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Xu L, Lou F, Jiang H. Effect of mini-open rotator cuff repair combined with intraoperative cocktail therapy in the treatment of rotator cuff injury: a prospective comparative study between the cocktail therapy and the control group. Arch Orthop Trauma Surg 2025; 145:246. [PMID: 40244435 DOI: 10.1007/s00402-025-05872-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Accepted: 04/08/2025] [Indexed: 04/18/2025]
Abstract
INTRODUCTION To investigate the clinical effect of mini-open rotator cuff repair combined with intraoperative cocktail therapy in the treatment of rotator cuff injury. METHODS A prospective comparative study of 78 patients with rotator cuff injury who underwent mini-open rotator cuff repair in our hospital from January 2020 to January 2022 and used block randomization to divide patients into 2 groups in this trial: The cocktail group received 150 mg ropivacaine, 40 mg of methylprednisolone succinate, 0.3 mg of epinephrine, and saline solution to a total of 100 mL, whereas the control group received 100mL of saline solution. The drug mixtures were injected into the glenohumeral joint, subacromial bursa, and anterior, middle, and posterior parts of the deltoid muscle. The patients' visual analog scale (VAS) scores preoperatively were recorded at 6, 12, 24, and 48 h postoperatively. We also recorded the Constant-Murley function scores and passive abduction angles of the operation shoulder at two weeks, one, three and six months postoperatively. We also compared the number of patients using postoperative celecoxib capsules and receiving parecoxib sodium injections; the number of patients experiencing nausea; the patients with infection; the course of disease and the tear size. RESULTS The cocktail group constituted 39 shoulders (50.0%), with 16 men (41.0%) and 23 women (59.0%); the mean age was 58.71 ± 6.39 years; the mean BMI was 24.25 ± 4.50 kg/m 2. The control group constituted 39 shoulders (50.0%), with 18 men (46.2%) and 21 women (53.8%); the mean age was 59.71 ± 10.78 years; the mean BMI was 23.25 ± 3.73 kg/m 2. We found no significant difference in sex, age and BMI between the 2 groups (P = 0.647, P = 0.620, P = 0.289). The VAS scores at 6, 12, 24 and 48 h postoperatively were significantly lower in the cocktail group (P = 0.023, P = 0.036, P = 0.014, P = 0.017). The number of patients receiving celecoxib capsules and parecoxib sodium injections tended to be lower in the cocktail group, and the difference was significant (P = 0.001, P = 0.001). There was no significant difference in the incidence of nausea(P = 0.617), infection, the course of disease(P = 0.182) and the tear size (P = 0.649)between the two groups. The Constant-Murley functional score and passive abduction angle of the operation shoulder were significantly improved in all patients after surgery, and there was no statistical difference in the functional score and active abduction angle of the operation shoulder between the two groups preoperatively (P = 0.430, P = 0.183) and at three(P = 0.468, P = 0.832) and six months postoperatively(P = 0.110, P = 0.381). However, at two weeks (P = 0.001, P = 0.001) and one month postoperatively (P = 0.001, P = 0.001), the Constant-Murley functional score and the passive abduction angle of the operation shoulder in the cocktail group were significantly higher than those in the control group. CONCLUSIONS The mini-open rotator cuff repair has satisfactory curative effect in the treatment of rotator cuff injury, and intraoperative cocktail therapy can alleviate postoperative pain and speed up postoperative functional rehabilitation and improvement of joint range of motion. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Libin Xu
- Department of Orthopedics, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, NO. 366 TaiHu Road, Taizhou, Jiangsu Province, 225300, China.
| | - Fangyong Lou
- Department of Orthopedics, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, NO. 366 TaiHu Road, Taizhou, Jiangsu Province, 225300, China
| | - Haitao Jiang
- Department of Orthopedics, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, NO. 366 TaiHu Road, Taizhou, Jiangsu Province, 225300, China
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Shitara H, Ichinose T, Sasaki T, Hamano N, Kamiyama M, Miyamoto R, Ino F, Nakase K, Honda A, Yamamoto A, Takagishi K, Chikuda H. Preoperative Nutrition Impacts Retear Rate After Arthroscopic Rotator Cuff Repair. J Bone Joint Surg Am 2024; 106:2111-2118. [PMID: 39213337 DOI: 10.2106/jbjs.23.01189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND A rotator cuff retear following arthroscopic rotator cuff repair (ARCR) is a concern in older patients. However, only a few of its risk factors are amenable to preoperative intervention. We aimed to elucidate the relationship between preoperative nutritional status and rotator cuff retears after ARCR. METHODS This single-center retrospective study included patients aged ≥65 years with rotator cuff tears who underwent ARCR. The Geriatric Nutritional Risk Index (GNRI) was used to assess preoperative nutritional status. Data collection encompassed patient demographics, clinical assessments, and surgical specifics. Patients were divided into healed and retear groups based on 2-year post-ARCR magnetic resonance imaging results. Logistic regression analysis was conducted to adjust for confounding factors and detect independent risk factors for retears. The GNRI cutoff value for retear prediction was determined by a stratum-specific likelihood ratio; clinical outcomes were compared based on the cutoff values obtained. RESULTS Overall, 143 patients were included. The retear rate was 20.3%. The albumin level, GNRI, postoperative shoulder strength of abduction and external rotation, and postoperative Japanese Orthopaedic Association and Constant scores in the retear group were significantly lower than those in the healed group. The logistic regression analysis showed that low risk of morbidity and mortality (compared with no risk) based on the GNRI (odds ratio [OR], 3.39) and medial-lateral tear size per mm (OR = 1.10) were independent risk factors for a retear 2 years after ARCR. Stratum-specific likelihood ratio analysis identified data-driven strata as GNRI < 103, 103 ≤ GNRI < 109, and GNRI ≥ 109. Univariate analysis showed that patients with GNRI < 103 had a significantly higher retear risk than those with 103 ≤ GNRI < 109 and those with GNRI ≥ 109. Logistic regression analysis showed that GNRI < 103 compared with 103 ≤ GNRI < 109 (OR = 3.88) and GNRI < 103 compared with GNRI ≥ 109 (OR = 5.62), along with the medial-lateral tear size per mm (OR = 1.10), were independent risk factors for a retear at 2 years after ARCR. CONCLUSIONS When assessing the risk of a retear after ARCR, GNRI ≥ 103 may indicate good preoperative nutritional status. However, more data are essential to ascertain the importance of this finding. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Daga S, Baid M, Sarkar P, Das A, Hemant Shah R, Dhandapani K. Rotator Cuff Repair by All-Arthroscopic Versus Mini-Open Technique: A Comparison of Clinical and Functional Outcome. Cureus 2024; 16:e71546. [PMID: 39544574 PMCID: PMC11563191 DOI: 10.7759/cureus.71546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2024] [Indexed: 11/17/2024] Open
Abstract
BACKGROUND Rotator cuff tears can lead to debilitating shoulder function and impairment. Rotator cuff repair aims to eliminate pain and improve function with increased shoulder strength and range of motion. This study evaluated the differences between all-arthroscopic (AA) and mini-open (MO) repair procedures for rotator cuff tendon tears regarding clinical and functional outcomes. METHODS This was a prospective study conducted at a tertiary care government Hospital in Kolkata, India, between March 2015 and September 2016 which evaluated 25 patients who had undergone all-arthroscopic surgery and 25 patients who underwent mini-open repair (total of 50 patients) for rotator cuff tear with a minimum one-year follow-up. The UCLA score was used to assess the functional outcome of these patients. RESULTS The mean age of all patients included in this study was 45.32 years. 86% of patients were male. The two groups had similar demographic characteristics, pre-operative baseline parameters, and intra-op findings. The average UCLA score showed significant improvement from 13.92 pre-operatively to 29.76 at the final follow-up. The patients in the all-arthroscopic surgery group experienced a notable decrease in pain within the first three months compared to the mini-open group. However, at the time of the final follow-up, no significant difference was noted between both groups when comparing the University of California at Los Angeles (UCLA) score, Visual Analogue Scale (VAS) score for pain, and active or passive glenohumeral motion. CONCLUSION The outcomes of all-arthroscopic and mini-open rotator cuff repair surgery are equivocal in terms of both clinical and functional results, with no significant difference in post-operative pain, shoulder joint strength range of motion, or patient satisfaction over the long term.
