Shoulder-specific outcomes 1 year after nontraumatic full-thickness rotator cuff repair: a systematic literature review and meta-analysis

Background Nontraumatic full-thickness rotator cuff tears are commonly initially treated conservatively. If conservative treatment fails, rotator cuff repair is a viable subsequent option. The objective of the present meta-analysis is to evaluate the shoulder-specific outcomes one year after arthroscopic or mini-open rotator cuff repair of nontraumatic rotator cuff tears. Methods A literature search was conducted in PubMed and EMBASE within the period January 2000 to January 2017. All studies measuring the clinical outcome at 12 months after nontraumatic rotator cuff repair of full-thickness rotator cuff tears were listed. Results We included 16 randomized controlled trials that met our inclusion criteria with a total of 1.221 shoulders. At 12 months after rotator cuff repair, the mean Constant score had increased 29.5 points; the mean American Shoulder and Elbow Score score increased by 38.6 points; mean Simple Shoulder Test score was 5.6 points; mean University of California Los Angeles score improved by 13.0 points; and finally, mean Visual Analogue Scale score decreased by 4.1 points. Conclusions Based on this meta-analysis, significant improvements in the shoulder-specific indices are observed 12 months after nontraumatic arthroscopic or mini-open rotator cuff repair.

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Arthroscopic Versus Mini-open Rotator Cuff Repair: A Randomized Trial and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/03635465211038233 ◽

2021 ◽

Vol 49 (12) ◽

pp. 3184-3195

Author(s):

Joy C. MacDermid ◽

Dianne Bryant ◽

Richard Holtby ◽

Helen Razmjou ◽

Kenneth Faber ◽

...

Keyword(s):

Rotator Cuff ◽

Adverse Events ◽

Rotator Cuff Repair ◽

Primary Outcome ◽

Meta Analysis ◽

Mean Difference ◽

Rotator Cuff Tears ◽

Standardized Mean Difference ◽

Cuff Repair ◽

Mini Open

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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A Randomized Clinical Trial Comparing Open to Arthroscopic Acromioplasty with Mini-Open Rotator Cuff Repair for Full-Thickness Rotator Cuff Tears

The American Journal of Sports Medicine ◽

10.1177/0363546508314409 ◽

2008 ◽

Vol 36 (6) ◽

pp. 1043-1051 ◽

Cited By ~ 61

Author(s):

Nicholas G. Mohtadi ◽

Robert M. Hollinshead ◽

Treny M. Sasyniuk ◽

Jennifer A. Fletcher ◽

Denise S. Chan ◽

...

Keyword(s):

Clinical Trial ◽

Rotator Cuff ◽

Randomized Clinical Trial ◽

Rotator Cuff Repair ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Cuff Repair ◽

Mini Open

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Changes From Baseline in Patient- Reported Outcomes at 1 Year Versus 2 Years After Rotator Cuff Repair: A Systematic Review and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/03635465211023967 ◽

2021 ◽

pp. 036354652110239

Author(s):

Sambit Sahoo ◽

Martina Stojanovska ◽

Peter B. Imrey ◽

Yuxuan Jin ◽

Richard J. Bowles ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Cohort Studies ◽

