Osteoporosis is a known risk factor for rotator cuff tears(RCTs),but the causal correlation and underlying mechanisms remain unclear.This study aims to evaluate the impact of osteoporosis on RCT risk and investigate t...Osteoporosis is a known risk factor for rotator cuff tears(RCTs),but the causal correlation and underlying mechanisms remain unclear.This study aims to evaluate the impact of osteoporosis on RCT risk and investigate their genetic associations.Using data from the UK Biobank(n=457871),cross-sectional analyses demonstrated that osteoporosis was significantly associated with an increased risk of RCTs(adjusted OR[95%CI]=1.38[1.25–1.52]).A longitudinal analysis of a subset of patients(n=268117)over 11 years revealed that osteoporosis increased the risk of RCTs(adjusted HR[95%CI]=1.56[1.29–1.87]),which is notably varied between sexes in sex-stratified analysis.Causal inference methods,including propensity score matching,inverse probability weighting,causal random forest and survival random forest models further confirmed the causal effect,both from cross-sectional and longitudinal perspectives.展开更多
BACKGROUND Shoulder arthroscopy is commonly used for the repair of glenohumeral ligament avulsions or tendon tears.The success of the operation depends on the ability of the ligaments or rotator cuff tendon to heal to...BACKGROUND Shoulder arthroscopy is commonly used for the repair of glenohumeral ligament avulsions or tendon tears.The success of the operation depends on the ability of the ligaments or rotator cuff tendon to heal to their original attachment site.Soft tissue healing can be evaluated with imaging methods or alternatively with second-look arthroscopy.AIM To investigate shoulder tendon and capsule healing after arthroscopic rotator cuff and instability repair using second-look arthroscopy.METHODS In this study,24 adult patients with rotator cuff tears(13 patients)or anterior shoulder instability(11 patients)were included.All patients were initially subjected to arthroscopic repair using suture anchors and were re-evaluated with second-look arthroscopy for reasons not related to the original pathology.The second operation was performed in 8 patients due to mild but persistent pain or stiffness,in 3 patients for recalcitrant stiffness,in 5 patients for secondary biceps tenotomy,in 6 patients for persistent acromioclavicular joint pain and in 2 patients for suture anchor prominence causing shoulder grinding.Soft tissue healing was evaluated visually and by probing,whereas clinical outcomes were evaluated using the University of California–Los Angeles(UCLA)and Rowe rating scales.RESULTS In almost all patients,complete soft tissue healing occurred at the site of tissue reattachment,either on the glenoid articular surface or the greater humeral tuberosity.The strongest repair,as confirmed by probe palpation,was encountered at the site of suture passage through the soft tissue.All suture material was covered with bursal synovial tissue,with no cases of knot impingement or cartilage fraying.The mean preoperative and postoperative UCLA scores for rotator cuff repair patients were 1354±3205 and 2931±2898,respectively(P<0.001),whereas for shoulder instability patients,the mean Rowe scores preoperatively and postoperatively were 2591±1338 and 9272±754,respectively(P<0.001).The use of bioabsorbable implants did not cause synovitis or other tissue reactions.CONCLUSION Soft tissue healing in the shoulder is successful and strongest at the site of suture anchor placement.展开更多
BACKGROUND Massive rotator cuff tears(RCTs)result in impaired shoulder function and quality of life.These tears lead to structural changes in the rotator cuff muscles,which compromise recovery after repair and increas...BACKGROUND Massive rotator cuff tears(RCTs)result in impaired shoulder function and quality of life.These tears lead to structural changes in the rotator cuff muscles,which compromise recovery after repair and increase re-tear rates.AIM To investigate the potential inhibitory effects of alpha-tocopherol(vitamin E)and OTR-4131 on muscle atrophy,fatty infiltration,and fibrosis in rotator cuff muscles following a massive RCT using a Wistar rat model,and establish a standardized methodology for evaluating potential therapeutic agents.METHODS This protocol outlines a controlled animal study using 40 male Wistar rats,randomized into five groups.The experimental groups will receive either systemic administration of alpha-tocopherol or local administration of OTR-4131 via intramuscular injection into the supraspinatus and infraspinatus muscles.Two sham groups will receive systemic and local saline injections respectively,while a control group will undergo no intervention.The interventions will be administered after surgical transection of the supraspinatus and infraspinatus tendons.Outcomes will be assessed via wet muscle weight measurements,muscle fiber diameter,fatty infiltration percentage,and fibrosis evaluation using histological methods.RESULTS The study anticipates that alpha-tocopherol and OTR-4131 will reduce muscle atrophy,fatty infiltration,and fibrosis compared to control and sham groups,supporting their potential protective role in rotator cuff muscle degeneration.CONCLUSION The results are expected to improve the understanding on the role of alpha-tocopherol and OTR-4131 in rotator cuff muscle protection after massive RCT and may serve as a foundation for further preclinical and clinical research aimed at improving rotator cuff repair outcomes.展开更多
BACKGROUND Long head of biceps tendon(LHBT)transposition is a novel technique based on the double-row suture bridge method,utilizing autologous reconstruction to treat massive rotator cuff tears.AIM To evaluate the mi...BACKGROUND Long head of biceps tendon(LHBT)transposition is a novel technique based on the double-row suture bridge method,utilizing autologous reconstruction to treat massive rotator cuff tears.AIM To evaluate the mid-to-long-term clinical outcomes following the double-row repair method for massive rotator cuff tears.METHODS This retrospective analysis included data from 53 patients with massive rotator cuff tears treated at our hospital between 2020 and 2021.The patients were divided into the double-row repair group(conventional group)and the doublerow repair combined with the LHBT transposition group(transposition group).Postoperative pain was assessed using the visual analogue scale at one week,one year,and the final follow-up.Shoulder function was evaluated using the American Shoulder and Elbow Surgeons and Constant-Murley scores at one year and the final follow-up.Rotator cuff healing was assessed postoperatively for one year using the Sugaya classification,which categorizes tendon integrity based on magnetic resonance imaging findings.RESULTS No perioperative complications were observed in any of the patients at any time.There were no significant differences between the groups regarding operative time and intraoperative blood loss.The transposition group had significantly lower visual analogue scale scores than the conventional group at one week postoperatively;however,there were no significant differences between the groups at one year or the final follow-up.At one year postoperatively,the transposition group showed significantly higher American Shoulder and Elbow Surgeons and Constant-Murley scores than the conventional group;no significant differences were observed at the final followup.There were no significant differences in rotator cuff healing between the groups at one year postoperatively.CONCLUSION Compared to double-row repair alone,double-row repair combined with LHBT transposition for treating massive rotator cuff tears more effectively alleviates short-term postoperative pain and improves shoulder function within the first year.展开更多
BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the ef...BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.METHODS We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials(RCTs)comparing sub-acromial injections for rotator cuff injuries.The interventions evaluated were hyaluronic acid(HA),platelet-rich plasma(PRP),prolotherapy,and corticosteroids.The outcomes of interest were pain and functional improvement,which were evaluated with standardized scores.The Risk of Bias 2 tool and the Grading of Recommendations,Assessment,Development and Evaluation methodology were used to assess data quality.RESULTS Twenty RCTs,comprising 1479 participants,were included.In the short term,HA achieved the best outcomes[pain mean difference(MD)=-1.48,95%confidence interval(CI)-2.37 to-0.59;function MD=10.18,95%CI:4.96-15.41].In the medium term,HA,PRP,HA+PRP,and corticosteroids were not superior to placebo in improving pain.Based on function,HA+PRP was superior to placebo,corticosteroids,and PRP(MD=26.72;95%CI:8.02-45.41).In the long term,HA,PRP,and corticosteroids were not superior to placebo in reducing pain.However,based on function,HA+PRP,PRP,and HA were superior to placebo,and HA+PRP had the best result(MD=36.64;95%CI:31.66-33.62).CONCLUSION HA provides satisfactory short-term results,while HA with PRP demonstrates functional improvement in the medium and long terms.However,no intervention maintained the pain-relief effect on>3-month follow-up.展开更多