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Affiliation(s)
- Saurabh Daga
- Orthopaedics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR
| | - Mahak Baid
- Orthopaedics and Traumatology, Aneurin Bevan University Health Board, Newport, GBR
| | - Pushpal Sarkar
- Orthopaedics, Swansea Bay University Health Board, Swansea, GBR
| | - Ayon Das
- Orthopaedics, Employees' State Insurance (ESI) Post Graduate Institutes for Medical Sciences and Research (PGIMSR) Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Joka, Kolkata, IND
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Jithesh K, Meleppuram JJ, Raju A, Nair AV, Mundakkal A, Thankappan A, Thammanassery PK, Khan PS. All-arthroscopic versus mini-open double row rotator cuff repair - A prospective randomised control study based on functional and radiological outcomes. J Orthop 2024; 51:27-31. [PMID: 38299061 PMCID: PMC10825916 DOI: 10.1016/j.jor.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 02/02/2024] Open
Abstract
Purpose In an era where arthroscopic rotator cuff repair is dominant in the United States (77.9 % preference) compared to open surgery (53.33 %), a shift towards minimally invasive All-Arthroscopic (AA) techniques over classical Mini-Open (MO) repair is emerging. This study explores current trends in shoulder procedures in India and compares functional outcomes and radiological repair integrity between AA and MO techniques, which are understudied in the Indian context. Methodology In this prospective study, 60 patients (30 in the AA group and 30 in the MO group) with rotator cuff tears underwent assessment. Pre/post-operative clinical evaluations and 12-month follow-ups using UCLA and Oxford Shoulder Score, along with preoperative MRI and postoperative USG, were conducted. Results At one-year follow-up, the AA group showed better functional outcomes (53.3 % excellent/good vs. 30.0 % in MO). No significant radiological differences (Sugaya grading) were found. Tear size was comparable with no association with functional/radiological outcomes. Conclusion The AA group demonstrated favourable functional outcomes, matched to MO group findings, which is in accordance with global studies. Despite higher costs, the increasing popularity of AA in India is justified by enhanced results and reduced postoperative discomfort.
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Affiliation(s)
- K. Jithesh
- Department of Orthopedics, Aster MIMS, Calicut, 673016, Kerala, India
| | | | - Aebel Raju
- Department of Orthopaedics, Apollo Adlux Hospital, Angamali, Kochi, Kerala, 683576, India
| | - Ayyappan V. Nair
- Department of Orthopaedics, Manipal Whitefield Hospital, Bangalore, Karnataka, 560066, India
| | - Arun Mundakkal
- Department of Orthopedics, Aster MIMS, Calicut, 673016, Kerala, India
| | - Ajayakumar Thankappan
- Department of Orthopaedics, Apollo Adlux Hospital, Angamali, Kochi, Kerala, 683576, India
| | | | - Prince Shanavas Khan
- Department of Orthopaedics, Apollo Adlux Hospital, Angamali, Kochi, Kerala, 683576, India
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Bae GC, Kwon WH, Na Y, Hwang YJ, Ryu DJ, D’Lima DD, Jeon YS. Clinical Outcomes and Repair Integrity After Double-Row Modified Mason-Allen Repair Technique With a Single Knot in Small to Medium Supraspinatus Tears. Orthop J Sports Med 2024; 12:23259671241246768. [PMID: 38665386 PMCID: PMC11044770 DOI: 10.1177/23259671241246768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/05/2023] [Indexed: 04/28/2024] Open
Abstract
Background Various arthroscopic rotator cuff repair techniques are being used for the treatment of rotator cuff tears with the development of surgical instruments. However, retears after repair are not completely avoidable, and efforts to reduce retears remain a challenge. Purpose/Hypothesis To introduce a new repair technique, the double-row modified Mason-Allen technique with a single knot, and to compare clinical outcomes and retear rates with the single-row modified Mason-Allen technique. It was hypothesized that this new technique would have a better clinical outcome and significantly lower retear rate than the single-row modified Mason-Allen technique. Study Design Cohort study; Level of evidence, 3. Methods A total of 110 patients with small- to medium-sized (<1.5 cm) full-thickness supraspinatus tears were enrolled into 2 groups, with 65 patients receiving the single-row modified Mason-Allen technique (group A) and 45 patients receiving the double-row modified Mason-Allen technique with a single knot (group B). The clinical and functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score; Disabilities of the Arm, Shoulder and Hand (DASH) score; and visual analog scale (VAS) for pain and satisfaction scores. All patients enrolled in this study were monitored for a minimum of 24 months. Magnetic resonance imaging was performed to analyze the integrity of tendons and retear at 6 months after surgery. Results No statistically significant differences between the 2 groups were found regarding the VAS for pain, ASES, and DASH scores. However, retear was found in 9 patients (13.8%) in group A and 1 patient (2.2%) in group B. The difference in the retear rate was statistically significant between the 2 groups (P = .037). Conclusion A significantly lower retear rate and comparable clinical outcomes were seen after the double-row modified Mason-Allen repair technique with a single knot when compared with the single-row modified Mason-Allen technique. Based on these findings, the double-row modified Mason-Allen repair technique with a single knot can be considered a surgical treatment option that can provide sufficient stability in small- to medium-sized supraspinatus tears.
