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Yee JS, Choi JK, Kim KT, Lee HW, Lee YB. Reinforcement Techniques in Arthroscopic Repair of Large-to-Massive Rotator Cuff Tears: A Comparative Study of Superior Capsule Reconstruction and Patch Graft Augmentation. J Clin Med 2024; 13:2276. [PMID: 38673549 PMCID: PMC11050902 DOI: 10.3390/jcm13082276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/31/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Large-to-massive rotator cuff tears (LMRCTs) present challenges in achieving successful repair due to factors such as muscle atrophy and tendon retraction. Arthroscopic rotator cuff repair (ARCR) with reinforcement techniques like superior capsule reconstruction (SCR) or patch graft augmentation (PGA) has emerged as a less invasive option to improve shoulder joint stability and prevent retear. This study aimed to compare the clinical and radiological outcomes of SCR and PGA as reinforcement techniques for the arthroscopic repair of LMRCTs. Methods: A single-center retrospective study was conducted on patients undergoing LMRCT repair between January 2019 and December 2021. Patients were divided into two groups: those receiving SCR (Group 1) and those receiving PGA (Group 2). Various clinical parameters including range of motion, functional scores, and radiological assessments were evaluated preoperatively and six months postoperatively. Results: Both SCR and PGA techniques demonstrated significant improvements in the range of motion and clinical scores postoperatively. However, Group 2 showed higher postoperative SST and UCLA scores compared to Group 1. Radiologically, there was a slightly higher retear rate in Group 2, although this was not statistically significant. Group 2 also had a shorter mean duration of surgery compared to Group 1. Conclusions: In the arthroscopic repair of LMRCTs, both SCR and PGA techniques exhibit favorable clinical and radiological outcomes. Despite the simplicity of PGA compared to SCR, it offers comparable results with a shorter surgical duration, making it a feasible reinforcement option for surgeons.
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Affiliation(s)
- Jae-Sung Yee
- Division of Physical Examination, Gyeonggi Bukbu Regional Office of Military Manpower, Uijeongbu 11642, Republic of Korea;
| | - Jin-Kwan Choi
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (J.-K.C.); (K.-T.K.)
| | - Ki-Tae Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (J.-K.C.); (K.-T.K.)
| | - Ho-Won Lee
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea;
| | - Yong-Beom Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (J.-K.C.); (K.-T.K.)
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Dey Hazra RO, Dey Hazra ME, Hanson JA, Rutledge JC, Horan MP, Rupp MC, Millett PJ. Patient-reported outcomes of arthroscopic repair for partial or full-thickness upper third subscapularis tendon tears with open sub-pectoral biceps tenodesis: minimum 10-year outcomes. J Shoulder Elbow Surg 2024; 33:832-840. [PMID: 37659702 DOI: 10.1016/j.jse.2023.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Although short-term results are promising, there are limited data for long-term results of arthroscopic subscapularis (SSC) repair. The purpose of this study is to report minimum 10-year outcomes of primary arthroscopic repair of isolated partial or full-thickness tears of the upper third of the SSC tendon. METHODS Patients who underwent arthroscopic repair of isolated upper third SSC tears, Lafosse type I (>50% of tendon thickness) or type II were included. Surgeries were performed by a single surgeon between November 2005 and August 2011. Patient-reported outcome measures were prospectively collected and retrospectively reviewed at minimum follow-up of 10 years. Patient-reported outcomes utilized included the American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score (SANE), Quick Disabilities of the Arm, Shoulder and Hand score (QuickDASH), the Short Form 12 physical component summary, return to activity, and patient satisfaction. A subanalysis of patient age and outcomes was performed. Retears, revision surgeries, and surgical complications were recorded. RESULTS In total, 29 patients with isolated upper third SSC repairs were identified. After application of exclusion criteria, 14 patients were included in the final analysis. Follow-up could be obtained from 11 patients. The mean age at surgery was 52.7 years (range: 36-72) and the mean follow-up was 12 years (range 10-15 years). The American Shoulder and Elbow Surgeons score improved from 52.9 ± 21.8 preoperatively to 92.2 ± 13.7 postoperatively (P < .001). Regarding the SANE and QuickDASH scores, only postoperative data were available. Mean postoperative SANE, QuickDASH, and Short Form 12 physical component summary scores were 90.27 ± 10.5, 14.6 ± 15.5, and 49.2 ± 6.6, respectively. Median patient satisfaction was 10 (range 6-10). Patients reported improvements in sleep, activities of daily living, and sports. There was no correlation between patient age and clinical outcome (P > .05). No patients underwent revision surgery for a SSC retear. CONCLUSION Arthroscopic repair of upper third SSC tendon tears leads to improved clinical scores and high patient satisfaction at minimum 10-year follow-up. The procedure is durable, with no failures in the presented cohort.
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Affiliation(s)
- Rony-Orijit Dey Hazra
- Steadman Philippon Research Institute, Vail, CO, USA; Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Maria E Dey Hazra
- Steadman Philippon Research Institute, Vail, CO, USA; Private Practice, Dr. Ulf Kuhlee, Berlin, Berlin, Germany
| | | | | | | | - Marco-Christopher Rupp
- Steadman Philippon Research Institute, Vail, CO, USA; Department of Orthopaedic Sports Medicine, Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
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Hwang JT, Kim YB, Cho MS, Seo SJ, Hong MS. Combination of Superior and Posterior Capsular Release Versus Superior Capsular Release Alone in Arthroscopic Repair of Large-to-Massive Rotator Cuff Tears. Orthop J Sports Med 2024; 12:23259671241235916. [PMID: 38486808 PMCID: PMC10938623 DOI: 10.1177/23259671241235916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/06/2023] [Indexed: 03/17/2024] Open
Abstract
Background Superior capsular release has been used to reduce tendon tension, especially in arthroscopic repair of large-to-massive rotator cuff tears. Some clinicians have used a more extensive release of capsules in arthroscopic cuff repair for adequate reduction of torn tendons to footprints. Purpose To explore the effects of additional posterior capsular release for superior capsular release in arthroscopic repair of large-to-massive rotator cuff tears. Study Design Cohort study; Level of evidence, 3. Methods We compared 26 shoulders that underwent superior and posterior capsular release (group S&P) with 26 shoulders that underwent superior capsular release alone (group S) in arthroscopic repair of large-to-massive rotator cuff tears between January 23, 2013 and December 2, 2015. The visual analog scale for pain, American Shoulder and Elbow Surgeons score, Constant score, and range of motion (ROM) and muscle power were checked preoperatively and at 2 years postoperatively. Follow-up ultrasound was checked at 2 years postoperatively. Results In both groups, the overall mean functional outcomes improved from preoperatively to postoperatively. Patients in group S&P showed more pre- to postoperative improvement than patients in group S with regard to internal rotation ROM (mean difference, 30.0° vs 20.6°; P < .001) and internal rotation power (3.4 vs 1.8 kgf; P = .001). Patients in group S had a higher retear rate on the follow-up ultrasound than patients in group S&P, but this difference did not reach statistical significance (23.1% vs 11.5%, respectively; P = .465). Conclusion In the current study, patients who underwent superior and posterior capsular release in arthroscopic repair of large-to-massive rotator cuff tears had greater postoperative improvement in internal rotation ROM and power compared with patients who underwent superior capsular release alone.
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Affiliation(s)
- Jung-Taek Hwang
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Yong-Been Kim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Min-Soo Cho
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Su-Jung Seo
- Department of Orthopedic Surgery, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Myung Sun Hong
- Department of Radiology, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
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Lädermann A, Cikes A, Zbinden J, Martinho T, Pernoud A, Bothorel H. Hydrotherapy after Rotator Cuff Repair Improves Short-Term Functional Results Compared with Land-Based Rehabilitation When the Immobilization Period Is Longer. J Clin Med 2024; 13:954. [PMID: 38398267 PMCID: PMC10889507 DOI: 10.3390/jcm13040954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Background: The evidence of hydrotherapy after rotator cuff repair (RCR) is limited as most studies either used it as an adjuvant to standard land-based therapy, or have different initiation timing. This study aimed to compare hydrotherapy and land-based therapy with varying immobilization time. Methods: Patients who underwent RCR with a 10-days or 1-month immobilization duration (early or late rehabilitation) were prospectively randomized. Results: Constant scores significantly differed at three months only, with the best score exhibited by the late hydrotherapy group (70.3 ± 8.2) followed by late land-based (61.0 ± 5.7), early hydrotherapy (55.4 ± 12.8) and early land-based (54.6 ± 13.3) groups (p < 0.001). There was a significant interaction between rehabilitation type and immobilization duration (p = 0.004). The effect of hydrotherapy compared to land-based therapy was large at three months when initiated lately only (Cohen's d, 1.3; 95%CI, 0.9-1.7). However, the relative risk (RR) of postoperative frozen shoulder or retear occurrence for late hydrotherapy was higher compared to early hydrotherapy (RR, 3.9; 95%CI, 0.5-30.0). Conclusions: Hydrotherapy was more efficient compared to land-based therapy at three months only and if initiated lately. Even though initiating hydrotherapy later brought greater constant scores at three months, it might increase the risk of frozen shoulders or retear compared to early hydrotherapy.
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, 1217 Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Alec Cikes
- Division of Orthopaedics and Trauma Surgery, Genolier Clinic, 1272 Genolier, Switzerland
- Synergy Medical Centre, Medbase Group, 1007 Lausanne, Switzerland
| | - Jeanni Zbinden
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, 1217 Meyrin, Switzerland
| | - Tiago Martinho
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, 1217 Meyrin, Switzerland
| | - Anthony Pernoud
- Research Department, La Tour Hospital, 1217 Meyrin, Switzerland
| | - Hugo Bothorel
- Research Department, La Tour Hospital, 1217 Meyrin, Switzerland
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5
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Rennie C, Futch KN, Brennan JC, Petre BM, Zaidi S, Turcotte JJ, Johnson AH, Redziniak DE. Total Intravenous Anesthesia Compared to Inhalational Anesthesia in Patients Undergoing Arthroscopic Rotator Cuff Repair. Cureus 2023; 15:e50775. [PMID: 38239510 PMCID: PMC10795481 DOI: 10.7759/cureus.50775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/22/2024] Open
Abstract
Background Inhalation anesthesia (IA) and total intravenous anesthesia (TIVA) are common general anesthesia techniques. During rotator cuff repair (RCR), an interscalene block is beneficial for intraoperative and early postoperative pain control. This study aimed to evaluate postoperative outcomes and opioid usage in patients undergoing arthroscopic RCR with an interscalene block and either IA or TIVA. Methodology A retrospective observational study was performed of 478 patients undergoing RCR at a single institution. Demographics, surgical details, intra and postoperative medications, and 90-day outcomes were collected. Univariate and multivariate analyses were performed to evaluate differences between groups. Results In total, 309 (64.6%) patients received IA and 169 (35.3%) received TIVA. Patients receiving IA were more likely to have comorbidities, such as diabetes (p = 0.002), sleep apnea (p = 0.006), gastroesophageal reflux disease (p < 0.001), and hypertension (p < 0.001). After adjusting for differences between groups in the multivariate analysis, patients who received TIVA had significantly shorter surgical time (β = -14.85, p < 0.001) and perioperative time (β = -21.01, p < 0.001) and significantly lower first post-anesthesia care unit Pasero opioid-induced sedation scores (β = -0.022, p = 0.040). Patients who received TIVA were less likely to receive intraoperative narcotics (odds ratio = 0.38; p = 0.031). Conclusions TIVA appears to be a safe and effective anesthetic for patients undergoing arthroscopic RCR. TIVA is a potentially beneficial alternative to IA for this patient population.
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Affiliation(s)
- Christopher Rennie
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Tampa, USA
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | - Katerina N Futch
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Tampa, USA
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | - Jane C Brennan
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | | | - Sohail Zaidi
- Anesthesiology, Anne Arundel Medical Center, Annapolis, USA
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Johnson AH, West M, Fowler MB, Petre BM, Turcotte JJ, Redziniak DE. What is the Optimal Construct to Reduce Failure in Arthroscopic Four Anchor Rotator Cuff Repair? Shoulder Elbow 2023; 15:33-39. [PMID: 37974601 PMCID: PMC10649482 DOI: 10.1177/17585732221076066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2023]
Abstract
Background Re-tear following rotator cuff repair (RCR) is a concerning complication that can lead to poor patient outcomes and necessitate the need for revision surgery. The purpose of our study was to look at the combined construct of knotted vs. knotless medial row and suture vs. suture tape, focusing primarily on re-tear rates following surgery. Methods A retrospective observational study of 343 consecutive patients undergoing arthroscopic double row, 4-anchor rotator cuff repair from February 2014 to March 2020 was conducted. Univariate and multivariate statistics were used to assess differences in demographics, comorbidities and tear characteristics between patients who experienced a symptomatic re-tear and those who did not. Results The overall symptomatic re-tear rate was 7.6%. Patients who had a knotted medial row repair had a significantly lower rate of re-tear (4.7 vs. 11.3%, p = 0.022). Patients that had a knotted medial row and suture tape repair were significantly less likely to experience a re-tear (OR: 0.180, p = 0.001). Discussion The use of suture tape and a knotted medial row repair decreases the incidence of symptomatic re-tear following rotator cuff repair. The combined construct of suture tape and a knotted medial row in rotator cuff repair decreases the risk for symptomatic re-tear following surgery.
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Affiliation(s)
- Andrea H Johnson
- Research Fellow, Anne Arundel Medical Center Orthopedics, Annapolis, MD
| | - Michaline West
- Clinical Research Coordinator, Anne Arundel Medical Center Orthopedics, Annapolis, MD
| | - M Brook Fowler
- Clinical Research Coordinator, Anne Arundel Medical Center Orthopedics, Annapolis, MD
| | - Benjamin M Petre
- Attending Orthopedic Surgeon, Anne Arundel Medical Center Orthopedics, Annapolis, MD
| | - Justin J Turcotte
- Director, Orthopedic and Surgical Research, Anne Arundel Medical Center Orthopedics, Annapolis, MD
| | - Daniel E Redziniak
- Attending Orthopedic Surgeon, Anne Arundel Medical Center Orthopedics, Annapolis, MD
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Dai X, Yuan M, Dang M, Liu D, Fei W. Development and Validation of a Predictive Model for Chronic Postsurgical Pain After Arthroscopic Rotator Cuff Repair: A Prospective Cohort Study. J Pain Res 2023; 16:3273-3288. [PMID: 37790188 PMCID: PMC10544136 DOI: 10.2147/jpr.s423110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Chronic pain management continues to present a significant challenge following arthroscopic shoulder surgery. Our purpose was to detect chronic postsurgical pain (CPSP) in patients who had undergone arthroscopic rotator cuff repair (ARCR) and develop a nomogram capable of predicting the associated risk. Patients and Methods We collected the demographic and clinical data of 240 patients undergoing ARCR in our hospital from January 2021 to May 2022. The pain level was monitored and evaluated three months after ARCR. LASSO regression was used to screen out pain-predicting factors, which were subsequently used to construct a nomogram. Internal validation was carried out using Bootstrap resampling. The data of 78 patients who underwent ARCR in our hospital from August 2022 to December 2022 were also collected for external verification of the nomogram. The predictive model was evaluated using the receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA). Results Age, duration of preoperative shoulder pain (DPSP), C-reactive protein (CRP), number of tear tendons, and American Shoulder and Elbow Surgical Score (ASES) were screened by LASSO regression as predictive factors for CPSP. These factors were then used to construct a chronic pain risk nomogram. The area under the curve (AUC) of the predictive and validation models were 0.756 (95% CI: 0.6386-0.8731) and 0.806 (95% CI: 0.6825-0.9291), respectively. Furthermore, the calibration curves and decision curve analysis (DCA) for both models indicated strong performance, affirming the reliability of this predictive model. Conclusion The CPSP risk model that has been developed exhibits strong predictive capabilities and practical utility. It offers valuable support to clinical healthcare professionals in making informed treatment decisions, reducing the unnecessary use of analgesic drugs, and optimizing the allocation of medical resources.