BACKGROUND Rotator cuff tears are a chief cause of shoulder pain and disability,and surgical repair is often required when conservative management fails.As digital health technologies have expanded,especially since th...BACKGROUND Rotator cuff tears are a chief cause of shoulder pain and disability,and surgical repair is often required when conservative management fails.As digital health technologies have expanded,especially since the coronavirus disease 2019 pandemic,digitally augmented rehabilitation programs emerged as a potential alternative to conventional physical therapy.AIM To determine if digitally assisted rehabilitation could be as practical,or even more effective,than the traditional methods most patients currently follow.METHODS Six electronic databases,including PubMed,Scopus,Cochrane Library,Google Scholar,EMBASE,and Web of Science,were searched to find articles that compare digital-based rehabilitation and conventional treatment.Outcomes of interest were Disabilities of the Arm,Shoulder and Hand(DASH)score and range of motion.The quality assessment of the included studies was performed using the risk-of-bias tool for randomized trials tool.RESULTS Three randomized controlled trial studies were enrolled in this study,including 195 cases.We did not find any significant differences between the two groups in terms of DASH score,flexion range of motion,and external rotation range of motion.There was a significant difference between the two groups for abduction range of motion.CONCLUSION Digital home-based rehab seems to be a strong alternative to traditional methods,offering similar results for people recovering from rotator cuff surgery.This approach might also make rehab more accessible and engaging for patients.That said,further research is needed to fully understand the potential of digital rehabilitation and ensure it works effectively for everyone.展开更多
Recently,we read a retrospective study by Chen et al,which demonstrated that electroacupuncture is highly effective in relieving pain due to rotator cuff injuries and accelerating the recovery of shoulder function,pro...Recently,we read a retrospective study by Chen et al,which demonstrated that electroacupuncture is highly effective in relieving pain due to rotator cuff injuries and accelerating the recovery of shoulder function,promoting repair of rotator cuff injuries.This study provides a new way to the conservative treatment of early rotator cuff injuries.In the present letter,we review the current treatment of rotator cuff injury with electroacupuncture combined with rehabilitation techniques and propose our views.展开更多
Background:Rehabilitation typically restores shoulder function after a common rotator cuff repair;however,it is unclear when to initiate physical therapy(PT)post-surgery.To understand effective start times,this study ...Background:Rehabilitation typically restores shoulder function after a common rotator cuff repair;however,it is unclear when to initiate physical therapy(PT)post-surgery.To understand effective start times,this study analyzed PT start times and their effect on shoulder function.The most effective shoulder outcomes were hypothesized to occur when PT started 0-4 weeks post-surgery.Methods:Data from 1002 patients who underwent rotator cuff repair were analyzed retrospectively from 52 outpatient clinics in the years of 2016-2021.The primary data of timings between surgery and the start of PT(0-2 weeks[0-14 days],2-4 weeks[15-28 days],4-6 weeks[29-42 days],and 6-14 weeks[43-100 days]),change in functional shoulder scores,number of PT visits utilized,and functional scores changed per visit were analyzed.Regression analyses of the impact of age,sex,payor source,and tear size were completed.Results:The change in functional scores and functional scores changed per visit are not affected by the initiation timing of PT postrotator cuff surgery,when controlling for baseline functional scores.This result is revealed despite initial functional scores being significantly different.Functional scores change per visit may have been affected by payor source(R^(2)=0.004,p≤0.010).PT start times may have been impacted by age(R^(2)=0.010,p=0.007),payor source(R^(2)=0.016,p=0.001),and tear size(R^(2)=0.007,p=0.026).Payor source may have influenced the number of PT visits(R^(2)=0.060,p<0.001).Conclusions:After rotator cuff surgery,patients should choose to complete rehabilitation to optimize shoulder function.However,the initiation timing of PT may not affect functional shoulder outcomes.展开更多
Despite transosseous rotator cuff tear repair using sutures is widely accepted for tendon-bone fixation,the fibrocartilaginous enthesis regeneration is still hardly achieved with the traditional sutures.In the present...Despite transosseous rotator cuff tear repair using sutures is widely accepted for tendon-bone fixation,the fibrocartilaginous enthesis regeneration is still hardly achieved with the traditional sutures.In the present work,degradable magnesium(Mg)alloy wire was applied to suture supraspinatus tendon in a rat acute rotator cuff tear model with Vicryl Plus 4±0 absorbable suture as control.The shoulder joint humerus-supraspinatus tendon complex specimens were retrieved at 4,8,and 12 weeks after operation.The Mg alloy suture groups showed better biomechanical properties in terms of ultimate load to failure.Gross observation showed that hyperplastic response of the scar tissue at the tendon-bone interface is progressively alleviated over time in the both Mg alloy suture and Vicryl suture groups.In the histological analysis,for Mg alloy suture groups,chondrocytes appear to proliferate at 4 weeks postoperatively,and the tendon-bone interface showed an orderly structural transition zone at 8 weeks postoperatively.The collagenous fiber tended to be aligned and the tendon-bone interlocking structures apparently formed,where transitional structure from unmineralized fibrocartilage to mineralized fibrocartilage was closer to the native fibrocartilaginous enthesis.In vivo degradation of the magnesium alloy wire was completed within 12 weeks.The results indicated that Mg alloy wire was promising as degradable suture with the potential to promotes fibrocartilaginous interface regeneration in rotator cuff repair.展开更多
BACKGROUND The rotator cuff is located below the acromion and deltoid muscles and comprises multiple tendons that wrap around the humeral head,maintaining shoulder joint stability.AIM To explore the effect of electroa...BACKGROUND The rotator cuff is located below the acromion and deltoid muscles and comprises multiple tendons that wrap around the humeral head,maintaining shoulder joint stability.AIM To explore the effect of electroacupuncture combined with rehabilitation techniques on shoulder function in patients with rotator cuff injuries.METHODS We selected 97 patients with rotator cuff injuries treated in the People's Hospital of Yuhuan from February 2020 to May 2023.Patients were grouped using the envelope method.RESULTS After treatment,the study group’s treatment effective rate was 94.90%(46/49 patients),significantly higher than that in the control group(79.17%,38/48 cases;P<0.05).Before treatment,there was no difference in Constant Murley Score(CMS)scores,shoulder mobility,or 36-Item Short Form Health Survey(SF-36)scale scores(P>0.05).Compared with those before treatment,the CMS scores(including pain,daily living ability,shoulder mobility,and muscle strength),all aspects of shoulder mobility(forward flexion,posterior extension,external rotation,internal rotation),and SF-36 scale scores(including physiological,psychological,emotional,physical,vitality,and health status)were higher in both groups after treatment and significantly higher in the study group(P<0.05).There was no difference in the occurrence of complications between the two treatment groups(P>0.05).CONCLUSION Electroacupuncture combined with rehabilitation techniques has a good treatment effect on patients with rotator cuff injuries,helps accelerate the recovery of shoulder function,improves the quality of life,and is highly safe.展开更多
BACKGROUND Arthroscopic rotator cuff repair is a common surgical treatment for rotator cuff injuries(RCIs).Although this procedure has certain clinical advantages,it requires rehabilitation management interventions to...BACKGROUND Arthroscopic rotator cuff repair is a common surgical treatment for rotator cuff injuries(RCIs).Although this procedure has certain clinical advantages,it requires rehabilitation management interventions to ensure therapeutic efficacy.AIM To investigate the effect of integrated traditional Chinese medicine and Western medicine(TCM-WM)under the multidisciplinary team(MDT)model on the postoperative recovery of patients undergoing arthroscopic surgery for RCIs.METHODS This study enrolled 100 patients who underwent arthroscopic rotator cuff repair for RCIs at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between June 2021 and May 2024.They were divided into a control group(n=48)that received routine rehabilitation treatment and an experimental group(n=52)that received TCM-WM under the MDT model(e.g.,acupuncture,TCM traumatology and orthopedics,and rehabilitation).The results of the Constant–Murley Shoulder Score(CMS),Visual Analogue Scale(VAS),Shoulder Pain and Disability Index(SPADI),muscular strength evaluation,and shoulder range of motion(ROM)assessments were analyzed.RESULTS After treatment,the experimental group showed significantly higher CMS scores in terms of pain,functional activity,shoulder joint mobility,and muscular strength than the baseline and those of the control group.The experimental group also exhibited significantly lower VAS and SPADI scores than the baseline and those of the control group.In addition,the experimental group showed significantly enhanced muscular strength(forward flexor and external and internal rotator muscles)and shoulder ROM(forward flexion,abduction,and lateral abduction)after treatment compared with the control group.CONCLUSION TCM-WM under the MDT model improved shoulder joint function,relieved postoperative pain,promoted postoperative functional recovery,and facilitated the recovery of muscular strength and shoulder ROM in patients with RCIs who underwent arthroscopic rotator cuff repair.展开更多
