Comparison of Gene Expression of Inflammation- and Fibrosis-Related Factors Between the Anterior and Posterior Capsule in Patients With Rotator Cuff Tear and Shoulder Stiffness

Background: Arthroscopic capsular release is an effective treatment for refractory shoulder stiffness, yet there are no basic studies that can explain the extent of the release. Purpose: This study aimed to compare the genetic expression of inflammation- and fibrosis-related factors between the anterior and posterior capsules in patients with shoulder stiffness and rotator cuff tear. Study Design: Descriptive laboratory study. Methods: Enrolled in this study were 35 patients who underwent arthroscopic capsular release for shoulder stiffness along with the rotator cuff repair. Anterior and posterior glenohumeral joint capsular tissues were obtained during the capsular release. For the control tissue, anterior capsule was obtained from 40 patients without stiffness who underwent arthroscopic rotator cuff repair. The gene expression of collagen types I and III, fibronectin, extracellular matrix, basic fibroblast growth factor, transforming growth factor–β, connective tissue growth factor, matrix metalloproteinase (MMP)-1, MMP-2, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, intercellular adhesion molecule 1, interleukin 1, and tumor necrotizing factor–α were analyzed using real-time reverse transcription polymerase chain reaction. Differences in gene expression between the anterior capsule, the posterior capsule, and the control tissue were compared with the Kruskal-Wallis test. Results: The expression levels of collagen types I and III were significantly higher in the anterior capsule with stiffness com (pared with both the posterior capsule with stiffness ( P = .010 for both) and the control ( P = .038 and .010, respectively). The levels of fibronectin, MMP-2, and MMP-9 in the anterior capsule were significantly higher than in both the posterior capsule ( P = .013, .003, and .006, respectively) and the control ( P = .014, .003, and .005, respectively). Conclusion: Genetic analysis of the shoulder capsule revealed that more fibrogenic processes occur in the anterior capsule compared with the posterior capsule in patients with shoulder stiffness. Clinical Relevance: Capsular release for shoulder stiffness should be more focused on the anterior capsule than on the posterior capsule.

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Prediction of Shoulder Stiffness After Arthroscopic Rotator Cuff Repair

The American Journal of Sports Medicine ◽

10.1177/03635465211028980 ◽

2021 ◽

pp. 036354652110289

Author(s):

Laurent Audigé ◽

Soheila Aghlmandi ◽

Cécile Grobet ◽

Thomas Stojanov ◽

Andreas M. Müller ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Prognostic Model ◽

Predictive Accuracy ◽

Arthroscopic Rotator Cuff Repair ◽

Shoulder Abduction ◽

Related Factors ◽

Shoulder Stiffness ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Postoperative shoulder stiffness (POSS) is a prevalent adverse event after arthroscopic rotator cuff repair (ARCR) that is associated with major limitations in everyday activities and prolonged rehabilitation. Purpose/Hypothesis: The purpose was to develop a predictive model for determining the risk of POSS within 6 months after primary ARCR. We hypothesized that sufficient discrimination ability of such a model could be achieved using a local institutional database. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive primary ARCRs documented in a local clinical registry between 2013 and 2017 were included, and patients who experienced POSS before the final clinical 6-month follow-up were identified. A total of 29 prognostic factor candidates were considered, including patient-related factors (n = 7), disease-related factors (n = 9), rotator cuff integrity factors (n = 6), and operative details (n = 7). We used imputed data for the primary analysis, and a sensitivity analysis was conducted using complete case data. Logistic regression was applied to develop a model based on clinical relevance and statistical criteria. To avoid overfitting in the multivariable model, highly correlated predictors were not included together in any model. A final prognostic model with a maximum of 8 prognostic factors was considered. The model’s predictive accuracy was assessed by the area under the receiver operating characteristic curve (AUC). Internal validation was performed using bootstrapping. Results: Of 1330 ARCR cases (N = 1330 patients), 112 (8.4%) patients had POSS. Our final model had a moderate predictive ability with an AUC of 0.67. The predicted risks of POSS ranged from 2.3% to 38.9% and were significantly higher in women; patients with partial tears, low baseline passive shoulder abduction, and lack of tendon degeneration; and when no acromioplasty was performed. Conclusion: A prognostic model for POSS was developed for patients with ARCR, offering a personalized risk evaluation to support the future decision process for surgery and rehabilitation.

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Effect of Capsular Release in the Treatment of Shoulder Stiffness Concomitant With Rotator Cuff Repair

The American Journal of Sports Medicine ◽

10.1177/0363546513519326 ◽

2014 ◽

Vol 42 (4) ◽

pp. 840-850 ◽

Cited By ~ 15

Author(s):

Jin-Young Park ◽

Seok Won Chung ◽

Zulkifli Hassan ◽

Jin-Young Bang ◽

Kyung-Soo Oh

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Shoulder Stiffness ◽

Capsular Release ◽

Cuff Repair

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Clinical Outcomes of Rotator Cuff Repair With Arthroscopic Capsular Release and Manipulation for Rotator Cuff Tear With Stiffness: A Matched-Pair Comparative Study Between Patients With and Without Stiffness

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2014.09.002 ◽

2015 ◽

Vol 31 (3) ◽

pp. 482-487 ◽

Cited By ~ 20

Author(s):

Chul-Hyun Cho ◽

Hyung-Kyu Jang ◽

Ki-Cheor Bae ◽

Si Wook Lee ◽

Young-Kuk Lee ◽

...