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Affiliation(s)
- Xiaomei Dai
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, People’s Republic of China
| | - Meijuan Yuan
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, People’s Republic of China
| | - Mengbo Dang
- Dalian Medical University, Dalian, People’s Republic of China
| | - Dianwei Liu
- Dalian Medical University, Dalian, People’s Republic of China
| | - Wenyong Fei
- Department of Orthopedics and Sports Medicine, Northern Jiangsu People’s Hospital, Affiliated to Yangzhou University, Yangzhou, People’s Republic of China
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Cho SH, Kim YS. Prediction of Retear After Arthroscopic Rotator Cuff Repair Based on Intraoperative Arthroscopic Images Using Deep Learning. Am J Sports Med 2023; 51:2824-2830. [PMID: 37565449 DOI: 10.1177/03635465231189201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND It is challenging to predict retear after arthroscopic rotator cuff repair (ARCR). The usefulness of arthroscopic intraoperative images as predictors of the ARCR prognosis has not been analyzed. PURPOSE To evaluate the usefulness of arthroscopic images for the prediction of retear after ARCR using deep learning (DL) algorithms. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 2. METHODS In total, 1394 arthroscopic intraoperative images were retrospectively obtained from 580 patients. Repaired tendon integrity was evaluated using magnetic resonance imaging performed within 2 years after surgery. Images obtained immediately after ARCR were included. We used 3 DL architectures to predict retear based on arthroscopic images. Three pretrained DL algorithms (VGG16, DenseNet, and Xception) were used for transfer learning. Training and test sets were split into 8:2. Threefold stratified validation was used to fine-tune the hyperparameters using the training data set. The validation results of each fold were evaluated. The performance of each model in the test set was evaluated in terms of accuracy, area under the receiver operating characteristic curve (AUC), F1-score, sensitivity, and specificity. RESULTS In total, 1138 and 256 arthroscopic images were obtained from 514 patients and 66 patients in the nonretear and retear groups, respectively. The mean validation accuracy of each model was 83% for VGG16, 89% for Xception, and 91% for DenseNet. The accuracy for the test set was 76% for VGG16, 87% for Xception, and 91% for DenseNet. The AUC was highest for DenseNet (0.92); it was 0.83 for VGG16 and 0.91 for Xception. For the test set, the specificity and sensitivity were 0.93 and 0.84 for DenseNet, 0.89 and 0.84 for Xception, and 0.70 and 0.80 for VGG16, respectively. CONCLUSION The application of DL algorithms to intraoperative arthroscopic images has demonstrated a high level of accuracy in predicting retear occurrences.
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Affiliation(s)
- Sung-Hyun Cho
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Ye Z, Qiao Y, Wu C, Chen C, Su W, Xu C, Dong S, Xu J, Zhao J. Effect of Anterior Acromial Coverage on Functional and Radiological Outcomes After Arthroscopic Repair of Anteroposterior Massive Rotator Cuff Tears. Am J Sports Med 2023; 51:2831-2841. [PMID: 37593843 DOI: 10.1177/03635465231187900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND Rotator cuff tear size, fatty infiltration, and scapular morphology are correlated with tendon healing and functional outcomes after arthroscopic repair; however, the association between anteroposterior acromial coverage and the clinical outcomes of anteroposterior massive rotator cuff tears (AP-MRCTs; involving all 3 tendons) remains unclear. PURPOSE To identify the association between AP acromial coverage and functional and radiological outcomes after arthroscopic repair of AP-MRCTs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 98 patients who underwent arthroscopic repair of AP-MRCTs between January 2015 and December 2020 were included in the study and classified according to whether anterior acromial coverage (AAC) was anterior (46 patients; positive AAC group) or posterior (52 patients; negative AAC group) to the scapular line on true lateral shoulder radiographs. Demographic characteristics, surgical details, and functional outcomes were prospectively collected. Acromial morphological features, global tear extension (GTE), the global fatty infiltration index (GFII), tendon integrity after repair, proximal humeral migration, and glenohumeral abduction were measured and calculated on radiographs or magnetic resonance imaging scans preoperatively and at 2 years postoperatively. Multivariate logistic regression was performed to identify the independent risk factors of a rotator cuff retear. RESULTS The positive AAC group showed larger AAC, posterior acromial tilt, and anterior acromial slope as well as smaller posterior acromial coverage compared with the negative AAC group. Postoperatively, the American Shoulder and Elbow Surgeons score (82.5 ± 8.3 vs 77.2 ± 11.5, respectively; P = .013), active abduction (157.8°± 27.1° vs 142.7°± 39.6°, respectively; P = .048), and glenohumeral abduction (45.6°± 10.4° vs 39.7°± 14.9°, respectively; P = .041) in the positive AAC group were significantly higher than those in the negative AAC group, while the retear rate (23.9% vs 44.2%, respectively; P = .035) and proximal humeral migration (1.7 ± 1.0 vs 2.3 ± 1.2 mm, respectively; P = .006) were significantly lower in the positive AAC group than in the negative AAC group. Smaller AAC (odds ratio [OR], 0.93 [95% CI, 0.87-1.00]; P = .040), larger GTE (OR, 1.03 [95% CI, 1.01-1.06]; P = .017), and a higher GFII (OR, 3.49 [95% CI, 1.09-11.19]; P = .036) were associated with an increased risk of a rotator cuff retear. CONCLUSION Increased AAC was associated with a lower retear rate and better functional outcomes after arthroscopic repair of AP-MRCTs. A preliminary risk evaluation integrating GTE, the GFII, and AAC is recommended to consider the necessity of additional procedures for patients in need of arthroscopic rotator cuff repair.
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Affiliation(s)
- Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang'an Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Gu Z, Wu S, Yang Y, Ren T, Zhang KW. Comparison of Arthroscopic Single-row and Double-row Repair for Rotator Cuff Injuries With Different Tear Sizes: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231180854. [PMID: 37655249 PMCID: PMC10467404 DOI: 10.1177/23259671231180854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/09/2023] [Indexed: 09/02/2023] Open
Abstract
Background There is no clinical gold standard for the indications for single-row (SR) versus double-row (DR) repair according to small, large, or massive rotator cuff tear size. Purpose To conduct a meta-analysis to compare the clinical outcomes and retear rates after arthroscopic SR and DR repair for rotator cuff injuries with different tear sizes. Study Design Systematic review; Level of evidence, 3. Methods On the basis of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, the PubMed, Embase, Cochrane Library databases, Web of Science, China National Knowledge Infrastructure, and China BioMedical Literature database were searched for relevant studies published before November 1, 2021, using the following search terms: "Rotator Cuff Injuries," "Rotator Cuff Tears," "Arthroscopy," "Arthroscopic Surgery," "single-row," and "double-row"; a total of 489 articles were retrieved. Quality evaluation was conducted for all the studies that met the inclusion criteria. This study evaluated the Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, and range of motion (ROM) as well as retear rate. A fixed-effects or random-effects model was adopted to calculate the results and assess risk. Results A total of 10 clinical studies were included, with 404 cases of DR and 387 cases of SR. Regarding overall results, DR had better forward elevation ROM (mean difference [MD] = -4.03° [95% CI, -6.00° to -2.06°]; P < .0001; I 2 = 46%) and a lower retear rate (MD = 2.39 [95% CI, 1.40 to 4.08]; P = .001; I 2 = 0%) compared with SR repair. With regard to small tears (<3 cm), there was no noticeable difference on any of the 3 outcome scores between SR and DR. For large rotator cuff tears (≥3 cm), DR repair showed significantly better ASES scores (MD = -3.09 [95% CI, -6.19 to 0.02]; P = .05; I 2 = 73%) and UCLA scores (MD = -1.47 [95% CI, -2.21 to -0.72]; P = .0001; I 2 = 31%) compared with SR repair. Conclusion Our meta-analysis revealed that DR had better UCLA scores, ASES scores, and ROM in forward elevation and lower retear rates. In rotator cuff tears <3 cm, there were no statistical differences in clinical outcome between SR and DR.
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Affiliation(s)
- Zhangyang Gu
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Shengguang Wu
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Yu Yang
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Tao Ren
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Kai-Wei Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
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Dey Hazra RO, Dey Hazra ME, Hanson JA, Rutledge JC, Doan KC, Ganokroj P, Horan MP, Dornan GJ, Millett PJ. Minimum 5-Year Clinical Outcomes of Arthroscopically Repaired Massive Rotator Cuff Tears: Effect of Age on Clinical Outcomes. Am J Sports Med 2023; 51:1979-1987. [PMID: 37259961 DOI: 10.1177/03635465231174430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Massive rotator cuff tears (MRCTs) can be challenging to treat, and the efficacy of repair of MRCTs in older patients has been debated. PURPOSE To report minimum 5-year outcomes after primary arthroscopic rotator cuff repair of MRCT and determine whether age affects outcomes. STUDY DESIGN Case series; Level of evidence 4. METHODS The study included consecutive patients with MRCTs who were treated with arthroscopic rotator cuff repair by a single surgeon between February 2006 and October 2016. MRCTs were defined as ≥2 affected tendons with tendon retraction to the glenoid rim and/or a minimum exposed greater tuberosity of ≥67. Patient-reported outcome (PRO) data collected preoperatively and at a minimum of 5 years included the American Shoulder and Elbow Surgeons (ASES) score; Single Assessment Numeric Evaluation (SANE) score; the shortened version of the Disabilities of the Arm, Shoulder and Hand score (QuickDASH); the 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS); and patient satisfaction. Surgical failure was defined as subsequent revision rotator cuff surgery or conversion to reverse total shoulder arthroplasty. Regression analysis was performed to determine whether age had an effect on clinical outcomes. RESULTS A total of 53 shoulders in 51 patients (mean age, 59.7 years; range, 39.6-73.8 years; 34 male, 19 female) met inclusion criteria with a mean follow-up of 8.1 years (range, 5.0-12.1 years). Three shoulders (5.7%) failed at 2.4, 6.0, and 7.1 years. Minimum 5-year follow-up was obtained in 45 of the remaining 50 shoulders (90%). Mean PROs improved as follows: ASES from 58.8 to 96.9 (P < .001), SANE from 60.5 to 88.5 (P < .001), QuickDASH from 34.2 to 6.8 (P < .001), and SF-12 PCS from 41.1 to 52.2 (P < .001). Patient satisfaction was a median of 10 (on a scale of 1-10). Age was not associated with any PRO measures postoperatively (P > .05). CONCLUSION This study demonstrated significantly improved clinical scores, decreased pain, and increased return to activity for patients with MRCT at midterm follow-up (mean, 8.1 years; range, 5.0-12.1 years). In this patient cohort, no association was found between age and clinical outcomes.
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Affiliation(s)
- Rony-Orijit Dey Hazra
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Jared A Hanson
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Kent C Doan
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| | - Phob Ganokroj
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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Dey Hazra RO, Dey Hazra ME, Hanson JA, Rutledge JC, Doan KC, Horan MP, Millett PJ. Minimum 10-Year Outcomes After Arthroscopic Repair of Partial-Thickness Supraspinatus Rotator Cuff Tears. Am J Sports Med 2023; 51:2404-2410. [PMID: 37306068 DOI: 10.1177/03635465231176557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The prevalence of partial-thickness rotator cuff tears (PTRCTs) has been reported to be 13% to 40% within the adult population, accounting for 70% of all rotator cuff tears. Approximately 29% of PTRCTs will progress to full-thickness tears if left untreated. The long-term clinical course after arthroscopic repair of PTRCTs is not well known. PURPOSE To investigate minimum 10-year patient-reported outcomes (PROs) after arthroscopic rotator cuff repair (RCR) of the supraspinatus tendon and to report reoperation and complication rates. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients were included who underwent arthroscopic RCR of a PTRCT performed by a single surgeon between October 2005 and October 2011. Arthroscopic RCR was performed with a transtendon repair of partial, articular-sided supraspinatus tendon avulsions, bursal-sided repair, or conversion into a full-thickness tear and repair. PRO data were collected preoperatively and at a minimum 10 years postoperatively. PRO measures included the American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, the shortened version of Disabilities of the Arm, Shoulder and Hand score (QuickDASH), the 12-Item Short Form Health Survey Physical Component Summary, and patient satisfaction. Subanalyses were performed to determine if tear location or age was associated with outcomes. Retears, revision surgery, and surgical complications were recorded. RESULTS In total, 33 patients (21 men, 12 women) at a mean age of 50 years (range, 23-68) met criteria for inclusion. Follow-up was obtained in 28 (87.5%) of the 32 eligible patients ≥10 years out from surgery (mean, 12 years; range, 10-15 years). Of the 33 PTCRTs, 21 were articular sided and 12 were bursal sided. Of the 33 patients, 26 underwent concomitant biceps tenodesis. At follow-up, the mean PROs were significantly improved when compared with preoperative levels: American Shoulder and Elbow Surgeons score from 67.3 to 93.7 (P < .001), Single Assessment Numeric Evaluation from 70.9 to 91.2 (P = .004), QuickDASH from 22.3 to 6.6 (P < .004), and 12-Item Short Form Health Survey Physical Component Summary from 44.8 to 54.2 (P < .001). Median postoperative satisfaction was 10 (range, 5-10). No patient underwent revision surgery. CONCLUSION Arthroscopic repair of PTRCTs results in excellent clinical outcomes and high patient satisfaction at minimum 10-year follow-up. Furthermore, the procedure is highly durable, with a clinical survivorship rate of 100% at 10 years.