Rotator Cuff Repair ◽

Constant Score ◽

Meta Analysis ◽

Level Of Evidence ◽

Patient Reported ◽

The Mean ◽

Cuff Repair

Background: Most orthopaedic journals currently require reporting outcomes of surgical interventions for at least 2 postoperative years, but there have been no rigorous studies on this matter. Various patient-reported outcome (PRO) measures (PROMs) have been used to assess the status of the shoulder after rotator cuff repair (RCR). Hypothesis: We hypothesized that the mean shoulder-specific PROMs at 1 year improve substantially over baseline but that there is no clinically meaningful difference between the mean 1- and 2-year PROMs after RCR. Study Design: Meta-analysis; Level of evidence, 2. Methods: We conducted a systematic review of published randomized controlled trials (RCTs) and prospective cohort studies (level of evidence 1 and 2) reporting the shoulder-specific American Shoulder and Elbow Surgeons (ASES), the Constant, or the Western Ontario Rotator Cuff (WORC) Index scores at baseline, 1 year, and 2 years after RCR. The methodologic quality of studies was assessed. Also, the random effects meta-analyses of changes in PROMs for each of the first and second postoperative years were conducted. Results: Fifteen studies (n = 11 RCTs; n = 4 cohort studies) with a total of 1371 patients were included. Studies were highly heterogeneous, but no visual evidence of major publication bias was observed. The weighted means of the baseline PROMs were 46.2 points for the ASES score, 46.4 points for the Constant score, and 38.8 points for the WORC Index. The first-year summary increments were 41.1 (95% CI, 36.0-46.2) points for the ASES score, 34.2 (95% CI, 28.8-39.6) points for the Constant score, and 42.9 (95% CI, 37.3-48.4) points for the WORC Index. In contrast, the second-year summary increments were 2.3 (95% CI, 1-3.6) points for the ASES score, 3.2 (95% CI, 1.9-4.4) points for the Constant score, and 2 (95% CI, -0.1 to 4) points for the WORC Index. Conclusion: All PROMs improved considerably from baseline to 1 year, but only very small gains that were below the minimal clinically important differences were observed between 1 year and 2 years after RCR. This study did not find any evidence for requiring a minimum of 2 years of follow-up for publication of PROs after RCR. Our results suggest that focusing on 1-year PROMs after RCR would foster more timely reporting, better control of selection bias, and better allocation of research resources.

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Outcome and Structural Integrity of Rotator Cuff after Arthroscopic Treatment of Large and Massive Tears with Double Row Technique: A 2-Year Followup

Advances in Orthopedics ◽

10.1155/2013/914148 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 13

Author(s):

Ignacio Carbonel ◽

Angel A. Martínez ◽

Elisa Aldea ◽

Jorge Ripalda ◽

Antonio Herrera

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

Functional Outcome ◽

Rotator Cuff Repair ◽

Structural Integrity ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Double Row ◽

Massive Rotator Cuff Tears ◽

Cuff Repair

Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears.Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI), and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively and 2 years after repair.Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (P<0.001). Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (P<0.001). MRI studies showed 24 cases of tear after repair (29%). Only 8 cases were a full-thickness tear.Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity.

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Rotátorköpeny-szakadás után kialakult zsíros degeneráció változása az ín rekonstrukcióját követően, 65 éves kor után

Orvosi Hetilap ◽

10.1556/650.2019.31326 ◽

2019 ◽

Vol 160 (14) ◽

pp. 533-539

Author(s):

Imre Sallai ◽

Márton Weidl ◽

Attila Szatmári ◽

Imre Antal ◽

Gábor Skaliczki

Keyword(s):

Rotator Cuff ◽

Muscle Atrophy ◽

Rotator Cuff Repair ◽

Constant Score ◽

Fatty Degeneration ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Before And After ◽

Cuff Repair

Abstract: Introduction: In the case of rotator cuff tears, the severity of the muscle atrophy and fatty degeneration has an effect on the success of the repair and on the functional outcome after surgery. Aim: The ability of regeneration reduces with ageing; therefore, the study examined the atrophy and the fatty degeneration after rotator cuff repair in patients over 65. Method: Eleven patients over 65 years of age were involved whose surgery was performed at the Department of Orthopaedics of Semmelweis University between 2012 and 2015. Their average age was 71.9 years and the average follow-up period was 39.9 months. Tear sizes were C1 in 3 cases, C2 in 3 cases, C3 in 4 cases, and C4 in 1 case. Each patient had magnetic resonance examination before and after the repair; the muscle atrophy and fatty degeneration were evaluated together with the type of the tear. Visual analogue scale and Constant score were used for the assessment of the pain and the shoulder function. Results: The average Constant score was 75 points. The occupancy ratio – referring to the severity of the atrophy – did not show significant improvement. The change in fatty degeneration and the atrophy were examined in different groups according to the size of the tears. In each group, the results showed progression. Conclusions: After rotator cuff repair in patients over 65, fatty degeneration and muscle atrophy also show progression. No significant relationship was found between the size of the tear and fatty degeneration or between the size of the tear and muscle atrophy. Orv Hetil. 2019; 160(14): 533–539.

