scholarly journals Postoperative Rehabilitation After Rotator Cuff Repair

2017 ◽  
Vol 5 (1) ◽  
pp. 232596711668477 ◽  
Author(s):  
Scott Mollison ◽  
Jason J. Shin ◽  
Alexander Glogau ◽  
R. Cole Beavis
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Demographic Data ◽  
Average Response Rate ◽  
Postoperative Rehabilitation ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Shoulder Range Of Motion ◽  
Rehabilitation Protocols ◽  
Cuff Repair

Background: Postoperative rehabilitation after arthroscopic rotator cuff repair (ARCR) remains controversial and suffers from limited high-quality evidence. Therefore, appropriate use criteria must partially depend on expert opinion. Hypothesis/Purpose: The purpose of the study was to determine and report on the standard and modified rehabilitation protocols after ARCR used by member orthopaedic surgeons of the American Orthopaedic Society for Sports Medicine (AOSSM) and the Arthroscopy Association of North America (AANA). We hypothesized that there will exist a high degree of variability among rehabilitation protocols. We also predict that surgeons will be prescribing accelerated rehabilitation. Study Design: Cross-sectional study; Level of evidence, 4. Methods: A 29-question survey in English language was sent to all 3106 associate and active members of the AOSSM and the AANA. The questionnaire consisted of 4 categories: standard postoperative protocol, modification to postoperative rehabilitation, operative technique, and surgeon demographic data. Via email, the survey was sent on September 4, 2013. Results: The average response rate per question was 22.7%, representing an average of 704 total responses per question. The most common immobilization device was an abduction pillow sling with the arm in neutral or slight internal rotation (70%). Surgeons tended toward later unrestricted passive shoulder range of motion at 6 to 7 weeks (35%). Strengthening exercises were most commonly prescribed between 6 weeks and 3 months (56%). Unrestricted return to activities was most commonly allowed at 5 to 6 months. The majority of the respondents agreed that they would change their protocol based on differences expressed in this survey. Conclusion: There is tremendous variability in postoperative rehabilitation protocols after ARCR. Five of 10 questions regarding standard rehabilitation reached a consensus statement. Contrary to our hypothesis, there was a trend toward later mobilization.

scholarly journals ALLOGENEIC PLATELET-RICH PLASMA FOR ROTATOR CUFF REPAIR

2017 ◽  
Vol 25 (1) ◽  
pp. 38-43 ◽  
Author(s):  
CHRIS HYUNCHUL JO ◽  
JI SUN SHIN ◽  
SEUNG YEON LEE ◽  
SUE SHIN
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Platelet Rich Plasma ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Significant Difference ◽  
One Year ◽  
Arthroscopic Rotator Cuff ◽  
Retrospective Comparative Study ◽  
Cuff Repair

ABSTRACT Objective: To investigate the safety and efficacy of allogeneic platelet-rich plasma (PRP) in rotator cuff repair . Methods: Seventeen patients with a full-thickness rotator cuff tear were included. Ten patients underwent arthroscopic rotator cuff repair with allogeneic, and seven patients with autologous PRP. Three PRP gels in a volume 3 ml each were applied between the torn end and the greater tuberosity. Clinical outcomes were assessed preoperatively and at a minimum of 2 years after surgery. Structural outcomes were evaluated with the presence of retear and the change of the cross-sectional area (ACT) of the supraspinatus . Results: Allogeneic PRP did not cause any adverse events during the follow-up period. There was no significant difference in the clinical outcome measures between the two groups (all p > 0.05). The retear rate was 33.3% and 25.0% in the allogeneic group and autologous group, respectively (p = 0.764). The change between the one-year postoperative and immediately postoperative ACT was not also significantly different between the two groups (p = 0.373) . Conclusion: Allogeneic PRP in arthroscopic rotator cuff did not cause any local or general complications and that has the efficacy comparable to autologous PRP with respect to the clinical and structural outcomes. Level of Evidence III, Retrospective Comparative Study.

scholarly journals Augmented latissimus dorsi transfer: initial results in patients with massive irreparable posterosuperior rotator cuff tears