BACKGROUND Rotator cuff tears and Bankart lesions significantly affect shoulder function and quality of life.Arthroscopic rotator cuff repair and Bankart repair has become the standard treatment for restoring function...BACKGROUND Rotator cuff tears and Bankart lesions significantly affect shoulder function and quality of life.Arthroscopic rotator cuff repair and Bankart repair has become the standard treatment for restoring function and reducing pain.Recent advancements include new suture anchor technologies,such as the Sironix suture anchor known for its biomechanical strength and promising outcomes.However,there are limited real-world data on its effectiveness and safety,particularly in the Indian population.AIM To evaluate the effectiveness and safety of Sironix suture anchors in rotator cuff and Bankart repair surgeries.METHODS Sixty participants underwent surgery between January 2021 and December 2022,and demographic data and postoperative outcomes were collected through retrospective reviews and telephonic interviews.Validated scales,including the PENN Shoulder Score(PSS),Disabilities of the Arm,Shoulder,and Hand(DASH)score,and Single Assessment Numeric Evaluation(SANE),were utilized for assessment.RESULTS Treatment with Sironix suture anchor devices,including Ceptre Knotted UHMWPE Suture Titanium Anchor,Spyke Knotted UHMWPE Suture Peek Anchor,Stativ Knotted UHMWPE Suture Anchor,and Viplok Knotless Peek Screw Anchor with Titanium Tip,revealed no repair failures.Participants demonstrated high satisfaction and functional improvement,as evidenced by the mean Quick DASH score(32.01)and PSS(71.65)and the satisfactory SANE scores for both injured joints(74.33)and non-injured(83.67)shoulder joints.CONCLUSION The study yielded favorable outcomes for rotator cuff tear repair and Bankart repair.No repair failures were observed,supporting the safety and efficacy of these devices in shoulder injury management.展开更多
Objective: To explore the clinical efficacy of shoulder arthroscopic one-knot-two-wire suture bridge technique in the treatment of small and medium-sized rotator cuff tears. Methods: The clinical data of 22 patients w...Objective: To explore the clinical efficacy of shoulder arthroscopic one-knot-two-wire suture bridge technique in the treatment of small and medium-sized rotator cuff tears. Methods: The clinical data of 22 patients with small and medium-sized rotator cuff injuries treated with the one-knot-two-wire suture bridge technique from February 2022 to June 2023 in the Department of Orthopaedics of Jingzhou Hospital Affiliated to Yangtze University were retrospectively analysed, among which 14 cases were male and 8 cases were female;the age ranged from 35 to 68 years old, with an average of (50.86 ± 10.80) years old. All cases underwent an MRI examination of the shoulder joint to understand the type and degree of injury. The duration of the disease ranged from 120 to 166 d, with a mean of (141.23 ± 13.46) d. The evaluation of the operation time, intraoperative bleeding, visual analogue scale (VAS) of pain, Constant-Murley score and Sugaya grading of shoulder MRI were performed at the last follow-up. Results: All 22 patients were followed up for 12 - 18 months, with a mean of (14.68 ± 1.89 d). The operation time was 38 - 58 min, mean (48.18 ± 5.92) min;intraoperative bleeding was 5 - 15 mL, mean (10.00 ± 3.45) mL. All patients achieved normal healing without re-tear, vascular and nerve injury, incision infection, anchor nail loosening and dislodgement and other complications. At the last follow-up, both shoulders were normal in shape and symmetrical on both sides. The VAS score was 0 - 1.2 points, with an average of 0.61 ± 0.42 points, and the Constant-Murley score was 70 - 98 points, with an average of 86.09 ± 8.56 points. The Sugaya classification of MRI examination was 17 cases of grade I, 4 cases of grade II, and 1 case of grade III. Conclusion: One-knot-two-wire suture bridge technique is used for the treatment of small and medium-sized rotator cuff tears with short operative time, low bleeding, and good clinical outcome.展开更多
Introduction: Ultrasound is the imaging technique of choice for the study of rotator cuff lesions. However, in the case of shoulder trauma, it is rarely requested in our context. This study aimed to show ultrasound le...Introduction: Ultrasound is the imaging technique of choice for the study of rotator cuff lesions. However, in the case of shoulder trauma, it is rarely requested in our context. This study aimed to show ultrasound lesions of the rotator cuff in cases of non-fracture shoulder trauma at the CHUYO in Ouagadougou. Methodology: This was a prospective descriptive cross-sectional study running from August 1 to November 30, 2017, in the medical imaging department of CHUYO. The study population consisted of patients received in the department for ultrasound in the context of non-fracture shoulder trauma. Results: We collected 20 cases (66.67%) of rotator cuff lesions out of 30 non-fracture shoulder injuries. The mean age of the patients was 27.6 years. Road traffic accidents accounted for 60% of injuries, sports accidents for 30%, and domestic accidents for 10%. Ultrasound lesions were mainly tendon ruptures (36.67%) and tendinitis (23.33%). Ruptures were non-transfixing in 90.90% of cases. The supraspinatus was the most affected (81.81%). Conclusion: Ultrasound can help diagnose rotator cuff injuries, particularly in non-fractured shoulder trauma.展开更多
Objective: To further understand what factors should be considered when deciding to do mini-open versus arthroscopic rotator cuff repair. Methods: A systematic literature search on the computer was done with the help ...Objective: To further understand what factors should be considered when deciding to do mini-open versus arthroscopic rotator cuff repair. Methods: A systematic literature search on the computer was done with the help of the PubMed database. Of the articles searched through, three have been chosen to specifically address topics of interest concerning the factors affecting arthroscopic vs mini-open RCR surgical approaches. Discussion: As we continue to progress down the line of factors impacting a clinician’s decision making, we begin to see how postoperative management is unchanged. Tear severity lacks sufficient evidence to base a decision on, but financial, educational, and logistical factors are proven to play a significant role in this decision. Conclusion: As of right now it seems that mini-open RCR is the most cost and time efficient method, especially amongst non-fellowship trained surgeons or ones with lower volume of shoulder scopes. However, further studies should be done to examine cost and efficiency in Sport Medicine fellowship trained orthopedic surgeons to validate these findings.展开更多
BACKGROUND Rotator cuff pathology is a very common source of shoulder pain.Similarly,osteoarthritis of the glenohumeral joint can cause shoulder pain and produce similar symptoms.Surgical management can be indicated f...BACKGROUND Rotator cuff pathology is a very common source of shoulder pain.Similarly,osteoarthritis of the glenohumeral joint can cause shoulder pain and produce similar symptoms.Surgical management can be indicated for both pathologies,however,outcomes data is limited when examining rotator cuff repair(RCR) in the setting of glenohumeral arthritis(GHOA).Thus,this study sought to determine outcomes for patients who undergo RCR in the setting of GHOA.AIM To evaluate if a relationship exists between outcomes of RCR in the setting of GHOA.METHODS This was a retrospective analysis of patients who underwent arthroscopic rotator cuff repair with concurrent glenohumeral osteoarthritis between 2010-2017.Patients were stratified based on rotator cuff tear size and glenohumeral osteoarthritis severity.Cohorts were paired 1:1 with patients without glenohumeral osteoarthritis.Patients included had a minimum two year follow-up.Rate of conversion to total shoulder arthroplasty,complication rates following initial surgery,and patient-reported outcome measures were collected.RESULTS A total of 142 patients were included.The number of patients that required total shoulder arthroplasty within two years after index surgery was low.2/71(2.8%) patients with GHOA,and 1/71(1.4%) without GHOA.Following rotator cuff repair,both groups showed favorable patientreported outcomes.CONCLUSION Patients with glenohumeral osteoarthritis who underwent arthroscopic rotator cuff repair showed comparable outcomes to patients without glenohumeral osteoarthritis.展开更多