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Affiliation(s)
- Gi Cheol Bae
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Won Hwan Kwon
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Yeop Na
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Yoon Joong Hwang
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Dong Jin Ryu
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Darryl D. D’Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - Yoon Sang Jeon
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
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Migliorini F, Maffulli N, Eschweiler J, Schenker H, Tingart M, Betsch M. Arthroscopic versus mini-open rotator cuff repair: A meta-analysis. Surgeon 2023; 21:e1-e12. [PMID: 34961701 DOI: 10.1016/j.surge.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 10/22/2021] [Accepted: 11/05/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND An all-arthroscopic rotator cuff repair (ASR) may result in less postoperative pain and better functional outcomes than the mini-open (MOR) approach. This meta-analysis provides an updated assessment of the current literature which compares the clinical outcomes of mini-open versus all arthroscopic rotator cuff repair techniques. MATERIAL AND METHODS The main online databases were accessed in October 2021. All the trials directly comparing primary ASR versus MOR for rotator cuff rupture were accessed. Studies concerning revision settings were not eligible, nor where those combining the surgical procedures with other adjuvants. RESULTS A total of 21 articles were retrieved. Data from 1644 procedures (ASR = 995, MOR = 649) were collected. The mean follow-up was 26.7 (6.0-56.4) months. Comparability was found between ASR and MOR groups at baseline with regards to age (P = 0.3), gender (P = 0.7) and mean duration of the follow-up (P = 0.7). No difference was found between ASR and MOR with regard to surgical duration (P = 0.05), Constant score (P = 0.2), University of California at Los Angeles Shoulder (P = 0.3), American Shoulder and Elbow Surgeons Shoulder (P = 0.5), VAS (P = 0.2), forward flexion (P = 0.3), abduction (P = 0.3), external rotation (P = 0.2), internal rotation (P = 0.7), re-tear (P = 0.9), adhesive capsulitis (P = 0.5). CONCLUSION Arthroscopic and mini-open rotator cuff repair result in similar clinical outcomes. Male gender and older age lead to greater rates of rotator cuff re-tears, while longer surgical duration was associated with a greater rate of adhesive capsulitis.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi 84081, SA, Italy; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England, UK; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, UK.
| | - Joerg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Hanno Schenker
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Markus Tingart
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of the University Heidelberg, Mannheim, Germany.
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Sivasubramanian H, Chua CXK, Manohara R, Ng DZ, Poh KS, Kumar VP. Optimum follow-up period of arthroscopic and mini-open rotator cuff repairs. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:315-317. [PMID: 35658157 DOI: 10.47102/annals-acadmedsg.2020474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Harish Sivasubramanian
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, Singapore
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Better Short-Term Outcomes After Rotator Cuff Repair in Studies With Poorer Mean Shoulder Scores and Predominantly Small to Medium-Sized Tears at Baseline: A Systematic Review and Meta-analysis. Arthroscopy 2022; 38:967-979.e4. [PMID: 34450217 DOI: 10.1016/j.arthro.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a meta-analysis to explore factors associated with clinical and structural short-term outcomes in randomized and nonrandomized prospective studies of rotator cuff repair. METHODS Medline, clinicaltrials.gov, and Mendeley were searched for literature published from January 2000 to December 2020 to identify randomized controlled trials (RCT) and nonrandomized prospective cohort studies (PCS) describing the outcome of surgical repair of full-thickness rotator cuff tears. Study quality was assessed by two independent reviewers. We calculated standardized mean difference (SMD) from baseline to follow-up in each trial arm, preferably at 12 months follow-up. Between-study heterogeneity of outcomes, small-study effects and rates of retear were assessed. Meta-regression was performed to estimate associations between prespecified variables and clinical and structural outcomes. RESULTS Outcomes in 64 RCT and 19 PCS trial arms were analyzed. Median age was 59 years. There was substantial between-study heterogeneity in clinical outcomes (SMD range: .42 to 6.44; I2 = 93% in RCT, 88% in PCS) and summary estimates were not calculated. On the basis of multivariate analysis, better clinical outcome was associated with lower (worse) mean outcome value at baseline, smaller tear size, and lower proportion of large-massive tears (R2 = 56 and 44%, respectively). Overall retear rate at median 13-month follow-up was 19.9% (interquartile range: 10-30). Higher mean age together with larger tear size and higher proportion of large-massive tears were associated with increased retear rates (R2 = 33% and 58%, respectively). Clinical outcome was not significantly related to rate of retear. CONCLUSIONS Studies with lower mean outcome values at baseline and predominantly small- to medium-sized tears reported better clinical outcomes. Studies with higher mean age and a predominance of large-massive tears had significantly increased retear rates, but retear rates were not associated with clinical outcome. LEVEL OF EVIDENCE Level II, meta-analysis of level I and II studies.
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Wang W, Kang H, Li H, Li J, Meng Y, Li P. Comparative efficacy of 5 suture configurations for arthroscopic rotator cuff tear repair: a network meta-analysis. J Orthop Surg Res 2021; 16:714. [PMID: 34895286 PMCID: PMC8665484 DOI: 10.1186/s13018-021-02847-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rotator cuff tear is one of the most common complaint with shoulder pain, disability, or dysfunction. So far, different arthroscopic techniques including single row (SR), double row (DR), modified Mason-Allen (MMA), suture bridge (SB) and transosseous (TO) have been identified to repair rotator cuff. However, no study has reported the comparative efficacy of these 5 suture configurations. The overall aim of this network meta-analysis was to analyze the clinical outcomes and healing rate with arthroscopy among SR, DR, MMA, SB and TO. METHODS A systematic literature was searched from PubMed, EBSCO-MEDLINE, Web of Science, google scholar and www.dayi100.com , and checked for the inclusion and exclusion standards. The network meta-analysis was conducted using Review Manager 5.3 and SATA 15.0 software. RESULTS Thirty-four studies were eligible for inclusion, including 15 randomized controlled trials, 17 retrospective and 2 prospective cohort studies, with total 3250 shoulders. Two individual reviewers evaluated the quality of the 34 studies, the score form 5 and 9 of 10 were attained according to the Newcastle-Ottawa Scale for the 17 retrospective and 2 prospective studies. There was no significant distinction for the Constant score among 5 groups in the 16 studies with 1381 shoulders. The treatment strategies were ranked as MMA, DR, SB, SR and TO. In ASES score, 14 studies included 1464 shoulders showed that no significant differences was showed among all 5 groups after surgery. Whereas the efficacy probability was TO, MMA, DR, SB and SR according to the cumulative ranking curve. The healing rate in 25 studies include 2023 shoulders was significant in both SR versus DR [risk ratio 0.45 with 95% credible interval (0.31, 0.65)], and SR versus SB [risk ratio 0.45 (95% credible interval 0.29, 0.69)], and no significant in the other comparison, the ranking probability was MMA, SB, DR, TO and SR. CONCLUSION Based on the clinical results, this network meta-analysis revealed that these 5 suture configurations shows no significant difference. Meanwhile, suture bridge may be the optimum treatment strategy which may improve the healing rate postoperatively, whereas the DR is a suboptimal option for arthroscopic rotator cuff repairs.
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Affiliation(s)
- Wei Wang
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Hui Kang
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Hongchuan Li
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Jian Li
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Yibin Meng
- Departments of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Peng Li
- Department of Hand Surgery, Honghui Hospital, Xi'an Jiaotong University, 76 Guo Road, Beilin South District, Xian City, 710054, Shanxi Province, China.