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Epidemiological Analysis of Changes in Clinical Practice for Full-Thickness Rotator Cuff Tears From 2010 to 2015

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119845912 ◽

2019 ◽

Vol 7 (5) ◽

pp. 232596711984591 ◽

Cited By ~ 4

Author(s):

Avinesh Agarwalla ◽

Gregory L. Cvetanovich ◽

Anirudh K. Gowd ◽

Anthony A. Romeo ◽

Brian J. Cole ◽

...

Keyword(s):

Clinical Practice ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Management Practices ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Biceps Tenodesis ◽

Rotator Cuff Injuries ◽

Cuff Repair ◽

Corticosteroid Injections

Background: Rotator cuff injuries are a leading cause of shoulder disability among adults. Surgical intervention is a common treatment modality; however, conservative management has been described for the treatment of rotator cuff tears. As the cost of health care increases, the industry has shifted to optimizing patient outcomes, reducing readmissions, and reducing expenditure. In 2010, the American Academy of Orthopaedic Surgeons created clinical practice guidelines (CPGs) to guide the management of rotator cuff injuries. Since their publication, there have been several randomized controlled trials assessing the management of rotator cuff injuries. Purpose: To quantitatively describe changes in the management of full-thickness rotator cuff tears over time with regard to the publication of the CPGs and prospective clinical trials. Study Design: Cohort study; Level of evidence, 3. Methods: Included in the study were Humana-insured patients in the PearlDiver database with the diagnosis of a full-thickness rotator cuff tear from 2010 to 2015. Patients undergoing rotator cuff repair (CPT-29827, CPT-23410, CPT-23412, CPT-23420) and patients undergoing nonoperative management in the queried years were identified. The incidence of physical therapy (PT), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections was assessed. Results: In 2015, patients with full-thickness rotator cuff tears were less likely to receive a corticosteroid injection (16.5% vs 23.9%, respectively; odds ratio [OR], 0.6; P < .001) or undergo PT (7.8% vs 12.1%, respectively; OR, 0.6; P < .001) before rotator cuff repair in comparison with 2010. Additionally, patients were no more likely to be prescribed NSAIDs before rotator cuff repair in 2015 in comparison with 2010 (OR, 1.0; P = .6). Patients with full-thickness rotator cuff tears were less likely to undergo acromioplasty in 2015 in comparison with 2010 (48.2% vs 76.9%, respectively; OR, 0.4; P < .001); however, the rate of concomitant biceps tenodesis slightly increased (14.8% vs 14.6%, respectively; OR, 1.1; P = .01). Conclusion: From 2010 to 2015, there were changes in the management of full-thickness rotator cuff tears, including decreased preoperative utilization of corticosteroid injections and PT as well as a decrease in concomitant acromioplasty, and the rate of biceps tenodesis slightly increased. As CPGs and prospective investigations continue to proliferate, management practices of patients with full-thickness rotator cuff tears continue to evolve.

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The Effect of Time Interval from MRI to Rotator Cuff Repair on Tear Size: Imaged vs. Actual Tear Size

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00277 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0027

Author(s):

Amanda J. Naylor ◽

Michael D. Charles ◽

Allison Jamie Rao ◽

Gregory Louis Cvetanovich ◽

Michael C. O’Brien ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Critical Time ◽

