scholarly journals Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation

2020 ◽  
pp. annrheumdis-2020-219099
Author(s):  
Sanna Cederqvist ◽  
Tapio Flinkkilä ◽  
Markus Sormaala ◽  
Jari Ylinen ◽  
Hannu Kautiainen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Rotator Cuff ◽  
Shoulder Function ◽  
Full Thickness ◽  
Rotator Cuff Disease ◽  
Link Type ◽  
And Function ◽  
Surgical Treatments ◽  
Non Surgical Treatment

BackgroundRotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression and non-surgical treatments provide equivalent results in RCD without a full-thickness tendon lesion. However, the importance of surgery for full-thickness tendon tears remains unclear.MethodsIn a pragmatic, randomised, controlled trial, 417 patients with subacromial pain underwent 3-month initial rehabilitation and MRI arthrography (MRA) for the diagnosis of RCD. Of these, 190 shoulders remained symptomatic and were randomised to non-surgical or surgical treatments. The primary outcomes were the mean changes in the Visual Analogue Scale for pain and the Constant Murley Score for shoulder function at the 2-year follow-up.ResultsAt the 2-year follow-up, both non-surgical and surgical treatments for RCD reduced pain and improved shoulder function. The scores differed between groups by 4 (95% CI −3 to 10, p=0.25) for pain and 3.4 (95% CI −0.4 to 7.1, p=0.077) for function. Among patients with full-thickness ruptures, the reduction in pain (13, 95% CI 5 to 22, p=0.002) and improvement in function (7.0, 95% CI 1.8 to 12.2, p=0.008) favoured surgery.ConclusionsNon-surgical and surgical treatments for RCD provided equivalent improvements in pain and function. Therefore, we recommend non-surgical treatment as the primary choice for patients with RCD. However, surgery yielded superior improvement in pain and function for full-thickness rotator cuff rupture. Therefore, rotator cuff repair may be suggested after failed non-surgical treatment.Trial registration detailsClinicalTrials.gov, NCT00695981 and NCT00637013.

scholarly journals Long Follow-up Study of Non-Surgical Treatment of Full Thickness Tears of Rotator Cuff.

1999 ◽  
Vol 48 (1) ◽  
pp. 158-161
Author(s):  
Mako Hirano ◽  
Kazutoshi Nomura ◽  
Noburo Hashimoto ◽  
Tetsuya Fukumoto ◽  
Shinichi Urata
Keyword(s):  
Surgical Treatment ◽  
Rotator Cuff ◽  
Full Thickness ◽  
Follow Up Study ◽  
Non Surgical Treatment

scholarly journals Five Years Follow-up After Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique: Evaluation of the Retear Rate and the Impairment of the Shoulder Function

2020 ◽  
Author(s):  
Zhang Sheng ◽  
Shi Huisheng ◽  
Liu Xiaohua ◽  
Wang Zheng ◽  
Li Yan ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Muscle Strength ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Suture Bridge ◽  
The Difference ◽  
Arthroscopic Rotator Cuff ◽  
Retear Rate

Abstract Purpose: To evaluate the retear rate after arthroscopic rotator cuff repair using a suture bridge (SB) technique for patients with full thickness rotator cuff tears and whether the non- healing cuff impaired the shoulder function.Methods: From January 2013 to January 2014, 92 patients in our institution underwent arthroscopic double-row suture bridge repair for the treatment of full-thickness rotator cuff tear 55 patients who have completed the 5 years follow-up were enrolled in this study. There were 36 female and 19 male patients, and the average age was 58.6 years (range, 41- 70 years). The tears were classified into small (<1 cm), medium (1-3 cm), large (3-5 cm), and massive (> 5 cm) according to the classification of DeOrio and Cofield. According to the intraoperative measurement, small tears were found in 5 shoulders (9%), medium tears in 19 shoulders (34.5%), large tears in 23 shoulders (41.8%), and massive tears in 8 shoulders (14.5%). The mean follow-up was 71.2 months (range, 66-78 months). Post-operative cuff integrity was evaluated with ultrasound (US) according to the published literature which was comparable to Sugaya MRI classification. Types I-III indicated cuff healing and types IV or V indicated retear. The retear patterns were divided into type 1 (failure at the original repair site) or 2 (failure around the medial row). At baseline and final follow-up, shoulder functional outcomes were measured using validated, shoulder-specific outcome scores, including the Constant-Murley score (CS) and the American Shoulder and Elbow Score (ASES). The difference in abduction muscle strength was also evaluated between the integrity and the retear group.Results: At final follow-up, the rotator cuff was completely healed in 45 of the 55 shoulders. There were recurrent tears in 10 shoulders, and the retear rate was 18.2%. The type 1 re- tear pattern was found in 4 shoulders (40%), and type 2 in 6 shoulders (60%). The Constant and ASES scores improved from 41.00 to 92.00, and from 41.33 to 88.00, respectively. The mean differences in shoulder scaption strength between the healing and the retear group were 1.1±0.82Kg and 3.0±0.88Kg respectively. The difference in muscle strength between the retear and the healing group was statistically significant (p<0.001).Conclusion: Arthroscopic suture bridge repair of full-thickness rotator cuff tears led to excellent improvement in shoulder function, but maintained a high retear rate. Although the retear group had inferior muscle strength, the patients were still satisfied, and shoulder function was improved due to pain relief. Whether such changes in muscle strength impair patients' long-term quality of life and shoulder function remains to be discussed.Level of evidence IV