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Affiliation(s)
- Rony-Orijit Dey Hazra
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | | | - Jared A Hanson
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Kent C Doan
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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Tokunaga T, Karasugi T, Tanimura S, Miyamoto T. Association of Severe Histological Degeneration of the Torn Supraspinatus Tendon and Retear After Arthroscopic Repair of Full-Thickness Rotator Cuff Tears Using the Suture Bridge Technique. Am J Sports Med 2023; 51:2411-2421. [PMID: 37345285 DOI: 10.1177/03635465231178294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Previous studies have demonstrated several prognostic factors for retear after arthroscopic rotator cuff repair (ARCR). However, studies that histologically evaluate the quality of the torn rotator cuff (RC) tendon and its association with postoperative outcomes are limited. PURPOSE To investigate factors associated with retear after ARCR using the suture bridge (SB) technique, including the degree of histological degeneration of the RC tendon edge. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The authors retrospectively evaluated 187 patients who underwent ARCR for full-thickness tears using the SB technique; intraoperative biopsy samples were taken to assess the degree of histological degeneration using the Bonar score. The cohort was divided into healed (n = 165) and retear (n = 22) groups according to magnetic resonance imaging results obtained ≥6 months postoperatively. The evaluation included preoperative patient data (age, sex, symptom duration, trauma history, history of heavy manual work, smoking habit, hypertension, diabetes mellitus, and hyperlipidemia) and radiological data (Hamada classification, Patte classification, Goutallier classification, and global fatty degeneration index [GFDI]). Additionally, intraoperative data (anteroposterior tear size, Lafosse classification for concomitant subscapularis tendon tear, and long head of biceps injury) and preoperative and postoperative clinical findings (active range of motion, University of California, Los Angeles [UCLA], score) were evaluated. RESULTS The retear rate was 11.8%. The retear group had a higher percentage of men (P = .031), higher Bonar score (P < .001), higher mean GFDI value (P = .002), higher rate of tear retraction degree (P = .010), and larger anteroposterior tear size (P = .020) than the healed group. The retear group had lower postoperative internal rotation (P = .031) and lower UCLA score (P < .001). Multivariate logistic regression analysis with a stepwise variable selection revealed anteroposterior tear size (odds ratio [OR], 2.4; 95% CI, 1.3-4.5; P = .004) and Bonar score (OR, 1.7; 95% CI, 1.3-2.4; P < .001) as independent predictors for a retear. CONCLUSION The results indicate that end-stage severe tendon degeneration might affect retear. Therefore, further investigation on the progression mechanisms of tendon degeneration and development of methods to assess degenerative tissue might improve clinical outcomes after ARCR.
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Affiliation(s)
- Takuya Tokunaga
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tatsuki Karasugi
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shuntaro Tanimura
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takeshi Miyamoto
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Liu SH, Patel V, Loyst RA, Lung B, Cohen D, Kashanchi K, Komatsu DE, Wang ED. Preoperative Risk Stratification in Arthroscopic Rotator Cuff Repair: Aspartate Aminotransferase-to-Platelet Ratio Index as an Estimate of Liver Dysfunction. Cureus 2023; 15:e41980. [PMID: 37593301 PMCID: PMC10427769 DOI: 10.7759/cureus.41980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) is a cost-effective and noninvasive measure of liver function, an alternative to the gold standard liver biopsy which is resource-intensive and invasive. This study investigates the association between various degrees of liver dysfunction based on APRI and 30-day postoperative complications following arthroscopic rotator cuff repair (aRCR). METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent aRCR between 2015 and 2021. The study population was divided into four groups based on preoperative APRI: normal/reference (APRI ≤ 0.5), mild fibrosis (0.5 < APRI ≤ 0.7), significant fibrosis (0.7 < APRI ≤ 1), and cirrhosis (APRI > 1). Multivariate logistic regression analysis was conducted to investigate the connection between preoperative APRI and postoperative complications. RESULTS Compared to normal liver function, mild fibrosis was significantly associated with male gender, lower BMI, American Society of Anesthesiologists (ASA) classification ≥ 3, and comorbid diabetes, hypertension, chronic obstructive pulmonary disease, and bleeding disorders. Significant fibrosis was significantly associated with male gender, greater BMI, ASA classification ≥ 3, and comorbid diabetes, hypertension, and bleeding disorders. Cirrhosis was significantly associated with younger age, ASA classification ≥ 3, smokers, and comorbid diabetes and bleeding disorders. Compared to normal liver function, fibrosis was not associated with complications, significant fibrosis was associated with myocardial infarction, and cirrhosis was associated with major complications, sepsis, non-home discharge, and mortality. However, mild fibrosis, significant fibrosis, and cirrhosis were independently associated with any adverse 30-day postoperative complications following aRCR. CONCLUSION Among those with predicted liver damage based on preoperative APRI, 30-day postoperative complications following aRCR were not found to be independently associated with preoperative mild fibrosis, significant fibrosis, or cirrhosis. Our results suggest that APRI predictive of liver dysfunction may be a weaker deterrent to undergoing aRCR compared to other orthopedic surgeries.
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Affiliation(s)
- Steven H Liu
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| | - Vaidehi Patel
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| | - Rachel A Loyst
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| | - Brandon Lung
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, USA
| | - Dorian Cohen
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| | - Kevin Kashanchi
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, USA
| | - David E Komatsu
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| | - Edward D Wang
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
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Lee JB, Kholinne E, Ben H, So SP, Alsaqri H, Lee HJ, Koh KH, Jeon IH. Clinical and Radiological Outcomes of Arthroscopic Superior Capsular Reconstruction Versus Primary Rotator Cuff Repair in Massive Rotator Cuff Tears: A Propensity Score-Matched Study. Am J Sports Med 2023; 51:1971-1978. [PMID: 37260275 DOI: 10.1177/03635465231171928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Arthroscopic superior capsular reconstruction (aSCR) has emerged as a treatment option for managing massive rotator cuff tears (MRCTs) given the unpredictable results after an arthroscopic rotator cuff repair (aRCR). Yet, few comparative studies of aSCR and aRCR have been conducted. PURPOSE To compare the clinical and radiological outcomes between aRCR and aSCR in patients with MRCT. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 163 cases of MRCT from 2010 to 2020 with follow-up ≥2 years were retrospectively reviewed. Among them, 102 had aRCR and 61 had aSCR using fascia lata autograft. Propensity score matching was used to select controls matched for age, sex, diabetes mellitus, osteoporosis, preoperative American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, Constant score, pain visual analog scale (pVAS) score, range of motion (ROM), tear size, global fatty degeneration index, and acromiohumeral distance (AHD). Last, 33 cases in each group were selected after propensity score matching. Radiological assessment was conducted using serial postoperative magnetic resonance imaging. Pre- and postoperative findings-including American Shoulder and Elbow Surgeons, pVAS, Single Assessment Numeric Evaluation, and Constant scores and ROM-were assessed to compare clinical outcomes. For radiological outcomes, global fatty degeneration index, AHD, and healing rate were evaluated. Healing failure was defined as Sugaya classification IV or V in the aRCR group, as compared with a full-thickness tear of the graft in the aSCR group, which corresponded to Sugaya classification IV or V. RESULTS Postoperative clinical outcomes were significantly improved at the final follow-up in both groups. In the aSCR group, postoperative forward flexion, pVAS, and AHD were significantly improved as compared with the aRCR group (mean, 161° vs 148° [P = .02]; 1.03 vs 1.64 [P = .047]; 7.00 vs 5.23 mm [P < .001], respectively). The healing rate was 20 of 33 (60.6%) for aRCR and 29 of 33 (87.9%) for aSCR (P = .022). CONCLUSION aSCR and aRCR are effective and reliable treatment options for MRCT. However, when compared with aRCR, aSCR showed improved clinical outcomes, including pVAS score, postoperative ROM, and favorable radiological findings, including AHD and a higher healing rate.
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Affiliation(s)
- Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, St Carolus Hospital, Faculty of Medicine, Trisakti University, Jakarta, Indonesia
| | - Hui Ben
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hood Alsaqri
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Rustaq Hospital, Rustaq, Sultanate of Oman
| | - Hyun June Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Sclafani SJ, Partan MJ, Tarazi JM, Sherman AE, Katsigiorigis G, Cohn RM. Risk Factors for Unexpected Admission Following Outpatient Rotator Cuff Repair: A National Database Study. Cureus 2023; 15:e40536. [PMID: 37461791 PMCID: PMC10350331 DOI: 10.7759/cureus.40536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction Rotator cuff repair (RCR) procedures are some of the most common orthopaedic surgeries performed in the United States. Compared to other orthopaedic procedures, RCRs are of relatively low morbidity. However, complications may arise that result in readmission to an inpatient healthcare facility. The purpose of this study is to identify the demographics and risk factors associated with unplanned 30-day readmission after RCR. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent elective RCR from 2015-2019. Univariate and multivariate analyses were utilized to assess patient demographics, comorbidities, and peri-operative variables predicting unplanned 30-day readmission. Results Of the identified 45,548 patients that underwent RCR, 597 (1.3%) required readmission within 30 days of the procedure. Multivariate analysis identified male sex (OR 1.36, 95% CI: 1.10, 1.67), hypertension (OR 1.29, 95% CI:1.03, 1.62), chronic obstructive pulmonary disease (COPD) (OR 2.07, 95% CI: 1.46, 2.93), American Society of Anesthesiologists (ASA) Class III (OR 1.85, 95% CI: 1.07, 3.18), ASA Class IV (OR 5.38, 95% CI: 2.70, 10.72), and total operative time (OR 1.002, 95% CI: 1.000, 1.004) as independent risk factors for unplanned readmission. Conclusion Unplanned 30-day readmission after RCR is infrequent. However, certain patients may be at increased risk for unplanned 30-day admission to an inpatient facility. This study confirmed male sex, COPD, hypertension, ASA Class III, ASA Class IV, and total operative time to be independent risk factors for readmission following outpatient RCR.
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Affiliation(s)
- Salvatore J Sclafani
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Department of Orthopaedic Surgery, Northwell Health-Huntington Hospital, Huntington, USA
| | - Matthew J Partan
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Department of Orthopaedic Surgery, Northwell Health-Huntington Hospital, Huntington, USA
| | - John M Tarazi
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Department of Orthopaedic Surgery, Northwell Health-Huntington Hospital, Huntington, USA
| | - Alain E Sherman
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Department of Orthopaedic Surgery, Northwell Health-Lenox Hill Hospital, Manhattan, USA
| | - Gus Katsigiorigis
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Department of Orthopaedic Surgery, Northwell Health-Huntington Hospital, Huntington, USA
- Department of Orthopaedic Surgery, Northwell Health-Long Island Jewish Valley Stream, Valley Stream, USA
| | - Randy M Cohn
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Department of Orthopaedic Surgery, Northwell Health-Huntington Hospital, Huntington, USA
- Department of Orthopaedic Surgery, Northwell Health-Long Island Jewish Valley Stream, Valley Stream, USA
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Hsieh YC, Kuo LT, Hsu WH, Tsai YH, Peng KT. Comparison of Outcomes after Arthroscopic Rotator Cuff Repair between Elderly and Younger Patient Groups: A Systematic Review and Meta-Analysis of Comparative Studies. Diagnostics (Basel) 2023; 13:diagnostics13101770. [PMID: 37238254 DOI: 10.3390/diagnostics13101770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
This study aimed to compare the outcomes of arthroscopic rotator cuff repair (ARCR) surgery between younger and older patients. We performed this systematic review and meta-analysis of cohort studies comparing outcomes between patients older than 65 to 70 years and a younger group following arthroscopic rotator cuff repair surgery. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and other sources for relevant studies up to 13 September 2022, and then assessed the quality of included studies using the Newcastle-Ottawa Scale (NOS). We used random-effects meta-analysis for data synthesis. The primary outcomes were pain and shoulder functions, while secondary outcomes included re-tear rate, shoulder range of motion (ROM), abduction muscle power, quality of life, and complications. Five non-randomized controlled trials, with 671 participants (197 older and 474 younger patients), were included. The quality of the studies was all fairly good, with NOS scores ≥ 7. The results showed no significant differences between the older and younger groups in terms of Constant score improvement, re-tear rate, or other outcomes such as pain level improvement, muscle power, and shoulder ROM. These findings suggest that ARCR surgery in older patients can achieve a non-inferior healing rate and shoulder function compared to younger patients.
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Affiliation(s)
- Yu-Chieh Hsieh
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yao-Hung Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Kuo-Ti Peng
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
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18
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Horan MP, Hanson JA, Rakowski DR, Patel RB, Vidal LB, Millett PJ. Outcomes and Survivorship 5 Years After Arthroscopic Rotator Cuff Repair in Active Patients 70 Years and Older. Orthop J Sports Med 2023; 11:23259671231168888. [PMID: 37250743 PMCID: PMC10214071 DOI: 10.1177/23259671231168888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 05/31/2023] Open
Abstract
Background Rotator cuff tears are common in the elderly population and are associated with increased pain, decreased function, and decreased enjoyment of recreational activities. Purpose To evaluate clinical outcomes at a minimum of 5 years after arthroscopic repair of full-thickness rotator cuff tears in recreational athletes aged ≥70 years at the time of surgery. Study Design Case series; Level of evidence, 4. Methods Included were recreational athletes aged ≥70 years who underwent arthroscopic rotator cuff repair (RCR) from December 2005 to January 2016. Patient and surgery characteristics were collected prospectively and retrospectively reviewed. Patient-reported outcome (PRO) scores utilized were the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), the shortened version of Disabilities of the Arm, Shoulder and Hand score (QuickDASH), 12-Item Short Form Health survey (SF-12) questionnaire (Physical Component Summary and Mental Component Summary), and patient satisfaction. Kaplan Meier survivorship analysis was performed, with failure defined as revision RCR or retear on magnetic resonance imaging (MRI). Results Overall, 71 shoulders (n = 67 patients [44 men, 23 women]; mean age, 73.4 years [range, 70.1-81.3 years]) were included in this study. Follow-up data was obtained for 65 of the 69 available shoulders (94%) at a mean of 7.8 years (range, 5-15.3 years). Mean age at follow-up was 81.2 years (range, 75.7-91.0). One RCR was revised after a traumatic accident, and another had a symptomatic, MRI-confirmed retear. One patient had lysis of adhesions for stiffness 3 months postoperatively. All PRO scores improved from pre- to postoperatively-ASES, from 55.3 to 93.6; SANE, from 62 to 89.6; QuickDASH, from 32.9 to 7.3; and SF-12 Physical Component Summary, from 43.3 to 53 (P < .001 for all)-and the median satisfaction score was 10 out of 10. Postoperatively, 63% of the patients returned to their original fitness program and 33% of patients modified their recreational activity. Survivorship analysis showed a 98% survival rate at 5 years and a 92% rate at 10 years. Conclusion Sustained improvement in function, reduced pain, and return to activities was seen after arthroscopic RCR in active patients ≥70 years old. Despite one-third of patients modifying their recreational activity, the cohort reported high levels of satisfaction and general health.