BACKGROUND Superior capsular reconstruction(SCR)with long head of biceps tendon(LHBT)transposition was developed to massive and irreparable rotator cuff tears(MIRCTs);however,the outcomes of this technique remain uncl...BACKGROUND Superior capsular reconstruction(SCR)with long head of biceps tendon(LHBT)transposition was developed to massive and irreparable rotator cuff tears(MIRCTs);however,the outcomes of this technique remain unclear.AIM To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical outcomes after LHBT transposition for MIRCTs.METHODS We performed a systematic electronic database search on PubMed,EMBASE,and Cochrane Library.Studies of SCR with LHBT transposition were included according to the inclusion and exclusion criteria.Biomechanical studies were assessed for main results and conclusions.Included clinical studies were evaluated for quality of methodology.Data including study characteristics,cohort demographics,and outcomes were extracted.A meta-analysis was conducted of the clinical outcomes.RESULTS According to our inclusion and exclusion criteria,a total of six biomechanical studies were identified and reported an overall improvement in subacromial contact pressures and prevention of superior humeral migration without limiting range of motion(ROM)after LHBT transposition for MIRCTs.A total of five clinical studies were included in the meta-analysis of LHBT transposition outcomes,consisting of 253 patients.The results indicated that compared to other surgical methods for MIRCTs,LHBT transposition had advantages of more significant improvement in ROM(forward flexion mean difference[MD]=6.54,95%confidence interval[CI]:3.07-10.01;external rotation[MD=5.15,95%CI:1.59-8.17];the acromiohumeral distance[AHD][MD=0.90,95%CI:0.21-1.59])and reducing retear rate(odds ratio=0.27,95%CI:0.15-0.48).No significant difference in American Shoulder and Elbow Surgeons score,visual analogue scale score,and University of California at Los Angles score was demonstrated between these two groups for MIRCTs.CONCLUSION In general,SCR with LHBT transposition was a reliable and economical technique for treating MIRCTs,both in terms of biomechanical and clinical outcomes,with comparable clinical outcomes,improved ROM,AHD,and reduced the retear rates compared to conventional SCR and other established techniques.More high-quality randomized controlled studies on the long-term outcomes of SCR with LHBT transposition are required to further assess.展开更多
Objective: To evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) for the detection of partial-thickness rotator cuff tears (PTT) and full-thickness rotator cuff tears(FTT) by comparing its findings w...Objective: To evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) for the detection of partial-thickness rotator cuff tears (PTT) and full-thickness rotator cuff tears(FTT) by comparing its findings with surgical findings as the gold standard and to improve the previous MRI accuracy in diagnosing rotator cuff tears (RCT) considering more variables. Methods: In 45 months, 804 patients underwent MRI shoulder joint. Among them, only 95 cases had undergone both MRI imaging and surgery accordingly. The patient records were evaluated retrospectively if MRI and surgery were performed within 40 days of MRI. MRI findings were categorized into PTT, FTT and no tears which were further divided into different types according to four main nominal data as variables viz. site, size, shape and muscle involvement in RCT and were correlated with surgical findings for statistical calculation by using Kappa coefficient and McNemar Bowker test. Results: 81 patients (86 RCTs) underwent surgery within 40 days. On the basis of site as variable, MRI correctly depicted 100% of full thickness tears(FTT), 85% of bursal partial thickness tears(PTT), 80.4% of articular partial thickness tears(PTT). The consistency in diagnosis of RCT between MRI and surgery was moderate (Kappa coefficient 0.645). Overall sensitivity, specificity and accuracy of MRI for diagnosing PTT was 87.3%, 53.3% and 81.3%;and that for FTT was 100%, 98.7% and 98.8% respectively. Likewise on the basis of size, shape and muscles involved, the consistency between MRI and surgery was poor for size and shape and moderate for muscles involved;and the difference in diagnosing RCT by MRI and surgery was significant for shape (P = 0.002) only, but not significant for size (P = 0.16) and for muscles involved (P = 0.206) respectively. The agreement between MRI and surgery in diagnosing calcific tendinitis and shoulder joint hematoma with Kappa coefficient is (0.577) and (0.556) respectively. Conclusion: MRI has better accuracy for detecting FTT and has high sensitivity and positive predictive value in diagnosing both PTT and FTT. Combining more others variables in addition to RCT, MRI offers a great value in diagnosing RCT.展开更多
BACKGROUND The reparability of large or massive rotator cuff tears is difficult to determine preoperatively.We previously identified age≥65 years,acromiohumeral interval≤6 mm,and anteroposterior tear size≥22 mm as ...BACKGROUND The reparability of large or massive rotator cuff tears is difficult to determine preoperatively.We previously identified age≥65 years,acromiohumeral interval≤6 mm,and anteroposterior tear size≥22 mm as risk factors for rotator cuff repair failure.We therefore developed a rotator cuff reparability score where each of the above risk factors is assigned a score of one point.AIM To determine the accuracy of a rotator cuff reparability score.METHODS This was a retrospective cohort study of recruited patients with large or massive rotator cuff tears treated at our institution between January 2013 and December 2019.Exclusion criteria were revision surgery and patients with contraindications for surgery.All patients underwent arthroscopic rotator cuff repair and were categorized into either complete or partial rotator cuff repair.Rotator cuff reparability scores were calculated for each patient.The sensitivity,specificity,positive and negative predictive value,and positive and negative likelihood ratio were assessed.A receiver operating characteristic curve was plotted to determine the optimal cut-off rotator cuff reparability score.RESULTS Eighty patients(mean age,61 years;range,25–84 years;41 females and 39 males)were recruited.Intra-and inter-observer reliabilities were good to excellent.The number of patients with 0,1,2,and 3 risk factors for rotator cuff repair failure were 24,33,17,and 6,respectively.Complete repair was performed in all patients without risk factors.Two of the 33 patients with one risk factor and seven of the 17 patients with two risk factors underwent partial repair.One of the six patients with three risk factors underwent complete repair.The area under the curve was 0.894.The optimal cut-off score was two points with a sensitivity of 85.71%and a specificity of 83.33%.CONCLUSION A rotator cuff reparability score of two was determined to be the optimal cut-off score for predicting the reparability of large or massive rotator cuff tears.展开更多
AIM To determine diagnostic performance of magnetic resonance arthrography(MRA) in evaluating rotator cuff tears(RCTs) using Snyder's classification for reporting.METHODS One hundred and twenty-six patients(64 mal...AIM To determine diagnostic performance of magnetic resonance arthrography(MRA) in evaluating rotator cuff tears(RCTs) using Snyder's classification for reporting.METHODS One hundred and twenty-six patients(64 males, 62 females; median age 55 years) underwent shoulder MRA and arthroscopy, which represented our reference standard. Surgical arthroscopic reports were reviewed and the reported Snyder's classification was recorded. MRA examinations were evaluated by two independent radiologists(14 and 5 years' experience) using Snyder's classification system, blinded to arthroscopy. Agreement between arthroscopy and MRA on partial-and fullthickness tears was calculated, first regardless of their extent. Then, analysis took into account also the extent of the tear. Interobserver agreement was also calculated the quadratically-weighted Cohen kappa statistics.RESULTS On arthroscopy, 71/126 patients(56%) had a fullthickness RCT. The remaining 55/126 patients(44%) had a partial-thickness RCT. Regardless of tear extent, out of 71 patients with arthroscopically-confirmed fullthickness RCTs, 66(93%) were correctly scored by both readers. All 55 patients with arthroscopic diagnosis of partial-thickness RCT were correctly assigned as having a partial-thickness RCT at MRA by both readers. Interobserver reproducibility analysis showed total agreement between the two readers in distinguishing partial-thickness from full-thickness RCTs, regardless of tear extent(k = 1.000). With regard to tear extent, in patients in whom a complete tear was correctly diagnosed, correct tear extent was detected in 61/66 cases(92%); in the remaining 5/66 cases(8%), tear extent was underestimated. Agreement was k = 0.955. Interobserver agreement was total(k = 1.000).CONCLUSION MRA shows high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder's classification for reporting. Snyder's classification may be adopted for routine reporting of MRA.展开更多
基金the Scientific Research Innovation Capability Support Project for Young Faculty(ZYGXQNJSKYCXNLZCXM-H8)Fundamental Research Funds for the Central Universities(2024ZYGXZR077)+3 种基金Guangdong Basic and Applied Basic Research Foundation(2023B1515120006)Guangzhou Basic and Applied Basic Research Foundation(2024A04J5776)the Research Fund(2023QN10Y421)Guangzhou Talent Recruitment Team Program(2024D03J0004),all related to this study.
