)
- Yvana Toh
- Surgery, Surgical Treatment and Rehabilitation Service (STARS), Brisbane, AUS
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Gowda CS, Mirza K, Galagali DA. Rotator Cuff Tears: Correlation Between Clinical Examination, Magnetic Resonance Imaging and Arthroscopy. Cureus 2024; 16:e56065. [PMID: 38618461 PMCID: PMC11009554 DOI: 10.7759/cureus.56065] [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] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
Background Arthroscopy in diagnosing a rotator cuff injury has surgical and anaesthesia-related risks. Magnetic resonance imaging (MRI), a non-invasive procedure, is expensive, and lacks dynamic components making it less favourable. Clinical examination narrows the diagnosis, but lacks diagnostic accuracy due to overlap of clinical signs and symptoms. We aimed to determine the diagnostic accuracy of clinical examination and MRI in rotator cuff tears by correlating it with arthroscopy. Methods This prospective, cross-sectional validation study included patients (N=28) with shoulder pain with clinical characteristics suggestive of rotator cuff tears. Clinical diagnoses and MRI were done preoperatively, following which each patient underwent arthroscopic surgery. Shoulder arthroscopy findings were correlated with those of clinical examination and MRI. Results The mean age of patients was 50.21±9.66 years, with 60.71% being males. Clinical examination was 100% sensitive and 73.8% specific for detecting rotator cuff tears. MRI was 92.85% sensitive and 98.8% specific in detecting rotator cuff tears. Shoulder MRI demonstrated a higher agreement with arthroscopy than clinical results for subscapularis, supraspinatus, infraspinatus, teres, and biceps tendon appearance. Conclusion MRI results in identifying rotator cuff pathologies are comparable with arthroscopy. Clinical examination findings are variable due to an examiner's bias and therefore its diagnostic scope is limited. However, clinical examination with MRI together might accurately identify the rotator cuff injury.
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Affiliation(s)
| | - Kiyana Mirza
- Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, GBR
| | - Dev A Galagali
- Foot and Ankle Surgery, Indian Foot and Ankle Society, Bangalore, IND
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Winkler S, Herbst B, Kafchitsas K, Wohlmuth P, Hoffstetter P, Rueth MJ. Pre-operative Assessment of Shoulder Pathologies on MRI by a Radiologist and an Orthopaedic Surgeon. Malays Orthop J 2024; 18:42-50. [PMID: 38638663 PMCID: PMC11023335 DOI: 10.5704/moj.2403.006] [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: 12/22/2022] [Accepted: 05/03/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction Pathologies of the shoulder, i.e. rotator cuff tears and labral injuries are very common. Most patients receive MRI examination prior to surgery. A correct assessment of pathologies is significant for a detailed patient education and planning of surgery. Materials and methods Sixty-nine patients were identified, who underwent both, a standardised shoulder MRI and following arthroscopic shoulder surgery in our hospital. For this retrospective comparative study, the MRIs were pseudonymised and evaluated separately by an orthopaedic surgeon and a radiologist. A third rater evaluated images and reports of shoulder surgery, which served as positive control. Results of all raters were then compared. The aim was an analysis of agreement rates of diagnostic accuracy of preoperative MRI by a radiologist and an orthopaedic surgeon. Results The overall agreement with positive control of detecting transmural cuff tears was high (84% and 89%) and lower for partial tears (70-80%). Subscapularis tears were assessed with moderate rates of agreement (60 - 70%) compared to intra-operative findings. Labral pathologies were detected mostly correctly. SLAP lesions and pulley lesions of the LHB were identified with only moderate agreement (66.4% and 57.2%) and had a high inter-rater disagreement. Conclusion This study demonstrated that tears of the rotator cuff (supraspinatus, infraspinatus) and labral pathologies can be assessed in non-contrast pre-operative shoulder MRI images with a high accuracy. This allows a detailed planning of surgery and aftercare. Pathologies of the subscapularis tendon, SLAP lesions and biceps instabilities are more challenging to detect correctly. There were only small differences between a radiologic and orthopaedic interpretation of the images.
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Affiliation(s)
- S Winkler
- Department of Orthopaedic Surgery, Asklepios Hospital Lindenlohe, Schwandorf, Germany
| | - B Herbst
- Department of Orthopaedic Surgery, Asklepios Hospital Lindenlohe, Schwandorf, Germany
| | - K Kafchitsas
- Department of Orthopaedic Surgery, Asklepios Hospital Lindenlohe, Schwandorf, Germany
| | - P Wohlmuth
- Department of Research, ASKLEPIOS Proresearch, Hamburg, Germany
| | - P Hoffstetter
- Department of Radiology, University of Regensburg, Regensburg, Germany
| | - M J Rueth
- Department Sports Clinic, Sportklinik Fichtelgebirge, Markredwitz, Germany
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Adriani M, Saccomanno MF, Motta M, Galli S, Milano G. Reliability of Magnetic Resonance Imaging Criteria for the Preoperative Assessment of Rotator Cuff Tears: A Systematic Review. Am J Sports Med 2024; 52:845-858. [PMID: 37183988 DOI: 10.1177/03635465231166077] [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: 05/16/2023]
Abstract
BACKGROUND Magnetic resonance (MR) imaging is the most common modality for assessment of the rotator cuff before and after surgery. Several classifications have been described aiming to define main tear characteristics. However, there is still confusion when it comes to the reliability of those classifications. PURPOSE (1) To identify all MR classifications available in the literature for preoperative assessment of rotator cuff tears, (2) to summarize available data on the reliability of identified classifications, and (3) to assess the methodological quality of reliability studies. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All studies reporting MR assessment in patients with a superior or posterosuperior rotator cuff tear were included. After identification of the available MR criteria, reliability studies were analyzed. Descriptive statistics were used to summarize findings. Methodological quality was assessed using the Quality Appraisal of Reliability Studies checklist. RESULTS A total of 75 studies were included in this review. Eight categories of outcomes could be identified. Of the total, 62 studies reported interobserver reliability whereas 32 reported intraobserver reliability of some of the identified criteria. Each category reflected a variety of reliability, ranging from poor to excellent agreement. MR proved to be a reliable imaging modality to detect the structural integrity of the posterosuperior cuff, especially in cases of full-thickness tear; it was also reliable in terms of tear width and length and muscle atrophy based on a tangent sign or Thomazeau classification. All other classifications did not prove acceptable reliability. Methodological quality was high for 23 articles and moderate for 14. CONCLUSION Preoperative MR is a reliable imaging modality to identify full-thickness tears, measure tear size and morphology, and identify muscle atrophy with tangent sign or Thomazeau classification. All other outcomes and classifications did not show acceptable reliability; therefore, caution is needed when using them for preoperative evaluation of a rotator cuff tear.