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Affiliation(s)
| | | | | | - Ravi B. Patel
- Steadman Philippon Research Institute,
Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado,
USA
| | - Leslie B. Vidal
- Steadman Philippon Research Institute,
Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado,
USA
| | - Peter J. Millett
- Steadman Philippon Research Institute,
Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado,
USA
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19
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Su P, Liu Y, Zhang L, Bai LB. Comparison of Analgesia Treatment Methods After Arthroscopic Rotator Cuff Repair: A Network Meta-analysis of 42 Randomized Controlled Trials. Orthop J Sports Med 2023; 11:23259671231167128. [PMID: 37346775 PMCID: PMC10280546 DOI: 10.1177/23259671231167128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 06/23/2023] Open
Abstract
Background The optimal method for postoperative analgesia after arthroscopic rotator cuff repair (ARCR) is still unclear. Purpose To compare the efficacy of postoperative analgesic methods after ARCR through network meta-analysis of randomized controlled trials and prospective controlled trials. Study Design Systematic review; Level of evidence, 2. Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, Embase, and Web of Science from inception until April 12, 2022, for randomized controlled trials and prospective controlled trials evaluating neuraxial analgesia, peripheral nerve block, periarticular local anesthetic infiltration, intravenous patient-controlled analgesia, oral analgesia, or any combination of these methods for pain management after ARCR. Outcomes included pain scores at rest, morphine consumption, and complications (nausea and vomiting). Study quality was assessed using the Cochrane risk-of-bias tool. Network meta-analysis was used to assess the relative efficacy of the methods for postoperative analgesia. The best choice for postoperative analgesia was defined as the one with significant differences in pain scores and morphine consumption compared with placebo, with no significant difference in complications, during the initial 48 hours postoperatively. Results Included were 42 studies with 3110 patients. Only suprascapular nerve block (SSNB) was significantly superior to placebo in pain scores (mean difference [MD], -0.93 [95% CI, -1.31 to -0.54] at 6 hours; MD, -2.34 [95% CI, -3.49 to -1.19] at 12 hours) and morphine consumption (MD, -17.70 [95% CI, -32.98 to -2.42] at 24 hours) (P < .05 for all), with no difference in complications (odds ratio, 0.96 [95% CI, 0.21 to 4.32]; P > .05). Pain scores were significantly lower with interscalene nerve block compared with SSNB (MD, -0.69 [95% CI, -1.17 to -0.20] at 6 hours; MD, -1.44 [95% CI, -2.21 to -0.67] at 12 hours) and with SSNB + axillary nerve block compared with SSNB (MD, -3.09 [95% CI, -4.18 to -1.99] at 6 hours; MD, -0.87 [95% CI, -1.71 to -0.03] at 12 hours) (P < .05 for all). Conclusion Based on the current evidence, most analgesic methods lowered pain and morphine consumption compared with placebo. There were significant differences in pain scores between interscalene nerve block and SSNB during the first 12 hours postoperatively, and adding axillary nerve block to SSNB enhanced the analgesic effect.
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Affiliation(s)
- Peng Su
- Department of Hand and Foot Surgery,
Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Yijia Liu
- Department of Orthopedic Surgery, West
China Hospital, Sichuan University, Chengdu, China
| | - Lu Zhang
- School of Finance, Qilu University of
Technology (Shandong Academy of Sciences), Jinan, China
| | - Long-bin Bai
- Department of Hand and Foot Surgery,
Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
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20
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Sadur A, Quan T, Nguyen C, Tabaie S. Metabolic Syndrome: Is Arthroscopic Rotator Cuff Repair Safe in This Patient Population? Cureus 2023; 15:e39299. [PMID: 37220568 PMCID: PMC10200266 DOI: 10.7759/cureus.39299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose Metabolic syndrome is associated with postoperative morbidity and mortality in surgical patients. With the increased use of arthroscopic techniques for rotator cuff repair (RCR), it is important to identify the impact this disorder has on surgical patients. The purpose of this study is to evaluate the clinical impact of metabolic syndrome on outcomes following arthroscopic RCR. Methods The 2006-2019 National Surgical Quality Improvement Program database was queried for adult patients who underwent arthroscopic RCR. Two patient groups were categorized: patients with metabolic syndrome and patients without metabolic syndrome. Demographics, comorbidities, and 30-day postoperative outcomes were compared using bivariate and multivariate analyses. Results Of 40,156 patients undergoing arthroscopic RCR, 36,391 did not have metabolic syndrome and 3,765 had metabolic syndrome. After adjusting for differences in baseline characteristics between the two groups, those with metabolic syndrome had an increased risk of developing renal complications and cardiac complications, as well as requiring hospital admission postoperatively and hospital readmission. Conclusion Metabolic syndrome is an independent risk factor for developing renal and cardiac complications, as well as requiring overnight hospital admission and hospital readmission. Providers should understand the need for preoperative evaluation and surveillance of these patients following their surgery to minimize the risk of poor outcomes.
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Affiliation(s)
- Alana Sadur
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Theodore Quan
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Chelsea Nguyen
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Sean Tabaie
- Orthopaedic Surgery, Children's National Hospital, Washington DC, USA
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21
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Potty AG, Potty ASR, Maffulli N, Blumenschein LA, Ganta D, Mistovich RJ, Fuentes M, Denard PJ, Sethi PM, Shah AA, Gupta A. Approaching Artificial Intelligence in Orthopaedics: Predictive Analytics and Machine Learning to Prognosticate Arthroscopic Rotator Cuff Surgical Outcomes. J Clin Med 2023; 12:jcm12062369. [PMID: 36983368 PMCID: PMC10056706 DOI: 10.3390/jcm12062369] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Machine learning (ML) has not yet been used to identify factors predictive for post-operative functional outcomes following arthroscopic rotator cuff repair (ARCR). We propose a novel algorithm to predict ARCR outcomes using machine learning. This is a retrospective cohort study from a prospectively collected database. Data were collected from the Surgical Outcome System Global Registry (Arthrex, Naples, FL, USA). Pre-operative and 3-month, 6-month, and 12-month post-operative American Shoulder and Elbow Surgeons (ASES) scores were collected and used to develop a ML model. Pre-operative factors including demography, comorbidities, cuff tear, tissue quality, and fixation implants were fed to the ML model. The algorithm then produced an expected post-operative ASES score for each patient. The ML-produced scores were compared to actual scores using standard test-train machine learning principles. Overall, 631 patients who underwent shoulder arthroscopy from January 2011 to March 2020 met inclusion criteria for final analysis. A substantial number of the test dataset predictions using the XGBoost algorithm were within the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds: 67% of the 12-month post-operative predictions were within MCID, while 84% were within SCB. Pre-operative ASES score, pre-operative pain score, body mass index (BMI), age, and tendon quality were the most important features in predicting patient recovery as identified using Shapley additive explanations (SHAP). In conclusion, the proposed novel machine learning algorithm can use pre-operative factors to predict post-operative ASES scores accurately. This can further supplement pre-operative counselling, planning, and resource allocation. Level of Evidence: III.
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Affiliation(s)
- Anish G Potty
- South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
- The Institute of Musculoskeletal Excellence (TIME Orthopaedics), Laredo, TX 78041, USA
- School of Osteopathic Medicine, The University of the Incarnate Word, San Antonio, TX 78209, USA
| | - Ajish S R Potty
- South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, 84084 Fisciano, Italy
- San Giovanni di Dio e Ruggi D'Aragona Hospital "Clinica Ortopedica" Department, Hospital of Salerno, 84124 Salerno, Italy
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent ST5 5BG, UK
| | - Lucas A Blumenschein
- Department of Orthopaedics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Deepak Ganta
- School of Engineering, Texas A&M International University, Laredo, TX 78041, USA
| | - R Justin Mistovich
- Department of Orthopaedics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Mario Fuentes
- School of Engineering, Texas A&M International University, Laredo, TX 78041, USA
| | | | - Paul M Sethi
- Orthopaedic & Neurosurgery Specialists, Greenwich, CT 06905, USA
| | - Anup A Shah
- Kelsey-Seybold Clinic, Houston, TX 77584, USA
| | - Ashim Gupta
- South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
- Future Biologics, Lawrenceville, GA 30043, USA
- BioIntegrate, Lawrenceville, GA 30043, USA
- Regenerative Orthopaedics, Noida 201301, Uttar Pradesh, India
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22
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Feng S, Li H, Zhong Y, Xie Y, Chen J, Chen Y, Chen S. Functional and Structural Outcomes After Arthroscopic Rotator Cuff Repair With or Without Preoperative Corticosteroid Injections. Am J Sports Med 2023; 51:733-742. [PMID: 36734466 DOI: 10.1177/03635465221145949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Corticosteroid injections (CSIs) are effective in alleviating pain in patients with rotator cuff tears, but controversy still exists regarding their potential adverse effects on clinical outcomes after rotator cuff repair. PURPOSE To compare both the functional and the structural outcomes in patients who underwent arthroscopic rotator cuff repair with or without preoperative CSIs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective cohort study was carried out among patients who underwent arthroscopic rotator cuff repair for partial- and full-thickness tears between 2015 and 2019. The patients who received preoperative CSIs were included in the CSI group and compared with a group without preoperative CSIs (non-CSI group), matched at a ratio of 1:2 based on tear size, age, and follow-up time. Both functional evaluation and structural assessments using magnetic resonance imaging (MRI) were performed at the final follow-up. Clinical outcomes-including retear rate as the primary outcome; pain; functional scores including the Constant-Murley score, American Shoulder and Elbow Surgeons score, and Fudan University Shoulder Score; range of motion (ROM); tendon integrity; tendon healing type; and cartilage thickness-were compared between the 2 groups with a statistical significance of P < .05 and power of 0.9. RESULTS Thirty-one patients were included in the CSI group, and 62 were included in the non-CSI group. After a mean 3-year follow-up, the 2 groups demonstrated no significant differences in retear rate; visual analog scale for pain; shoulder functional scores; and active ROM including forward flexion, abduction, external rotation, and internal rotation. No significant differences were observed on postoperative MRI scans of the rotator cuff tendon (tendon integrity, healing type, residual tendon attachment area, etc), cartilage thickness, and muscle atrophy. CONCLUSION No significant differences were found at a mean 3-year follow-up in the retear rates, pain, ROM, and glenohumeral structure on postoperative MRI scans after arthroscopic rotator cuff repair with or without preoperative CSIs.
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Affiliation(s)
- Sijia Feng
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Huizhu Li
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuting Zhong
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuxue Xie
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuzhou Chen
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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23
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Hackett L, Ting RS, Lam PH, Murrell GAC. A Systematic Temporal Assessment of Changes in Tendon Stiffness Following Rotator Cuff Repair. J Ultrasound Med 2023. [PMID: 36851879 DOI: 10.1002/jum.16201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/29/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES How the material properties of the human supraspinatus tendon change following arthroscopic rotator cuff repair is undetermined. Shear wave elastography ultrasound is a relatively new, noninvasive measure of tissue stiffness. We aimed to evaluate any temporal changes in stiffness and/or thickness of supraspinatus tendons in humans following primary arthroscopic rotator cuff repair. METHODS Shear wave elastography was performed at three predetermined regions by a single sonographer at 1-, 6-, 12-, 24-, and 52 weeks postoperatively in 50 consecutive single-row inverted mattress primary arthroscopic rotator cuff repairs. One-way ANOVA with Tukey's correction and Spearman's correlation tests was performed. RESULTS Of 50 patients, two retore by 1-week and were excluded. Two patients retore at 6 weeks, two at 12 weeks, and one at 24 weeks. The mean tendon stiffness in 48 patients at the tendon footprint increased by 21% (1.32 m/s) at 6 months (P < .001), with the lateral tendon stiffening before the medial tendon. Tendon thickness decreased by 11% (0.6 mm) at 6 weeks (P = .008), then stabilized to 24 weeks. Tendons that were less elastographically stiff at 1 week were more likely to be thinner at 6-weeks (r = .38, P = .010). CONCLUSIONS The data supports the hypothesis that rotator cuff tendons repaired using the single-row inverted-mattress technique take 6 weeks to heal to bone. Unlike in other tendons, there was no hypertrophic healing response. Prior to 6 weeks, the tendon may stretch/thin-out, particularly if its material properties, as assessed by shear wave elastography, are inferior. The material properties of the tendon improved at the tendon insertion site first, then medially out to 12 months post-repair.
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Affiliation(s)
- Lisa Hackett
- University of New South Wales, Sydney, New South Wales, Australia
| | - Ryan S Ting
- University of New South Wales, Sydney, New South Wales, Australia
| | - Patrick H Lam
- University of New South Wales, Sydney, New South Wales, Australia
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24
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Luthringer TA, Kane LT, Vaughn AK, Reddy YC, Lazarus MD, Namdari S. Work Related Outcomes of Revision Rotator Cuff Repair for Patients Receiving Workers' Compensation. J Shoulder Elbow Surg 2023:S1058-2746(23)00125-8. [PMID: 36849028 DOI: 10.1016/j.jse.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Workers' compensation (WC) patients are susceptible to poorer outcomes following primary rotator cuff repair (RCR). Failure of structural healing can explain some poor results and outcomes of revision RCR in this population are unknown. METHODS Retrospective review of subjects receiving WC who underwent arthroscopic revision RCR with or without dermal allograft augmentation at a single institution between January 2010 and April 2021. Preoperative MRI scans were assessed for rotator cuff tear characteristics, Sugaya classification, and Goutallier grade. Postoperative imaging was not routinely obtained unless for continued symptoms or re-injury. Primary outcome measures included return-to-work status, reoperation, American Shoulder and Elbow Surgeons (ASES) and Single Alpha Numeric Evaluation (SANE) scores. RESULTS Twenty-seven shoulders (25 patients) were included. The population was 84% male, mean age of 54, 67% manual laborers, 11% sedentary workers, and 22% with a mixed profession. Average follow-up was 35.4 months. Fifteen patients (56%) returned to work at full duty status. Six (22%) returned to work with permanent restrictions. Six (22%) were unable to return to work in any capacity. Thirty percent of all patients and 35% of manual laborers changed occupation following revision RCR. Mean time to return-to-work was 6.7 months. Overall, symptomatic rotator cuff retear was found in 13 patients (48%). Reoperation rate after revision RCR was 37% (10 cases). Among patients who did not undergo reoperation, mean ASES scores improved from 37.8 to 69.4 at final follow-up (p<0.001). Mean SANE scores only improved marginally from 51.6 to 57.0 (p=0.61). No statistically significant correlation was found between preoperative MRI findings and outcome measures. CONCLUSION Workers' compensation patients demonstrated fair improvements in outcomes scores after revision RCR. While some patients are able to return to full duty, nearly half were either unable to return or returned with permanent restrictions. This data is helpful for surgeons when counseling patients about expectations and return to work after revision RCR in this challenging population.
