Analysis of Functional Recovery and Subjective Well-Being after Arthroscopic Rotator Cuff Repair

A therapeutic assessment of tranexamic acid on functional recovery after rotator cuff repair surgery: A study of early and mid-term follow-up

Purpose

To perform therapeutic assessment of tranexamic acid on functional recovery after rotator cuff repair surgery in terms of early and mid-term follow up.

Methods

From December 2021 to April 2023, a total of 40 patients with rotator cuff injury were enrolled and randomly assigned to two groups with equal number of patients, and all patients received shoulder arthroscopic surgery before receiving either tranexamic acid or normal saline managements. Patients in the experimental group, group A, treated with 2g tranexamic acid (diluted with normal saline to 20ml) via intra-articular injection, while patients in the control group (group B) received 20ml normal saline management. The whole process was conducted in accordance with randomized double-blind controlled trials. Clinical outcomes were assessed preoperatively and postoperatively via American Shoulder and Elbow Surgeons (ASES) score, a UCLA shoulder rating, a CONSTANT score, and visual analog scale (VAS). Early and mid-term follow-up were performed at 1 week, 1 month, 3 months, and 6 months after surgery.

Results

The ASES score and CONSTANT score at 1 month, 3 months and 6 months after operation in the tranexamic acid group were higher than those in the normal saline group (p < 0.05). Meanwhile, the UCLA score at 3 months and 6 months after operation in the tranexamic acid group was higher than that in the normal saline group (p < 0.05). In addition, the muscle strength score and external rotation value at 6 months after operation in the tranexamic acid group and normal saline group were higher than those in the normal saline group (p < 0.05). There was no significant difference in the VAS score between the two groups at each observation cut-off point (p > 0.05).

Conclusions

Injection of tranexamic acid after rotator cuff repair surgery plays an positive role on the recovery of patients muscle strength and tone as well as shoulder flexibility. Therapeutic assessment demonstrates the favorable clinic efficacy either early or mid-term follow-up.

Factors associated with subjective shoulder function preoperatively and postoperatively after arthroscopic rotator cuff repair

Background

Understanding factors associated with improvements in subjective shoulder function after arthroscopic rotator cuff repair (ARCR) helps clinicians identify targets for postoperative rehabilitation. The aim of this study was to investigate the factors associated with subjective shoulder function after ARCR.

Methods

Patients who underwent ARCR for rotator cuff tear with at least 12 months of follow-up were included. Subjective shoulder function was assessed preoperatively and at 6 and 12 months postoperatively, using the Shoulder36 (Sh36) 5 domain scores (pain, range of motion [ROM], strength, activities of daily living, and general health). Stepwise multivariable regression analysis was performed to extract the relevant factors for each Sh36 domain score using active shoulder ROM, isometric shoulder and elbow strength, pain score, demographic data, intraoperative findings, medical complications, and cuff integrity.

Results

A total of 104 patients met the inclusion criteria for this study. Multivariable regression analysis identified active abduction ROM as the factor associated with 5 Sh36 domain scores at preoperatively. At 6 months postoperatively, isometric external rotation strength at the body side or 90° abduction position, but not the ROM factor, was identified as a significant associated factor with 5 Sh36 domain scores. At 12 months postoperatively, pain score was the most associated factor with pain, ROM, strength, and activities of daily living domain scores of Sh36.

Conclusion

Factors associated with subjective shoulder function after ARCR differed between the preoperative and postoperative periods. Postoperative treatment, including rehabilitation, should be modified according to the postoperative period after ARCR.

Comparative Study on Postoperative Immobilization in Reverse Total Shoulder Arthroplasty: 4 Weeks vs. 6 Weeks of Immobilization Yields Similar Clinical and Functional Outcomes

