scholarly journals Retear rates after rotator cuff surgery: a systematic review and meta-analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Umile Giuseppe Longo ◽  
Arianna Carnevale ◽  
Ilaria Piergentili ◽  
Alessandra Berton ◽  
Vincenzo Candela ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Meta Analysis ◽  
Fatty Infiltration ◽  
Surgical Techniques ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
Factors Influencing ◽  
Main Factors ◽  
Tear Size

Abstract Background Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing. Methods A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ2. The association between retear rate after surgery and patients’ age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used. Results Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3–6 months follow-up, 16% at 6–12 months follow-up, 21% at 12–24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures). Conclusions Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results.

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.

A Rotator Cuff Tear Concomitant With Shoulder Stiffness Is Associated With a Lower Retear Rate After 1-Stage Arthroscopic Surgery

2018 ◽  
Vol 46 (8) ◽  
pp. 1909-1918 ◽  
Author(s):  
In-Bo Kim ◽  
Dong-Wook Jung
Keyword(s):  
Rotator Cuff ◽  
External Rotation ◽  
Arthroscopic Surgery ◽  
Fatty Infiltration ◽  
Symptom Duration ◽  
Shoulder Stiffness ◽  
Tear Size ◽  
Retear Rate

Background: Few studies have reported on the radiological characteristics and repair integrity of coexistent rotator cuff tears (RCTs) and shoulder stiffness after simultaneous arthroscopic rotator cuff repair and capsular release. Purpose: To evaluate the radiological characteristics and repair integrity of 1-stage arthroscopic surgery of RCTs concomitant with shoulder stiffness. Study Design: Cohort study; Level of evidence, 3. Methods: Among patients who underwent arthroscopic repair of full-thickness RCTs, the stiff group underwent simultaneous capsular release for shoulder stiffness, and the nonstiff group had no stiffness. Symptom duration, prevalence of diabetes, tear size, tendon involvement (type 1, supraspinatus; type 2, supraspinatus and subscapularis; and type 3, supraspinatus and infraspinatus; type 4, supraspinatus, subscapularis, and infraspinatus), and fatty infiltration (Goutallier stages 0-4) were evaluated. A retear was appraised using magnetic resonance imaging, and clinical outcomes were assessed using range of motion, the Korean Shoulder Scoring System (KSS), and the University of California, Los Angeles (UCLA) shoulder score. Results: The stiff group showed a significantly lower retear rate (1/39, 2.6%) than the nonstiff group (47/320, 14.7%) ( P = .043). There were significant differences in symptom duration (7.4 ± 6.6 vs 15.0 ± 23.7 months, respectively; P < .001), mediolateral tear size (18.9 ± 8.9 vs 24.1 ± 12.0 mm, respectively; P = .002), tendon involvement (94.9%, 5.1%, 0.0%, and 0.0% vs 85.3%, 6.9%, 7.8%, and 0.0%, respectively; P = .048), and fatty infiltration of the subscapularis (66.7%, 33.3%, 0.0%, 0.0%, and 0.0% vs 31.9%, 61.3%, 5.6%, 1.3%, and 0.0%, respectively; P < .001) and teres minor (74.4%, 20.5%, 5.1%, 0.0%, and 0.0% vs 47.2%, 48.8%, 3.8%, 0.0%, and 0.3%, respectively; P = .007) between the stiff and nonstiff groups. Preoperatively, the stiff group showed significantly worse forward flexion (95.9° ± 23.6° vs 147.7° ± 4.2°, respectively; P < .001), external rotation (17.4° ± 10.1° vs 51.6° ± 12.1°, respectively; P < .001), and internal rotation (L5 vs L2, respectively; P < .001) and lower KSS (52.1 ± 13.8 vs 66.3 ± 13.5, respectively; P < .001) and UCLA scores (18.7 ± 4.8 vs 22.5 ± 4.5, respectively; P < .001) than the nonstiff group. However, these differences became insignificant from 3 months postoperatively for forward flexion ( P > .05) and KSS ( P > .05) and UCLA scores ( P > .05), from 1 year postoperatively for external rotation ( P > .05), and at the last follow-up for internal rotation ( P > .05). A multiple logistic regression analysis revealed that only mediolateral tear size (odds ratio, 1.043; P = .014) and type 2 tendon involvement (odds ratio, 4.493; P = .003) were independent predictors of a retear. Conclusion: RCTs concomitant with shoulder stiffness showed a smaller mediolateral tear size, anterosuperior tendon involvement, and less severe fatty infiltration preoperatively and better repair integrity postoperatively than RCTs without stiffness. Furthermore, the clinical outcomes and range of motion at final follow-up were similar between the 2 groups.