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25
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Tokgöz MA, Elma T, Yapar A, Özer M, Ataoğlu MB, Kanatli U. Does the presence of arthroscopically detected stage 1-2 glenohumeral osteoarthritis have any clinical impact on the outcome of arthroscopic rotator cuff repairs? Turk J Med Sci 2023; 53:218-224. [PMID: 36945963 PMCID: PMC10387902 DOI: 10.55730/1300-0144.5576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 10/10/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND : Rotator cuff rupture (RCR) and glenohumeral osteoarthritis (GHO) are two common disorders of the shoulder joint. However, there are very few reports that examine the relationship between them. This study aimed to present at least two years' clinical results of arthroscopic rotator cuff repair of full-thickness and massive tears accompanied by arthroscopically detected early-stage osteoarthritis. METHODS From August 2016 to December 2017, three hundred and twenty patients with total or massive rotator cuff tears were evaluated retrospectively. Thirty-five patients who were determined as stage 1 and 2 according to the Outerbridge scale for cartilage lesions were found appropriate for investigation. Patients were assessed using the University of California Los Angeles (UCLA) score, and a visual analog scale (VAS) score before surgery and at the final follow-up. The American Shoulder and Elbow Surgeons (ASES) shoulder score was used to evaluate the final outcomes and compare the UCLA shoulder scores. RESULTS The UCLA scores increased from the preoperative value of 19.1 ± 3.2 to 29.8 ± 4.8 at the last follow-up and increased by an average of 10.7 ± 6.0 (p < 0.001). The median VAS score decreased from the preoperative value of 3.0 to 1.0 (p < 0.001). Besides, the mean ASES score was found as 80.2 ± 10.6. An excellent positive correlation was found between postoperative UCLA scores and ASES scores (r = 0.887; p < 0.001). DISCUSSION To the best of our knowledge, this is one of the first arthroscopic comparative studies about the effect of early glenohumeral osteoarthritis on clinical outcomes after rotator cuff tear treatment. Finding good and excellent results up to 71% after RCR repair in patients with early-stage osteoarthritis was an indication that arthroscopic repair could be planned as the first-line treatment option for RCR pathologies in patients with early-stage degenerative arthritis without considering the rerupture rate.
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Affiliation(s)
- Mehmet Ali Tokgöz
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Tarık Elma
- Department of Orthopaedics and Traumatology, Private Medline Adana Hospital, Adana, Turkey
| | - Aliekber Yapar
- Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mustafa Özer
- Department of Orthopaedics and Traumatology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Muhammet Baybars Ataoğlu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ulunay Kanatli
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
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26
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Guo AA, Hackett L, Murrell GAC. Stiffness and arthroscopic rotator cuff repair: a literature review. Ann Jt 2023; 8:7. [PMID: 38529245 PMCID: PMC10929314 DOI: 10.21037/aoj-22-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 12/01/2022] [Indexed: 03/27/2024]
Abstract
Background and Objective Tendon retear is the most common complication following rotator cuff repair surgery. Understanding the factors that are associated with greater risks of retear is important so surgeons can provide accurate prognostic information to patients. Advanced age and larger tear size have been shown to be associated with greater risk of retear at 6 months using multiple logistic regression analysis. Stiffness is the second most common complication, however recent evidence suggests that early postoperative stiffness may be associated with a more robust healing response. Thus, this paper aims to critically review the independent predictors of retear in rotator cuff repair patients. Methods Literature review was conducted using electronic databases from their dates of inception. Key Content and Findings There are multiple factors that affect rotator cuff repair integrity detailed in the literature. Tear size appeared to be the most important predictor of retear following rotator cuff repair. Postoperative stiffness at 6 and 12 weeks after surgery appears to be a factor associated with more intact repairs at 6 months. Shoulder stiffness tends to resolve within 6 months following the operation. This protective effect persists up to 5 years postoperatively. Conclusions Shoulder stiffness may be an important protective factor against rotator cuff retear which requires further investigation from future studies. It is important to determine the relative importance of stiffness when compared to known important factors such as tear size with regards to its effect on rotator cuff repair integrity.
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Affiliation(s)
- Allen A Guo
- Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, Australia
| | - Lisa Hackett
- Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, Australia
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27
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Routledge JC, Saber AY, Pennington N, Gupta N. Re-Tear Rates Following Rotator Cuff Repair Surgery. Cureus 2023; 15:e34426. [PMID: 36874651 PMCID: PMC9981227 DOI: 10.7759/cureus.34426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/02/2023] Open
Abstract
Aim Re-tears following rotator cuff repair surgery are a common occurrence. Previous studies have identified several factors that have been shown to increase the risk of re-tears. The purpose of this study was to evaluate the rate of re-tear following primary rotator cuff repair and to identify the factors that may contribute to this rate. Method The authors performed a retrospective review, looking at rotator cuff repair surgeries performed between May 2017 and July 2019 performed in a hospital by three specialist surgeons. All methods of repair were included. All patients' medical data, including imaging and operation records, were reviewed. Results A total of 148 patients were identified. Ninety-three males and 55 females with a mean age of 58 years (range 33-79 years). Thirty-four patients (23%) had post-operative imaging with either magnetic resonance imaging or ultrasound, where it was found that 20 (14%) had a confirmed re-tear. Of these patients, nine went on to have further repair surgery. The average age of the re-tear patients was 59 (age range 39-73) and 55% were female. The majority of the re-tears were from chronic rotator cuff injuries. This paper did not identify any correlation between smoking status or diabetes mellitus and re-tear rates. Conclusions This study indicates that re-tear after rotator cuff repair surgery is a common complication. The majority of studies find increasing age to be the biggest risk factor; however, this was not the case in our study which found females in their 50s to have the highest rate of re-tear. Additional research is required to understand what factors can contribute towards rotator cuff re-rupture rates.
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Affiliation(s)
- Jamie C Routledge
- Trauma and Orthopedics, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, GBR
| | - Ahmed Y Saber
- Trauma and Orthopedics, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, GBR
| | - Neil Pennington
- Trauma and Orthopedics, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, GBR
| | - Neha Gupta
- Plastic Surgery, Pinderfields Hospital, Wakefield, GBR
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Zhu R, Jiang H, Xu W, Shen L, Jin G. Impact of intra-articular injection with tranexamic acid on total blood loss and postoperative pain after arthroscopic rotator cuff repair surgery. Front Surg 2023; 10:1052039. [PMID: 36911608 PMCID: PMC9995381 DOI: 10.3389/fsurg.2023.1052039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Objectives To evaluate the impact of intra-articular injection with tranexamic acid (TXA) on total blood loss (TBL) and postoperative pain after arthroscopic rotator cuff repair (ARCR). Methods This study retrospectively included patients with full-thickness rotator cuff tears who underwent shoulder ARCR surgery in Taizhou hospital, China, between January 2018 and December 2020. Patients received 10 ml (100 mg/ml) of intra-articular TXA injection (TXA group) or 10 ml of normal saline (non-TXA group) after the incision was sutured. The primary variable was the type of drug injected into the shoulder joint at the end of the operation. The primary outcome were perioperative TBL and postoperative pain [measured by visual analog scale (VAS)]. The secondary outcomes were differences in red blood cell count, hemoglobin count, hematocrit, platelet count. Results A total of 162 patients were included, 83 patients in TXA group and 79 patients in non-TXA group. Notably, patients in TXA group were more likely to have lower TBL volume [261.21 (175.13-506.67) ml vs. 382.41 (236.11-593.31), P = 0.025], and postoperative VAS score ≤ 2 within 24 h (P = 0.031) compared with those in non-TXA group. In addition, the median hemoglobin count difference was significantly lower in TXA group than that of in non-TXA group (P = 0.045), while, the differences in median counts of red blood cell, hematocrit, and platelet between the two groups were comparable (all P > 0.05). Conclusion Intra-articular injection of TXA might reduce the TBL and degree of postoperative pain within 24 h after shoulder arthroscopy.
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Affiliation(s)
- Rangteng Zhu
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Hantao Jiang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Wei Xu
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Liping Shen
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Gang Jin
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
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Zhang L, Zhu Y, Xu T, Fu W. Bone marrow stimulation in arthroscopic rotator cuff repair is a cost-effective and straightforward technique to reduce retear rates: A systematic review and meta-analysis. Front Surg 2023; 10:1047483. [PMID: 36896263 PMCID: PMC9989271 DOI: 10.3389/fsurg.2023.1047483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Abstract
Background Bone marrow stimulation (BMS) has been considered a well-established method for treating knee and ankle osteochondral lesions. Some studies have also shown that BMS can promote healing of the repaired tendon and enhance biomechanical properties during rotator cuff repair. Our purpose was to compare the clinical outcomes of arthroscopic repair rotator cuff (ARCR) with and without BMS. Methods A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, Embase, Web of Science, Google scholar, ScienceDirect, and the Cochrane Library were searched from inception to March 20, 2022. Data on retear rates, shoulder functional outcomes, visual analog score and range of motion were pooled and analyzed. Dichotomous variables were presented as odds ratios (OR), and continuous variables were presented as mean differences (MD). Meta-analyses were conducted with Review Manager 5.3. Results Eight studies involving 674 patients were included, with mean follow-up period ranging from 12 to 36.8 months. Compared to ARCR alone, the intraoperative combination of the BMS resulted in lower retear rates (P < 0.0001), but showed similar results in Constant score (P = 0.10), University of California at Los Angeles (UCLA) score (P = 0.57), American Shoulder and Elbow Surgeons (ASES) score (P = 0.23), Disabilities of the Arm, Shoulder and Hand (DASH) score (P = 0.31), VAS (visual analog score) score (P = 0.34), and range of motion (ROM) (forward flexion, P = 0.42; external rotation, P = 0.21). After sensitivity analyses and subgroup analyses, no significant changes in statistical results were observed. Conclusion Compared to ARCR alone, the combination of intraoperative BMS can significantly reduce the retear rates, but showed similar short-term results in functional outcomes, ROM and pain. Better clinical outcomes are anticipated in the BMS group by improving structural integrity during long-term follow-up. Currently, BMS may be a viable option in ARCR based on its straightforward and cost-effective advantages. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022323379.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yanlin Zhu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Tianhao Xu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Lu Y, Labott JR, Salmons Iv HI, Gross BD, Barlow JD, Sanchez-Sotelo J, Camp CL. Identifying modifiable and nonmodifiable cost drivers of ambulatory rotator cuff repair: a machine learning analysis. J Shoulder Elbow Surg 2022; 31:2262-2273. [PMID: 35562029 DOI: 10.1016/j.jse.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/25/2022] [Accepted: 04/09/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Implementing novel tools that identify contributors to the cost of orthopedic procedures can help hospitals maximize efficiency, minimize waste, improve surgical decision-making, and practice value-based care. The purpose of this study was to develop and internally validate a machine learning algorithm to identify key drivers of total charges after ambulatory arthroscopic rotator cuff repair and compare its performance with a state-of-the-art statistical learning model. METHODS A retrospective review of the New York State Ambulatory Surgery and Services Database was performed to identify patients who underwent elective outpatient rotator cuff repair (RCR) from 2015 to 2016. Initial models were constructed using patient characteristics (age, gender, insurance status, patient income, Elixhauser Comorbidity Index) as well as intraoperative variables (concomitant procedures and services, operative time). These were subsequently entered into 5 separate machine learning algorithms and a generalized additive model using natural splines. Global variable importance and partial dependence curves were constructed to identify the greatest contributors to cost. RESULTS A total of 33,976 patients undergoing ambulatory RCR were included. Median total charges after ambulatory RCR were $16,017 (interquartile range: $11,009-$22,510). The ensemble model outperformed the generalized additive model and demonstrated the best performance on internal validation (root mean squared error: $7112, 95% confidence interval: 7036-7188; logarithmic root mean squared error: 0.354, 95% confidence interval: 0.336-0.373, R2: 0.53), and identified major drivers of total charges after RCR as increasing operating room time, patient income level, number of anchors used, use of local infiltration anesthesia/peripheral nerve blocks, non-White race/ethnicity, and concurrent distal clavicle excision. The model was integrated into a web-based open-access application capable of providing individual predictions and explanations on a case-by-case basis. CONCLUSION This study developed an ensemble supervised machine learning algorithm that outperformed a sophisticated statistical learning model in predicting total charges after ambulatory RCR. Important contributors to total charges included operating room time, duration of care, number of anchors used, type of anesthesia, concomitant distal clavicle excision, community characteristics, and patient demographic factors. Generation of a patient-specific payment schedule based on the Agency for Healthcare Research and Quality risk of mortality highlighted the financial risk assumed by physicians in flat episodic reimbursement schedules given variable patient comorbidities and the importance of an accurate prediction algorithm to appropriately reward high-value care at low costs.
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Affiliation(s)
- Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joshua R Labott
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Shen W, Wang W, Xue Y, Shi J, Pu Z, Gao Q. Comparative effectiveness of different platelet-rich plasma for arthroscopic rotator cuff repair: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e31260. [PMID: 36281097 PMCID: PMC9592368 DOI: 10.1097/md.0000000000031260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Rotator cuff tears are one of the most common injuries of the shoulder joint in adults. Arthroscopic rotator cuff repair (ARCR) has become the gold standard for the treatment of rotator cuff injuries, but it still has a high rate of retear. Platelet-rich plasma (PRP) has been widely used as an adjunct to ARCR. However, the comparative efficacy of different PRP for ARCR remain unclear. In order to evaluate the relative efficacy of PRP for individuals with ARCR, we will conduct a systematic review and network meta-analysis of randomized controlled trials. METHODS A systematic literature search will be conducted in Embase, PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Chinese Biomedical Literature Database will be searched up to October 2022. The primary outcome will focus on the retear rate at the last follow-up. The secondary outcomes include the Visual Analogue Scale for postoperative pain and functional capacity scores. The risk of bias for individual studies will be assessed according to the revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0). Data analysis will be performed using R 4.1.2. Publication bias will be examined using comparison-adjusted funnel plots and Egger's test using STATA 15.0. The quality of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS The results of this study will be submitted to a peer-reviewed journal for publication. CONCLUSIONS The review will compare the efficacy of different PRP for patients with ARCR. The result of the study will provide evidence-based medical evidence for ARCR with PRP augmentation.