2018 ◽  
Vol 11 (1_suppl) ◽  
pp. 59-67 ◽  
Author(s):  
Claudia C. Sidler-Maier ◽  
Jennifer A. Mutch ◽  
Martin Sidler ◽  
Dimitra Leivadiotou ◽  
Jubin B. Payandeh ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Latissimus Dorsi ◽  
Negative Impact ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Level Of Evidence ◽  
Latissimus Dorsi Transfer ◽  
Cuff Repair

Background The surgical treatment of irreparable massive rotator cuff tears is challenging. The purpose of the present study was to report the initial outcomes after a modified latissimus dorsi transfer (LDT) augmented by acellular dermal allograft (ADA). Methods This retrospective study includes 24 patients managed with LDT using ADA augmentation as a bursal-sided onlay between March 2009 and December 2015. Results All patients were men with a mean age of 57 years (range 48 years to 70 years). Seven patients had a previously failed rotator cuff repair and ten patients presented with a deficient subscapularis tendon. At last follow-up (mean 27 months), there was a significant improvement in active forward flexion (mean increase 31°; p = 0.016), and abduction by 25° ( p = 0.059). The acromiohumeral distance remained stable and the failure rate was low (4%). Neither a history of previous rotator cuff surgery, nor the presence of a subscapularis tear had a negative impact on functional outcome. Conclusions In our cohort of patients, LDT augmented with ADA was a reasonable option for patients with previously failed rotator cuff repair, as well as in the subgroup of patients with a deficient subscapularis tendon. Level of evidence Level IV: Therapeutic study (case series)

What happens to the long head of the biceps tendon after arthroscopic rotator cuff repair?

2020 ◽  
Vol 102-B (9) ◽  
pp. 1194-1199
Author(s):  
Hyo-Jin Lee ◽  
Eung-Sic Kim ◽  
Yang-Soo Kim
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Biceps Brachii ◽  
Morphological Changes ◽  
Biceps Tendon ◽  
Cross Sectional ◽  
Postoperative Changes ◽  
Long Head ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Aims The purpose of this study was to identify the changes in untreated long head of the biceps brachii tendon (LHBT) after a rotator cuff tear and to evaluate the factors related to the changes. Methods A cohort of 162 patients who underwent isolated supraspinatus with the preservation of LHBT was enrolled and evaluated. The cross-sectional area (CSA) of the LHBT on MRI was measured in the bicipital groove, and preoperative to postoperative difference was calculated at least 12 months postoperatively. Second, postoperative changes in the LHBT including intratendinous signal change, rupture, dislocation, or superior labral lesions were evaluated with seeking of factors that were correlated with the changes or newly developed lesions after rotator cuff repair. Results The postoperative CSA (12.5 mm2 (SD 8.3) was significantly larger than preoperative CSA (11.5 mm2 (SD 7.5); p = 0.005). In total, 32 patients (19.8%) showed morphological changes in the untreated LHBT 24 months after rotator cuff repair. Univariate regression analysis revealed that the factor chiefly related to the change in LHBT status was an eccentric LHBT position within the groove found on preoperative MRI (p = 0.011). Multivariate analysis using logistic regression also revealed that an eccentric LHBT position was a factor related to postoperative change in untreated LHBTs (p = 0.011). Conclusion The CSA of the LHBT inside the biceps groove increased after rotator cuff repair. The preoperative presence of an eccentrically positioned LHBT was associated with further changes of the tendon itself after rotator cuff repair. Cite this article: Bone Joint J 2020;102-B(9):1194–1199.

scholarly journals Effects of Electrical Muscle Stimulation for Preventing Deltoid Muscle Atrophy after Rotator Cuff Repair: Preliminary Results of a Prospective, Randomized, Single-blind Trial