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Affiliation(s)
- Marco Adriani
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Maristella Francesca Saccomanno
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Marcello Motta
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Galli
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [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: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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Velasquez Garcia A, Hsu KL, Marinakis K. Advancements in the diagnosis and management of rotator cuff tears. The role of artificial intelligence. J Orthop 2024; 47:87-93. [PMID: 38059047 PMCID: PMC10696306 DOI: 10.1016/j.jor.2023.11.011] [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: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 12/08/2023] Open
Abstract
Background This review examined the role of artificial intelligence (AI) in the diagnosis and management of rotator cuff tears (RCTs). Methods A literature search was conducted in October 2023 using PubMed (MEDLINE), SCOPUS, and EMBASE databases, included only peer-reviewed studies. Relevant articles on AI technology in RCTs. A critical analysis of the relevant literature was conducted. Results AI is transforming RCTs management through faster and more precise identification and assessment using algorithms that facilitate segmentation, quantification, and classification of the RCTs across various imaging modalities. Precise algorithms focusing on preoperative factors to assess RCTs reparability have been developed for personalized treatment planning and outcome prediction. AI also aids in exercise classification and promotes patient adherence during at-home physiotherapy. Despite promising advancements, challenges in data quality and symptom integration persist. Future research should include refining AI algorithms, expanding their integration into various imaging techniques, and exploring their roles in postoperative care and surgical decision-making. Conclusions AI-driven solutions improve diagnostic accuracy and have the potential to influence treatment planning and postoperative outcomes through the automated RCTs analysis of medical imaging. Integration of high-quality datasets and clinical symptoms into AI models can enhance their reliability. Current AI algorithms can also be refined, integrated into other imaging techniques, and explored further in surgical decision-making and postoperative care.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Clínica Universidad de los Andes, Department of Orthopedic Surgery, Santiago, Chile
| | - 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
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Rossi LA, Piuzzi N, Tanoira I, Brandariz R, Huespe I, Ranalletta M. Subacromial Platelet-Rich Plasma Injections Produce Significantly Worse Improvement in Functional Outcomes in Patients With Partial Supraspinatus Tears Than in Patients With Isolated Tendinopathy. Arthroscopy 2023; 39:2000-2008. [PMID: 37001744 DOI: 10.1016/j.arthro.2023.03.019] [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: 09/02/2022] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE To compare the effect of subacromial leukocyte-rich platelet-rich plasma (PRP) injections in patients with isolated rotator cuff tendinopathy (RCT) and those with partial-thickness rotator cuff tears (PTRCTs) based on functional outcomes, pain improvement, sleep disturbances, and return to sports. METHODS Between November 2019 and March 2021, 150 patients underwent PRP injections at our institution for refractory rotator cuff tendinopathy and partial rotator cuff tears (105 RCTs and 45 PTRCTs). The American Shoulder and Elbow Surgeons (ASES) score, the visual analog scale (VAS) for pain, the Single Assessment Numeric Evaluation (SANE) and The Pittsburgh Sleep Quality Index were evaluated at 2-, 6-, and 12-month follow-up. Return to sports was also evaluated. An ultrasound examination was performed to evaluate structural outcomes 12 months after the injection. RESULTS The mean age was 36.6 years (±9.08). Overall, the ASES, VAS, SANE, and Pittsburgh scores showed statistical improvement after the injection (P < .01). Specifically, the improvement in the ASES score, which was the primary outcome measure was significantly greater in the group without tears than in the group with PTRCTs at all follow-up times. Moreover, 94% of the patients in the isolated RCT group and 49% in the PTRCTs group achieved a substantial clinical benefit at 12 months follow-up. Ten out of the 50 patients (20%) who received PRP injections due to a partial RC tear underwent surgery due to the lack of clinical improvement. CONCLUSIONS Subacromial PRP injections produced a significant improvement in shoulder function, pain, and sleep disturbances in most patients with RCT refractory to conservative treatment that was maintained at the 12-month follow-up. Moreover, most patients returned to sports at the same level prior to injury. However, improvement in symptoms and functional outcomes was significantly worse in patients who had a PTRCT compared with patients who had an isolated tendinopathy. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Luciano A Rossi
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Nicolás Piuzzi
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Brandariz
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ivan Huespe
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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de Castro RLB, Antonio BP, Giovannetti GA, Annichino-Bizzacchi JM. Total Healing of a Partial Rupture of the Supraspinatus Tendon Using Barbotage Technique Associated with Platelet-Rich Plasma: A Randomized, Controlled, and Double-Blind Clinical Trial. Biomedicines 2023; 11:1849. [PMID: 37509489 PMCID: PMC10376779 DOI: 10.3390/biomedicines11071849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 07/30/2023] Open
Abstract
The prevalence of partial rotator cuff tears (PRCTs) is high in the general population. Our hypothesis is that barbotage, when associated with platelet-rich plasma (PRP), is an effective method for healing these tears. The aim of this study was to compare the effects of barbotage with or without PRP on the healing of partial supraspinatus tendon tears (PSTTs). This study assessed the Western Ontario Rotator Cuff Index score and ultrasound (US) images at 6 weeks and 6 months after treatment. Patients in both groups showed clinical improvement, with no significant difference in scores at 6 weeks. However, at 6 months, the PRP group exhibited significant improvement (p = 0.019). Both groups experienced a reduction in ST tear size, but the PRP group demonstrated a significant enhancement at 6 weeks and 6 months. In conclusion, the US-guided barbotage technique, whether associated with PRP or saline solution, proved to be an effective treatment for clinical improvement and reduction in the size of PSTT. Better clinical improvement results were observed with PRP at 6 months. The combination of PRP with barbotage was superior in reducing the size of the ST tear at both 6 weeks and 6 months, resulting in complete healing in 79.3% of the tears.
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Affiliation(s)
- Renato Luiz Bevilacqua de Castro
- Hematology and Hemotherapy Center, University of Campinas, Cidade Universitária, Rua Carlos Chagas 480, Campinas 13083-878, São Paulo, Brazil
- Center for Tissue Regeneration Studies, Avenida Barão de Itapura 3378, Taquaral, Campinas 13070-300, São Paulo, Brazil
| | - Breno Pazinatto Antonio
- Hematology and Hemotherapy Center, University of Campinas, Cidade Universitária, Rua Carlos Chagas 480, Campinas 13083-878, São Paulo, Brazil
- Center for Tissue Regeneration Studies, Avenida Barão de Itapura 3378, Taquaral, Campinas 13070-300, São Paulo, Brazil
| | - Gustavo Atra Giovannetti
- Center for Tissue Regeneration Studies, Avenida Barão de Itapura 3378, Taquaral, Campinas 13070-300, São Paulo, Brazil
| | - Joyce Maria Annichino-Bizzacchi
- Hematology and Hemotherapy Center, University of Campinas, Cidade Universitária, Rua Carlos Chagas 480, Campinas 13083-878, São Paulo, Brazil
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Saavedra JP, Droppelmann G, García N, Jorquera C, Feijoo F. High-accuracy detection of supraspinatus fatty infiltration in shoulder MRI using convolutional neural network algorithms. Front Med (Lausanne) 2023; 10:1070499. [PMID: 37305126 PMCID: PMC10248442 DOI: 10.3389/fmed.2023.1070499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Background The supraspinatus muscle fatty infiltration (SMFI) is a crucial MRI shoulder finding to determine the patient's prognosis. Clinicians have used the Goutallier classification to diagnose it. Deep learning algorithms have been demonstrated to have higher accuracy than traditional methods. Aim To train convolutional neural network models to categorize the SMFI as a binary diagnosis based on Goutallier's classification using shoulder MRIs. Methods A retrospective study was performed. MRI and medical records from patients with SMFI diagnosis from January 1st, 2019, to September 20th, 2020, were selected. 900 T2-weighted, Y-view shoulder MRIs were evaluated. The supraspinatus fossa was automatically cropped using segmentation masks. A balancing technique was implemented. Five binary classification classes were developed into two as follows, A: 0, 1 v/s 3, 4; B: 0, 1 v/s 2, 3, 4; C: 0, 1 v/s 2; D: 0, 1, 2, v/s 3, 4; E: 2 v/s 3, 4. The VGG-19, ResNet-50, and Inception-v3 architectures were trained as backbone classifiers. An average of three 10-fold cross-validation processes were developed to evaluate model performance. AU-ROC, sensitivity, and specificity with 95% confidence intervals were used. Results Overall, 606 shoulders MRIs were analyzed. The Goutallier distribution was presented as follows: 0 = 403; 1 = 114; 2 = 51; 3 = 24; 4 = 14. Case A, VGG-19 model demonstrated an AU-ROC of 0.991 ± 0.003 (accuracy, 0.973 ± 0.006; sensitivity, 0.947 ± 0.039; specificity, 0.975 ± 0.006). B, VGG-19, 0.961 ± 0.013 (0.925 ± 0.010; 0.847 ± 0.041; 0.939 ± 0.011). C, VGG-19, 0.935 ± 0.022 (0.900 ± 0.015; 0.750 ± 0.078; 0.914 ± 0.014). D, VGG-19, 0.977 ± 0.007 (0.942 ± 0.012; 0.925 ± 0.056; 0.942 ± 0.013). E, VGG-19, 0.861 ± 0.050 (0.779 ± 0.054; 0.706 ± 0.088; 0.831 ± 0.061). Conclusion Convolutional neural network models demonstrated high accuracy in MRIs SMFI diagnosis.