文摘Osteoporosis is a known risk factor for rotator cuff tears(RCTs),but the causal correlation and underlying mechanisms remain unclear.This study aims to evaluate the impact of osteoporosis on RCT risk and investigate their genetic associations.Using data from the UK Biobank(n=457871),cross-sectional analyses demonstrated that osteoporosis was significantly associated with an increased risk of RCTs(adjusted OR[95%CI]=1.38[1.25–1.52]).A longitudinal analysis of a subset of patients(n=268117)over 11 years revealed that osteoporosis increased the risk of RCTs(adjusted HR[95%CI]=1.56[1.29–1.87]),which is notably varied between sexes in sex-stratified analysis.Causal inference methods,including propensity score matching,inverse probability weighting,causal random forest and survival random forest models further confirmed the causal effect,both from cross-sectional and longitudinal perspectives.
文摘BACKGROUND Shoulder arthroscopy is commonly used for the repair of glenohumeral ligament avulsions or tendon tears.The success of the operation depends on the ability of the ligaments or rotator cuff tendon to heal to their original attachment site.Soft tissue healing can be evaluated with imaging methods or alternatively with second-look arthroscopy.AIM To investigate shoulder tendon and capsule healing after arthroscopic rotator cuff and instability repair using second-look arthroscopy.METHODS In this study,24 adult patients with rotator cuff tears(13 patients)or anterior shoulder instability(11 patients)were included.All patients were initially subjected to arthroscopic repair using suture anchors and were re-evaluated with second-look arthroscopy for reasons not related to the original pathology.The second operation was performed in 8 patients due to mild but persistent pain or stiffness,in 3 patients for recalcitrant stiffness,in 5 patients for secondary biceps tenotomy,in 6 patients for persistent acromioclavicular joint pain and in 2 patients for suture anchor prominence causing shoulder grinding.Soft tissue healing was evaluated visually and by probing,whereas clinical outcomes were evaluated using the University of California–Los Angeles(UCLA)and Rowe rating scales.RESULTS In almost all patients,complete soft tissue healing occurred at the site of tissue reattachment,either on the glenoid articular surface or the greater humeral tuberosity.The strongest repair,as confirmed by probe palpation,was encountered at the site of suture passage through the soft tissue.All suture material was covered with bursal synovial tissue,with no cases of knot impingement or cartilage fraying.The mean preoperative and postoperative UCLA scores for rotator cuff repair patients were 1354±3205 and 2931±2898,respectively(P<0.001),whereas for shoulder instability patients,the mean Rowe scores preoperatively and postoperatively were 2591±1338 and 9272±754,respectively(P<0.001).The use of bioabsorbable implants did not cause synovitis or other tissue reactions.CONCLUSION Soft tissue healing in the shoulder is successful and strongest at the site of suture anchor placement.
基金thank the staff of the accredited animal facility of the laboratory of anatomy,Histology and Embryology of Aristotle University of Thessaloniki’s veterinary school for their assistance in animal handling and care.
文摘BACKGROUND Massive rotator cuff tears(RCTs)result in impaired shoulder function and quality of life.These tears lead to structural changes in the rotator cuff muscles,which compromise recovery after repair and increase re-tear rates.AIM To investigate the potential inhibitory effects of alpha-tocopherol(vitamin E)and OTR-4131 on muscle atrophy,fatty infiltration,and fibrosis in rotator cuff muscles following a massive RCT using a Wistar rat model,and establish a standardized methodology for evaluating potential therapeutic agents.METHODS This protocol outlines a controlled animal study using 40 male Wistar rats,randomized into five groups.The experimental groups will receive either systemic administration of alpha-tocopherol or local administration of OTR-4131 via intramuscular injection into the supraspinatus and infraspinatus muscles.Two sham groups will receive systemic and local saline injections respectively,while a control group will undergo no intervention.The interventions will be administered after surgical transection of the supraspinatus and infraspinatus tendons.Outcomes will be assessed via wet muscle weight measurements,muscle fiber diameter,fatty infiltration percentage,and fibrosis evaluation using histological methods.RESULTS The study anticipates that alpha-tocopherol and OTR-4131 will reduce muscle atrophy,fatty infiltration,and fibrosis compared to control and sham groups,supporting their potential protective role in rotator cuff muscle degeneration.CONCLUSION The results are expected to improve the understanding on the role of alpha-tocopherol and OTR-4131 in rotator cuff muscle protection after massive RCT and may serve as a foundation for further preclinical and clinical research aimed at improving rotator cuff repair outcomes.
基金Supported by the General Program of the Hubei Provincial Natural Science Foundation of China Key Project,No.2021CFB520.
文摘BACKGROUND Long head of biceps tendon(LHBT)transposition is a novel technique based on the double-row suture bridge method,utilizing autologous reconstruction to treat massive rotator cuff tears.AIM To evaluate the mid-to-long-term clinical outcomes following the double-row repair method for massive rotator cuff tears.METHODS This retrospective analysis included data from 53 patients with massive rotator cuff tears treated at our hospital between 2020 and 2021.The patients were divided into the double-row repair group(conventional group)and the doublerow repair combined with the LHBT transposition group(transposition group).Postoperative pain was assessed using the visual analogue scale at one week,one year,and the final follow-up.Shoulder function was evaluated using the American Shoulder and Elbow Surgeons and Constant-Murley scores at one year and the final follow-up.Rotator cuff healing was assessed postoperatively for one year using the Sugaya classification,which categorizes tendon integrity based on magnetic resonance imaging findings.RESULTS No perioperative complications were observed in any of the patients at any time.There were no significant differences between the groups regarding operative time and intraoperative blood loss.The transposition group had significantly lower visual analogue scale scores than the conventional group at one week postoperatively;however,there were no significant differences between the groups at one year or the final follow-up.At one year postoperatively,the transposition group showed significantly higher American Shoulder and Elbow Surgeons and Constant-Murley scores than the conventional group;no significant differences were observed at the final followup.There were no significant differences in rotator cuff healing between the groups at one year postoperatively.CONCLUSION Compared to double-row repair alone,double-row repair combined with LHBT transposition for treating massive rotator cuff tears more effectively alleviates short-term postoperative pain and improves shoulder function within the first year.
文摘BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.METHODS We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials(RCTs)comparing sub-acromial injections for rotator cuff injuries.The interventions evaluated were hyaluronic acid(HA),platelet-rich plasma(PRP),prolotherapy,and corticosteroids.The outcomes of interest were pain and functional improvement,which were evaluated with standardized scores.The Risk of Bias 2 tool and the Grading of Recommendations,Assessment,Development and Evaluation methodology were used to assess data quality.RESULTS Twenty RCTs,comprising 1479 participants,were included.In the short term,HA achieved the best outcomes[pain mean difference(MD)=-1.48,95%confidence interval(CI)-2.37 to-0.59;function MD=10.18,95%CI:4.96-15.41].In the medium term,HA,PRP,HA+PRP,and corticosteroids were not superior to placebo in improving pain.Based on function,HA+PRP was superior to placebo,corticosteroids,and PRP(MD=26.72;95%CI:8.02-45.41).In the long term,HA,PRP,and corticosteroids were not superior to placebo in reducing pain.However,based on function,HA+PRP,PRP,and HA were superior to placebo,and HA+PRP had the best result(MD=36.64;95%CI:31.66-33.62).CONCLUSION HA provides satisfactory short-term results,while HA with PRP demonstrates functional improvement in the medium and long terms.However,no intervention maintained the pain-relief effect on>3-month follow-up.
