The Incidence of Chronic Opioid Use Following Arthroscopic Rotator Cuff Repair and Patient Opioid Education

Objectives: Opioids are commonly prescribed for pain management following Arthroscopic Rotator Cuff Repair (ARCR). While their efficacy outweighs their risks in the short term, chronic opioid use is associated with significant adverse effects, such as dependence, endocrine imbalance or respiratory depression. The rate of chronic opioid use and dependence following ARCR is unknown. The purpose of this study is to determine the rate of chronic opioid use following ARCR and establish the effect of preoperative opioid education on reducing chronic consumption. A secondary aim is to determine if any correlation exists between chronic opioid use and shoulder functionality. Methods: A prospective, randomized study of 140 patients undergoing ARCR was performed with a minimum follow-up of 24 months. Patients were randomized to receive preoperative opioid education (risks of abuse, dependence, etc.) or no education. State registry database opioid prescription data monitoring software were utilized to search for all opioid prescriptions following ARCR in our patient population and this was compared to our electronic medical database for accuracy/discrepancy. The total number of opioid prescriptions and number of tablets was determined as well as time from surgery to most recent prescription. Patients were contacted to determine a shoulder Single Assessment Numeric Evaluation (SANE) score and Visual Analog Scale (VAS) pain score. Categorical data was analyzed via chi-squared tests as appropriate. Numeric data was analyzed using t-tests as appropriate. Results: Forty-five patients (32%) continued to fill opioid prescriptions chronically following ARCR. Seventeen (38%) of these patents received pre-operative opioid educated, whereas twenty-eight (62%) did not (p=0.05). Sixty percent of patients with a history of pre-operative opioid use continued to take opioids, while 23% of opioid naive patients continued (p< 0.01). There was no significant difference in SANE (p= 0.53) or VAS (p= 0.65) scores between the education and control group. Patients taking opioids prior to surgery had worse SANE scores (71.28) than the non-users (86.28), p< 0.01. Conclusion: Almost a third of patients will chronically use opioids following ARCR, including 23% of opioid naive patients. Preoperative opioid use is strongly associated with chronic opioid utilization, as well as decreased shoulder function 2 years after ARCR. Preoperative opioid education significantly decreased the rate of chronic opioid use; however, there is no effect on long-term shoulder function. [Table: see text]

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The Incidence of Chronic Opioid Use Following Arthroscopic Rotator Cuff Repair

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2019.11.032 ◽

2019 ◽

Vol 35 (12) ◽

pp. e11-e12

Author(s):

Richard E. Campbell ◽

Danielle Weekes ◽

Michael DeFrance ◽

Jenna Feldman ◽

Fotios Tjoumakaris ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff Repair ◽

Opioid Use ◽

Chronic Opioid Use ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

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Arthroscopic Subscapularis Tendon Repair Using the Mason-Allen Technique

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1387-8079 ◽

2021 ◽

Author(s):

Junqi Huang ◽

Jiajia Cheng ◽

Shitian Tang ◽

Bo Shi ◽

Gang Liu ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Tendon Repair ◽

Shoulder Function ◽

Arthroscopic Rotator Cuff Repair ◽

Subscapularis Tendon ◽

Function Recovery ◽

The Mean ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Abstract Background Arthroscopic rotator cuff repair has recently been popularized for treating tears. In a biomechanical trial, the Mason-Allen stitch improved the fixation quality of poorly vascularized tendons. The use of this technique involving the subscapularis tendon remains rare. The aim of this study was to evaluate the clinical outcomes of Mason-Allen technique repaired subscapularis tendons. Methods A retrospective research of collected data from 98 patients with subscapularis tears who had undergone arthroscopic repair between May 2015 and December 2018. There were 75 males and 23 females. The mean age was 56.4 ± 9.6 years and the mean follow-up was 12.5 ± 4.0 months. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Constant-Murley score were used to analyze shoulder function. An MRI was performed to assess the integrity of the repair. Results Patients had significantly less pain and a better active range of motion compared with preoperative levels. VAS improved significantly from a preoperative mean of 3.42 to a postoperative mean of 1.91. ASES increased significantly from the preoperative mean of 43.6 to the postoperative mean of 74.5. Seven cases suffered from retears, which were confirmed by an MRI examination. Conclusion Arthroscopic rotator cuff repair with the Mason-Allen method resulted in a decreased level of pain and satisfied function recovery.