scholarly journals Non-Surgical Treatment of Full Thickness Tears of the Rotator Cuff.

1995 ◽  
Vol 44 (3) ◽  
pp. 1191-1193
Author(s):  
Mako Hirano ◽  
Kazutoshi Nomura ◽  
Noburo Hashimoto ◽  
Yasuhiro Shimizu ◽  
Tetsuya Fukumoto
Keyword(s):  
Surgical Treatment ◽  
Rotator Cuff ◽  
Full Thickness ◽  
Non Surgical Treatment

scholarly journals Subacromial Decompression in Patients with Impingement Syndrome Results in Better Clinical Outcome Compared to Physiotherapy in the Long Term. A Prospective Randomised Study

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0011 ◽  
Author(s):  
Stefanos Farfaras ◽  
Ninni Sernert ◽  
Lars Rostgard-Christensen ◽  
Erling Hallstrom ◽  
Juri T. Kartus
Keyword(s):  
Surgical Treatment ◽  
Rotator Cuff ◽  
Clinical Outcome ◽  
Constant Score ◽  
Impingement Syndrome ◽  
Ultra Sound ◽  
X Rays ◽  
Full Thickness

Objectives: The long-term outcome after treatment of subacromial impingement syndrome (SAIS) with either non-surgical or surgical methods is not thoroughly investigated. The purpose of this study was to evaluate the long-term clinical outcome, the presence of rotator-cuff injuries and osteoarthritis after both surgical and non-surgical treatment. Methods: Eighty-seven patients with SAIS were randomised to three groups: open acromioplasty (OSG), arthroscopic acromioplasty (ASG) or physiotherapy (PTG). The Constant score and the Watson & Sonnabend score were used as outcome measures. Furthermore, bilateral ultrasound examinations to detect rotator-cuff ruptures and bilateral x-rays to detect osteoarthritis were performed. Sixty-six patients (76%) attended the clinical follow-up, 14 (SD 1.5) years after the initial treatment. Results: The groups were demographically comparable at baseline. The Constant score had improved significantly at follow-up in both the OSG and the ASG (p=0.003 and 0.011 respectively). No improvement was detected in the PTG. The OSG revealed a significant improvement compared to the PTG at follow-up (p=0.011), otherwise no significant differences were found. For the Watson & Sonnabend score the OSG revealed significant improvement in 13/14 questions. The corresponding was found in the ASG and the PTG in 9/14 questions (p=0.14). Using ultra-sound 1/20 patients in the OSG revealed a full-thickness rotator cuff rupture on the index side. The corresponding was found for 1/18 in the ASG and 4/28 in the PTG (p=0.29). On the contralateral side 2/20 patients in the OSG revealed a full-thickness rotator cuff tear. The corresponding was found for 1/18 in the ASG and 4/28 in the PTG (p=0.36). On the x-rays 3/20 patients in the OSG revealed moderate or severe osteoarthritis in the index shoulder. The corresponding was found for 1/18 in the ASG and 0/28 in the PTG (p=0.12). 1/20 patients in the OSG revealed osteoarthritis in the contra-lateral shoulder. The corresponding was found for 1/18 in the ASG and 0/28 in the PTG (p=0.11). Conclusion: In the long term surgical treatment of SAIS appears to render better clinical results than physiotherapy. No significant differences were found between the groups in terms of the presence of full thickness rotator cuff ruptures and osteoarthritis.