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Affiliation(s)
- Juan Pablo Saavedra
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Guillermo Droppelmann
- Research Center on Medicine, Exercise, Sport and Health, MEDS Clinic, Santiago, Chile
- Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Murcia, Spain
- Principles and Practice of Clinical Research (PPCR), Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Nicolás García
- Research Center on Medicine, Exercise, Sport and Health, MEDS Clinic, Santiago, Chile
| | - Carlos Jorquera
- Facultad de Ciencias, Escuela de Nutrición y Dietética, Universidad Mayor, Santiago, Chile
| | - Felipe Feijoo
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
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12
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Diagnostic sensitivity of ultrasound of the supraspinatus tendon when compared to magnetic resonance imaging prior to arthroscopy: A retrospective study. SONOGRAPHY 2023. [DOI: 10.1002/sono.12348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
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13
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Delaminated Tears of the Rotator Cuff: MRI Interpretation with Clinical Correlation. Diagnostics (Basel) 2023; 13:diagnostics13061133. [PMID: 36980441 PMCID: PMC10047851 DOI: 10.3390/diagnostics13061133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
(1) Background: A delaminated tear is described as a horizontal split in the tendon substance. This review summarizes the clinical and radiologic characteristics of delaminated tears of the rotator cuff. (2) Methods: Initial radiological characteristics of a delaminated tear include the horizontal component of a partial-thickness tear determined using magnetic resonance (MR) arthrography. As demonstrated using indirect MR arthrography, the tear gradually progresses to be defined as either horizontal intrasubstantial splitting of the bursal and articular layers or differential retraction of the bursal and articular layers. (3) Results: The existence of delaminated tears is a poor prognostic factor in functional and morphologic outcomes after the repair of rotator cuff tendons and many surgical techniques have been introduced to solve this problem. Although the presence of a delaminated tear does not affect the arthroscopic repair outcome, the presence of medium-to-large, retracted delaminated tears may be an adverse negative prognostic factor after single-row repair. (4) Conclusion: Advances in imaging and surgical techniques have improved the detection of delaminated rotator cuff tears. Preoperative identification of delaminated tears on magnetic resonance imaging is clinically important because tailored surgical repair techniques must be chosen for successful outcomes.
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14
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Application of Preoperative Ultrasonography in the Percutaneous Minimally Invasive Repair of Acute Closed Achilles Tendon Rupture. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8956803. [PMID: 36654870 PMCID: PMC9842412 DOI: 10.1155/2023/8956803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023]
Abstract
Percutaneous minimally invasive surgery involving Achilles tendon (AT) repair has the advantages of a low rerupture rate and fewer postoperative complications. However, due to the inability to operate under direct vision, the injury of the small saphenous vein (SSV) and sural nerve (SN) remains largely a high risk involving many challenges. We propose to introduce the preoperative application and advantages of ultrasonography in percutaneous minimally invasive surgery for acute AT rupture. Our results indicated that ultrasonography could locate the position of the SN more accurately and reduce the risk of iatrogenic nerve injury. Compared with the traditional surface markers, the preoperative localization and marking of AT, SSV, and SN in ultrasonography significantly reduced the risk of intraoperative accidental injury to blood vessels and nerves, which could reduce postoperative complications and promote early rehabilitation of patients. We ultimately exploit the properties of ultrasonography in percutaneous minimally invasive surgery to treat Achilles tendon rupture.
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15
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Update on Diagnostic Imaging of the Rotator Cuff. Clin Sports Med 2023; 42:25-52. [DOI: 10.1016/j.csm.2022.08.009] [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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Familiari F, Galasso O, Massazza F, Mercurio M, Fox H, Srikumaran U, Gasparini G. Artificial Intelligence in the Management of Rotator Cuff Tears. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16779. [PMID: 36554660 PMCID: PMC9779744 DOI: 10.3390/ijerph192416779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Technological innovation is a key component of orthopedic surgery. Artificial intelligence (AI), which describes the ability of computers to process massive data and "learn" from it to produce outputs that mirror human cognition and problem solving, may become an important tool for orthopedic surgeons in the future. AI may be able to improve decision making, both clinically and surgically, via integrating additional data-driven problem solving into practice. The aim of this article will be to review the current applications of AI in the management of rotator cuff tears. The article will discuss various stages of the clinical course: predictive models and prognosis, diagnosis, intraoperative applications, and postoperative care and rehabilitation. Throughout the article, which is a review in terms of study design, we will introduce the concept of AI in rotator cuff tears and provide examples of how these tools can impact clinical practice and patient care. Though many advancements in AI have been made regarding evaluating rotator cuff tears-particularly in the realm of diagnostic imaging-further advancements are required before they become a regular facet of daily clinical practice.
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Affiliation(s)
- Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, “Magna Græcia” University, 88100 Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, “Magna Græcia” University, 88100 Catanzaro, Italy
| | - Federica Massazza
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, “Magna Græcia” University, 88100 Catanzaro, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, “Magna Græcia” University, 88100 Catanzaro, Italy
| | - Henry Fox
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, “Magna Græcia” University, 88100 Catanzaro, Italy
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17
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Postoperative Imaging of the Rotator Cuff: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2022; 219:717-723. [PMID: 35642759 DOI: 10.2214/ajr.22.27847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND. It is unclear which, MRI or ultrasound (US), is the most useful imaging tool to diagnose rotator cuff retears. OBJECTIVE. The objective of this study was to evaluate MRI and US in terms of diagnosing retear of a repaired rotator cuff tendon using a systematic review and meta-analysis. EVIDENCE ACQUISITION. A comprehensive literature search was performed on the main concepts of MRI (including noncontrast MRI and MR arthrography), US, and rotator cuff repairs. Inclusion criteria consisted of original research studies that assessed the diagnostic accuracy of MRI and US (index tests) for the diagnosis of rotator cuff tendon retear after prior rotator cuff repair using surgical findings as the reference standard. QUADAS-2 was used to assess methodologic quality. Meta-analyses were performed to compare MRI and US studies in the diagnosis of all retears and of full-thickness retears. Study variation was analyzed using the Cochran Q test and I2 statistic. EVIDENCE SYNTHESIS. Eight studies (MRI, n = 6; US, n = 2) satisfied inclusion and exclusion criteria, consisting of 304 total patients (MRI, n = 221; US, n = 83) and 309 shoulders (MRI, n = 226; US, n = 83). Years of publication ranged from 1993 to 2006 for the MRI studies and from 2003 to 2018 for the US studies. Two studies had high risk of bias in terms of applicability to clinical practice because of patient selection. Five studies had potential risk of bias in two categories, whereas two had potential risk of bias in three categories. For all retears, mean sensitivity and specificity for MRI were 81.4% (95% CI, 73.3-87.5%) and 82.6% (95% CI, 76.3-87.5%) and 83.7% (95% CI, 67.4-92.7%) and 90.7% (95% CI, 73.6-97.1%) for US. For full-thickness retears, mean sensitivity and specificity for MRI were 85.9% (95% CI, 80.2-90.2%) and 89.1% (95% CI, 84.6-92.4%) and 89.7% (95% CI, 75.6-96.1%) and 91.0% (95% CI, 75.5-97.1%) for US. There was no significant difference in terms of sensitivity or specificity for either comparison (p = .28-.76). CONCLUSION. Our analyses revealed no significant difference between US and MRI for the diagnosis of rotator cuff tendon tears after prior cuff repair. CLINICAL IMPACT. Either MRI or US can be considered a first-line imaging option to assess suspected rotator cuff retear after prior repair.