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MacDermid JC, Bryant D, Holtby R, Razmjou H, Faber K, Balyk R, Boorman R, Sheps D, McCormack R, Athwal G, Hollinshead R, Lo I, Bicknell R, Mohtadi N, Bouliane M, Glasgow D, Lebel ME, Lalani A, Moola FO, Litchfield R, Moro J, MacDonald P, Bergman JW, Bury J, Drosdowech D. Arthroscopic Versus Mini-open Rotator Cuff Repair: A Randomized Trial and Meta-analysis. Am J Sports Med 2021; 49:3184-3195. [PMID: 34524031 DOI: 10.1177/03635465211038233] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with complete rotator cuff tears who fail a course of nonoperative therapy can benefit from surgical repair. PURPOSE This randomized trial compared mini-open (MO) versus all-arthroscopic (AA) rotator cuff repair. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients with rotator cuff tears were randomized to undergo MO or AA repair at 9 centers by 23 surgeons. The primary outcome (Western Ontario Rotator Cuff Index [WORC]) and secondary outcomes (American Shoulder and Elbow Surgeons [ASES] score, Shoulder Pain and Disability Index [SPADI] pain subscale, 12-Item Short Form Health Survey [SF-12], reported medication use, adverse events), as well as measurements of range of motion and strength, were collected at 1 month before surgery; at 2 and 6 weeks postoperatively; and at 3, 6, 12, 18, and 24 months postoperatively. A blinded radiologist evaluated rotator cuff integrity on magnetic resonance imaging (MRI) at baseline and 1 year. Intention-to-treat analysis of covariance with the preoperative WORC score, age, and tear size as covariates assessed continuous outcomes. Sex differences were assessed. A meta-analysis synthesized the primary outcome between MO and AA repair with previous trials. RESULTS From 954 patients screened, 411 were ineligible (276 because of recovery with physical therapy), 449 were screened at surgery (175 ineligible), and 274 completed follow-up (138 MO and 136 AA). The AA and MO groups were similar before surgery. WORC scores improved from 40 preoperatively to 89 (AA) and 93 (MO) at 2 years, for an adjusted mean difference of 3.4 (95% CI, -0.4 to 7.2). There were no statistically significant differences between the AA and MO groups at any time point. All secondary patient-reported outcomes were not significantly different between the MO and AA groups, except the 2-year SPADI pain score (8 vs 12, respectively; P = .02). A similar recovery in range of motion and strength occurred in both groups over time. MRI indicated minimal improvement in muscle relative to fat (AA: n = 3; MO: n = 2), with most worsening (AA: n = 25; MO: n = 24) or remaining unchanged (AA: n = 70; MO: n = 70). Opioid use was significantly reduced after surgery (from 21% to 5%). The meta-analysis indicated no significant standardized mean difference between groups in the primary outcome across all pooled studies (standardized mean difference, -0.06 [95% CI, -0.34 to 0.22]). CONCLUSION Both AA and MO rotator cuff repair provide large clinical benefits, with few adverse events. There is strong evidence of equivalent clinical improvements. TRIAL REGISTRATION NCT00128076.
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Affiliation(s)
- Joy C MacDermid
- Departments of Surgery and Physical Therapy, University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Dianne Bryant
- Departments of Surgery and Physical Therapy, University of Western Ontario, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Richard Holtby
- Department of Orthopaedic Surgery, Holland Orthopaedic & Arthritic Centre, Toronto, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Helen Razmjou
- Department of Rehabilitation, Holland Orthopaedic & Arthritis Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Kenneth Faber
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
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- Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Robert Balyk
- Department of Surgery and Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Richard Boorman
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - David Sheps
- Department of Surgery and Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Robert McCormack
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - George Athwal
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Robert Hollinshead
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Ian Lo
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Ryan Bicknell
- Department of Surgery, Queen's University, Kingston, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Nicholas Mohtadi
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Martin Bouliane
- Department of Surgery and Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Donald Glasgow
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Marie-Eve Lebel
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Aleem Lalani
- Department of Surgery and Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Farhad O Moola
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Robert Litchfield
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Jaydeep Moro
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Peter MacDonald
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - J W Bergman
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Jeff Bury
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Darren Drosdowech
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
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11
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Sakha S, Erdogan S, Shanmugaraj A, Betsch M, Leroux T, Khan M. Update on all-arthroscopic vs. mini-open rotator cuff repair: A systematic review and meta-analysis. J Orthop 2021; 24:254-263. [PMID: 33867750 DOI: 10.1016/j.jor.2021.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/23/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose To provide an updated comparison between modern arthroscopic and mini-open repairs for treating rotator cuff tears. Methods Multiple online databases were searched from 2010 to October 1st, 2020. A meta-analysis was conducted for patient-reported outcomes and complications. Results Eleven studies were included. Majority of patients underwent mini-open repair (MOR) compared to arthroscopic repair (AR) (57.4% vs 42.6%). A meta-analysis found statistically significant differences (p < 0.05) in patient-reported outcomes favouring AR. While retear rates were higher in AR (p = 0.03) analysis of retear rates for arthroscopic double row and mini-open repairs, yielded no differences between groups (p = 0.48). Conclusion Patients undergoing AR for rotator cuff tears had improved post-operative clinical outcomes in some functional outcomes compared to MOR. Modern arthroscopic double row repair result in similar failure rates to open repair techniques. Level of evidence Level III, Systematic Review of Level I-III studies.
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Affiliation(s)
- Seaher Sakha
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Safiya Erdogan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marcel Betsch
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Center of Orthopaedics and Trauma Surgery, University Hospital Mannheim, Medical Faculty University Heidelberg, Mannheim, Germany
| | - Timothy Leroux
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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12
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Effects of arthroscopic vs. mini-open rotator cuff repair on function, pain & range of motion. A systematic review and meta-analysis. PLoS One 2019; 14:e0222953. [PMID: 31671101 PMCID: PMC6822715 DOI: 10.1371/journal.pone.0222953] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 09/10/2019] [Indexed: 01/08/2023] Open
Abstract
Objective To assess the effectiveness of arthroscopic versus mini-open rotator cuff repair on function, pain and range of motion at 3-, 6- and 12-month follow ups. Design Systematic review and meta-analysis of randomized controlled trials. Setting Clinical setting. Participants Patients 18 years and older with a rotator cuff tear. Intervention/Comparison Arthroscopic/mini-open rotator cuff repair surgery followed by post operative rehabilitation. Main outcome measures Function and pain. Results Six RCTs (n = 670) were included. The pooled results, demonstrated no significant difference between arthroscopic and mini open approach to rotator cuff repair on function (very low quality, 4 RCTs, 495 patients, SMD 0.00, 3-month; very low quality, 4 RCTs, 495 patients, SMD -0.01, 6-month; very low quality, 3 RCTs, 462 patients, SMD -0.09, 12-months). For pain, the pooled results, were not statistically different between groups (very low quality, 3 RCTs, 254 patients, MD -0.21, 3-month; very low quality, 3 RCTs, 254 patients, MD -0.03, 6-month; very low quality, 2 RCTs, 194 patients, MD -0.35, 12-months). Conclusion The effects of arthroscopic compared to mini-open rotator cuff repair, on function, pain and range of motion are too small to be clinically important at 3-, 6- and 12-month follow ups.