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Affiliation(s)
- Weiwei Shen
- Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, China
| | - Wei Wang
- Department of Orthopedics, The Third People’s Hospital, Baiyin, China
| | - Yun Xue
- Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, China
| | - Jie Shi
- Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, China
| | - Zhongshu Pu
- Department of Infection Control, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, China
| | - Qiuming Gao
- Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, China
- * Correspondence: Qiuming Gao, Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, Gansu Province 730050, China (e-mail: )
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Nicholson AD, Estrada JA, Mathew JI, Finocchiaro A, Pinnamaneni S, Okeke L, Dines DM, Dines JS, Taylor SA, Warren RF, Cordasco FA, Rodeo SA, Gulotta LV. Minimum 15-year follow-up for clinical outcomes of arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2022; 31:1696-1703. [PMID: 35158066 DOI: 10.1016/j.jse.2022.01.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/22/2021] [Accepted: 01/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Arthroscopic rotator cuff repair surgery is one of the most common shoulder procedures performed in the United States. Although several studies have shown considerable symptomatic relief in the short term following surgery, a relatively high rate of recurrent defects has led surgeons to question the long-term durability of this operation. We hypothesized that outcomes at a minimum of 15 years of follow-up in patients who underwent all-arthroscopic rotator cuff repair would be maintained and would remain significantly improved compared with the preoperative status. METHODS All-arthroscopic rotator cuff repairs were performed in 193 patients from 2003 to 2005. Patient-reported outcomes were collected preoperatively and at 1, 2, 5, and ≥15 years postoperatively. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. Secondary outcomes included Single Assessment Numeric Evaluation (SANE), Shoulder Activity Scale (SAS), visual analog scale, and Patient-Reported Outcomes Measurement Information System (PROMIS)-Upper Extremity (UE) scores. Patient demographic characteristics, revision surgical procedures, and complications were recorded. Generalized estimating equations were used to model scores over time, and multiple comparisons between time points were performed using Tukey adjustment. RESULTS This study included 60 patients with a mean follow-up period of 16.5 years (range, 15.8-17.7 years). The mean ASES score improved from 60.2 ± 18.8 preoperatively to 93.0 ± 9.4 at ≥15 years (P < .0001). The mean visual analog scale pain score decreased from 4.1 ± 0.7 preoperatively to 0.7 ± 0.3 at ≥15 years (P < .0001). The average SANE, SAS, and PROMIS-UE scores at ≥15 years were 87.8 ± 14.8, 8.8 ± 4.3, and 49.6 ± 10.2, respectively. Of 60 patients, 7 underwent revision surgery. Older age and female sex were associated with lower SAS scores at 15 years, whereas female sex was associated with lower PROMIS-UE scores. There were no factors predictive of ASES or SANE scores. CONCLUSION At long-term follow-up (≥15 years), the patient-reported outcomes of all-arthroscopic rotator cuff repair show significant improvement from baseline preoperative function and remain durable over a period of 15 years. This information is useful in counseling patients regarding the long-term results of this procedure.
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Kim JY, Zhong Z, Lee HW, Lee GW, Noh KC. Quantitative Magnetic Resonance Imaging measurement of muscle atrophy and fatty degeneration after arthroscopic rotator cuff repair. J Orthop Surg (Hong Kong) 2022; 30:10225536221095276. [PMID: 35775586 DOI: 10.1177/10225536221095276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It is unclear whether muscle atrophy (MA) and fatty degeneration (FD) have improved after arthroscopic rotator cuff repair (ARCR). Therefore, the objective of this study was to perform quantitative magnetic resonance imaging (MRI) measurement to evaluate MA and FD before and after surgery. Correlations of clinical outcome with changes in MA and FD were also analyzed. MATERIALS AND METHODS From March 2013 to March 2017, 40 patients who had no re-tear up to 1 year after ARCR were enrolled. MA and FD of supraspinatus muscle before surgery, at 3 days after surgery, and at 1 year after surgery were measured quantitatively in conventional Y-view and supraspinatus origin-view (SOV). Measurement items were muscle area (mm2), occupation ratio (%), fatty infiltration (FI, %), and fatty degenerative area (mm2). Postoperative clinical outcomes were measured at 1 year after ARCR. Correlation between measure values and outcome scores were analyzed. RESULTS Inter-measurement reliability was high (ICC = 0.933, Cronbach-α = 0.963). There was no significant change in MA in conventional Y-view at 1 year after surgery (Occupation ratio, p = 0.2770; MA, p = 0.3049) or in SOV (MA, p = 0.5953). FI and fat area measured with the conventional method on Y-view and showed significant differences (p = 0.0001). However, FI and fat area measured with the modified method on Y-view and SOV showed no significant difference (all p > 0.05). Postoperative clinical outcomes showed significant improvement compared to preoperative ones (p = 0.0001). However, there was no significant correlation between FD and FA (p = 0.653). CONCLUSION Quantitative MRI measurement was shown to be a reliable and valid method. MA and FD do not improve after ARCR considering postoperative anatomical changes of supraspinatus at 1-year follow-up. FD of the supraspinatus in conventional Y-view, but not in SOV, showed a significant change at 1 year postoperatively. MA showed no significant improvement. There was no correlation between improvement in clinical scores and changes in FD and MA.
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Affiliation(s)
- Jung Youn Kim
- Department of Orthopaedic Surgery, 65521Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Zhuan Zhong
- Department of Sports Medicine and Arthroscopy, Orthopedic Center, The 2nd Hospital, 154454Jilin Universtiy, Changchun, China
| | - Ho Won Lee
- Department of Orthopaedic Surgery, 65521Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Geun Woo Lee
- Department of Orthopaedic Surgery, 65521Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Kyu-Cheol Noh
- Department of Orthopaedic Surgery, 65521Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
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Mackenzie SP, Spasojevic M, Smith M, Mattern O, Piggott RP, Patel SS, Bedaiwy N, Cass B, Young A. The effect of single-dose, preoperative intravenous tranexamic acid on early postoperative pain scores after rotator cuff repair: a double-blind, randomized controlled trial. J Shoulder Elbow Surg 2022; 31:1399-1408. [PMID: 35346849 DOI: 10.1016/j.jse.2022.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/30/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is commonly used in upper and lower limb arthroplasty to limit blood loss and postoperative hematoma formation. The role of TXA in rotator cuff repair (RCR) surgery is less defined. This trial assessed the effect of preoperative TXA on early postoperative pain scores. METHODS A randomized double-blind trail was conducted in 89 patients undergoing RCR. Patients were randomized to either 2 g of intravenous TXA or placebo at induction. The primary outcome was visual analog scale (VAS)-pain score at day 3 postoperation, with secondary outcomes including VAS-pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Constant scores at 2, 8, 24, and 52 weeks. RESULTS There was no significant difference in VAS-pain scores between groups at day 3 postoperation. Pain scores were significantly better in the TXA group at 8 weeks. There was no difference between groups at any time point in the ASES or Constant score. The TXA group had improved motion at 6 months with a reduced rate of secondary adhesive capsulitis. CONCLUSION TXA did not improve postoperative pain scores after RCR, however, patients who received the intervention demonstrated greater range of motion at 6 months with lower rates of secondary adhesive capsulitis.
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Affiliation(s)
| | - Miloš Spasojevic
- Sydney Shoulder Research Institute, St Leonards, NSW, Australia.
| | - Margaret Smith
- Institute of Bone and Joint Research (University of Sydney) at Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Owen Mattern
- Sydney Shoulder Research Institute, St Leonards, NSW, Australia
| | | | - Shaan S Patel
- Sydney Shoulder Research Institute, St Leonards, NSW, Australia
| | - Najla Bedaiwy
- Sydney Shoulder Research Institute, St Leonards, NSW, Australia
| | - Benjamin Cass
- Sydney Shoulder Research Institute, St Leonards, NSW, Australia
| | - Allan Young
- Sydney Shoulder Research Institute, St Leonards, NSW, Australia
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Abstract
BACKGROUND Rotator cuff tears represent a significant cause of shoulder pain and dysfunction in the United States. The development of these injuries is associated with older patient age and higher levels of physical activity; however, data regarding the rate of return to work after arthroscopic rotator cuff repair in patients older than 50 years of age who have physically strenuous jobs is inconclusive. PURPOSE/HYPOTHESIS The purpose of this study was to report short term outcomes and return to work rates after arthroscopic rotator cuff repair in a cohort of patients aged 50 to 60 years working in manual labor jobs. It was hypothesized that arthroscopic rotator cuff repair would result in good functional outcomes for these patients and allow for return to work rates in excess of 80%. STUDY DESIGN Case series; Level of evidence, 4. METHODS Preoperative and final evaluations including the pain visual analog scale (VAS), the Single Assessment Numeric Evaluation (SANE), and the American Shoulder and Elbow Surgeons (ASES) Shoulder Score were collected. A total of 73 patients were screened for inclusion. Nineteen patients were outside of the inclusion age range, 2 underwent exclusionary concomitant procedures, and 4 patients were lost to follow up, leaving a total of 48 patients with a mean follow up of 34.02 months (range, 24-67 months) available for analysis. None of the patients were involved in a workers' compensation claim. Subgroup analysis was performed to determine if arm dominance or tear size affected surgical outcomes or return to work rates. RESULTS After arthroscopic rotator cuff repair, 43 of 48 patients (89.6%) were able to return to manual labor positions. Tears were classified using the Southern California Orthopaedic Institute Classification at the time of repair as massive (C4) in 9 patients (18.75%), large (C3) in 13 patients (27.08%), medium (C2) in 21 patients (43.75%), and small (C1) in 5 patients (10.42%). At latest follow up, the mean VAS decreased from 8.0 ± 1.81 to 0.46 ± 1.20, the average SANE increased from 47.50 ± 18.59 to 91.88 ± 12.30, and the average ASES score improved from 39.58 ± 10.71 to 93.44 ± 11.97 (P < .0001). Outcomes did not differ between patients who underwent surgery on their dominant shoulder and those who underwent surgery on their nondominant shoulder. The overall postoperative complication rate was 8.33%. CONCLUSION Arthroscopic rotator cuff repair portended favorable outcomes and high rates of return to work in this cohort of manual laborers, with 89.6% of patients able to return to work.
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Affiliation(s)
- Clare K Green
- George Washington University School of Medicine, Washington, DC
| | - John P Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - John C Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Rachel S Rosner
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA.,Department of Orthopaedic Surgery, Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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Candela V, Aimino R, Mezzaqui L, Standoli JP, Gumina S. Macroscopic aspects of glenohumeral synovitis are related to rotator cuff tear severity. J Shoulder Elbow Surg 2022; 31:1055-1061. [PMID: 34871731 DOI: 10.1016/j.jse.2021.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/23/2021] [Accepted: 10/30/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The microscopic pattern of inflammatory mediators associated with rotator cuff pathology is well documented; however, little is known regarding the contemporary presence of macroscopic inflammatory joint involvement. Our aim was to investigate shoulder synovitis in a large group of patients with different sized rotator cuff tears (RCTs) and to correlate the degree of macroscopic inflammatory changes of the glenohumeral joint with RCT severity. MATERIALS AND METHODS A total of 296 consecutive patients (169 F, 127 M; mean age ± standard deviation: 60.75 ± 7.91) submitted to arthroscopic RCT repair were enrolled. RCT was classified intraoperatively. Glenohumeral synovitis was investigated according to 4 parameters (Davis classification 2017: capsule color, villous projections, capillaries, and axillary recess). A total score was calculated, and a 3-grade severity scale was introduced. Statistics was performed. RESULTS Intraclass correlation coefficient (ICC) results show good to excellent reliability: capsule color (ICC: 0.95; 95% confidence interval [CI]: 0.89-0.99), villous projections (ICC: 0.90; 95% CI: 0.85-0.95), capillaries (ICC: 0.91; 95% CI: 0.86-0.95), and axillary recess (ICC: 0.55; 95% CI: 0.80-0.89).The synovitis total score was found to be 1.47 ± 1.16, 2.86 ± 1.84, and 3.99 ± 1.64 in patients with type I, II, and III RCTs, respectively. A significant difference was found between groups (P < .001). The prevalence of all the examined parameters was found to be significantly different between the different sized RCT groups (capsule color: P < .001; villous projections: P < .001; capillaries: P < .001; and axillary recess: P < .001). According to a 3-grade severity scale, the prevalence of absent, mild, and severe glenohumeral synovitis significantly differed between the RCT severity groups (P < .001). CONCLUSIONS The present study demonstrated that synovitis is a constant finding of rotator cuff pathology; it is present in 75% of patients with RCTs and correlates with tear severity. Whether synovitis is the cause or effect of RCT is still questionable. Further studies are also needed to better understand its role as a pain generator, as documented in other diseases.