Background/Objectives: To investigate clinical and functional outcomes of patients undergoing reverse total shoulder arthroplasty (RTSA) using a rehabilitation protocol of either 4 or 6 weeks of immobilization. Methods: This comparative study analyzed a consecutive patient cohort that underwent RTSA in a single institute from January 2021-February 2023. Patients were assigned to groups according to the duration of postoperative immobilization and were followed up for a minimum of one year. Patient demographics, range of motion (ROM), functional outcomes using the Simple Shoulder Test (SST) and the American Shoulder and Elbow Score (ASES) as well as postoperative complications were recorded. The minimum clinically important difference (MCID) was used to assess whether the differences between the groups in SST, ASES, SWB, and VAS were clinically relevant. Results: Sixty patients met the inclusion criteria (35 patients in the 6-week immobilization group (6 WG) and 25 patients in the 4-week immobilization group (4 WG)) and were available for the total follow-up period. Similar baseline demographics were observed between the groups. Active ROM significantly improved for both groups, with abduction and forward flexion improving the most. In terms of functional outcomes, significant improvement (p < 0.001) was demonstrated for both groups (ASES, SST, VAS, and SWB). However, patients in the 4 WG reached significantly better results in VAS and SWB at 6 weeks and 3 months, as well as in ASES 3 months postoperatively, whereas both groups leveled off at the end of the follow-up period after 1 year. Taking into account the MCID, these differences for ASES at 3 months, as well as VAS and SWB at 6 weeks and 3 months postoperatively, were significant. Surprisingly, there were no differences between the groups over the entire follow-up period in terms of the SST. Conclusions: The author's findings suggest faster clinical recovery at 6 weeks and 3 months in patients undergoing postoperative immobilization of 4 weeks compared to 6 weeks following RTSA. However, clinical and functional outcomes were equal for 4 WG and 6 WG at one year follow up.

Functional recovery prediction during rehabilitation after rotator cuff tears by decision support system

BACKGROUND

Today's rehabilitation decision-making still relies on conventional methods and different specific targeted rehabilitation protocols. Our study focuses on the decision support system for early rehabilitation after rotator cuff (RC) tears repair, where a multicriteria decision-making framework (MCDM) is applied for the prediction of successful functional recovery and selection of a rehabilitation protocol.

OBJECTIVE

To identify factors that affect recovery outcomes and to develop a decision support system methodology for predicting functional recovery outcomes at early rehabilitation after RC repair.

METHODS

Twelve rehabilitation experts were involved in the design, calibration, and evaluation of a rehabilitation protocol based on the proposed decision support system constructed using the MCDM framework. For the development of a decision support system, 20 patients after RC surgery undergoing outpatient rehabilitation were enrolled in a prospective cohort clinical trial.

RESULTS

The MCDM framework (SWARA method) sensitively assesses different criteria and determines the corresponding criteria weights that were similar to criteria weights assessed subjectively by rehabilitation experts. The assignment of patients into the classes, according to the heuristic evaluation method based on expert opinion and the standard qualitative evaluation methods showed the validity of MCDM methods remain the best new alternative in predicting recovery during rehabilitation.

CONCLUSIONS

The results of this paper show that sustainable rehabilitation is an area that is quite suitable for the use of MCDM. The most of rehabilitation protocols are based on traditional methods and approaches, but the sensitive results showed the validity of MCDM methods and remains the best new alternative in prediction recovery protocols during rehabilitation.

Patients with rotator cuff tears present a psychological impairment, not only a functional deficit: a systematic review

INTRODUCTION

Psychological factors impact patients with rotator cuff tears (RCT) in terms of pain level, shoulder function, sleep disturbance, and quality of life (QoL). The aim of this study was to quantify the prevalence of psychological factors in those patients, evaluate their influence on patient-reported outcomes (PROMs), and assess the possible improvement with surgical treatment.

METHODS

The literature search was performed on PubMed, Web of Science, Wiley Cochrane Library up to January, 2023.

INCLUSION CRITERIA

RCT treated with arthroscopic rotator cuff reconstruction (ARCR), description of psychological variables evaluated with validated questionnaires, descriptions of PROMs.

RESULTS

Thirty-nine studies included 7021 patients. Depression was found in eight studies (19.2%), anxiety in 6 (13.0%), sleep disturbance in seven (71.3%), and distress in three studies (26.4%). Studies evaluating the relationship between psychological impairment and pain documented more pain and impaired shoulder function before and after ARCR in patients with altered psychological status.

DISCUSSION

An impaired psychological status has an important impact on patients' perception of their disease. RCT patients with psychological alterations often experience more pain and reduced shoulder function, thus having worse QoL.

CONCLUSION

This study underlines that psychological impairment largely affects RCT patient condition and treatment outcome, which underlines the importance of a multidisciplinary biopsychosocial intervention to achieve better results.