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13
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Day MA, Westermann RW, Bedard NA, Glass NA, Wolf BR. Trends Associated with Open Versus Arthroscopic Rotator Cuff Repair. HSS J 2019; 15:133-136. [PMID: 31327943 PMCID: PMC6609773 DOI: 10.1007/s11420-018-9628-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rotator cuff (RTC) repair is performed using open/mini-open or arthroscopic procedures, and the use of arthroscopic techniques is increasing. The extent to which surgery has transitioned from open to arthroscopic techniques has yet to be elucidated. QUESTIONS/PURPOSES The purpose of this study was to evaluate trends in open and arthroscopic rotator cuff repair in the USA and describe tendencies in treatment across gender, age, and geographic region. We hypothesized that surgeons would be more likely to perform arthroscopic rotator cuff repair, with similar trends across the USA. METHODS A retrospective review of a comprehensive national insurance database (Humana) was performed using the PearlDiver software for all patients who underwent RTC repair between January 2007 and June 2015. Patients were identified by Current Procedural Terminology (CPT) codes. χ 2 tests evaluated the proportion of arthroscopic surgeries by gender and geographic region; logistic regression analysis assessed differences from 2007 to 2015. RESULTS In the study period, 54,740 patients underwent RTC repair (68% arthroscopic, 52% male), with the highest frequency of RTC repair in patients between 65 and 69 years old. The proportion of open RTC repair increased with increasing patient age, with no significant difference between men and women. The proportion of arthroscopic RTC surgeries increased from 56.9% in 2007 to 75.1% in 2015. The overall trend was 188% increase in total RTC repairs. Arthroscopic repair was more frequent than open repair in all US regions, with the highest proportion in the South. CONCLUSION Arthroscopic RTC surgery predominates and continues to rise. With increasing patient age, there was an increase in the proportion of open repair. The majority of RTC repairs were performed in patients between 65 and 69 years of age.
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Affiliation(s)
- Molly A. Day
- 0000 0004 0434 9816grid.412584.eDepartment of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Robert W. Westermann
- 0000 0004 0434 9816grid.412584.eDepartment of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Nicholas A. Bedard
- 0000 0004 0434 9816grid.412584.eDepartment of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Natalie A. Glass
- 0000 0004 0434 9816grid.412584.eDepartment of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Brian R. Wolf
- 0000 0004 0434 9816grid.412584.eDepartment of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 USA
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14
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Khatri C, Ahmed I, Parsons H, Smith NA, Lawrence TM, Modi CS, Drew SJ, Bhabra G, Parsons NR, Underwood M, Metcalfe AJ. The Natural History of Full-Thickness Rotator Cuff Tears in Randomized Controlled Trials: A Systematic Review and Meta-analysis. Am J Sports Med 2019; 47:1734-1743. [PMID: 29963905 DOI: 10.1177/0363546518780694] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff tears are the most common tendon injury in the adult population, resulting in substantial morbidity. The optimum management for these patients is not known. PURPOSE To assess the overall treatment response to all interventions in full-thickness rotator cuff tears among patients enrolled in randomized clinical trials. STUDY DESIGN Systematic review and meta-analysis. METHODS Randomized controlled trials (RCTs) were identified from a systematic search of Medline, Embase, CINHAL, and the Cochrane Central Register of Controlled Trials. Patients were aged ≥18 years with a full-thickness rotator cuff tear. The primary outcome measure was change in Constant shoulder score from baseline to 52 weeks. A meta-analysis to assess treatment response was calculated via the standardized mean change in scores. RESULTS A total of 57 RCTs were included. The pooled standardized mean change as compared with baseline was 1.42 (95% CI, 0.80-2.04) at 3 months, 2.73 (95% CI, 1.06-4.40) at 6 months, and 3.18 (95% CI, 1.64-4.71) at 12 months. Graphic plots of treatment response demonstrated a sustained improvement in outcomes in nonoperative trial arms and all operative subgroup arms. CONCLUSION Patients with full-thickness rotator cuff tears demonstrated a consistent pattern of improvement in Constant score with nonoperative and operative care. The natural history of patients with rotator cuff tears included in RCTs is to improve over time, whether treated operatively or nonoperatively.
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Affiliation(s)
- Chetan Khatri
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - Imran Ahmed
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - Helen Parsons
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - Nicholas A Smith
- Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Thomas M Lawrence
- Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Chetan S Modi
- Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Stephen J Drew
- Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Gev Bhabra
- Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Nicholas R Parsons
- Statistics & Epidemiology Unit, University of Warwick Medical School, Coventry, UK
| | - Martin Underwood
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - Andrew J Metcalfe
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
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15
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van Deurzen DFP, Scholtes VAB, Willems WJ, Geerdink HH, van der Woude HJ, van der Hulst VPM, van den Bekerom MPJ. Long-term results of arthroscopic and mini-open repair of small- to medium-size full-thickness rotator cuff tears. Shoulder Elbow 2019; 11:68-76. [PMID: 31019565 PMCID: PMC6463376 DOI: 10.1177/1758573218773529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/08/2018] [Accepted: 03/28/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND This retrospective cohort study evaluated functional outcome and structural integrity after arthroscopic- or mini-open repair of small- to medium-size rotator cuff tears assessed at long-term follow-up. METHODS All patients operated between 2001 and 2004 were invited to participate. Functional outcome was measured by Constant-Murley Score, Disability of Arm, Shoulder and Hand and Oxford Shoulder Score. Quality of life was assessed with EuroQol Health 5 Dimension. Patient satisfaction was assessed in terms of pain and overall result. Structural integrity of the rotator cuff repair was determined using ultrasound. RESULTS Of the eligible 62 patients, 44 patients were available for follow-up. After a mean of 11.3 years, 76% of the patients had good to excellent functional outcome on the Constant-Murley Score (median 82, range 29-95). The majority of patients reported good results on both Disability of Arm, Shoulder and Hand and Oxford Shoulder Score (median Disability of Arm, Shoulder and Hand 5.0, range 1.0-54; median Oxford Shoulder Score 19, range 13-39). The quality of life was also good (mean EuroQol Health 5 Dimension utility score 0.88, standard deviation 0.12). Eighty per cent was satisfied with the overall result. Ultrasound examination revealed structural integrity in 76% of all cases. CONCLUSION This study shows that functional outcome is good and structural integrity is high for the majority of patients 11.3 years after repair of small- to medium-size rotator cuff lesions.
