An Evaluation of the Rotator Cuff Repair Research Pipeline

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.

Download Full-text

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

The Bone & Joint Journal ◽

10.1302/0301-620x.102b9.bjj-2020-0076.r1 ◽

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.

Download Full-text

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

Clinics in Shoulder and Elbow ◽

10.5397/cise.2019.22.4.195 ◽

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 (p=0.016, p=0.677, and p=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 (p=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.

Download Full-text

Cross-Sectional Area of the Supraspinatus Muscle After Rotator Cuff Repair

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.l.00938 ◽

2013 ◽

Vol 95 (19) ◽

pp. 1785-1791 ◽

Cited By ~ 19

Author(s):

Chris Hyunchul Jo ◽

Ji Sun Shin

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Supraspinatus Muscle ◽

Cuff Repair

Download Full-text

Postoperative Rehabilitation After Rotator Cuff Repair

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967116684775 ◽

2017 ◽

Vol 5 (1) ◽

pp. 232596711668477 ◽

Cited By ~ 6

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.

Download Full-text

ALLOGENEIC PLATELET-RICH PLASMA FOR ROTATOR CUFF REPAIR

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172501163417 ◽

2017 ◽

Vol 25 (1) ◽

pp. 38-43 ◽

Cited By ~ 4

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.

Download Full-text