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18
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Kim H, Shin K, Kim H, Lee ES, Chung SW, Koh KH, Kim N. Can deep learning reduce the time and effort required for manual segmentation in 3D reconstruction of MRI in rotator cuff tears? PLoS One 2022; 17:e0274075. [PMID: 36215291 PMCID: PMC9550047 DOI: 10.1371/journal.pone.0274075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/22/2022] [Indexed: 11/07/2022] Open
Abstract
Background/Purpose The use of MRI as a diagnostic tool has gained popularity in the field of orthopedics. Although 3-dimensional (3D) MRI offers more intuitive visualization and can better facilitate treatment planning than 2-dimensional (2D) MRI, manual segmentation for 3D visualization is time-consuming and lacks reproducibility. Recent advancements in deep learning may provide a solution to this problem through the process of automatic segmentation. The purpose of this study was to develop automated semantic segmentation on 2D MRI images of rotator cuff tears by using a convolutional neural network to visualize 3D models of related anatomic structures. Methods MRI scans from 56 patients with rotator cuff tears (T2 Linear Coronal MRI; 3.0T, 512 mm × 512 mm, and 2.5-mm slice thickness) were collected. Segmentation masks for the cuff tendon, muscle, bone, and cartilage were obtained by four orthopedic shoulder surgeons, and these data were revised by a shoulder surgeon with more than 20 years’ experience. We performed 2D and 3D segmentation using nnU-Net with secondary labels for reducing false positives. Final validation was performed in an external T2 MRI dataset (10 cases) acquired from other institutions. The Dice Similarity Coefficient (DSC) was used to validate segmentation quality. Results The use of 3D nnU-Net with secondary labels to reduce false positives achieved satisfactory results, even with a limited amount of data. The DSCs (mean ± SD) of the cuff tendon, muscle, bone, and cartilage in the internal test set were 80.7% ± 9.7%, 85.8% ± 8.6%, 97.8% ± 0.6%, and 80.8% ± 15.1%, respectively. In external validation, the DSC of the tendon segmentation was 82.74±5.2%. Conclusion Automated segmentation using 3D U-Net produced acceptable accuracy and reproducibility. This method could provide rapid, intuitive visualization that can significantly facilitate the diagnosis and treatment planning in patients with rotator cuff tears.
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Affiliation(s)
- Hyojune Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Keewon Shin
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hoyeon Kim
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eui-sup Lee
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: (KHK); (NK)
| | - Namkug Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: (KHK); (NK)
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19
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Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: A Clinical Practice Guideline. J Orthop Sports Phys Ther 2022; 52:647-664. [PMID: 35881707 DOI: 10.2519/jospt.2022.11306] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To develop a clinical practice guideline covering the assessment, management, and return to work of adults with rotator cuff disorders. DESIGN: Clinical practice guideline. METHODS: Using systematic reviews, appraisal of the literature, and an iterative approach to obtain consensus from key stakeholders, clinical recommendations and algorithms were developed in the context of the health care system and work environment of the province of Quebec (Canada). RESULTS: Recommendations (n = 73) and clinical decision algorithms (n = 3) were developed to match the objectives. The initial assessment should include the patient's history, a subjective assessment, and a physical examination. Diagnostic imaging is only necessary in select circumstances. Acetaminophen, nonsteroidal anti-inflammatory drugs, and injection therapies may be useful to reduce pain in the short term. Clinicians should prescribe an active and task-oriented rehabilitation program (exercises and education) to reduce pain and disability in adults with rotator cuff disorders. Subacromial decompression is not recommended to treat rotator cuff tendinopathy. Surgery is appropriate for selected patients with a full-thickness rotator cuff tear. A return-to-work plan should be developed early, in collaboration with the worker and other stakeholders, and must combine multiple strategies to promote return to work. CONCLUSION: This clinical practice guideline was developed to assist the multidisciplinary team of clinicians who provide health care for adults with a rotator cuff disorder. The CPG guides clinical decisionmaking for diagnosis and treatment, and planning for successful return to work. J Orthop Sports Phys Ther 2022;52(10):647-664. Epub: 27 July 2022. doi:10.2519/jospt.2022.11306.
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20
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Dimitriou D, Winkler E, Zindel C, Grubhofer F, Wieser K, Bouaicha S. Is routine magnetic resonance imaging necessary in patients with clinically diagnosed frozen shoulder? Utility of magnetic resonance imaging in frozen shoulder. JSES Int 2022; 6:855-858. [PMID: 36081696 PMCID: PMC9446195 DOI: 10.1016/j.jseint.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Dimitris Dimitriou
- Corresponding author: Dimitris Dimitriou, MD, Balgrist University Hospital, Orthopaedic Department, University of Zurich, Forchstrasse 340, Zurich CH-8008, Switzerland.
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21
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Upadhyay D, Scheidt M, Garbis N, Salazar D. Bubble Sign: An Arthroscopic Technical Trick to Differentiate Between Partial- and Full-Thickness Rotator Cuff Tears. Arthrosc Tech 2022; 11:e1353-e1357. [PMID: 35936860 PMCID: PMC9353585 DOI: 10.1016/j.eats.2022.03.022] [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: 02/14/2022] [Accepted: 03/11/2022] [Indexed: 02/03/2023] Open
Abstract
Distinguishing between partial-thickness and small focal full-thickness tears of rotator cuff may be important for determining the appropriate surgical treatment options and repair constructs in the care of patients with rotator cuff pathology. This article presents a simple intraoperative technical trick to aid in identification of small full-thickness tears of the superior rotator cuff. The relatively higher-pressured subacromial space and the low-pressured glenohumeral joint are separated by the supraspinatus tendon. When this barrier is compromised due to a full-thickness tear, free fluid flows from high to low pressure down the native pressure gradient. This is seen as the movement of air bubbles into the glenohumeral joint from the subacromial space and can be used to identify the presence of a full-thickness rotator cuff tear on diagnostic arthroscopy.