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Affiliation(s)
- DFP van Deurzen
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands,DFP van Deurzen, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, Amsterdam 1090HM, The Netherlands.
| | - VAB Scholtes
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - WJ Willems
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - HH Geerdink
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - HJ van der Woude
- Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - VPM van der Hulst
- Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - MPJ van den Bekerom
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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16
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Xu B, Chen L, Zou J, Gu Y, Hao L, Peng K. The Clinical Effect of Arthroscopic Rotator Cuff Repair techniques: A Network Meta-Analysis and Systematic Review. Sci Rep 2019; 9:4143. [PMID: 30858460 PMCID: PMC6411857 DOI: 10.1038/s41598-019-40641-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/20/2019] [Indexed: 12/18/2022] Open
Abstract
Rotator cuff tears are common and are associated with shoulder pain, disability, and dysfunction. Previous studies that have reported different arthroscopic techniques are controversial. A network meta-analysis with indirect and direct evidence was performed to compare the effectiveness of arthroscopic techniques for the treatment of rotator cuff tears. PUBMED, the Cochrane Register of Controlled Trials, EMBASE and Scopus were searched based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and related studies that evaluated arthroscopic techniques for the treatment of rotator cuff tears were identified in May 2018. The primary outcome measure was the retear rate. The secondary outcome measures included the constant score and the range of motion (forward flexion and external rotation). Twenty-one trials comprising 1815 shoulders were included in the study. This study indicated that single-row (SR) repair resulted in a higher retear rate than suture bridge (SB) and double-row (DR) repairs. Moreover, the SR and DR repairs resulted in higher incidences of retear than SB repair. The ranking of the treatments based on the constant score and external rotation was SB repair, SR repair and DR repair, whereas the treatment ranking according to forward flexion was SB repair, DR repair and SR repair. In summary, this network meta-analysis provides evidence that SB repairs might be the best choice to improve the postoperative recovery of function and decrease the retear rate.
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Affiliation(s)
- Binwu Xu
- Department of Orthopedics, the second affiliated hospital of Nanchang university, Nanchang, Jiangxi, China
| | - Long Chen
- Department of Orthopedics, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Jun Zou
- Department of Orthopedics, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Yurong Gu
- Department of Orthopedics, the second affiliated hospital of Nanchang university, Nanchang, Jiangxi, China
| | - Liang Hao
- Department of Orthopedics, the second affiliated hospital of Nanchang university, Nanchang, Jiangxi, China
| | - Kun Peng
- Department of Orthopedics, the second affiliated hospital of Nanchang university, Nanchang, Jiangxi, China.
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17
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Day M, Westermann R, Duchman K, Gao Y, Pugely A, Bollier M, Wolf B. Comparison of Short-term Complications After Rotator Cuff Repair: Open Versus Arthroscopic. Arthroscopy 2018; 34:1130-1136. [PMID: 29305290 DOI: 10.1016/j.arthro.2017.10.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To define and compare the incidence and risk factors for short-term complications after arthroscopic and open rotator cuff repair (RTCR), and to identify independent risk factors for complications after RTCR. METHODS All patients who underwent open or arthroscopic RTCR from 2005 to 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Short-term complications were categorized as surgical, medical, mortality, and unplanned 30-day readmission. Univariate analysis allowed the comparison of patient demographics and comorbidities. Propensity score matching was used to control for demographic differences between arthroscopic and open RTCR patient groups. Independent risk factors for complication were identified using multivariate logistic regression. RESULTS Overall, 11,314 RTCRs were identified (24% open, 76% arthroscopic). The mean operative time for open RTCR was 78 minutes compared with 91 minutes for arthroscopic repairs (P < .001). The overall complication rate was 1.3%, with the highest complication unplanned return to the operating room (41 patients, 0.36%). The 30-day readmission was 1.16% (76/6,560 patients) and the mortality rate was 0.03% (3 patients). Total 30-day complications in the propensity-score-matched patient group were higher after open versus arthroscopic repair (1.79% vs 1.17%; P = .006). The overall infection rate after RTCR was 0.56%, with deep wound infection higher in the open repair patient group (P = .003). Multivariate analysis identified age >65 years (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.2-2.3), operative time >90 minutes (OR 1.5; CI 1.1-2.1), and open RTCR (OR 1.6; CI 1.1-2.3) as independent risk factors for complications. CONCLUSIONS Short-term complications after RTCR are rare. Total complications are higher after open RTCR in propensity-matched patient groups and in multivariate analysis. Risk factors for complications include patient age >65, operative time >90 minutes, and open repair. Open RTCR is associated with an increased risk of surgical infections. LEVEL OF EVIDENCE Level III, retrospective comparative trial.
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Affiliation(s)
- Molly Day
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A..
| | - Robert Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Kyle Duchman
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Yubo Gao
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Andrew Pugely
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Matthew Bollier
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Brian Wolf
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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18
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Baker DK, Perez JL, Watson SL, McGwin G, Brabston EW, Hudson PW, Ponce BA. Arthroscopic Versus Open Rotator Cuff Repair: Which Has a Better Complication and 30-Day Readmission Profile? Arthroscopy 2017; 33:1764-1769. [PMID: 28688827 DOI: 10.1016/j.arthro.2017.04.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/03/2017] [Accepted: 04/12/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide a comparative 30-day postoperative analysis of complications and unplanned readmission rates, using the National Surgical Quality Improvement Program database, after open or arthroscopic rotator cuff repair (RCR). METHODS The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for postoperative complications after open or arthroscopic RCR over an 8-year period, from 2007 through 2014. Patients were identified by use of Current Procedural Terminology codes. The open group contained 3,590 cases (21.8%) and the arthroscopic group had 12,882 cases (78.2%), for a total of 16,472 patients undergoing RCR. The risk of complications was compared between the 2 groups, along with patient demographic characteristics, operative time, length of stay, and unplanned readmission within 30 days. We compared dichotomous variables using the Fisher exact test and continuous variables with 1-way analysis of variance. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated when appropriate. RESULTS The open RCR group had a higher prevalence of patients aged 65 years or older and comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease, smoking, and alcoholism (P < .05). Patients undergoing open RCR had a higher risk of any adverse event when compared with arthroscopic RCR patients (1.48% vs 0.84%; RR, 1.17; 95% CI, 1.05-1.30; P = .0010). They were also at higher risk of return to the operating room within 30 days (0.70% vs 0.26%; RR, 1.36; 95% CI, 1.09-1.69; P = .0004). Open RCR was associated with a longer average hospital stay (0.48 ± 2.7 days vs 0.23 ± 4.2 days, P = .0007), whereas arthroscopic RCR had a longer average operative time (90 ± 45 minutes vs 79 ± 45 minutes, P < .0001). CONCLUSIONS Although both open and arthroscopic approaches to RCR had low morbidity, arthroscopy was associated with lower risks of any adverse event and return to the operating room during the initial 30-day postoperative period. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Dustin K Baker
- University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Jorge L Perez
- University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Shawna L Watson
- University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Gerald McGwin
- University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | | | - Parke W Hudson
- University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Brent A Ponce
- University of Alabama at Birmingham, Birmingham, Alabama, U.S.A..
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19
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Bond EC, Hunt L, Brick MJ, Leigh WB, Maher A, Young SW, Caughey MA. Arthroscopic, open and mini-open approach for rotator cuff repair: no difference in pain or function at 24 months. ANZ J Surg 2017; 88:50-55. [PMID: 28940835 DOI: 10.1111/ans.14176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/01/2017] [Accepted: 07/12/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The New Zealand Rotator Cuff Registry was established in 2009 to collect prospective functional, pain and outcome data on patients undergoing rotator cuff repair (RCR). METHODS Information collected included an operation day technical questionnaire completed by the surgeon and Flex Shoulder Function (SF) functional and pain scores preoperatively, immediately post-operatively and at 6, 12 and 24 months. A multivariate analysis was performed analysing the three surgical approaches to determine if there was a difference in pain or functional outcome scores. RESULTS A total of 2418 RCRs were included in this paper. There were 418 (17.3%) arthroscopic, 956 (39.5%) mini-open and 1044 (43.2%) open procedures. Twenty-four-month follow-up data were obtained for pain and Flex SF in 71% of patients. At 24 months, there was no difference in the average Flex SF score for the arthroscopic, mini-open and open groups. There was no difference in improvement in Flex SF score at 24 months. At 24 months, there was no difference in mean pain scores. There was no difference in improvement in pain score from preoperation to 24 months. Most patients returned to work within 3 months of surgery, with no difference between the three surgical approaches. CONCLUSION RCR has good to excellent outcomes in terms of improvement in pain and function at 2-year follow-up. We found no difference in pain or functional outcome at 24 months between arthroscopic, open and mini-open approaches for RCR.