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Functional Outcomes of Arthroscopic Rotator Cuff Repair: Correlation of Fatty Degeneration in the Cuff Muscles with Shoulder Function (SS-25)

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2007.03.037 ◽

2007 ◽

Vol 23 (6) ◽

pp. e13

Author(s):

Hiroshi Takeda

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Functional Outcomes ◽

Fatty Degeneration ◽

Shoulder Function ◽

Arthroscopic Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

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Factors affecting return to work following arthroscopic rotator cuff repair: A retrospective observational study in an occupational medicine clinic and single-surgeon practice

10.1101/2021.09.20.21263877 ◽

2021 ◽

Author(s):

Ijaz Khan ◽

Manaal Fatima ◽

Corey Scholes ◽

Vikram Kandhari ◽

K.M. Ponnanna ◽

...

Keyword(s):

Rotator Cuff ◽

Return To Work ◽

Rotator Cuff Repair ◽

Activity Level ◽

Arthroscopic Rotator Cuff Repair ◽

Factors Affecting ◽

Significant Difference ◽

Arthroscopic Rotator Cuff ◽

Chi Square Analysis ◽

Cuff Repair

Background: Return to work (RTW) following arthroscopic rotator cuff repair (aRCR) within New South Wales (NSW), Australia, under compensable schemes has not been reported. Aims: Determine factors affecting RTW status and time in patients treated with aRCR under state-based compensation schemes, compared to those outside such schemes. Methods: Patients undergoing aRCR by one surgeon with minimum 1-year follow-up were grouped into those under (CP) or outside (non-CP) workers or vehicle accident compensation schemes, matched by age and gender. RTW status and time were assessed using chi-square analysis and multivariable linear regression. Results: Of 1054 available patients, 90 CP patients were identified with 29 consented and matched to non-CP (N=29). A higher proportion of CP patients (17.2 vs 0%, P<0.001) never returned to work and a lower proportion resumed pre-injury duties at first RTW (3 vs 52%, P<0.01). Median time to first RTW did not differ between CP and non-CP groups (5.1 vs 4.4, P=0.86). Smoking (P=0.007) and post-injury activity level (P=0.004) were significantly associated with longer time to first RTW, whereas compensation status was not. Conclusions: CP patients undergoing aRCR in NSW are at risk of not returning to work. For those that return, there is no significant difference compared to non-CP in time to first RTW. Particularly, patient and management factors associated with extended time to first RTW have been identified. Interventions aimed at modifiable factors such as smoking cessation and increasing preoperative activity may improve future outcomes.

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Biceps Tenodesis Combined With Rotator Cuff Repair Increases Functional Status And Elbow Strength In Both Operated And Contralateral Arms

10.21203/rs.3.rs-94002/v1 ◽

2020 ◽

Author(s):

Ali Ihsan KILIC ◽

Onur HAPA ◽

Ramadan OZMANEVRA ◽

Nihat Demirhan DEMIRKIRAN ◽

Onur GURSAN

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Constant Score ◽

Elbow Flexion ◽

Arthroscopic Rotator Cuff Repair ◽

Biceps Tenodesis ◽

Significant Difference ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Abstract Purpose: Aim of the present study was to prospectively evaluate the elbow flexion and supination strengths, and the functional outcomes of patients after arthroscopic rotator cuff repair combined with simultaneous biceps tenodesis.Methods: Nineteen patients who underwent arthroscopic rotator cuff repair and biceps tenodesis with at least 24 months follow-up were included. Patients were evaluated using a visual analogue scale (VAS) for bicipital groove pain, American Shoulder and Elbow Surgeons (ASES), and constant scores(CS), biceps apex distance (BAD), elbow flexion and supination strengths.Results: VAS for biceps groove measurement averages of postoperative 6th, 12th and 24th month were lower in comparison to pre-operative data and were considered to be statistically significant (p<0.05). Constant score, an average of all post-operative measurements and scores were found higher than pre-operative values and was considered to be statistically significant (p<0,01). There was a significant difference in the comparison of operated and contralateral forearm supination and elbow flexion muscle strength measurements at postoperative 3rd and 6th-month follow-up (p<0.01).Conclusion: Arthroscopic biceps tenodesis into the anchors of lateral row combined rotator cuff repair provides an increase in strength of elbow flexion and forearm supination, while decreases pain. Level of Evidence: Level IV

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