文摘BACKGROUND Rotator cuff tears are a chief cause of shoulder pain and disability,and surgical repair is often required when conservative management fails.As digital health technologies have expanded,especially since the coronavirus disease 2019 pandemic,digitally augmented rehabilitation programs emerged as a potential alternative to conventional physical therapy.AIM To determine if digitally assisted rehabilitation could be as practical,or even more effective,than the traditional methods most patients currently follow.METHODS Six electronic databases,including PubMed,Scopus,Cochrane Library,Google Scholar,EMBASE,and Web of Science,were searched to find articles that compare digital-based rehabilitation and conventional treatment.Outcomes of interest were Disabilities of the Arm,Shoulder and Hand(DASH)score and range of motion.The quality assessment of the included studies was performed using the risk-of-bias tool for randomized trials tool.RESULTS Three randomized controlled trial studies were enrolled in this study,including 195 cases.We did not find any significant differences between the two groups in terms of DASH score,flexion range of motion,and external rotation range of motion.There was a significant difference between the two groups for abduction range of motion.CONCLUSION Digital home-based rehab seems to be a strong alternative to traditional methods,offering similar results for people recovering from rotator cuff surgery.This approach might also make rehab more accessible and engaging for patients.That said,further research is needed to fully understand the potential of digital rehabilitation and ensure it works effectively for everyone.
基金Supported by Zhejiang Administration of Traditional Chinese Medicine,No.2023ZF019Natural Science Foundation of Zhejiang Province,No.(2020)56+1 种基金Cultivation of Health High-level Talents in Zhejiang Province in 2022,No.(2019)58and National Natural Science Foundation of China,No.H02710.
文摘Recently,we read a retrospective study by Chen et al,which demonstrated that electroacupuncture is highly effective in relieving pain due to rotator cuff injuries and accelerating the recovery of shoulder function,promoting repair of rotator cuff injuries.This study provides a new way to the conservative treatment of early rotator cuff injuries.In the present letter,we review the current treatment of rotator cuff injury with electroacupuncture combined with rehabilitation techniques and propose our views.
文摘Background:Rehabilitation typically restores shoulder function after a common rotator cuff repair;however,it is unclear when to initiate physical therapy(PT)post-surgery.To understand effective start times,this study analyzed PT start times and their effect on shoulder function.The most effective shoulder outcomes were hypothesized to occur when PT started 0-4 weeks post-surgery.Methods:Data from 1002 patients who underwent rotator cuff repair were analyzed retrospectively from 52 outpatient clinics in the years of 2016-2021.The primary data of timings between surgery and the start of PT(0-2 weeks[0-14 days],2-4 weeks[15-28 days],4-6 weeks[29-42 days],and 6-14 weeks[43-100 days]),change in functional shoulder scores,number of PT visits utilized,and functional scores changed per visit were analyzed.Regression analyses of the impact of age,sex,payor source,and tear size were completed.Results:The change in functional scores and functional scores changed per visit are not affected by the initiation timing of PT postrotator cuff surgery,when controlling for baseline functional scores.This result is revealed despite initial functional scores being significantly different.Functional scores change per visit may have been affected by payor source(R^(2)=0.004,p≤0.010).PT start times may have been impacted by age(R^(2)=0.010,p=0.007),payor source(R^(2)=0.016,p=0.001),and tear size(R^(2)=0.007,p=0.026).Payor source may have influenced the number of PT visits(R^(2)=0.060,p<0.001).Conclusions:After rotator cuff surgery,patients should choose to complete rehabilitation to optimize shoulder function.However,the initiation timing of PT may not affect functional shoulder outcomes.
基金the National Key Research and Development Program of China(No.2020YFC1107501)the National Natural Science Foundation of China(No.51971222,51801220)+4 种基金the Natural Science Foundation of Liaoning Province of China(No.2020-MS-001)the Dong Guan Innovative Research Team Program(No.2020607134012)the Military Translational Medicine Fund of Chinese PLA General Hospital(ZH19008)Capital’s Funds for Health Improvement and Research(CFH 2022-2-5051)the Dong Guan Science and Technology Service Network Initiative(20201600200042)。
文摘Despite transosseous rotator cuff tear repair using sutures is widely accepted for tendon-bone fixation,the fibrocartilaginous enthesis regeneration is still hardly achieved with the traditional sutures.In the present work,degradable magnesium(Mg)alloy wire was applied to suture supraspinatus tendon in a rat acute rotator cuff tear model with Vicryl Plus 4±0 absorbable suture as control.The shoulder joint humerus-supraspinatus tendon complex specimens were retrieved at 4,8,and 12 weeks after operation.The Mg alloy suture groups showed better biomechanical properties in terms of ultimate load to failure.Gross observation showed that hyperplastic response of the scar tissue at the tendon-bone interface is progressively alleviated over time in the both Mg alloy suture and Vicryl suture groups.In the histological analysis,for Mg alloy suture groups,chondrocytes appear to proliferate at 4 weeks postoperatively,and the tendon-bone interface showed an orderly structural transition zone at 8 weeks postoperatively.The collagenous fiber tended to be aligned and the tendon-bone interlocking structures apparently formed,where transitional structure from unmineralized fibrocartilage to mineralized fibrocartilage was closer to the native fibrocartilaginous enthesis.In vivo degradation of the magnesium alloy wire was completed within 12 weeks.The results indicated that Mg alloy wire was promising as degradable suture with the potential to promotes fibrocartilaginous interface regeneration in rotator cuff repair.
文摘BACKGROUND The rotator cuff is located below the acromion and deltoid muscles and comprises multiple tendons that wrap around the humeral head,maintaining shoulder joint stability.AIM To explore the effect of electroacupuncture combined with rehabilitation techniques on shoulder function in patients with rotator cuff injuries.METHODS We selected 97 patients with rotator cuff injuries treated in the People's Hospital of Yuhuan from February 2020 to May 2023.Patients were grouped using the envelope method.RESULTS After treatment,the study group’s treatment effective rate was 94.90%(46/49 patients),significantly higher than that in the control group(79.17%,38/48 cases;P<0.05).Before treatment,there was no difference in Constant Murley Score(CMS)scores,shoulder mobility,or 36-Item Short Form Health Survey(SF-36)scale scores(P>0.05).Compared with those before treatment,the CMS scores(including pain,daily living ability,shoulder mobility,and muscle strength),all aspects of shoulder mobility(forward flexion,posterior extension,external rotation,internal rotation),and SF-36 scale scores(including physiological,psychological,emotional,physical,vitality,and health status)were higher in both groups after treatment and significantly higher in the study group(P<0.05).There was no difference in the occurrence of complications between the two treatment groups(P>0.05).CONCLUSION Electroacupuncture combined with rehabilitation techniques has a good treatment effect on patients with rotator cuff injuries,helps accelerate the recovery of shoulder function,improves the quality of life,and is highly safe.
基金General Project of Health and Family Planning Scientific Research of Pudong New Area Health Commission:Evaluation of the Clinical Effectiveness of the Integrated Traditional Chinese and Western Medicine Clinical Program for Accelerating Postoperative Recovery of Patients with Rotator cuff Injury under the Multidisciplinary Team Mode,No.PW2021A-66Shanghai Municipal Health Commission Key Department of Integrated Traditional Chinese and Western MedicinePeak Discipline of Traditional Chinese Medicine(Orthopedics and Traumatology Department of Integrated Traditional Chinese and Western Medicine),Shanghai Pudong New Area Health Commission,No.YC-2023-0601.