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Affiliation(s)
- Elizabeth C Bond
- Orthopaedic Department, Wellington Regional Hospital, Capital & Coast District Health Board, Wellington, New Zealand
| | - Lynette Hunt
- Department of Statistics, The University of Waikato, Hamilton, New Zealand
| | - Matthew J Brick
- Orthosports North Harbour, Millennium Institute, Auckland, New Zealand
| | - Warren B Leigh
- Orthosports North Harbour, Millennium Institute, Auckland, New Zealand
| | - Anthony Maher
- Orthopaedic Department, Taranaki District Health Board, New Plymouth, New Zealand
| | - Simon W Young
- Orthopaedic Department, Wellington Regional Hospital, Capital & Coast District Health Board, Wellington, New Zealand
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20
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Huang R, Wang S, Wang Y, Qin X, Sun Y. Systematic Review of All-Arthroscopic Versus Mini-Open Repair of Rotator Cuff Tears: A Meta-Analysis. Sci Rep 2016; 6:22857. [PMID: 26947557 PMCID: PMC4780011 DOI: 10.1038/srep22857] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/18/2016] [Indexed: 02/06/2023] Open
Abstract
The objective of this study was to compare outcomes in patients with rotator cuff tears undergoing all-arthroscopic versus mini-open rotator cuff repair. A systematic review and meta-analysis of outcomes of all-arthroscopic repair versus mini-open repair in patients with rotator cuff repair was conducted. Studies meeting the inclusion criteria were screened and included from systematic literature search for electronic databases including Medline, Embase, Cochrane CENTRAL, and CINAHL library was conducted from 1969 and 2015. A total of 18 comparative studies including 4 randomized clinical trials (RCTs) were included. Pooled results indicate that there was no difference in the functional outcomes, range of motion, visual analog scale (VAS) score, and short-form 36 (SF-36) subscales. However, Constant-Murley functional score was found to be significantly better in patients with mini-open repair. However, the results of the review should be interpreted with caution due to small size and small number of studies contributing to analysis in some of the outcomes. All-arthroscopic and mini-open repair surgical techniques for the management of rotator cuff repair are associated with similar outcomes and can be used interchangeably based on the patient and rotator tear characteristics.
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Affiliation(s)
- Rongzhong Huang
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Sanrong Wang
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yule Wang
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoxia Qin
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Sun
- Institute of Ultrasound Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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21
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Risk Factors for Infection After Rotator Cuff Repair. Arthroscopy 2016; 32:428-34. [PMID: 26483170 DOI: 10.1016/j.arthro.2015.08.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 07/24/2015] [Accepted: 08/11/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify risk factors for infection after rotator cuff repair. We hypothesized that patient characteristics and surgical technique would affect the rate of infection. METHODS The records of 1,824 rotator cuff repairs performed by a single surgeon from 1995 to 2010 were reviewed retrospectively. Fourteen patients had an early deep postoperative wound infection that was treated with surgical irrigation and debridement. One hundred eighty-five control patients who were treated with rotator cuff repair and did not develop an infection were selected randomly for comparison and statistical analysis. Data regarding preoperative and intraoperative risk factors for infection were recorded, and a multiple logistic regression was conducted to investigate predictors of infection. RESULTS The infection rate was 0.77% (14/1,822). On average 2.1 (range 1 to 4) surgical debridements were performed in addition to treatment with intravenous antibiotics. Patients who had open or miniopen rotator cuff repair had a significantly greater risk of acute postoperative infection (odds ratio [OR] = 8.63, P = .002). Seventy-nine percent of the patients in the infection group had an open or miniopen repair, whereas only 28% of the control group had an open or miniopen repair. Male patients also had a significantly greater risk of acute postoperative infection (OR = 9.52, P = .042). A total of 92% of the infection patients were male compared with 58% of the control group. In addition, as body mass index increased there was a reduction in the odds of infection (OR = 0.81, P = .023). CONCLUSIONS The results of this case control study demonstrate that open or miniopen surgical technique and male sex are significant risk factors for infection after rotator cuff repair. In our study, arthroscopic rotator cuff repair reduced the risk of infection compared with open techniques. LEVEL OF EVIDENCE Level IV.
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Sambandam SN, Khanna V, Gul A, Mounasamy V. Rotator cuff tears: An evidence based approach. World J Orthop 2015; 6:902-918. [PMID: 26716086 PMCID: PMC4686437 DOI: 10.5312/wjo.v6.i11.902] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/04/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, cost-effective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.
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Arshi A, Kabir N, Cohen JR, Lord EL, Wang JC, McAllister DR, Petrigliano FA. Utilization and Costs of Postoperative Physical Therapy After Rotator Cuff Repair: A Comparison of Privately Insured and Medicare Patients. Arthroscopy 2015; 31:2392-9.e1. [PMID: 26231991 DOI: 10.1016/j.arthro.2015.06.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/11/2015] [Accepted: 06/18/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the utilization and charges related to physical therapy (PT) after rotator cuff repair in privately insured and Medicare patients and between arthroscopic and open/mini-open repair techniques. METHODS The PearlDiver insurance database was queried for patients receiving postoperative PT using Current Procedural Terminology codes. Data were available from 2007 to 2011 for United Healthcare and from 2005 to 2011 for Medicare patients. Patients undergoing arthroscopic (CPT 29827) or open/mini-open approaches (CPT 23410, 23412, 23420) were identified in both populations. Utilization was determined by both the percentage of patients with at least one postoperative PT-related code and the average number of encounters per patient. Per-patient average charge was determined by dividing total charges within the billing period by the patient total. RESULTS A total of 365,891 patients undergoing rotator cuff repair were identified. There was an increase in the number of arthroscopic repairs (+29.1%, P = .027, United Healthcare; +78.9%, P < .001, Medicare) and a decrease in the number of open/mini-open repairs (-18.2%, P = .038, United Healthcare; -18.2%, P < .001, Medicare) across the study period. At 6 months postoperatively, PT utilization was greater in the United Healthcare groups (82.9% arthroscopic, 81.0% open/mini-open) than in the Medicare groups (41.8% arthroscopic, 43.2% open/mini-open). Utilization-weighted per-patient average charge was comparable among all 4 groups, with slightly higher charges in the United Healthcare groups ($3,376 arthroscopic, $3,251 open/mini-open) compared with the Medicare groups ($2,940 arthroscopic, $2,807 open/mini-open). The United Healthcare groups had a greater number of utilization-weighted billed encounters (36.1 for open/mini-open, 9.5 for arthroscopic) than their Medicare counterparts (12.8 open/mini-open, 16.7 arthroscopic). CONCLUSIONS Utilization of PT after rotator cuff repair is substantially higher in privately insured than in Medicare patients. Utilization rates appear to be comparable between surgical approaches. Per-patient costs were comparable irrespective of surgical approach and insurance modality. LEVEL OF EVIDENCE Level IV, economic.