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Affiliation(s)
- Drashti Upadhyay
- Loyola University Chicago Stritch School of Medicine, Orland Park,Address correspondence to Drashti Upadhyay, B.S., Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL 60153.
| | - Michael Scheidt
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood
| | - Nickolas Garbis
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Rehabilitation, Loyola University Hospital System, Maywood, Illinois, U.S.A
| | - Dane Salazar
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Rehabilitation, Loyola University Hospital System, Maywood, Illinois, U.S.A
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22
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Schanda JE, Eigenschink M, Laky B, Schwinghammer A, Lanz U, Pauzenberger L, Heuberer PR. Rotator Cuff Delamination Is Associated With Increased Tendon Retraction and Higher Fatty Muscle Infiltration: A Comparative Study on Arthroscopy and Magnetic Resonance Imaging. Arthroscopy 2022; 38:2131-2141.e1. [PMID: 34968654 DOI: 10.1016/j.arthro.2021.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/11/2021] [Accepted: 12/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate (1) tendon delamination according to different rotator cuff tear patterns as well as (2) the association of tendon retraction and fatty muscle infiltration with delamination of the rotator cuff. Furthermore, we aimed to establish the accuracy of magnetic resonance imaging for the detection of rotator cuff delamination. METHODS Magnetic resonance imaging scans of patients who underwent arthroscopic rotator cuff repair from 2013 to 2015 were retrospectively compared to intraoperative findings. Prevalences of tendon delamination, tendon retraction, and fatty muscle infiltration were categorized according to different rotator cuff tear patterns. For comparability of the amount of tendon retraction of delaminated and non-delaminated rotator cuff tears, we introduced the global retraction index, a description individually assessing tendon retraction in magnetic resonance imaging scans of all visible layers. RESULTS Of 349 shoulders, tendon delamination was observed in 231 patients (66.2%). Of these, rotator cuff delamination was most commonly seen in posterosuperior rotator cuff tears (84.6%). Delaminated rotator cuff tears presented with a significantly higher global retraction index (P < .001) as well as higher fatty muscle infiltration of the supraspinatus (P = .001) and infraspinatus (P = .001). Magnetic resonance imaging had only moderate accuracy (57.3%) to detect rotator cuff delamination, with a positive predictive value of 100% (95% confidence interval [CI] 95.6% to 100.0%) and a negative predictive value of 44.2% (95% CI 38.1% to 50.4%). CONCLUSIONS Tendon delamination was most commonly observed in posterosuperior rotator cuff tears. Delaminated rotator cuff tears showed a significantly greater tendon retraction as well as a higher amount of fatty muscle infiltration of the supraspinatus and infraspinatus. Magnetic resonance imaging has only moderate accuracy for detection of rotator cuff delamination. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Jakob E Schanda
- Department for Trauma Surgery, AUVA Trauma Center Vienna-Meidling, Vienna, Austria; Ludwig Boltzmann Institute Traumatology in the AUVA Trauma Research Center, Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Martin Eigenschink
- II Orthopedic Department, Sacred Heart Hospital of Jesus, 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; Centre of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Andreas Schwinghammer
- Department of Orthopedic Surgery, University Clinic Sankt Pölten, Sankt Pölten, Austria
| | | | - Leo Pauzenberger
- II Orthopedic Department, Sacred Heart Hospital of Jesus, Vienna, Austria; Healthpi Medical Center, 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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23
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Levin JM, Wickman J, Lazarides AL, Cunningham DJ, Goltz DE, Mather RC, Anakwenze O, Lassiter TE, Klifto CS. Is Advanced Imaging to Assess Rotator Cuff Integrity Before Shoulder Arthroplasty Cost-effective? A Decision Modeling Study. Clin Orthop Relat Res 2022; 480:1129-1139. [PMID: 35014977 PMCID: PMC9263501 DOI: 10.1097/corr.0000000000002110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/20/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder arthroplasty is increasingly performed for patients with symptoms of glenohumeral arthritis. Advanced imaging may be used to assess the integrity of the rotator cuff preoperatively because a deficient rotator cuff may be an indication for reverse shoulder arthroplasty (RSA) rather than anatomic total shoulder arthroplasty (TSA). However, the cost-effectiveness of advanced imaging in this setting has not been analyzed. QUESTIONS/PURPOSES In this cost-effectiveness modeling study of TSA, all patients underwent history and physical examination, radiography, and CT, and we compared (1) no further advanced imaging, (2) selective MRI, (3) MRI for all, (4) selective ultrasound, and (5) ultrasound for all. METHODS A simple chain decision model was constructed with a base-case 65-year-old patient with a 7% probability of a large-to-massive rotator cuff tear and a follow-up of 5 years. Strategies were compared using the incremental cost-effectiveness ratio (ICER) with a willingness to pay of both USD 50,000 and 100,000 per quality-adjusted life year (QALY) used, in accordance with the Second Panel on Cost-Effectiveness in Health and Medicine. Diagnostic test sensitivity and specificity were extracted from published systematic reviews and meta-analyses, and patient utilities were obtained using the Cost-Effectiveness Analysis Registry from the Center for the Evaluation of Value and Risk in Health. Final patient states were categorized as either inappropriate or appropriate based on the actual rotator cuff integrity and type of arthroplasty performed. Additionally, to evaluate the real-world impact of intraoperative determination of rotator cuff status, a secondary analysis was performed where all patients indicated for TSA underwent intraoperative rotator cuff examination to determine appropriate implant selection. RESULTS Selective MRI (ICER of USD 40,964) and MRI for all (ICER of USD 79,182/QALY) were the most cost-effective advanced imaging strategies at a willingness to pay (WTP) of USD 50,000/QALY gained and 100,000/QALY gained, respectively. Overall, quality-adjusted life years gained by advanced soft tissue imaging were minimal: 0.04 quality-adjusted life years gained for MRI for all. Secondary analysis accounting for the ability of the surgeon to alter the treatment plan based on intraoperative rotator cuff evaluation resulted in the no further advanced imaging strategy as the dominant strategy as it was the least costly (USD 23,038 ± 2259) and achieved the greatest health utility (0.99 ± 0.05). The sensitivity analysis found the original model was the most sensitive to the probability of a rotator cuff tear in the population, with the value of advanced imaging increasing as the prevalence increased (rotator cuff tear prevalence greater than 12% makes MRI for all cost-effective at a WTP of USD 50,000/QALY). CONCLUSION In the case of diagnostic ambiguity based on physical exam, radiographs, and CT alone, having both TSA and RSA available in the operating room appears more cost-effective than obtaining advanced soft tissue imaging preoperatively. However, performing selective MRI to assess rotator cuff integrity to indicate RSA or TSA is cost-effective if surgical preparedness, patient expectations, and implant availability preclude the ability to switch implants intraoperatively. LEVEL OF EVIDENCE Level III, economic and decision analysis.
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Affiliation(s)
- Jay M. Levin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - John Wickman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Daniel J. Cunningham
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Daniel E. Goltz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Richard C. Mather
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Tally E. Lassiter
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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24
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Lädermann A, Collin P, Zbinden O, Meynard T, Saffarini M, Chiu JCH. Diagnostic Accuracy of Clinical Tests for Subscapularis Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 9:23259671211042011. [PMID: 35146034 PMCID: PMC8822023 DOI: 10.1177/23259671211042011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Previous systematic reviews and meta-analyses on the diagnostic accuracy of shoulder clinical tests do not reach conclusions regarding subscapularis tears. Purpose: To compare the diagnostic accuracy of commonly used clinical tests for subscapularis tears. Study Design: Systematic review; Level of evidence, 3. Methods: An electronic literature search was conducted using Medline, Embase, and the Cochrane Library/Central. Eligibility criteria were original clinical studies reporting the diagnostic accuracy of clinical tests to diagnose the presence of rotator cuff tears involving the subscapularis. Results: The electronic literature search returned 2212 records, of which 13 articles were eligible. Among 8 tests included in the systematic review, the lift-off test was most frequently reported (12 studies). Four tests were eligible for meta-analysis: bear-hug test, belly-press test, internal rotation lag sign (IRLS), and lift-off test. The highest pooled sensitivity was 0.55 (95% CI, 0.28-0.79) for the bear-hug test, while the lowest pooled sensitivity was 0.32 (95% CI, 0.13-0.61), for the IRLS. In all tests, pooled specificity was >0.90. Conclusion: Among the 4 clinical tests eligible for meta-analysis (bear-hug test, belly-press test, IRLS, and lift-off test), all had pooled specificity >0.90 but pooled sensitivity <0.60. No single clinical test is sufficiently reliable to diagnose subscapularis tears. Registration: PROSPERO (CRD42019137019).