文摘BACKGROUND Arthroscopic rotator cuff repair is a common surgical treatment for rotator cuff injuries(RCIs).Although this procedure has certain clinical advantages,it requires rehabilitation management interventions to ensure therapeutic efficacy.AIM To investigate the effect of integrated traditional Chinese medicine and Western medicine(TCM-WM)under the multidisciplinary team(MDT)model on the postoperative recovery of patients undergoing arthroscopic surgery for RCIs.METHODS This study enrolled 100 patients who underwent arthroscopic rotator cuff repair for RCIs at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between June 2021 and May 2024.They were divided into a control group(n=48)that received routine rehabilitation treatment and an experimental group(n=52)that received TCM-WM under the MDT model(e.g.,acupuncture,TCM traumatology and orthopedics,and rehabilitation).The results of the Constant–Murley Shoulder Score(CMS),Visual Analogue Scale(VAS),Shoulder Pain and Disability Index(SPADI),muscular strength evaluation,and shoulder range of motion(ROM)assessments were analyzed.RESULTS After treatment,the experimental group showed significantly higher CMS scores in terms of pain,functional activity,shoulder joint mobility,and muscular strength than the baseline and those of the control group.The experimental group also exhibited significantly lower VAS and SPADI scores than the baseline and those of the control group.In addition,the experimental group showed significantly enhanced muscular strength(forward flexor and external and internal rotator muscles)and shoulder ROM(forward flexion,abduction,and lateral abduction)after treatment compared with the control group.CONCLUSION TCM-WM under the MDT model improved shoulder joint function,relieved postoperative pain,promoted postoperative functional recovery,and facilitated the recovery of muscular strength and shoulder ROM in patients with RCIs who underwent arthroscopic rotator cuff repair.
文摘BACKGROUND Rotator cuff tears and Bankart lesions significantly affect shoulder function and quality of life.Arthroscopic rotator cuff repair and Bankart repair has become the standard treatment for restoring function and reducing pain.Recent advancements include new suture anchor technologies,such as the Sironix suture anchor known for its biomechanical strength and promising outcomes.However,there are limited real-world data on its effectiveness and safety,particularly in the Indian population.AIM To evaluate the effectiveness and safety of Sironix suture anchors in rotator cuff and Bankart repair surgeries.METHODS Sixty participants underwent surgery between January 2021 and December 2022,and demographic data and postoperative outcomes were collected through retrospective reviews and telephonic interviews.Validated scales,including the PENN Shoulder Score(PSS),Disabilities of the Arm,Shoulder,and Hand(DASH)score,and Single Assessment Numeric Evaluation(SANE),were utilized for assessment.RESULTS Treatment with Sironix suture anchor devices,including Ceptre Knotted UHMWPE Suture Titanium Anchor,Spyke Knotted UHMWPE Suture Peek Anchor,Stativ Knotted UHMWPE Suture Anchor,and Viplok Knotless Peek Screw Anchor with Titanium Tip,revealed no repair failures.Participants demonstrated high satisfaction and functional improvement,as evidenced by the mean Quick DASH score(32.01)and PSS(71.65)and the satisfactory SANE scores for both injured joints(74.33)and non-injured(83.67)shoulder joints.CONCLUSION The study yielded favorable outcomes for rotator cuff tear repair and Bankart repair.No repair failures were observed,supporting the safety and efficacy of these devices in shoulder injury management.
文摘Objective: To explore the clinical efficacy of shoulder arthroscopic one-knot-two-wire suture bridge technique in the treatment of small and medium-sized rotator cuff tears. Methods: The clinical data of 22 patients with small and medium-sized rotator cuff injuries treated with the one-knot-two-wire suture bridge technique from February 2022 to June 2023 in the Department of Orthopaedics of Jingzhou Hospital Affiliated to Yangtze University were retrospectively analysed, among which 14 cases were male and 8 cases were female;the age ranged from 35 to 68 years old, with an average of (50.86 ± 10.80) years old. All cases underwent an MRI examination of the shoulder joint to understand the type and degree of injury. The duration of the disease ranged from 120 to 166 d, with a mean of (141.23 ± 13.46) d. The evaluation of the operation time, intraoperative bleeding, visual analogue scale (VAS) of pain, Constant-Murley score and Sugaya grading of shoulder MRI were performed at the last follow-up. Results: All 22 patients were followed up for 12 - 18 months, with a mean of (14.68 ± 1.89 d). The operation time was 38 - 58 min, mean (48.18 ± 5.92) min;intraoperative bleeding was 5 - 15 mL, mean (10.00 ± 3.45) mL. All patients achieved normal healing without re-tear, vascular and nerve injury, incision infection, anchor nail loosening and dislodgement and other complications. At the last follow-up, both shoulders were normal in shape and symmetrical on both sides. The VAS score was 0 - 1.2 points, with an average of 0.61 ± 0.42 points, and the Constant-Murley score was 70 - 98 points, with an average of 86.09 ± 8.56 points. The Sugaya classification of MRI examination was 17 cases of grade I, 4 cases of grade II, and 1 case of grade III. Conclusion: One-knot-two-wire suture bridge technique is used for the treatment of small and medium-sized rotator cuff tears with short operative time, low bleeding, and good clinical outcome.
文摘Introduction: Ultrasound is the imaging technique of choice for the study of rotator cuff lesions. However, in the case of shoulder trauma, it is rarely requested in our context. This study aimed to show ultrasound lesions of the rotator cuff in cases of non-fracture shoulder trauma at the CHUYO in Ouagadougou. Methodology: This was a prospective descriptive cross-sectional study running from August 1 to November 30, 2017, in the medical imaging department of CHUYO. The study population consisted of patients received in the department for ultrasound in the context of non-fracture shoulder trauma. Results: We collected 20 cases (66.67%) of rotator cuff lesions out of 30 non-fracture shoulder injuries. The mean age of the patients was 27.6 years. Road traffic accidents accounted for 60% of injuries, sports accidents for 30%, and domestic accidents for 10%. Ultrasound lesions were mainly tendon ruptures (36.67%) and tendinitis (23.33%). Ruptures were non-transfixing in 90.90% of cases. The supraspinatus was the most affected (81.81%). Conclusion: Ultrasound can help diagnose rotator cuff injuries, particularly in non-fractured shoulder trauma.
文摘Objective: To further understand what factors should be considered when deciding to do mini-open versus arthroscopic rotator cuff repair. Methods: A systematic literature search on the computer was done with the help of the PubMed database. Of the articles searched through, three have been chosen to specifically address topics of interest concerning the factors affecting arthroscopic vs mini-open RCR surgical approaches. Discussion: As we continue to progress down the line of factors impacting a clinician’s decision making, we begin to see how postoperative management is unchanged. Tear severity lacks sufficient evidence to base a decision on, but financial, educational, and logistical factors are proven to play a significant role in this decision. Conclusion: As of right now it seems that mini-open RCR is the most cost and time efficient method, especially amongst non-fellowship trained surgeons or ones with lower volume of shoulder scopes. However, further studies should be done to examine cost and efficiency in Sport Medicine fellowship trained orthopedic surgeons to validate these findings.
文摘BACKGROUND Rotator cuff pathology is a very common source of shoulder pain.Similarly,osteoarthritis of the glenohumeral joint can cause shoulder pain and produce similar symptoms.Surgical management can be indicated for both pathologies,however,outcomes data is limited when examining rotator cuff repair(RCR) in the setting of glenohumeral arthritis(GHOA).Thus,this study sought to determine outcomes for patients who undergo RCR in the setting of GHOA.AIM To evaluate if a relationship exists between outcomes of RCR in the setting of GHOA.METHODS This was a retrospective analysis of patients who underwent arthroscopic rotator cuff repair with concurrent glenohumeral osteoarthritis between 2010-2017.Patients were stratified based on rotator cuff tear size and glenohumeral osteoarthritis severity.Cohorts were paired 1:1 with patients without glenohumeral osteoarthritis.Patients included had a minimum two year follow-up.Rate of conversion to total shoulder arthroplasty,complication rates following initial surgery,and patient-reported outcome measures were collected.RESULTS A total of 142 patients were included.The number of patients that required total shoulder arthroplasty within two years after index surgery was low.2/71(2.8%) patients with GHOA,and 1/71(1.4%) without GHOA.Following rotator cuff repair,both groups showed favorable patientreported outcomes.CONCLUSION Patients with glenohumeral osteoarthritis who underwent arthroscopic rotator cuff repair showed comparable outcomes to patients without glenohumeral osteoarthritis.