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Affiliation(s)
- Armin Arshi
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Nima Kabir
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Jeremiah R Cohen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Elizabeth L Lord
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - David R McAllister
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A..
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Alteration and recovery of arm usage in daily activities after rotator cuff surgery. J Shoulder Elbow Surg 2015; 24:1346-52. [PMID: 25825140 DOI: 10.1016/j.jse.2015.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/30/2015] [Accepted: 01/31/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective measurement of dominant/nondominant arm use proportion in daily life may provide relevant information on healthy and pathologic arm behavior. This prospective case-control study explored the potential of such measurements as indicators of upper limb functional recovery after rotator cuff surgery. METHODS Data on dominant/nondominant arm usage were acquired with body-worn sensors for 7 hours. The postsurgical arm usage of 21 patients was collected at 3, 6, and 12 months after rotator cuff surgery in the sitting, walking, and standing postures and compared with a reference established with 41 healthy subjects. The results were calculated for the dominant and nondominant surgical side subgroups at all stages. The correlations with clinical scores were calculated. RESULTS Healthy right-handed and left-handed dominant arm usage was 60.2% (±6.3%) and 53.4% (±6.6%), respectively. Differences in use of the dominant side were significant between the right- and left-handed subgroups for sitting (P = .014) and standing (P = .009) but not for walking (P = .328). The patient group showed a significant underuse of 10.7% (±8.9%) at 3 months after surgery (P < .001). The patients recovered normal arm usage within 12 months, regardless of surgical side. The arm underuse measurement was weakly related to function and pain scores. CONCLUSION This study provided new information on arm recovery after rotator cuff surgery using an innovative measurement method. It highlighted that objective arm underuse measurement is a valuable indicator of upper limb postsurgical outcome that captures a complementary feature to clinical scores.
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Ji X, Bi C, Wang F, Wang Q. Arthroscopic versus mini-open rotator cuff repair: an up-to-date meta-analysis of randomized controlled trials. Arthroscopy 2015; 31:118-24. [PMID: 25442664 DOI: 10.1016/j.arthro.2014.08.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 08/12/2014] [Accepted: 08/15/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this meta-analysis was to compare the clinical outcomes of arthroscopic and mini-open rotator cuff repairs based on recently published Level I randomized controlled trials (RCTs). METHODS We systematically searched electronic databases to identify RCTs that compared arthroscopic and mini-open rotator cuff repairs from 1980 to October 2013. The clinical outcome scores, including the University of California, Los Angeles score and the Constant-Murley score, were converted to a common 100-point outcome score for further analysis. The results of the pooled studies were analyzed in terms of surgery time, weighted 100-point score, pain on a visual analog scale (VAS), and range of motion. Study quality was assessed and relevant data were extracted independently by 2 reviewers. RESULTS Five RCTs, including 166 patients in the arthroscopic repair group and 163 patients in the mini-open repair group, were included in this meta-analysis. The results of the meta-analysis showed that there were no significant differences in surgery time (P = .11), weighted 100-point score (P = .65), VAS pain score (P = .87), or range of motion (P = .29 for forward flexion and P = .82 for external rotation). CONCLUSIONS On the basis of current literature, no differences in surgery time, functional outcome score, VAS pain score, and range of motion were found at the end of follow-up between the arthroscopic and mini-open rotator cuff repair techniques. In addition, there was no significant difference in VAS pain score in the early phase between the 2 repairs. LEVEL OF EVIDENCE Level I, meta-analysis of Level I studies.
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Affiliation(s)
- Xiaoxi Ji
- Orthopaedic Traumatology Department, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chun Bi
- Orthopaedic Traumatology Department, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fang Wang
- Orthopaedic Traumatology Department, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiugen Wang
- Orthopaedic Traumatology Department, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Shields E, Mirabelli M, Amsdell S, Thorsness R, Goldblatt J, Maloney M, Voloshin I. Functional and imaging outcomes of arthroscopic simultaneous rotator cuff repair and bankart repair after shoulder dislocations. Am J Sports Med 2014; 42:2614-20. [PMID: 25261085 DOI: 10.1177/0363546514550993] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies have investigated outcomes of simultaneous rotator cuff (RC) repair and superior labral injury repair; however, there is limited information in the literature on outcomes of simultaneous RC repair and Bankart lesion repair after acute shoulder dislocations. PURPOSE To determine functional and imaging outcomes of simultaneous arthroscopic RC repair and Bankart repair after acute shoulder dislocations and to compare functional outcomes to contralateral, asymptomatic shoulders. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Consecutive patients who underwent arthroscopic simultaneous RC repair and Bankart repair with a minimum of 2 years' follow-up were recruited. All patients had suffered an acute shoulder dislocation. The American Shoulder and Elbow Surgeons (ASES), Constant-Murley, and Short Form (SF)-36 scores were obtained. The affected shoulder also underwent ultrasound imaging to assess the integrity of the RC. RESULTS Thirteen patients (mean age, 58.8 ± 11.2 years; mean follow-up, 38.5 ± 12.3 months) were recruited. In a comparison of the affected versus unaffected shoulder, there were no significant differences in the mean ASES score (89.7 ± 12.6 vs 95.0 ± 6.7, respectively), mean Constant score (80.5 ± 18.9 vs 86.8 ± 7.9, respectively), or mean abduction strength (15.4 ± 6.4 lb vs 15.4 ± 5.2 lb, respectively) (P > .05). The mean SF-36 physical component summary was 48.4. According to ultrasound imaging, there were persistent/recurrent full-thickness tears in 4 patients, and 1 patient had a new full-thickness tear. At follow-up, patients with full-thickness RC tears in the affected shoulder compared with their unaffected shoulder showed similar mean ASES scores (90.9 ± 11.8 vs 97.6 ± 4.3, respectively), mean Constant scores (77.8 ± 20.3 vs 84.8 ± 7.2, respectively), and mean abduction strength (11.5 ± 5.3 lb vs 12.6 ± 4.5 lb, respectively) (P > .05). CONCLUSION After simultaneous arthroscopic repair of the RC and a Bankart lesion in patients after shoulder dislocations, the affected extremity had similar functional outcomes compared to the noninjured, asymptomatic side at a mean of 3 years after surgery. Persistent or recurrent RC tears involving the operative extremity were common, but they did not significantly affect functional outcomes in this small study.
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Affiliation(s)
- Edward Shields
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, USA
| | - Mark Mirabelli
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, USA
| | - Simon Amsdell
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, USA
| | - Robert Thorsness
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, USA
| | - John Goldblatt
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, USA
| | - Michael Maloney
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, USA
| | - Ilya Voloshin
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, USA
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