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Orthopedics and Trauma Service, University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France
| | - Olivia Zbinden
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Timon Meynard
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | | | - Joe Chih-Hao Chiu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan
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25
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Ahmad RG. Shoulder impingement: various risk factors for supraspinatus tendon tear: A case group study. Medicine (Baltimore) 2022; 101:e28575. [PMID: 35060519 PMCID: PMC8772690 DOI: 10.1097/md.0000000000028575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 12/22/2021] [Indexed: 01/05/2023] Open
Abstract
A total of 680 cases of monolateral shoulder pain and functional impairment were included, and Chi-Squared tests was incorporated to test for possible associations.No relation between impingement syndrome and potential risk factors was found, such as presence of down slopping (P = .083), presence of ossification acromiale (P = .102), presence of calcific tendinitis (P = .144), types of acromion (I [P = .600], II [P = .536], III [P = .633] and IV [P = .832]) and grade of acromioclavicular degenerative changes (mild [P = .077], moderate [P = .111], and severe [P = .700]). However, a significant relationship was uncovered between impingement syndrome and risk factors such as gender (X2 = 7.004, df = 1, P = .08) (where females were more prone), history of shoulder dislocation (X2 = 19.440, df = 1, P = .001), presence of supraspinatus tendon tear or tendinopathy (X2 = 69.344, df = 1, P = .001) and supraspinatus complete tear (X2 = 13.593, df = 1, P = .001). A significant relationship was found between the type of supraspinatus pathology and factors such as gender (female more prone) (X2 = 34.719, df = 3, P = .01), presence of down slopping (X2 = 57.765, df = 3, P = .01), history of shoulder dislocation (X2 = 148.880, df = 3, P = .001), type III of the acromion (X2 = 12.979, df = 3, P = .005), presence of acromioclavicular generative changes mild (X2 = 76.408, df = 3, P = .001) and moderate (X2 = 29.697, df = 3, P = .001), and acromiohumeral distance of ≤3 mm (X2 = 18.915, df = 3, P = .001), 3.1 to 6 mm (X2 = 13.212, df = 3, P = .004), and 9.1-12 mm (X2 = 15.066, df = 3, P = .002). Overall, the Magnetic Resonance Imaging results yielded high sensitivity for detecting full-thickness supraspinatus tears.Considering the findings, this study may help radiologists understand the salient risk factors and identify which factors are mainly responsible for supraspinatus tendon tears and the respective grade of tear (articular partial, bursal partial, complete, or tendinopathy).
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Diagnosis and Management of Partial Thickness Rotator Cuff Tears: A Comprehensive Review. J Am Acad Orthop Surg 2021; 29:1031-1043. [PMID: 34520444 DOI: 10.5435/jaaos-d-20-01092] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 08/10/2021] [Indexed: 02/01/2023] Open
Abstract
Partial thickness rotator cuff tears (PRCTs) are a challenging disease entity. Optimal management of PRCTs continues to be controversial. Although advances in magnetic resonance imaging and ultrasonography have aided in early diagnosis, arthroscopic evaluation remains the benchmark for diagnosis. Conservative treatment is often the first line of management for most patients; however, evidence suggests that surgical intervention may limit tear progression and the long-term sequelae. Surgical decision making is driven by factors such as age, arm dominance, etiology, activity level, tear thickness, and tear location. Many surgical options have been described in the literature to treat PRCTs including arthroscopic débridement, transosseous, in situ repair techniques, and tear completion and repair. Biologic supplements have also become an attractive alternative to aid in healing; however, the long-term efficacy of these modalities is largely unknown. This article will provide a detailed review of the etiology and natural history of PRCTs, as well as diagnosis, and current management to guide clinical decision-making and formulate an algorithm for management of PRCTs for the orthopaedic surgeon.
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Jensen J, Kristensen MT, Bak L, Kristensen SS, Graumann O. MR arthrography of the shoulder; correlation with arthroscopy. Acta Radiol Open 2021; 10:20584601211062059. [PMID: 34881048 PMCID: PMC8646798 DOI: 10.1177/20584601211062059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background Shoulder dislocation is a common injury, particularly in the younger population. Common
long-term sequelae include pain, recurrence, and shoulder arthritis. Immediate and
correct diagnosis following shoulder dislocation is key to achieving optimum outcomes.
Although magnetic resonance arthrography (MRA) is frequently used for diagnosing
shoulder instabilities, arthroscopy is still considered the gold standard. Purpose This study aims to compare the diagnostic value of arthroscopy and MRA of the shoulder
joint. Materials and methods This retrospective study estimates the sensitivity and specificity of MRA of the
shoulder. Data from patients who had undergone shoulder MRA and subsequent arthroscopy
during a 5-year period were retrospectively collected. Sensitivity and specificity were
calculated using the arthroscopic findings as the gold standard. Moreover, diagnostic
accuracy was estimated using McNemar’s test. Results In total, 205 cases were included from which 372 pathological findings were uncovered
during the arthroscopic procedures as opposed to 360 findings diagnosed from the MRA
images. The glenoid labral tear was the most common finding reported by MRA and
arthroscopy. For the detection of glenoid labral tears on MRA, the sensitivity was 0.955
but with eight missed lesions; the specificity was 0.679. Capsular tears, rotator cuff
tears, and cartilage lesions proved the most difficult to correctly diagnose using MRA
with sensitivities of 0.2, 0.346, and 0.366, respectively. Conclusions With a sensitivity of 95%, MRA is a valuable diagnostic tool for assessing shoulder
instabilities, particularly when diagnosing labral lesions, including bony and
soft-tissue Bankart lesions. Sensitivities and specificities for other glenohumeral
lesions are less convincing, however.
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Affiliation(s)
- Janni Jensen
- Department of Radiology, Odense University Hospital, Odense, Denmark.,Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | | | - Lene Bak
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Søren S Kristensen
- Clinical Institute, University of Southern Denmark, Odense, Denmark.,Department of Orthopedics, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark.,Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
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Farooqi AS, Lee A, Novikov D, Kelly AM, Li X, Kelly JD, Parisien RL. Diagnostic Accuracy of Ultrasonography for Rotator Cuff Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211035106. [PMID: 34660823 PMCID: PMC8511934 DOI: 10.1177/23259671211035106] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears. Purpose To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds. Study Design Systematic review; Level of evidence, 3. Methods The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published between January 1, 2010, and April 1, 2020. The inclusion criteria were studies that evaluated the diagnostic accuracy of US for rotator cuff tears or biceps tendon tears utilizing arthroscopy as the reference standard. The exclusion criteria were studies with <10 patients, studies including massive tears without reporting diagnostic data for specific tendons, and studies lacking diagnostic outcome data. Extracted outcomes included diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value. The mean difference and 95% confidence interval were calculated for both US and MRI diagnostic values, and meta-analysis was conducted using the Mantel-Haenszel random-effects model. Results In total, 23 eligible studies involving 2054 shoulders were included. US demonstrated a higher median diagnostic accuracy for supraspinatus tendon tears (0.83) and biceps tendon tears (0.93) as compared with subscapularis tendon tears (0.76). US was found to have a higher median accuracy (0.93) for full-thickness supraspinatus tears than partial-thickness tears (0.81). US had superior median sensitivity for partial-thickness supraspinatus tears when performed by radiologists as opposed to surgeons (0.86 vs 0.57). Meta-analysis of the 5 studies comparing US and MRI demonstrated no statistically significant difference in diagnostic sensitivity, specificity, or accuracy for any thickness supraspinatus tears (P = .31-.55), full-thickness tears (P = .63-.97), or partial-thickness tears (P = .13-.81). Conclusion For experienced operators, US is a highly sensitive and specific diagnostic modality for the diagnosis of supraspinatus tears and demonstrates statistically equivalent capability to MRI in the diagnosis of both full- and partial-thickness rotator cuff tears.