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Affiliation(s)
- Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy; Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy.
| | - Rossana Aimino
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy; Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Lorenzo Mezzaqui
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy; Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Jacopo Preziosi Standoli
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy; Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
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Randelli PS, Cucchi D, Fossati C, Boerci L, Nocerino E, Ambrogi F, Menon A. Arthroscopic Rotator Cuff Repair Augmentation With Autologous Microfragmented Lipoaspirate Tissue Is Safe and Effectively Improves Short-term Clinical and Functional Results: A Prospective Randomized Controlled Trial With 24-Month Follow-up. Am J Sports Med 2022; 50:1344-1357. [PMID: 35302901 DOI: 10.1177/03635465221083324] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autologous microfragmented lipoaspirate tissue has been recently introduced in orthopaedics as an easily available source of nonexpanded adipose-derived mesenchymal stem cells. Autologous microfragmented lipoaspirate tissue is expected to create a suitable microenvironment for tendon repair and regeneration. Rotator cuff tears show a high incidence of rerupture and represent an ideal target for nonexpanded mesenchymal stem cells. PURPOSE To evaluate the safety and efficacy of autologous lipoaspirate tissue in arthroscopic rotator cuff repair. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Consecutive patients referring to the investigation center for surgical treatment of magnetic resonance imaging-confirmed degenerative posterosuperior rotator cuff tears were assessed for eligibility. Those who were included were randomized to receive a single-row arthroscopic rotator cuff repair, followed by intraoperative injection of autologous microfragmented adipose tissue processed with an enzyme-free technology (treatment group) or not (control group). Clinical follow-up was conducted at 3, 6, 12, 18, and 24 months; at 18 months after surgery, magnetic resonance imaging of the operated shoulder was obtained to assess tendon integrity and rerupture rate. RESULTS An overall 177 patients were screened, and 44 (22 per group) completed the 24-month follow-up. A statistically significant difference in favor of the treatment group in terms of Constant-Murley score emerged at the primary endpoint at 6-month follow-up (mean ± SD; control group, 76.66 ± 10.77 points; treatment group, 82.78 ± 7.00 points; P = .0050). No significant differences in clinical outcome measures were encountered at any of the other follow-up points. No significant differences emerged between the groups in terms of rerupture rate, complication rate, and number of adverse events. CONCLUSION This prospective randomized controlled trial demonstrated that the intraoperative injection of autologous microfragmented adipose tissue is safe and effective in improving short-term clinical and functional results after single-row arthroscopic rotator cuff repair. REGISTRATION NCT02783352 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Pietro S Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Milan, Italy.,REsearch Center for Adult and Pediatric Rheumatic Diseases, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Davide Cucchi
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Chiara Fossati
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Milan, Italy
| | - Linda Boerci
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Milan, Italy
| | - Elisabetta Nocerino
- Department of Diagnostic and Interventional Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccaro," Università degli Studi di Milano, Milan, Italy
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Ozcamdalli M, Eken G, Misir A, Oguzkaya S, Uzun E. The effect of watching shoulder ROM changes on functional outcome and quality of life following arthroscopic rotator cuff repair. J Orthop Surg (Hong Kong) 2022; 30:23094990211069693. [PMID: 35086382 DOI: 10.1177/23094990211069693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeThis study aimed to evaluate the effectiveness of watching video records of their shoulder motion changes on functional outcomes and quality of life after arthroscopic rotator cuff repair (ARCR). Methods The patients were divided into two groups. In Group 1, video records of pre- and postoperative shoulder motions were recorded and showed. In Group 2, no video was showed to the patients. In Group 1, the first postoperative evaluation was done before video watching, and the second evaluation was done just after watching video records. In Group 2, the first and second postoperative measurements were performed with 10-20 days interval. The Constant Murley score (CS), the American Shoulder and Elbow Surgeons score (ASES), the Short-Form 36 (SF-36) score, and active shoulder range of motion (ROM) values were used as an outcome tool. Results A total of 196 patients (Group 1; 76 patients and Group 2; 120 patients) with a mean age of 62.06 ± 7.17 years were included. There was a significant improvement in postoperative scores of SF-36 subscales (except emotional well-being and energy/fatigue), ASES, CM scores, and joint ROM values when compared to preoperative values for both groups (p < .001). The first postoperative outcomes were similar between groups (p > .05). In the second postoperative evaluation, emotional role functioning, energy/fatigue, emotional well-being, health change subscales of SF-36, and ASES scores were significantly higher in Group 1 compared with Group 2 (p < .05). Conclusion When patients watch the pre- and postoperative video records of their shoulder ROM after ARCR, patients' satisfaction and well-being perception increase in the short-term despite unchanged shoulder ROM.
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Affiliation(s)
- Mustafa Ozcamdalli
- Department of Orthopaedics and Traumatology, 317030Basaksehir Pine and Sakura City Hospital, Istanbul, Turkey
| | - Gokay Eken
- Department of Orthopaedics and Traumatology, 147020Uludag University Faculty of Medicine, Bursa, Turkey
| | - Abdulhamit Misir
- Department of Orthopaedics and Traumatology, 317030Basaksehir Pine and Sakura City Hospital, Istanbul, Turkey
| | - Sinan Oguzkaya
- Department of Orthopaedics and Traumatology, 472606Sarkisla State Hospital, Sivas, Turkey
| | - Erdal Uzun
- Department of Orthopaedics and Traumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
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Correia FD, Molinos M, Luís S, Carvalho D, Carvalho C, Costa P, Seabra R, Francisco G, Bento V, Lains J. Digitally Assisted Versus Conventional Home-Based Rehabilitation After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Am J Phys Med Rehabil 2022; 101:237-249. [PMID: 33935152 PMCID: PMC8826616 DOI: 10.1097/phm.0000000000001780] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical impact of a 12-wk home-based digitally assisted rehabilitation program after arthroscopic rotator cuff repair against conventional home-based rehabilitation. DESIGN The digital therapy group performed independent technology-assisted sessions complemented with 13 face-to-face sessions, and the conventional therapy group had conventional face-to-face physical therapy (30 sessions). Primary outcome was functional change between baseline and 12 wks, measured through the Constant-Murley score. Secondary outcomes were the change in the QuickDASH Scale and shoulder range of motion. RESULTS Fifty participants enrolled; 41 completed the 12-wk program (23 digital therapy group vs. 18 conventional therapy group), and 32 (15 vs. 17) were available for the 12-mo follow-up assessment. No differences were found between groups regarding study endpoints at the end of the 12-wk program. However, follow-up results revealed the superiority of the digital therapy group for QuickDASH (P = 0.043), as well as an interaction between time and group in the Constant-Murley score (P = 0.047) in favor of the digital therapy group. CONCLUSIONS The results demonstrate that digital therapeutics can be used to achieve similar, if not superior, short- and long-term outcomes as conventional approaches after arthroscopic rotator cuff repair, while being far less human resource intensive than conventional care.Level of evidence: II.
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Lawrence RL, Ruder MC, Zauel R, Jalics A, Olszewski AM, Diefenbach BJ, Moutzouros V, Makhni EC, Muh S, Bey MJ. In Vivo Static Retraction and Dynamic Elongation of Rotator Cuff Repair Tissue After Surgical Repair: A Preliminary Analysis at 3 Months. Orthop J Sports Med 2022; 10:23259671221084294. [PMID: 35387360 PMCID: PMC8978322 DOI: 10.1177/23259671221084294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Rotator cuff repair is a common orthopaedic procedure that provides pain relief for many patients, but unfortunately, an estimated 20% to 70% of repair procedures will fail. Previous research has shown that elongation (ie, retraction) of a repaired tendon is common even in patients with a repair construct that appears intact on magnetic resonance imaging. However, it is unknown how this repair tissue functions under dynamic conditions. Purpose: To quantify static retraction and maximum dynamic elongation of repair tissue after rotator cuff repair. Study Design: Case series; Level of evidence, 4. Methods: Data from 9 patients were analyzed for this study. During surgery, a 3.1-mm tantalum bead was sutured to the supraspinatus tendon, medial to the repair site. Glenohumeral kinematics were assessed at 1 week (static) and 3 months (static and during scapular-plane abduction) after surgery using a biplanar videoradiographic system. The 3-dimensional position of the bead was calculated relative to the tendon’s insertion on the humerus (ie, bead-to-insertion distance). Static retraction was calculated as the change in the bead-to-insertion distance under static conditions between 1 week and 3 months after surgery, and maximum dynamic elongation was calculated as the maximal positive change in the bead-to-insertion distance during dynamic motion relative to the start of motion. The magnitudes of static retraction and maximum dynamic elongation were assessed with 1-sample t tests. Results: At 3 months after surgery, static retraction occurred in all patients by a mean of 10.0 ± 9.1 mm (P = .01 compared with no elongation). During scapular-plane abduction, maximum dynamic elongation averaged 1.4 ± 1.0 mm (P < .01 compared with no elongation). Descriptively, dynamic elongation consistently took 1 of 2 forms: an initial increase in the bead-to-insertion distance (mean, 2.0 ± 0.6 mm) before decreasing until the end of motion or an immediate and substantial decrease in the bead-to-insertion distance at the onset of motion. Conclusion: Repair tissue elongation (static retraction and maximum dynamic elongation) appeared to be a common and significant finding at 3 months after arthroscopic rotator cuff repair. Dynamic elongation of repair tissue during scapular-plane abduction exhibited 1 of 2 distinct patterns, which may suggest different patterns of supraspinatus mechanical and neuromuscular function.
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Affiliation(s)
| | - Matthew C Ruder
- Bone & Joint Center, Henry Ford Health System, Detroit, Michigan, USA
| | - Roger Zauel
- Bone & Joint Center, Henry Ford Health System, Detroit, Michigan, USA
| | - Alena Jalics
- Bone & Joint Center, Henry Ford Health System, Detroit, Michigan, USA
| | - Adam M Olszewski
- Bone & Joint Center, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Stephanie Muh
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Michael J Bey
- Bone & Joint Center, Henry Ford Health System, Detroit, Michigan, USA
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Plachel F, Jo OI, Rüttershoff K, Andronic O, Ernstbrunner L. A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs. Am J Sports Med 2022:3635465211073332. [PMID: 35179393 DOI: 10.1177/03635465211073332] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic rotator cuff repair (aRCR) has shown similar midterm functional results and retear rates as open/mini-open rotator cuff repair (oRCR). A pooled analysis of long-term results of both techniques is yet missing. PURPOSE To evaluate the long-term results of aRCR and oRCR for full-thickness rotator cuff tears. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The CENTRAL (Cochrane), MEDLINE (PubMed), and Embase databases were searched for studies that reported on long-term clinical and radiographic outcomes of full-thickness aRCR and oRCR with a minimum follow-up of 9 years. RESULTS Eleven studies were included: 5 studies on aRCR and 6 studies on oRCR. Studies were based on 550 shoulders (539 patients) with a mean patient age of 56.3 years (range, 25-77). After a mean follow-up of 14.0 years (range, 9-20), the mean preoperative absolute Constant score (CS) and American Shoulder and Elbow Surgeons (ASES) shoulder score were significantly improved postoperatively (CS, 44 to 78 points; ASES, 52% to 91%; both comparisons, P < .001). The retear rate was 41% (141 of 342 shoulders) without a significant difference between groups (aRCR, 43%; oRCR, 39%) (P = .364). A retear was associated with significantly reduced CS as compared with a healed repair (P = .004). No significant differences were found in postoperative functional scores, complications, and retear rates after failed cuff repairs between the arthroscopic and open/mini-open repair groups. CONCLUSION Pooled analysis of arthroscopic and open rotator cuff repairs demonstrated sustained improvement in long-term shoulder scores and pain with a substantial retear rate in both groups, which was associated with inferior shoulder function. There were no significant differences in long-term functional outcomes, retear rates, and complications. Both surgical techniques may be used on the basis of factors such as patient or surgeon preference and cost. Further studies using a more robust randomized controlled trial or larger cohort design are recommended to ascertain whether one surgical repair technique is superior to the other. REGISTRATION CRD42020180448 (PROSPERO).
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Affiliation(s)
- Fabian Plachel
- Charité-Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Olivia Imkyeong Jo
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Katja Rüttershoff
- Charité-Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Octavian Andronic
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.,Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia.,Melbourne Orthopaedic Group, Windsor, Victoria 3181, Australia
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Day Hazra RO, Ernat JJ, Rakowski DR, Boykin RE, Millett PJ. The Evolution of Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2021; 9:23259671211050899. [PMID: 34901288 PMCID: PMC8652190 DOI: 10.1177/23259671211050899] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023] Open
Abstract
Over the past 30 years, arthroscopic rotator cuff repair (ARCR) has evolved to become the gold standard in treating rotator cuff pathology. As procedural concepts of ARCR continue to improve, it is also continually compared with the open rotator cuff repair as the historical standard of care. This review highlights the evolution of ARCR, including a historical perspective; the anatomic, clinical, and surgical implications of the development of an arthroscopic approach; how arthroscopy improved some of the problems of the open approach; adaptations in techniques and technologies associated with ARCR; future perspectives in orthobiologics as they pertain to ARCR; and lastly, the clinical improvements, or lack of improvements, with all of these adaptations.
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Affiliation(s)
- Rony-Orijit Day Hazra
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Justin J Ernat
- Steadman Philippon Research Institute, Vail, Colorado, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | | | - Robert E Boykin
- Steadman Philippon Research Institute, Vail, Colorado, USA.,EmergeOrtho, Asheville, North Carolina, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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Chu J, Shieh JS, Wu K, Guan H, Roche S, Held MFG, Yang H, Guo JJ. Simultaneous or Staged Bilateral Arthroscopic Rotator Cuff Repair: An Observational Study of Intraoperative and Postoperative Outcomes. Orthop J Sports Med 2021; 9:23259671211041994. [PMID: 34708140 PMCID: PMC8543723 DOI: 10.1177/23259671211041994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Bilateral arthroscopic rotator cuff repair (ARCR) is frequently performed in
patients with symptomatic bilateral rotator cuff tears. Purpose: To compare patient-reported outcomes and mobility between simultaneous and
staged bilateral ARCR. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 51 patients who underwent simultaneous (anesthetized once) and
42 patients who underwent staged (anesthetized twice) bilateral ARCR between
January 2014 and January 2018; for the staged group, the interval between
procedures was at least 12 months. All operations were performed by the same
surgeon, and all patients had minimum 24-month follow up in both shoulders.
Patient-reported outcomes and range of motion (ROM) were assessed
preoperatively and postoperatively and compared between groups. Outcome
measures included the Constant-Murley score (CMS) and American Shoulder and
Elbow Surgeons (ASES) score as well as measures of psychological status,
health-related quality of life, activities of daily living (ADL), and
patient satisfaction with the state of one’s shoulders. Results: The mean follow-up times for the staged and simultaneous ARCR groups were
44.1 months (range, 36-60 months) and 37.5 months (range, 25-59 months),
respectively. There were no significant differences in age, tear size, or
fatty degeneration of rotator cuff muscles between the groups. The
cumulative length of hospital stay in the staged group was significantly
longer than in the simultaneous group (P < .001). At the
final follow-up, both groups showed significant improvement in ROM, CMS, and
ASES scores (P < .05). No significant differences
between the groups were observed in terms of ROM, CMS, and ASES scores
postoperatively. At 24 months postoperatively, psychological status and
health-related quality of life in both groups improved significantly
(P < .05), and there were no significant
between-group differences. Patients were able to perform most essential ADL.
Both groups had high patient satisfaction, but patient satisfaction for the
second shoulder of the staged group was lower than that of the simultaneous
group (P = .039). Conclusion: Simultaneous bilateral ARCR was shown to be effective, resulting in similar
improvements in clinical outcomes to staged bilateral ARCR at 2-year
follow-up. In addition to higher patient satisfaction, simultaneous
bilateral ARCR also had a shorter treatment cycle.