T Test ◽

Rotator Cuff Tears ◽

Time Interval ◽

Consecutive Series ◽

Full Thickness ◽

Cuff Repair ◽

Tear Size

Objectives: Magnetic resonance imaging (MRI) is the advanced imaging modality of choice for the evaluation and diagnosis of full thickness rotator cuff tears (RCT). Tear size progression has been correlated with increasing pain. However, there is little data on tear size progression in symptomatic RCT with regard to time from MRI to actual rotator cuff repair (RCR). The purpose of the study was to evaluate the effect of time (from date of MRI measured tear dimensions to date of RCR measured intraoperative tear dimensions) on tear size progression. Methods: In the course of a study on physical examination manual muscle tests in patients with known full thickness RCT requiring repair, MRI was obtained for each patient undergoing RCR. Tears were measured intraoperatively in the Anterior-Posterior (A-P) and Medial-Lateral (M-L) dimensions with a graduated probe. Location (anterior, central, posterior in the supraspinatus tendon), area of the tear, and anterior band of supraspinatus status (intact/ not intact) were recorded.The preoperative MRI was evaluated by the same examiner blinded to the operative results at least 4 weeks after the RCR and the same parameters measured.There were 64 consecutive shoulders with 40 male, 24 female at an average age of 58 yrs (40-76) that had MRI and underwent RCR. The mean MRI dimensions were: A-P tear:16.53 mm (SD 9.70); M-L tear: 17.3 mm (SD 9.75); Tear area: 366.7 square mm. The average time from preoperative MRI to RCR was 107.3 days (range 12-399 days). Operative mean RCT dimensions were: A-P tear: 18.38 mm (SD 10.0); M-L tear: 14.06 mm (SD 8.15); Tear area: 307.7 square mm.Descriptive statistical analysis with two-sample T-test was performed to determine the temporal effect on tear size from date of MRI to the date of surgery, and whether there was a change.Patients were grouped in the following time cohorts based on the length of time elapsed between the preoperative MRI and date of RCR: ≤1 month, 1 month to 2 months, 2 months to 3 months, 3 months to 9 months, and ≥9 months. The delta, or difference between intraoperative measurements and preoperative MRI measurements, was calculated for each cohort. Results: The t-test revealed a significant time effect with regard to tear size between the MRI and the intraoperative measured tear requiring repair. This was significant for the A-P dimension (p<0.001), the Medial-Lateral dimension (p<0.001), and the total area of the tear (p=0.009). In an attempt to determine a “watershed” or critical time interval where MRI and RCT size correlated, an additional analysis was performed. The change in A-P tear dimension between MRI and RCR findings showed increasing delta with increasing time. Positive mean delta in A-P dimension was seen in the 2-3 month group (2.64), with larger differences seen in the 3 month to 9 month (5.89) and ≥9 month (7.3) groups. A similar trend was seen for mean delta values in the M-L dimension among the cohorts. Conclusion: In a consecutive series of RCTs undergoing repair, the measured MRI dimensions and the intraoperative dimensions were recorded and analyzed. A surgeon can have a level of confidence that the RCT size will correlate with MRI tear size within a certain time frame. There is a significant effect of time on tear size progression from MRI dimensions to actual RCT dimensions at time of repair.

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Arthroscopic Rotator Cuff Repair with and without Acromioplasty in the Treatment of Full-Thickness Rotator Cuff Tears

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.k.00488 ◽

2011 ◽

Vol 93 (21) ◽

pp. 1953-1960 ◽

Cited By ~ 106

Author(s):

Peter MacDonald ◽

Sheila McRae ◽

Jeffrey Leiter ◽

Randy Mascarenhas ◽

Peter Lapner

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff Repair ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

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Evaluation of Deltoid Origin Status Following Open and Arthroscopic Repair of Large Rotator Cuff Tears: A Propensity-Matched Case-Control Study

Clinics in Shoulder and Elbow ◽

10.5397/cise.2020.00017 ◽

2020 ◽

Vol 23 (1) ◽

pp. 11-19

Author(s):

Erica Kholinne ◽

Jae-Man Kwak ◽

Yucheng Sun ◽

Hyojune Kim ◽

Kyoung Hwan Koh ◽

...