2019 ◽  
Vol 22 (4) ◽  
pp. 195-202
Author(s):  
Goo Joo Lee ◽  
Hangyeol Cho ◽  
Byung-Hyun Ahn ◽  
Ho-Seung Jeong
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Neuromuscular Electrical Stimulation ◽  
Cross Sectional ◽  
Post Surgery ◽  
Significant Difference ◽  
Functional Scores ◽  
Arthroscopic Rotator Cuff ◽  
Abduction Strength ◽  
Cuff Repair

Background: This study investigates the effects of neuromuscular electrical stimulation (NMES) in preventing deltoid atrophy during the first 12 weeks after arthroscopic rotator cuff repair.Methods: Eighteen patients undergoing arthroscopic repair of a medium-sized rotator cuff tear by a single surgeon, were randomized into two groups: NMES and transcutaneous electrical nerve stimulation (TENS). Each group used the respective device for 6 weeks after surgery. Pain was measured at baseline, 6, and 12 weeks postoperatively, using the visual analogue scale (VAS); range of motion (ROM), abduction strength and functional scores were measured at baseline and 12 weeks postoperatively. Deltoid thickness and cross-sectional areas were measured using magnetic resonance imaging at 12 weeks postoperatively.Results: At 12 weeks post-surgery, no statistically significant difference was observed between the NMES and TENS groups in the pain VAS, the Disabilities of the Arm, Shoulder and Hand score, ROM, and abduction strength. Postoperative decrease in the thickness of the anterior, middle, and posterior deltoid, at the level just below the coracoid, was -2.5%, -0.7%, and -6.8%, respectively, in the NMES group, and -14.0%, -2.6%, and -8.2%, respectively, in the TENS group (<i>p</i>=0.016, <i>p</i>=0.677, and <i>p</i>=0.791, respectively). At the level of the inferior glenoid tubercle, postoperative decrease in area of the deltoid was -5.4% in the NMES group and -14.0% in the TENS group, which was significantly different (<i>p</i>=0.045).Conclusions: NMES has the potential for reducing deltoid atrophy after arthroscopic rotator cuff repair, suggesting that NMES might help minimize postoperative atrophy after various shoulder surgeries.

scholarly journals Patients With Diabetes Mellitus Have a Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair: A Meta-analysis

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096140 ◽  
Author(s):  
Chih-Kai Hong ◽  
Chao-Jui Chang ◽  
Fa-Chuan Kuan ◽  
Kai-Lan Hsu ◽  
Yueh Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
English Language ◽  
Arthroscopic Rotator Cuff Repair ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Retear of a repaired rotator cuff tendon is a major issue for shoulder surgeons. It is possible that diabetes mellitus (DM) is associated with a greater risk of tendon retear after arthroscopic rotator cuff repair. Purpose: To determine whether patients with DM have a higher tendon retear risk after arthroscopic rotator cuff repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the Web of Science, PubMed, and Embase databases. Inclusion criteria were articles written in the English language that included patients undergoing arthroscopic rotator cuff repair surgeries, reported the numbers of patients with and those without DM, and reported the number of rotator cuff retears. Data relevant to this study were extracted and statistically analyzed. Random-effects models were used to generate pooled odds ratio estimates and CIs. Results: A total of 160 studies were identified from the initial search, and 5 of them met the inclusion criteria. A total of 1065 patients (207 patients with DM and 858 patients without DM) were included. The pooled results showed that the patients in the DM group had a significantly higher tendon retear risk than did those in the non-DM group (relative risk, 2.25; 95% CI, 1.14-4.45; P = .02). Conclusion: Patients with DM have a 2.25 times higher risk of tendon retear after arthroscopic rotator cuff repair compared with patients without DM.

scholarly journals Clinical and Radiologic Outcomes of Combined Use of Biocomposite and PEEK Suture Anchors during Arthroscopic Rotator Cuff Repair: A Prospective Observational Study

2020 ◽  
Vol 9 (8) ◽  
pp. 2545
Author(s):  
Jae-Hoo Lee ◽  
Yong-Beom Lee
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Functional Outcomes ◽  
Fluid Collection ◽  
Cyst Formation ◽  
Arthroscopic Rotator Cuff Repair ◽  
Suture Anchors ◽  
Shoulder Range Of Motion ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