基金the National Natural Science Foundation of China,No.81972125 and No.82172510.
文摘BACKGROUND Superior capsular reconstruction(SCR)with long head of biceps tendon(LHBT)transposition was developed to massive and irreparable rotator cuff tears(MIRCTs);however,the outcomes of this technique remain unclear.AIM To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical outcomes after LHBT transposition for MIRCTs.METHODS We performed a systematic electronic database search on PubMed,EMBASE,and Cochrane Library.Studies of SCR with LHBT transposition were included according to the inclusion and exclusion criteria.Biomechanical studies were assessed for main results and conclusions.Included clinical studies were evaluated for quality of methodology.Data including study characteristics,cohort demographics,and outcomes were extracted.A meta-analysis was conducted of the clinical outcomes.RESULTS According to our inclusion and exclusion criteria,a total of six biomechanical studies were identified and reported an overall improvement in subacromial contact pressures and prevention of superior humeral migration without limiting range of motion(ROM)after LHBT transposition for MIRCTs.A total of five clinical studies were included in the meta-analysis of LHBT transposition outcomes,consisting of 253 patients.The results indicated that compared to other surgical methods for MIRCTs,LHBT transposition had advantages of more significant improvement in ROM(forward flexion mean difference[MD]=6.54,95%confidence interval[CI]:3.07-10.01;external rotation[MD=5.15,95%CI:1.59-8.17];the acromiohumeral distance[AHD][MD=0.90,95%CI:0.21-1.59])and reducing retear rate(odds ratio=0.27,95%CI:0.15-0.48).No significant difference in American Shoulder and Elbow Surgeons score,visual analogue scale score,and University of California at Los Angles score was demonstrated between these two groups for MIRCTs.CONCLUSION In general,SCR with LHBT transposition was a reliable and economical technique for treating MIRCTs,both in terms of biomechanical and clinical outcomes,with comparable clinical outcomes,improved ROM,AHD,and reduced the retear rates compared to conventional SCR and other established techniques.More high-quality randomized controlled studies on the long-term outcomes of SCR with LHBT transposition are required to further assess.
文摘Objective: To evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) for the detection of partial-thickness rotator cuff tears (PTT) and full-thickness rotator cuff tears(FTT) by comparing its findings with surgical findings as the gold standard and to improve the previous MRI accuracy in diagnosing rotator cuff tears (RCT) considering more variables. Methods: In 45 months, 804 patients underwent MRI shoulder joint. Among them, only 95 cases had undergone both MRI imaging and surgery accordingly. The patient records were evaluated retrospectively if MRI and surgery were performed within 40 days of MRI. MRI findings were categorized into PTT, FTT and no tears which were further divided into different types according to four main nominal data as variables viz. site, size, shape and muscle involvement in RCT and were correlated with surgical findings for statistical calculation by using Kappa coefficient and McNemar Bowker test. Results: 81 patients (86 RCTs) underwent surgery within 40 days. On the basis of site as variable, MRI correctly depicted 100% of full thickness tears(FTT), 85% of bursal partial thickness tears(PTT), 80.4% of articular partial thickness tears(PTT). The consistency in diagnosis of RCT between MRI and surgery was moderate (Kappa coefficient 0.645). Overall sensitivity, specificity and accuracy of MRI for diagnosing PTT was 87.3%, 53.3% and 81.3%;and that for FTT was 100%, 98.7% and 98.8% respectively. Likewise on the basis of size, shape and muscles involved, the consistency between MRI and surgery was poor for size and shape and moderate for muscles involved;and the difference in diagnosing RCT by MRI and surgery was significant for shape (P = 0.002) only, but not significant for size (P = 0.16) and for muscles involved (P = 0.206) respectively. The agreement between MRI and surgery in diagnosing calcific tendinitis and shoulder joint hematoma with Kappa coefficient is (0.577) and (0.556) respectively. Conclusion: MRI has better accuracy for detecting FTT and has high sensitivity and positive predictive value in diagnosing both PTT and FTT. Combining more others variables in addition to RCT, MRI offers a great value in diagnosing RCT.
文摘BACKGROUND The reparability of large or massive rotator cuff tears is difficult to determine preoperatively.We previously identified age≥65 years,acromiohumeral interval≤6 mm,and anteroposterior tear size≥22 mm as risk factors for rotator cuff repair failure.We therefore developed a rotator cuff reparability score where each of the above risk factors is assigned a score of one point.AIM To determine the accuracy of a rotator cuff reparability score.METHODS This was a retrospective cohort study of recruited patients with large or massive rotator cuff tears treated at our institution between January 2013 and December 2019.Exclusion criteria were revision surgery and patients with contraindications for surgery.All patients underwent arthroscopic rotator cuff repair and were categorized into either complete or partial rotator cuff repair.Rotator cuff reparability scores were calculated for each patient.The sensitivity,specificity,positive and negative predictive value,and positive and negative likelihood ratio were assessed.A receiver operating characteristic curve was plotted to determine the optimal cut-off rotator cuff reparability score.RESULTS Eighty patients(mean age,61 years;range,25–84 years;41 females and 39 males)were recruited.Intra-and inter-observer reliabilities were good to excellent.The number of patients with 0,1,2,and 3 risk factors for rotator cuff repair failure were 24,33,17,and 6,respectively.Complete repair was performed in all patients without risk factors.Two of the 33 patients with one risk factor and seven of the 17 patients with two risk factors underwent partial repair.One of the six patients with three risk factors underwent complete repair.The area under the curve was 0.894.The optimal cut-off score was two points with a sensitivity of 85.71%and a specificity of 83.33%.CONCLUSION A rotator cuff reparability score of two was determined to be the optimal cut-off score for predicting the reparability of large or massive rotator cuff tears.
文摘AIM To determine diagnostic performance of magnetic resonance arthrography(MRA) in evaluating rotator cuff tears(RCTs) using Snyder's classification for reporting.METHODS One hundred and twenty-six patients(64 males, 62 females; median age 55 years) underwent shoulder MRA and arthroscopy, which represented our reference standard. Surgical arthroscopic reports were reviewed and the reported Snyder's classification was recorded. MRA examinations were evaluated by two independent radiologists(14 and 5 years' experience) using Snyder's classification system, blinded to arthroscopy. Agreement between arthroscopy and MRA on partial-and fullthickness tears was calculated, first regardless of their extent. Then, analysis took into account also the extent of the tear. Interobserver agreement was also calculated the quadratically-weighted Cohen kappa statistics.RESULTS On arthroscopy, 71/126 patients(56%) had a fullthickness RCT. The remaining 55/126 patients(44%) had a partial-thickness RCT. Regardless of tear extent, out of 71 patients with arthroscopically-confirmed fullthickness RCTs, 66(93%) were correctly scored by both readers. All 55 patients with arthroscopic diagnosis of partial-thickness RCT were correctly assigned as having a partial-thickness RCT at MRA by both readers. Interobserver reproducibility analysis showed total agreement between the two readers in distinguishing partial-thickness from full-thickness RCTs, regardless of tear extent(k = 1.000). With regard to tear extent, in patients in whom a complete tear was correctly diagnosed, correct tear extent was detected in 61/66 cases(92%); in the remaining 5/66 cases(8%), tear extent was underestimated. Agreement was k = 0.955. Interobserver agreement was total(k = 1.000).CONCLUSION MRA shows high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder's classification for reporting. Snyder's classification may be adopted for routine reporting of MRA.