Keyword(s):

Rotator Cuff ◽

Propensity Score ◽

Propensity Score Matching ◽

Rotator Cuff Repair ◽

Arthroscopic Repair ◽

Rotator Cuff Tears ◽

Open Approach ◽

Full Thickness ◽

Lateral Border ◽

Cuff Repair

Background: The purpose of this study was to evaluate and compare deltoid origin status following large rotator cuff repair carried out using either an open or an arthroscopic method with a propensity score matching technique. Methods: A retrospective review of 112 patients treated for full-thickness, large rotator cuff tear via either a classic open repair (open group) or an arthroscopic repair (arthroscopic group) was conducted. All patients included in the study had undergone postoperative magnetic resonance imaging (MRI) and clinical follow-up for at least 12 and 18 months after surgery, respectively. Propensity score matching was used to select controls matched for age, sex, body mass index, and affected site. There were 56 patients in each group, with a mean age of 63.3 years (range, 50–77 years). The postoperative functional and radiologic outcomes for both groups were compared. Radiologic evaluation for postoperative rotator cuff integrity and deltoid origin status was performed with 3-Tesla MRI.Results: The deltoid origin thickness was significantly greater in the arthroscopic group when measured at the anterior acromion (P=0.006), anterior third (P=0.005), and middle third of the lateral border of the acromion level (P=0.005). The deltoid origin thickness at the posterior third of the lateral acromion was not significantly different between the arthroscopic and open groups. The arthroscopic group had significantly higher intact deltoid integrity with less scarring (P=0.04). There were no full-thickness deltoid tears in either the open or arthroscopic group. Conclusion: Open rotator cuff repair resulted in a thinner deltoid origin, especially from the anterior acromion to the middle third of the lateral border of the acromion, at the 1-year postoperative MRI evaluation. Meticulous reattachment of the deltoid origin is as essential as rotator cuff repair when an open approach is selected.

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Assessment of functional outcome of mini-open rotator cuff repair: a hospital based prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20180681 ◽

2018 ◽

Vol 4 (2) ◽

pp. 285 ◽

Cited By ~ 1

Author(s):

Vikas Sharma ◽

Shailesh V. Udapudi ◽

Somnath T. Sanikop ◽

Sameer Haveri ◽

Mahantesh Y. Patil

Keyword(s):

Rotator Cuff ◽

Functional Outcome ◽

Shoulder Joint ◽

Rotator Cuff Repair ◽

Constant Score ◽

Cuff Tear ◽

Ucla Score ◽

Cuff Repair ◽

Mini Open

Background: The mini-open repair is considered to be the gold standard for rotator cuff repair. This study was aimed to assess functional outcome of mini-open rotator cuff repair of shoulder joint in adult patients.Methods: This was a one year hospital based prospective study conducted from January 2016 to December 2016. A total of 20 patients diagnosed to have rotator cuff tear of shoulder joint undergoing rotator cuff repair in the department of Orthopaedics, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, and KLES Dr. Prabhakar Kore Charitable Hospital, Belagavi were studied.Results: Majority of the patients (85%) of the patients was male and male to female ratio was 5.6:1. Most of the patients were aged between 31 to 40 years (30%). The mean age was 41.90±13.98 years. Most of patients had degenerative rotator cuff tear (45%) and (70%) presented with features of swelling. At enrollment all the patients (100%) had poor constant score (>30) and fair/poor UCLA score (<27) suggestive of severe pain functional restriction. There were gradual but steady increase in scores from enrollment to each follow up till six month follow up with respect to mean flexion (6.25±5.35 to 163.50±7.63),abduction (5.50±5.10 to 112.0±5.94),external rotation (3.00±4.7 to 82.50±2.56 ),internal rotation (2.50±4.44 to 67.25±3.43 ) and UCLA score (5.35±1.63 to 29.60±0.82 ) (p<0.001) also there was gradual but steady decrease in mean VAS score from enrolment (7.70±0.47 ) to six months follow up (0.00±0.00) and constant score ( from 85.70±1.98 to 7.85±1.46 respectively) (p<0.001). The constant score and UCLA score at six month follow up revealed excellent functional outcome. Conclusions: The mini-open rotator cuff repair of shoulder joint results in excellent functional outcome among adult patients with rotator cuff tear of shoulder joint especially after six month with no complications and complete pain relief.

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