The aim of the current study was to evaluate the functional and radiologic outcomes of biocompatible non-absorbable PEEK (polyetheretherketone) and biocomposite (poly-L-lactic acid/poly(lactic-co-glycolic acid) 70% + β-tricalcium phosphate) anchors, especially in terms of perianchor cyst formation during the first six months postoperatively. We prospectively analysed 29 patients who underwent arthroscopic rotator cuff repair between March and May 2019. Both PEEK and biocomposite suture anchors were used as lateral anchors in one body. Clinical outcomes were assessed using the shoulder range of motion (ROM), visual analogue scale (VAS) for pain and satisfactory score, American Shoulder and Elbow Surgeons (ASES) score, and Simple Shoulder Test (SST). All these were obtained in patients preoperatively at 3 and 6 months after surgery. The imaging evaluation included perianchor cyst formation, anchor absorption, repaired cuff integrity, and retear pattern. All functional outcomes significantly improved over time. The biocomposite anchor had a statistically significant tendency to form higher grades of fluid collection at 3 months after surgery. However, the perianchor cyst reduced by the sixth postoperative month. Six months postoperatively, the functional outcomes were improved after rotator cuff repair and similar degrees of perianchor cyst formation were observed, regardless of the suture anchor material used.

scholarly journals The Effects of a Standard Postoperative Rehabilitation Protocol for Arthroscopic Rotator Cuff Repair on Pain, Function, and Health Perception

Joints ◽  
2018 ◽  
Vol 06 (03) ◽  
pp. 145-152 ◽  
Author(s):  
Roberta Monesi ◽  
Maria Benedetti ◽  
Alessandro Zati ◽  
Daniela Vigna ◽  
Domenico Romanello ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Case Series ◽  
Arthroscopic Rotator Cuff Repair ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
Constant Murley Score ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Purpose There is still conflicting evidence to support postoperative rehabilitation protocols using immobilization following rotator cuff repair over early motion. The objective of the study was to evaluate the evolution of pain, shoulder function, and patients' perception of their health status up to 1 year after cuff rotator repair and a standard postoperative rehabilitation protocol consisting of 4 weeks of immobilization followed by a 2-week assisted controlled rehabilitation. Methods Descriptive, longitudinal, uncontrolled case-series study was performed on 49 patients who underwent arthroscopic rotator cuff repair following traumatic or degenerative lesions. VAS scale for pain, Constant–Murley score for function, and SF-12 score for quality of life were used as outcome measures and were administered before the rehabilitation treatment, at the end of the 2-week rehabilitation, 3 months, and 1 year after surgery. Results VAS pain score decreased significantly along the follow-up reaching almost a nil value after 1 year (0.2). Function as measured by Constant–Murley score had a significant improvement during follow-up, reaching a mean value of 84.6. The short form (SF)-12 score increased over time reaching 46.3 for the physical and 43.8 for the psychological dimension, respectively, at 1 year. Conclusion The present study confirmed an excellent outcome at 1 year after rotator cuff repair using a traditional 4-week immobilization followed by a 2-week rehabilitation protocol without evidence of tendon un-healing or re-tearing. Level of Evidence This is a level IV, therapeutic case series.

scholarly journals An Evaluation of the Rotator Cuff Repair Research Pipeline

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880573 ◽  
Author(s):  
Jake X. Checketts ◽  
Jared Scott ◽  
Josh Gordon ◽  
Jaclyn Jones ◽  
Jarryd Horn ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Work Group ◽  
World Health ◽  
Bibliographic Databases ◽  
Knowledge Gaps ◽  
Management Options ◽  
Cross Sectional ◽  
Orthopaedic Literature ◽  
Cuff Repair