scholarly journals Sex-Based Differences in Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988195
Author(s):  
Stephen D. Daniels ◽  
Cory M. Stewart ◽  
Kirsten D. Garvey ◽  
Emily M. Brook ◽  
Laurence D. Higgins ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcomes ◽  
Surgical Techniques ◽  
Arthroscopic Rotator Cuff Repair ◽  
Patient Reported ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Rotator cuff repair is one of the most common surgical procedures performed on the shoulder. Previous studies have indicated that pain and disability can vary significantly between patients with similarly appearing rotator cuff tears on diagnostic imaging. Prior literature has compared functional outcomes between operative and nonoperative treatments as well as variability in surgical techniques. However, few studies have examined postoperative outcomes based on patient factors such as sex. Purpose: To compare patient-reported outcomes after rotator cuff repair between men and women. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 283 patients (153 male, 130 female) who underwent primary arthroscopic rotator cuff repair were included in this study; of those, 275 patients (97.2%) completed 1-year follow-up. Patient-reported pain visual analog scale (VAS), Veterans RAND 12-item Health Survey (VR-12 mental and physical components), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE) scores were collected preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year postoperatively using an electronic outcomes system. Results: Women reported higher VAS pain scores when compared with men preoperatively ( P < .01) and at 2 weeks ( P < .01), 6 weeks ( P < .01), and 3 months ( P = .02) postoperatively. Additionally, women experienced a greater overall change in the mean VAS score preoperatively when compared with 1 year postoperatively ( P < .01). The use of narcotic pain medication 2 weeks after surgery was greater in women ( P = .032). Women had significantly lower preoperative VR-12 mental scores ( P = .03) and experienced a greater increase in the mean VR-12 mental score preoperatively when compared with 1 year postoperatively ( P < .01). Men had higher ASES scores preoperatively ( P < .01) and at 3 months postoperatively ( P < .01). Women experienced a greater overall change in the ASES score preoperatively when compared with 1 year postoperatively ( P < .01). Conclusion: Women reported greater pain and decreased shoulder function compared with men during the initial 3 months after arthroscopic rotator cuff repair. There were no sex-based differences in patient-reported outcomes at 1-year follow-up. The results of this study indicate that there are sex-related differences in the early postoperative recovery of patients undergoing rotator cuff repair, contributing to postoperative expectations for both clinicians and patients alike.

scholarly journals Study factors influencing ventricular enlargement in schizophrenia: A 20year follow-up meta-analysis

NeuroImage ◽  
2012 ◽  
Vol 59 (1) ◽  
pp. 154-167 ◽  
Author(s):  
Angelo Sayo ◽  
Robin G. Jennings ◽  
John Darrell Van Horn
Keyword(s):  
Meta Analysis ◽  
Ventricular Enlargement ◽  
Factors Influencing

scholarly journals Is routine distal clavicle resection necessary in rotator cuff repair surgery? A systematic review and meta-analysis

2017 ◽  
Vol 11 (1_suppl) ◽  
pp. 39-45 ◽  
Author(s):  
Ann Livingstone ◽  
Rafik Asaid ◽  
Afshin Kamali Moaveni
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Analogue Scale ◽  
Meta Analysis ◽  
Distal Clavicle ◽  
Randomized Controlled ◽  
Cuff Repair ◽  
Distal Clavicle Resection

Background The objective of the present study was to perform a systematic review and meta-analysis of randomized controlled trials looking at the effect of distal clavicle resection in patients undergoing rotator cuff repair (RCR). Methods A systematic literature search was undertaken to identify randomized controlled trials looking at RCR +/– distal clavicle resection. Primary clinical outcome measures included in the meta-analysis were American Shoulder Elbow Society (ASES) score, pain on visual analogue scale and range of motion in forward elevation. Results The systematic review identified three studies with a total of 203 participants. Those who underwent distal clavicle resection in conjunction with RCR had worse pain and acromioclavicular joint tenderness at 3-month follow-up. This difference, however, was not observed at the 24-month follow-up. The mean difference (95% confidence interval) for the ASES score was 0.45 (–3.67 to 4.58) and pain on visual analogue scale was – 0.27 (–0.70 to 0.16). Conclusions Routine distal clavicle resection in the setting of rotator cuff repair does not result in improved outcomes for patients with no difference being observed at 24 months post surgery. The results of our systematic review and meta-analysis do not support routine distal clavicle resection when performing RCR.