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Affiliation(s)
- Jiabao Chu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ju-Sheng Shieh
- Center for Health Policy and Management Studies, Nanjing University, China
| | - Kailun Wu
- Department of Orthopedics, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Huaqing Guan
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Stephen Roche
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Michael F G Held
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiong Jiong Guo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
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Tanaka S, Gotoh M, Tanaka K, Mitsui Y, Nakamura H, Ozono H, Okawa T, Shiba N. Functional and Structural Outcomes After Retears of Arthroscopically Repaired Large and Massive Rotator Cuff Tears. Orthop J Sports Med 2021; 9:23259671211035752. [PMID: 34631904 PMCID: PMC8493310 DOI: 10.1177/23259671211035752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/14/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Most studies have shown acceptable clinical results in patients with large or massive tears treated by arthroscopic rotator cuff repair (ARCR); however, the effects of retears after surgery in these patients remain unknown. Purpose: To evaluate functional and structural outcomes after retears of large and massive rotator cuff tears treated by ARCR. Study Design: Case series; Level of evidence, 4. Methods: A total of 196 consecutive patients with large to massive rotator cuff tears underwent physical examination and magnetic resonance imaging before and after ARCR at 6, 12, and 24 months. Of these, 9 patients were lost at 6 months after surgery. Therefore, 187 patients were followed up for 24 months after surgery; 148 patients showed no postsurgical ruptures. Consequently, the remaining 39 patients with postsurgical ruptures were included in this study (mean age at surgery, 64.2 ± 8.7 years). Functional outcome measures comprised the University of California, Los Angeles (UCLA) and Japanese Orthopaedic Association (JOA) scores. Structural outcome measures consisted of the global fatty degeneration index (GFDI), mediolateral tear size, and residual tendon attachment area as evaluated by our own scoring system. Results: The mean UCLA and JOA scores significantly improved from 16.3 ± 3.9 and 63.2 ± 10.7 preoperatively to 27.9 ± 5.5 (P < .0001) and 84.5 ± 9.4 (P < .0001) at final follow-up, respectively. The mean mediolateral tear size (P = .03, .02, and .02, respectively) and residual tendon attachment area (P = .04, .03, and .04, respectively) significantly improved from preoperatively to 6, 12, and 24 months postoperatively. The correlation analysis between the functional and structural variables confirmed significant associations between the residual tendon attachment area, the JOA and UCLA scores at 24 months postoperatively, and the preoperative GFDI (r = –0.81 to 0.78). Conclusion: The residual tendon attachment area after a retear was significantly larger at 24 months after surgery than before surgery. In addition, significant associations were confirmed between preoperative fatty degeneration, the residual tendon attachment area, and functional outcomes after a retear. These results may explain why functional outcomes significantly improved even after retears in this series.
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Affiliation(s)
- Suguru Tanaka
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Japan
| | - Koji Tanaka
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yasuhiro Mitsui
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hidehiro Nakamura
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hiroki Ozono
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Takahiro Okawa
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Japan
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
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Cancienne JM, Denard PJ, Garrigues GE, Werner BC. The Relationship of Staged, Bilateral Arthroscopic Primary Rotator Cuff Repair Timing and Postoperative Complications. Am J Sports Med 2021; 49:2027-2034. [PMID: 34081550 DOI: 10.1177/03635465211015198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although previous studies have reported acceptable clinical outcomes after simultaneous, single-stage bilateral and staged bilateral rotator cuff repair (RCR), few studies have been adequately powered to compare postoperative complication rates at various time intervals between procedures. PURPOSE To examine the relationship between the timing of bilateral arthroscopic RCR and complications. STUDY DESIGN Descriptive epidemiology study. METHODS Patients from the Medicare data set within the PearlDiver database who underwent bilateral RCR between 2005 and 2014 were identified. These patients were then stratified by time between surgeries into cohorts: (1) single stage, (2) <3 months, (3) 3 to 6 months, (4) 6 to 9 months, (5) 9 months to 1 year, and (6) 1 to 2 years. Surgical and medical complications of these cohorts were compared with those of a control cohort of patients who underwent bilateral RCR >2 years apart using a regression analysis. RESULTS A total of 11,079 patients who underwent bilateral RCR were identified. Patients who underwent single-stage bilateral arthroscopic RCR experienced higher rates of revision RCR (odds ratio [OR], 2.1; P < .0001), reverse total shoulder arthroplasty (RTSA) (OR, 2.47; P < .0001), and postoperative infection (OR, 2.18; P = .007) in addition to higher rates of venous thromboembolism (VTE) (OR, 1.78; P = .031) and emergency department visits (OR, 1.51; P = .002) compared with the control group. Patients who underwent bilateral RCR with a <3-month interval had higher rates of revision surgery (OR, 1.56; P = .003), RTSA (OR, 1.89; P = .002), and lysis of adhesions (OR, 2.31; P < .0001) in addition to increased rates of VTE (OR, 1.92; P = .015) and emergency department visits (OR, 1.62; P < .0001) compared with the control group. There were no differences in any surgical or medical complications when surgeries were staged by ≥3 months compared with controls. CONCLUSION Patients with Medicare undergoing single-stage and staged bilateral RCR who had the second repair within 3 months had significantly higher rates of multiple medical and surgical complications compared with patients waiting >2 years between procedures.
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Affiliation(s)
| | | | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
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Tokish JM, Hawkins RJ. Current concepts in the evolution of arthroscopic rotator cuff repair. JSES Rev Rep Tech 2021; 1:75-83. [PMID: 37588146 PMCID: PMC10426701 DOI: 10.1016/j.xrrt.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Arthroscopic rotator cuff repair has become one of the most common and successful surgeries performed in orthopedics. It represents the culmination of advances in many diverse fields such as optics, fluid dynamics, mechanical engineering, and most recently, orthobiologics. This article reviews the current state of the art of arthroscopic rotator cuff repair, through the lens of its historical context and evolution to our present understanding. We review the limitations in the current approach, and glance toward the future of rotator cuff regeneration with emerging technologies.
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Jeong HJ, Kim HS, Rhee SM, Oh JH. Risk factors for and prognosis of folded rotator cuff tears: a comparative study using propensity score matching. J Shoulder Elbow Surg 2021; 30:826-35. [PMID: 32707329 DOI: 10.1016/j.jse.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prognosis of rotator cuff repair (RCR) may be affected by the shape and quality of the torn rotator cuff tendon. However, only a few studies have reported on folded rotator cuff tears (FCTs). Therefore, this study aimed to evaluate the prognostic factors for FCT and clinical outcomes of FCT repair. METHODS Through propensity score matching (PSM), 200 (40 patients with FCTs and 160 controls) of 1927 patients who underwent RCR from 2010 to 2016 were included. The variables not used for PSM were compared. The anatomic and functional outcomes were assessed at the final follow-up (32.3 ± 21.2 months), and the related prognostic factors for FCTs were evaluated. RESULTS The risk factors for FCT were heel-type spur (odds ratio [OR], 11.6; P < .001) and delamination (OR, 2.3; P = .034). Although the functional scores at the final follow-up for both groups improved postoperatively and were not significantly different, the visual analog scale scores for pain (1.9 ± 2.1 vs. 1.2 ± 1.7, P = .034) and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores (83.1 ± 14.3 vs. 88.5 ± 12.2, P = .018) were significantly worse in the FCT group at 6 months postoperation. The retear rate was significantly higher in the FCT group (25.0 vs. 10.0%, P = .018). An FCT was a significant risk factor for retears (OR, 3.0; P = .015); however, a subgroup analysis revealed that the retear rate according to the management strategy for the folded portion (débridement of the folded portion vs. en masse repair including the folded portion) was not significantly different (26.7 vs. 24.0%, P > .99). CONCLUSION The risk factors for FCTs were heel-type spur and delamination. The retear rate was significantly higher for patients with FCTs. An FCT was indicative of poor quality of the remaining tendon; therefore, FCT may be a prognostic factor for worse functional outcomes during the early postoperative period and poor healing potential.
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Moriyama H, Gotoh M, Tanaka K, Mitsui Y, Nakamura H, Ozono H, Okawa T, Shiba N. Midterm Functional and Structural Outcomes of Large/Massive Cuff Tears Treated by Arthroscopic Partial Repair. Orthop J Sports Med 2021; 9:2325967120988795. [PMID: 34250157 PMCID: PMC8226377 DOI: 10.1177/2325967120988795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Previous studies have shown good clinical outcomes in patients with
irreparable large or massive rotator cuff tears treated using arthroscopic
partial repair (APR); however, few studies have evaluated both functional
and structural outcomes in these patients. Purpose: To evaluate both functional and structural outcomes in patients with large or
massive rotator cuff tears treated using APR. Study Design: Case series; Level of evidence, 4. Methods: Between March 2009 and November 2016, a total of 30 patients underwent APR
because of the irreparability of their large or massive rotator cuff tears
during surgery. Of these patients, 24 completed the minimum 24-month
follow-up (mean, 61.8 ± 27.1 months; range, 24-112 months) and were included
in this study. Functional outcome measures included the Japanese Orthopaedic
Association (JOA) and University of California Los Angeles (UCLA) scores and
the visual analog scale for pain. Structural outcome measures comprised
preoperative fatty degeneration, mediolateral tear size, residual tendon
attachment area, and glenohumeral (GH) arthritic changes evaluated on
magnetic resonance imaging scans or plain radiographs before and after
surgery. Functional and structural outcomes were evaluated preoperatively,
at 3 months postoperatively, and at the final follow-up. Results: The JOA scores for all patients significantly improved from 67.9 ± 11.3
preoperatively to 85.4 ± 15.6 postoperatively (P <
.0001). Similarly, the UCLA scores significantly improved from 15.8 ± 4.20
preoperatively to 29 ± 6.69 at final follow-up postoperatively
(P < .0001). The mediolateral tear size were
significantly decreased at 3 months postoperatively (P <
.001) and at the final follow-up (P < .001). Compared
with preoperative scores, the novel score evaluating the residual tendon
attachment area improved from 3.08 ± 0.46 to 3.54 ± 0.41 (P
< .001) after surgery overall, although it significantly deteriorated
from 3 months postoperatively to the final follow-up. GH osteoarthritis
progressed in 6 patients (25%). Patients who developed osteoarthritis had
lower JOA and UCLA scores than did those who did not (JOA,
P = .010; UCLA, P = .037). Conclusion: In irreparable large or massive rotator cuff tears treated using APR,
functional outcome improved after surgery. Although the residual tendon
attachment area improved, functional outcome after APR corresponded to the
GH alterations at the midterm follow-up. Longer-term follow-up is needed to
further elucidate the effect of APR on clinical outcomes in these
patients.
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Affiliation(s)
- Hiroaki Moriyama
- Department of Orthopedic Surgery, Kurume University, Kurume, Fukuoka, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Koji Tanaka
- Department of Orthopedic Surgery, Kurume University, Kurume, Fukuoka, Japan
| | - Yashuhiro Mitsui
- Department of Orthopedic Surgery, Kurume University, Kurume, Fukuoka, Japan
| | - Hidehiro Nakamura
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Hiroki Ozono
- Department of Orthopedic Surgery, Kurume University, Kurume, Fukuoka, Japan
| | - Takahiro Okawa
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University, Kurume, Fukuoka, Japan
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Ma L, Xu Y, Xu X, Pan Q, Xu Y. Application of biomimetic double-layer biofilm stent in arthroscopic rotator cuff repair: A protocol of randomized controlled trial. Medicine (Baltimore) 2021; 100:e23960. [PMID: 33429756 PMCID: PMC7793376 DOI: 10.1097/md.0000000000023960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Rotator cuff injury is the most common cause of shoulder dysfunction. Despite the continuous advancement of surgical techniques, the incidence of re-tearing after rotator cuff repair is still high. The main reason is that it is difficult to reconstruct the normal tendon bone interface and the process is slow, and the application of tissue engineering technology can promote tendon and bone healing. This study will evaluate the effect of the bionic double membrane stent on the rotator cuff healing after arthroscopic rotator cuff repair. METHODS This is a prospective randomized controlled trial to study the effect of biomimetic double-layer biofilm stent on rotator cuff healing. Approved by the clinical research ethics committee of our hospital. The patients were randomly divided into 1 of 2 treatment options: (A) a biomimetic double-layer biofilm stent group and (B) a non-bionic dual-layer biofilm stent group. Observation indicators include: visual analog scale score, University of California Los Angeles score, American Shoulder & Elbow Surgeons score and Constant-Murley score. Data were analyzed using the statistical software package SPSS version 16.0 (Chicago, IL). DISCUSSION This study will evaluate and evaluate the effect of the bionic double-layer membrane stent on the rotator cuff healing after arthroscopic rotator cuff repair. The results of this experiment will provide new treatment ideas for promoting rotator cuff tendon bone healing. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/FWKD6.
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Burns KA, Robbins LM, LeMarr AR, Childress AL, Morton DJ, Wilson ML. Healing rates after rotator cuff repair for patients taking either celecoxib or placebo: a double-blind randomized controlled trial. JSES Int 2020; 5:247-253. [PMID: 33681844 PMCID: PMC7910746 DOI: 10.1016/j.jseint.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Use of anti-inflammatory medications (NSAIDs) is an important component of multimodal pain control after orthopedic procedures to avoid opioid overutilization and abuse. However, the deleterious effects of NSAIDs on tendon healing are of particular concern in rotator cuff repair (RCR). The purpose of this study was to evaluate the effect of celecoxib or placebo on healing rates after RCR when administered in the perioperative and immediate postoperative period using MRI evaluation at one year postoperatively. A secondary aim was to determine whether clinical differences existed between patients with intact or non-intact repairs. Methods Patients aged ≤65 years with partial- or full-thickness rotator cuff tear (<25x25 mm) were randomized to receive celecoxib 400 mg or placebo 1 hour before the procedure and 200mg bid for 3 weeks postoperatively. All patients were treated as clinically indicated at the time of surgery and followed standard postoperative protocol. Repair integrity was evaluated with MRI using the Sugaya classification for repair integrity. Data were analyzed using multivariable logistic regression by intent to treat. Results Seventy-nine patients were enrolled; 21 were lost to follow-up, 6 did not have cuff repair, 5 were revised, and 2 declined follow-up, leaving 45 patients with one-year follow-up. Five of these patients did not complete MRI, leaving 40 patients for review. Eighteen of 20 patients (90%) who received celecoxib completed all doses of study medication as did 15 of 20 patients (75%) who received placebo. The patient groups were similar for demographics, clinical results, and healing rate. After adjusting for tear size, no statistically significant difference in healing rate was found between groups, with 10 of 20 celecoxib patients (50%) having intact repair at 1 year compared with 14 of 20 placebo patients (70%) (OR = 0.53, 95% CI: 0.14, 2.08, P = 0.35). Conclusion Half of the patients who received celecoxib had an intact repair compared with 70% intact repair for patients receiving placebo. Although not statistically significant in this small study, larger studies are needed to clarify this important clinical concern. The authors do not recommend use of celecoxib for postoperative pain control after RCR.
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Affiliation(s)
- Katherine A Burns
- SSM Health Orthopedics, SSM Health DePaul Hospital, St. Louis, MO, USA
| | - Lynn M Robbins
- SSM Health Orthopedics, SSM Health DePaul Hospital, St. Louis, MO, USA
| | - Angela R LeMarr
- SSM Health Orthopedics, SSM Health DePaul Hospital, St. Louis, MO, USA
| | - Amber L Childress
- SSM Health Orthopedics, SSM Health DePaul Hospital, St. Louis, MO, USA
| | - Diane J Morton
- SSM Health Orthopedics, SSM Health DePaul Hospital, St. Louis, MO, USA
| | - Melissa L Wilson
- University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA, USA
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