Background: We conducted a study of recommendations from the American Academy of Orthopaedic Surgeons (AAOS) guideline, “Optimizing the Management of Rotator Cuff Problems.” Using these recommendations, we conducted searches of clinical trial registries and bibliographic databases to note the extent to which new research has been undertaken to address areas of deficiency. Hypothesis: Newly conducted research regarding rotator cuff repair and injury is available that will fill knowledge gaps identified by the AAOS guideline. Study Design: Cross-sectional study. Methods: For each recommendation in the AAOS guideline, we created PICO (participants, intervention, comparator, outcome) questions and search strings. Searches were conducted of ClinicalTrials.gov , the World Health Organization’s International Clinical Trials Registry Platform, MEDLINE via PubMed, and EMBASE to locate studies undertaken after the final literature search performed by the AAOS work group. Results: We located 210 newly registered trials and 448 published studies that are relevant to the recommendations made in the rotator cuff guideline. The majority of the recommendations have been addressed by relevant registered trials or published studies. Of the 448 published studies, 185 directly addressed the guideline recommendations. Additionally, 71% of the 185 published studies directly addressing the recommendations were randomized trials or systematic reviews/meta-analyses. The most important finding of our study was that the recommendations in the AAOS rotator cuff guideline have been adequately addressed. Conclusion: Orthopaedic researchers have adequately addressed knowledge gaps regarding rotator cuff repair treatment and management options. As such, the AAOS may consider a guideline update to ensure that recommendations reflect current findings in orthopaedic literature.

Preoperative Opioid Use Is a Risk Factor for Revision Surgery, Complications, and Increased Resource Utilization After Arthroscopic Rotator Cuff Repair

2020 ◽  
Vol 48 (13) ◽  
pp. 3339-3346
Author(s):  
Kevin X. Farley ◽  
Jacob M. Wilson ◽  
Corey C. Spencer ◽  
Spero Karas ◽  
John Xerogeanes ◽  
...  
Keyword(s):  
Risk Factor ◽  
Rotator Cuff ◽  
Revision Surgery ◽  
Rotator Cuff Repair ◽  
Linear Models ◽  
Hospital Admissions ◽  
Oral Morphine ◽  
Opioid Use ◽  
Level Of Evidence ◽  
Cuff Repair

Background: Studies have shown preoperative opioid use to influence outcomes after various surgical procedures. Researchers have not assessed this relationship after rotator cuff repair (RCR). Hypothesis/Purpose: The purpose was to assess the relationship between preoperative opioid use and outcomes after arthroscopic RCR. We hypothesized that patients prescribed higher daily averages of preoperative oral morphine equivalents (OMEs) would show increased rates of 90-day complications and 3-year revision surgery. Study Design: Cohort study; Level of evidence, 3. Methods: The MarketScan claims database was utilized to identify patients who underwent arthroscopic RCR between 2009 and 2018. We used preoperative opioid use status to divide patients into groups based on the average daily OMEs consumed in the 6 months before surgery: opioid-naïve, <1, 1-<5, 5-<10, and ≥10 OMEs per day. We retrieved 90-day complication and 3-year revision surgery rates. Opioid use groups were then compared with binomial logistic regression and generalized linear models. Results: We identified 214,283 patients. Of those patients, 50.7% did not receive any preoperative opioids, while 7.7%, 26.8%, 6.3%, and 8.6% received <1, 1-<5, 5-<10, and ≥10 OMEs per day over a 6-month time period, respectively. Complications increased with increasing preoperative OMEs. Multivariate analysis revealed that any patient using ≥1 OME per day had increased rates of 3-year revision surgery, reoperations, and infections. Specifically, patients averaging ≥10 OMEs per day showed a 103% (odds ratio, 2.03 [95% CI, 1.62-2.54]; P < .001) increase in the odds of revision surgery compared with opioid-naïve patients. Rates of hospital admissions and postoperative emergency department encounters were higher in all opioid use groups. Adjusted differences in 6-month preoperative and 3-month postoperative health care costs were seen in the opioid use groups compared with opioid-naïve patients, ranging from US$1307 to US$5820 ( P < .001). Conclusion: Preoperative opioid use was a risk factor for complications and revision surgery after arthroscopic RCR. We also observed a dose-dependent response between opioid use and postoperative complications.

Sign in / Sign up

Export Citation Format

Share Document