Evaluating the Outcomes of Rotator Cuff Repairs With Polytetrafluoroethylene Patches for Massive and Irreparable Rotator Cuff Tears With a Minimum 2-Year Follow-up

2018 ◽  
Vol 46 (13) ◽  
pp. 3155-3164 ◽  
Author(s):  
Vasanth Seker ◽  
Lisa Hackett ◽  
Patrick H. Lam ◽  
George A.C. Murrell
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
External Rotation ◽  
Case Series ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Irreparable Tear ◽  
Pain At Rest

Background: Massive and irreparable rotator cuff tears are difficult to manage surgically. One technique is to use a synthetic polytetrafluoroethylene (PTFE) patch to bridge the tear. However, there is little information regarding the outcomes of this procedure. Purpose: To determine the ≥2-year outcomes of patients for whom synthetic patches were used as tendon substitutes to bridge irreparable rotator cuff defects. Study Design: Case series; Level of evidence, 4. Methods: This retrospective cohort study used prospectively collected data. Patients included those with a synthetic patch inserted as an interposition graft for large and/or irreparable rotator cuff tears with a minimum 2-year follow-up. Standardized assessment of shoulder pain, function, range of motion, and strength was performed preoperatively, at 6 and 12 weeks, and at 6 months and ≥2 years. Radiograph and ultrasound were performed preoperatively, at 6 months, and ≥2 years. Results: At a mean of 36 months, 58 of 68 eligible patients were followed up, and 53 of 58 (90%) patches remained in situ. Three patches failed at the patch-tendon interface, while 1 patient (2 shoulders/patches) went on to have reverse total shoulder replacements. Patient-ranked shoulder stiffness ( P < .001), frequency of pain with activity and sleep ( P < .0001), level of pain at rest and overhead ( P < .0001), and overall shoulder function improved from bad to very good ( P < .0001) by 6 months. Supraspinatus (mean ± SEM: 29 ± 16 N to 42 ± 13 N) and external rotation (39 ± 13 N to 59 ± 15 N) strength were the most notable increases at the ≥2-year follow-up ( P < .0001). Passive range of motion also improved by 49% to 67%; forward flexion, from 131° to 171°; abduction, from 117° to 161°; external rotation, from 38° to 55°; and internal rotation, from L3 to T10 ( P < .0001) preoperatively to ≥2 years. The most improvement in passive range of motion occurred between 12 months and ≥2 years. The mean (SD) Constant-Murley score was 90 (12), while the American Shoulder and Elbow Surgeons score was 95 (8). Conclusion: At 36 months postoperatively, patients who had synthetic patches used as tendon substitutes to bridge irreparable rotator cuff defects reported less pain and greater overall shoulder function as compared with preoperative assessments. They demonstrated improved range of passive motion and improved strength. The data support the hypothesis that the technique of using a synthetic PTFE patch to bridge a large and/or irreparable tear has good construct integrity and improves patient and clinical outcomes.

scholarly journals Mesenchymal Stem Cells and Transforming Growth Factor-β3 (TGF-β3) to Enhance the Regenerative Ability of an Albumin Scaffold in Full Thickness Wound Healing

2018 ◽  
Vol 9 (4) ◽  
pp. 65 ◽  
Author(s):  
Dale Feldman ◽  
John McCauley
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Surgical Treatment ◽  
Growth Factor ◽  
Healing Rate ◽  
Pressure Ulcers ◽  
Transforming Growth Factor ◽  
Bed Rest ◽  
Full Thickness ◽  
Non Surgical Treatment

Pressure ulcers are one of the most common forms of skin injury, particularly in the spinal cord injured (SCI). Pressure ulcers are difficult to heal in this population requiring at least six months of bed rest. Surgical treatment (grafting) is the fastest recovery time, but it still requires six weeks of bed rest plus significant additional costs and a high recurrence rate. A significant clinical benefit would be obtained by speeding the healing rate of a non-surgical treatment to close to that of surgical treatment (approximately doubling of healing rate). Current non-surgical treatment is mostly inactive wound coverings. The goal of this project was to look at the feasibility of doubling the healing rate of a full-thickness defect using combinations of three treatments, for the first time, each shown to increase healing rate: application of transforming growth factor-β3 (TGF-β3), an albumin based scaffold, and mesenchymal stem cells (MSCs). At one week following surgery, the combined treatment showed the greatest increase in healing rate, particularly for the epithelialization rate. Although the target level of a 100% increase in healing rate over the control was not quite achieved, it is anticipated that the goal would be met with further optimization of the treatment.

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