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Affiliation(s)
- Ali S Farooqi
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexander Lee
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Novikov
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ann Marie Kelly
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Xinning Li
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - John D Kelly
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Li L, Dong J, Li Q, Dong J, Wang B, Zhou D, Liu F. MRA improves sensitivity than MRI for the articular-sided partial-thickness rotator cuff tears. Sci Prog 2021; 104:368504211059976. [PMID: 34939473 PMCID: PMC10364937 DOI: 10.1177/00368504211059976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aims to compare the diagnostic accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) for the articular-sided partial-thickness rotator cuff tear (PTRCT). METHODS Three electronic databases, PubMed/Medline, Embase and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting articular-sided PTRCTs. The pooled statistical indexes included sensitivity, specificity, positive/negative predictive value, diagnostic odds ratio (DOR) and the area under the receiver operating characteristic curve (AUC). RESULTS Eleven studies involving 1703 patients and 1704 shoulders were included. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRA to diagnose articular-sided PTRCTs were 0.81 (95% CI, 0.65-0.90), 0.96 (95% CI, 0.91-0.98), 68.14 (95% CI, 33.20-139.84) and 0.96 (95% CI, 0.94-0.97), respectively. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRI were 0.78 (95% CI, 0.65-0.87) and 0.97 (95% CI, 0.84-0.99), 47.82 (95% CI, 8.29-275.89) and 0.89 (95% CI, 0.86-0.92), respectively. CONCLUSIONS This meta-analysis reveals that MRA has a better diagnostic value than that of MRI for the diagnosis of articular-sided partial-thickness rotator cuff tears because of an improvement of sensitivity.
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Affiliation(s)
- Lianxin Li
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Qinghu Li
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jinye Dong
- Department of Ultrasound, Weifang People's Hospital, Weifang 261041, Shandong, PR China
| | - Bingzhi Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
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Bohndorf K, Hannig A, Müller-Rath R. [Image and report quality of outpatient MRI examinations : Evaluation of organizational, technical and report-related parameters in patients with arthroscopically secured rotator cuff rupture]. DER ORTHOPADE 2021; 51:131-137. [PMID: 34398274 DOI: 10.1007/s00132-021-04138-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND MRI is commonly used to diagnose and assess prognosis for rotator cuff (RM) pathology in addition to history and clinical examination. AIM This study investigates the image and report quality of shoulder MRIs with regard to prognosis-relevant parameters in outpatients who subsequently underwent surgical treatment for RM rupture. MATERIALS AND METHODS Using a defined questionnaire, both the MR images and the original reports of 94 patients were evaluated by an experienced radiologist with regard to referral information, MRI technology and quality of the MRI reports. RESULTS Questions or comments on RC were noted in 39% (general practitioners) and 48% (orthopaedics/UCH) of referrals. In MRI reports with the diagnosis "complete rupture of the RC", no information on the size of the defect was available in 47% of cases. In 18 and 30% of the reports, respectively, a fatty infiltration of the RM musculature or atrophy of the musculature was mentioned. When a partial RC rupture (n = 25) was diagnosed; the depth diameter (< or > 50% of the tendon thickness) was determined in only one case. The protocol recommendations valid today for MRI diagnostics of the shoulder were implemented in 60% of the examinations. According to the evaluating radiologist, 93-97% of the available MRI examinations were able to answer prognostic-relevant questions of an RC rupture. DISCUSSION The questions by physicians referring to the MRI examination of a shoulder with a subsequently arthroscopically verified RC rupture were predominantly unspecific or insufficient. In the radiological reports of these MRI examinations, prognosis-relevant parameters could not be extracted in sufficient form and number, although the MRI technique would have allowed this.
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Affiliation(s)
- Klaus Bohndorf
- Universitätsklinik und Poliklinik für Radiologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
| | - Andrea Hannig
- Orthopädische Praxisklinik Neuss, Breite Straße 96, 41460, Neuss, Deutschland
| | - Ralf Müller-Rath
- Orthopädische Praxisklinik Neuss, Breite Straße 96, 41460, Neuss, Deutschland
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Lädermann A, Meynard T, Denard PJ, Ibrahim M, Saffarini M, Collin P. Reliable diagnosis of posterosuperior rotator cuff tears requires a combination of clinical tests. Knee Surg Sports Traumatol Arthrosc 2021; 29:2118-2133. [PMID: 32725446 DOI: 10.1007/s00167-020-06136-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/26/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Clinical diagnosis of posterosuperior rotator cuff tears remains uncertain due to a lack of evidence-based consensus. This review aimed to compare the diagnostic accuracy of commonly used clinical tests for posterosuperior rotator cuff tears. METHODS The authors conducted an electronic literature search using Medline, Embase and the Cochrane library/Central, to identify original clinical studies reporting diagnostic accuracy of clinical tests to diagnose the presence of posterosuperior rotator cuff tears involving the infraspinatus, supraspinatus and/or teres minor. RESULTS The electronic literature search returned 1981 records, of which 14 articles were eligible. Among 17 tests included in the systematic review, 6 tests were eligible for meta-analysis: drop arm sign, Jobe test, external rotation lag sign, Hawkins-Kennedy test, Neer test and painful arc abduction test. According to QUADAS-2 criteria, risk of bias was low in 1 study, moderate in 2 and high in 4. The highest pooled sensitivity was 0.77 (CI 0.67-0.85), for the Jobe test, while the lowest pooled sensitivity was 0.38 (CI 0.01-0.98), for the drop arm sign. CONCLUSIONS The Jobe test had the best pooled sensitivity, while the drop arm sign had the best pooled specificity. As no single clinical test is sufficiently reliable to diagnose posterosuperior rotator cuff tears, clinicians should consider various combinations of patient characteristics and clinical tests, as well as imaging modalities, to confirm diagnosis and select the appropriate treatment option. More reliable clinical diagnosis of posterosuperior rotator cuff tears could reduce the reliance on magnetic resonance imaging or arthrography and their associated costs and waiting times. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland. .,Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Orthopedics and Trauma Service, University Hospitals of Geneva, Geneva, Switzerland.
| | - Timon Meynard
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA.,Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Mohamed Ibrahim
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.,Faculty of Medicine, University of Fayoum, Fayoum, Egypt
| | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France
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The Evolving Roles of MRI and Ultrasound in First-Line Imaging of Rotator Cuff Injuries. AJR Am J Roentgenol 2021; 217:1390-1400. [PMID: 34161130 DOI: 10.2214/ajr.21.25606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rotator cuff tears are the most likely source of shoulder pain in adults and may cause protracted disability. Management of rotator cuff tears is associated with considerable costs. Accurate diagnosis can guide surgical planning and help achieve a favorable clinical outcome. While radiographs remain the initial imaging test for shoulder injury, the roles of MRI and ultrasound (US) as first-line imaging after radiography are evolving. This review leverages current literature and the practical experience of subspecialty musculoskeletal radiologists from different institutions in describing a practical approach to imaging rotator cuff pathology. Both MRI and US are accurate for identifying rotator cuff tears, but each has advantages and shortcomings. As both modalities currently represent reasonable first-line approaches, considerable practice variation has evolved. Given the low cost of US, imagers should strive to optimize the quality of shoulder US examinations and to build referrer confidence in this modality. The roles of direct CT and MR angiography, as well as imaging evaluation of the postoperative rotator cuff, are also considered. Through careful selection among the available imaging modalities, as well as optimal performance and interpretation of such examinations, radiologists can positively contribute to the diagnosis and treatment of patients with rotator cuff injuries.