Keyword(s):

Rotator Cuff ◽

Comparative Study ◽

Clinical Outcomes ◽

Rotator Cuff Tear ◽

Rotator Cuff Repair ◽

Matched Pair ◽

Capsular Release ◽

Cuff Tear ◽

Arthroscopic Capsular Release ◽

Cuff Repair

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Effect of Arthroscopic Capsular Release on Shoulder Stiffness Concomitant with a Rotator Cuff Tear -Diabetes as a Predisposing Factor Associated with Treatment Outcome

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2015.05.014 ◽

2015 ◽

Vol 24 (8) ◽

pp. e238

Author(s):

Seok Won Chung ◽

Kyung-Soo Oh ◽

Jong Pil Yoon ◽

Jin-Young Park

Keyword(s):

Treatment Outcome ◽

Rotator Cuff ◽

Rotator Cuff Tear ◽

Predisposing Factor ◽

Shoulder Stiffness ◽

Capsular Release ◽

Cuff Tear ◽

Arthroscopic Capsular Release

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Distinct Gene Expression Profile in Patients With Poor Postoperative Outcomes After Rotator Cuff Repair: A Case-Control Study

The American Journal of Sports Medicine ◽

10.1177/03635465211023212 ◽

2021 ◽

pp. 036354652110232

Author(s):

Jessica M. Eager ◽

William J. Warrender ◽

Carly B. Deusenbery ◽

Grant Jamgochian ◽

Arjun Singh ◽

...

Keyword(s):

Gene Expression ◽

Rotator Cuff ◽

Surgical Outcomes ◽

Rotator Cuff Repair ◽

Case Control Study ◽

Case Control ◽

Gene Sets ◽

Poor Outcomes ◽

Cuff Repair ◽

Control Study

Background: Impaired healing after rotator cuff repair is a major concern, with retear rates as high as 94%. A method to predict whether patients are likely to experience poor surgical outcomes would change clinical practice. While various patient factors, such as age and tear size, have been linked to poor functional outcomes, it is currently very challenging to predict outcomes before surgery. Purpose: To evaluate gene expression differences in tissue collected during surgery between patients who ultimately went on to have good outcomes and those who experienced a retear, in an effort to determine if surgical outcomes can be predicted. Study Design: Case-control study; Level of evidence, 3. Methods: Rotator cuff tissue was collected at the time of surgery from 140 patients. Patients were tracked for a minimum of 6 months to identify those with good or poor outcomes, using clinical functional scores and follow-up magnetic resonance imaging to confirm failure to heal or retear. Gene expression differences between 8 patients with poor outcomes and 28 patients with good outcomes were assessed using a multiplex gene expression analysis via NanoString and a custom-curated panel of 145 genes related to various stages of rotator cuff healing. Results: Although significant differences in the expression of individual genes were not observed, gene set enrichment analysis highlighted major differences in gene sets. Patients who had poor healing outcomes showed greater expression of gene sets related to extracellular matrix production ( P < .0001) and cellular biosynthetic pathways ( P < .001), while patients who had good healing outcomes showed greater expression of genes associated with the proinflammatory (M1) macrophage phenotype ( P < .05). Conclusion: These results suggest that a more proinflammatory, fibrotic environment before repair may play a role in poor healing outcome. With validation in a larger cohort, these results may ultimately lead to diagnostic methods to preoperatively predict those at risk for poor surgical outcomes.

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Effectiveness of arthroscopic management of idiopathic shoulder stiffness: A meta-analysis

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200267 ◽

2021 ◽

pp. 1-8

Author(s):

Ya-Dong Wang ◽

Yu-Xiang Ming ◽

Yong-Hua Pang ◽

Wei-Nan Chen ◽

Xu-Hua Zong ◽

...

Keyword(s):

Range Of Motion ◽

External Rotation ◽

Meta Analysis ◽

Eligibility Criteria ◽

Shoulder Stiffness ◽

Capsular Release ◽

Shoulder Range Of Motion ◽

Arthroscopic Capsular Release ◽

Shoulder Range

BACKGROUND: Persisting shoulder stiffness adversely affects quality of life by causing pain and motion restrictions especially in patients with diabetes. OBJECTIVE: The aim of this study was to evaluate the outcomes of arthroscopic capsular release in patients with idiopathic shoulder stiffness. METHOD: A literature search was conducted in electronic databases and studies were selected by following precise eligibility criteria. Random-effects meta-analyses were performed to estimate the changes at latest follow-up in scores of the Constant, American Shoulder and Elbow Surgeons (ASES), and University of California at Los Angelis (UCLA) scales, Visual Analogue Scale (VAS), and shoulder range of motion. RESULTS: Nineteen studies were included. The follow-up duration was 42 months [95% confidence interval (CI): 32, 51]. Improvements in scores of the Constant, ASES, UCLA scales, and VAS were 48.3 [95% CI: 38.0, 58.6], 44.6 [95% CI: 24.6, 64.6], 19.3 [95% CI: 16.6, 22.0], and -6.1 [95% CI: -6.9, -5.4] respectively (P< 0.05 all). Improvements in the shoulder range of motion were: abduction 82.0 [95% CI: 65.0, 98.9]; forward flexion 75.9 [95% CI: 59.7, 92.1]; external rotation 43.2 [95% CI: 37.5, 49.0]; and internal rotation 25.4 [95% CI: 15.2, 35.5] degrees; P< 0.05 all). CONCLUSION: Arthroscopic capsular release effectively improves shoulder function in patients with idiopathic shoulder stiffness.

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