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Kanatlı U, Ayanoglu T, Esen E, Ataoglu MB, Ozer M, Cetinkaya M, Kaptan AY. Reply to the Letter to the Editor. J Orthop Surg (Hong Kong) 2020; 28:2309499020917476. [PMID: 32372686 DOI: 10.1177/2309499020917476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ulunay Kanatlı
- Department of Orthopedics and Traumatology, Medical Faculty, Gazi University, Ankara, Turkey
| | - Tacettin Ayanoglu
- Department of Orthopaedics and Traumatology, Yozgat City Hospital, Yozgat, Turkey
| | - Erdinc Esen
- Department of Orthopedics and Traumatology, Medical Faculty, Gazi University, Ankara, Turkey
| | | | - Mustafa Ozer
- Department of Orthopedics and Traumatology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Cetinkaya
- Department of Orthopedics and Traumatology, Erzincan Mengucek Gazi Research Hospital, Erzincan, Turkey
| | - Ahmet Yigit Kaptan
- Department of Orthopedics and Traumatology, Medical Faculty, Gazi University, Ankara, Turkey
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Simon MJ, Regan WD. Bubble Sign to Confirm the Integrity of the Shoulder Rotator Cuff. Arthrosc Tech 2020; 9:e1389-e1395. [PMID: 33024682 PMCID: PMC7528655 DOI: 10.1016/j.eats.2020.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/29/2020] [Indexed: 02/03/2023] Open
Abstract
The presence of an intra-articular air bubble adjacent to the rotator cuff at the time of diagnostic shoulder arthroscopy will confirm an intact rotator cuff and is helpful in ambiguous cases. After the introduction of the arthroscope, air is pulled owing to negative air pressure in the joint cavity. Fluid inflow is then started after the inflow has been properly flushed of all air. This creates an intra-articular air bubble, which can be found at the top of the capsular-supraspinatus attachment site in cases with an intact rotator cuff. Secondary subacromial positioning of the arthroscope is used to confirm the intact rotator cuff from the bursal side.
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Affiliation(s)
- Maciej J.K. Simon
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Orthopaedics, University of British Columbia, Chan Gunn Pavilion, Allan McGavin Sports Medicine Clinic, Vancouver, British Columbia, Canada
| | - William D. Regan
- Department of Orthopaedics, University of British Columbia, Chan Gunn Pavilion, Allan McGavin Sports Medicine Clinic, Vancouver, British Columbia, Canada
- Address correspondence to William D. Regan, M.D., F.R.C.S.C., Department of Orthopaedics, University of British Columbia, Chan Gunn Pavilion, Allan McGavin Sports Medicine Clinic, 2553 Wesbrook Mall, Vancouver, BC, Canada V6T1Z3.
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Dalai A, Langford L, Beavis C, Obaid H. Development of supraspinatus imaging guidance for primary care physicians with a focus on patient selection. Ultrasound J 2020; 12:40. [PMID: 32880025 PMCID: PMC7467996 DOI: 10.1186/s13089-020-00187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Primary care physicians frequently encounter patients with supraspinatus pathology and face a difficult task of managing this subset of patients using limited imaging resources. The purpose of this study was to develop a guidance that could help primary care physicians choose appropriate imaging tests judiciously for patients with suspected supraspinatus pathology. Methods The imaging reports of one hundred patients who underwent ultrasound and MRI for suspected supraspinatus tendinopathy were retrospectively assessed. The supraspinatus tendon was recorded as intact, partial tear (articular or bursal), or full-thickness tear (focal or complete width). The agreement between imaging modalities was then evaluated using factors such as pathology type and age. Results There was agreement between modalities in 48/100 patients (Kappa statistic = 0.30). The consistency varied with type of pathology: intact tendons by ultrasound had 55.8% agreement with MRI, partial sided bursal tears 50%, partial sided articular tears 25%, and full-thickness focal tears 33.3%. Full-thickness complete-width tears had a much better agreement with MRI at 90.9%. Age was also significant, with increased disagreement between ultrasound and MRI in patients over 50 years old. Conclusions Our data showed that ultrasound findings correlated well with MRI in patients under 50 years of age and also in patients with full-thickness supraspinatus tears. We recommend that primary care physicians may consider using ultrasound as the initial test in younger patients and in patients with suspected full supraspinatus tears, based on clinical exam, with MRI as an option for further evaluation to quantify supraspinatus muscle atrophy. These patient selection recommendations will help promote mindful utilization of scarce resources.
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Affiliation(s)
- Anurag Dalai
- Department of Radiology, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
| | - Leanne Langford
- Department of Radiology, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Cole Beavis
- Department of Orthopedic Surgery, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Haron Obaid
- Department of Radiology, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
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Wang B, Li Q, Dong J, Zhou D, Liu F. Comparisons of the surface micromotions of cementless femoral prosthesis in the horizontal and vertical levels: a network analysis of biomechanical studies. J Orthop Surg Res 2020; 15:293. [PMID: 32736633 PMCID: PMC7393913 DOI: 10.1186/s13018-020-01794-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/14/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Numerous quantitatively biomechanical studies measuring the fixation stability of femoral stem using micromotions at the bone-implant interfaces in different directions and levels remain inconclusive. This network meta-analysis performed systematically aims to explore the rank probability of micromotions at the bone-implant interfaces based on biomechanical data from studies published. METHODS Two electronic databases, PubMed/MEDLINE and Embase, were utilized to retrieve biomechanical studies providing the data of micromotions at the bone-stem interfaces. After screening and diluting out, the studies that met inclusion criteria will be utilized for statistical analysis. In order to contrast the stability of commonness and differences of the different parts of the femoral stem, the horizontal and vertical comparison of micromotions at the bone-implant interfaces were conducted using the pooled evaluation indexes including the mean difference (MD) and the surface under the cumulative ranking (SUCRA) curve, while inconsistency analysis, sensitivity analysis, subgroup analyses, and publication bias were performed for the stability evaluation of outcomes. RESULTS Screening determined that 20 studies involving a total of 249 samples were deemed viable for inclusion in the network meta-analysis. Tip point registered the highest micromotions of 13 measurement points. In the horizontal level, the arrangements of 4 measurement points at the proximal (P1-P4), middle (P5-P8) and distal part of the stem (P9-P12) were P1 = P2 = P3 = P4, P7 > P8 > P6 = P5 and P10 ≥ P12 = P9 = P11, respectively. In the vertical level, the arrangements of 3 measurement points at the anterior, posterior, medial, and lateral directions was P9 > P5 = P1, P10 > P6 > P2, P11 > P7 > P3, and P12 > P8 > P4, respectively. CONCLUSION The network meta-analysis seems to reveal that the distal part of the femoral stem is easier to register higher micromotion, and tip point of femoral stem registers the highest micromotions.
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Affiliation(s)
- Bomin Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Qinghu Li
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China.
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