scholarly journals Surgical management of focal chondral defects of the knee: a Bayesian network meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Filippo Migliorini ◽  
Jörg Eschweiler ◽  
Hanno Schenker ◽  
Alice Baroncini ◽  
Markus Tingart ◽  
...  
Keyword(s):  
Bayesian Network ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Continuous Variables ◽  
Surgical Interventions ◽  
Bayesian Hierarchical ◽  
Chondral Defects ◽  
Chondrocyte Implantation ◽  
Meta Analyses

Abstract Background Focal chondral defects of the knee are common. Several surgical techniques have been proposed for the management of chondral defects: microfractures (MFX), osteochondral autograft transplantation (OAT), autologous matrix-induced chondrogenesis (AMIC) and autologous chondrocyte implantation (ACI)—first generation (pACI), second generation (cACI) and third generation (mACI). A Bayesian network meta-analysis was conducted to compare these surgical strategies for chondral defects in knee at midterm follow-up. Methods This Bayesian network meta-analysis was conducted according to the PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. PubMed, Google Scholar, Embase and Scopus databases were accessed in July 2021. All the prospective comparative clinical trials investigating two or more surgical interventions for chondral defects of the knee were accessed. The network meta-analyses were performed through a Bayesian hierarchical random-effects model analysis. The log odds ratio (LOR) effect measures were used for dichotomic variables, while the standardized mean difference (SMD) for the continuous variables. Results Data from 2220 procedures (36 articles) were retrieved. The median follow-up was 36 (24 to 60) months. The ANOVA test found good baseline comparability between symptoms duration, age, sex and body mass index. AMIC resulted in higher Lysholm score (SMD 3.97) and Tegner score (SMD 2.10). AMIC demonstrated the lowest rate of failures (LOR −0.22) and the lowest rate of revisions (LOR 0.89). As expected, MFX reported the lower rate of hypertrophy (LOR −0.17) followed by AMIC (LOR 0.21). No statistically significant inconsistency was found in the comparisons. Conclusion AMIC procedure for focal chondral defects of the knee performed better overall at approximately 3 years’ follow-up.

The Effect of Tendon Delamination on Rotator Cuff Healing

2019 ◽  
Vol 47 (5) ◽  
pp. 1074-1081 ◽  
Author(s):  
Pascal Boileau ◽  
Olivier Andreani ◽  
Martin Schramm ◽  
Mohammed Baba ◽  
Hugo Barret ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Fatty Infiltration ◽  
Tendon Healing ◽  
Type A ◽  
Rotator Cuff Tears ◽  
Type B ◽  
Partial Coverage ◽  
Type C ◽  
Cuff Repair ◽  
Tear Size

Background: While patient age, tear size, and muscle fatty infiltration are factors known to affect the rate of tendon healing after rotator cuff repair, the effect of tendon delamination is less known. Purpose: To assess the effect of tendon delamination on rotator cuff healing after arthroscopic single-row (SR) repair. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients (N = 117) with chronic full-thickness rotator cuff tears underwent arthroscopic SR repair with the tension-band cuff repair. The mean ± SD age at the time of surgery was 60 ± 8 years. There were 25 small, 63 medium, and 29 large tears. Tendon delamination was assessed intraoperatively under arthroscopy with the arthroscope placed in the lateral portal. Patients were divided into 2 groups: those with nondelaminated (n = 80) and delaminated (n = 37) cuff tears. The 2 groups were comparable for age, sex, body mass index, preoperative pain, strength, and a Constant-Murley score. Repair integrity was evaluated with sonography (mean, 24 months after surgery; range, 6-62 months) and classified into 3 categories: type A, indicating complete, homogeneous, and thick coverage of the footprint; type B, partial coverage with a thin tendon; and type C, no coverage of the footprint. Results: The prevalence of tendon delamination observed under arthroscopy was 32% (37 of 117), which increased with tear size and retraction: from 15% in small tears to 32% in medium tears and 45% in large tears ( P = .028). Postoperatively, 83 patients had complete coverage of footprint (type A = 71%) and the cuff was considered healed, whereas 26 had partial coverage or a thin tendon (type B = 22%) and 8 had no coverage (type C = 7%). Overall, the rate of complete healing was 78% in nondelaminated cuff tears and 57% in the case of tendon delamination ( P = .029). In large retracted tears, the healing rate dropped from 81% in the absence of delamination to 39% when the tendons were delaminated ( P = .027). Conclusion: Tendon delamination increases with tear size and retraction. Patients with chronic delaminated and retracted rotator cuff tears (stage 2 or 3) are at risk of failure after SR cuff repair, whereas patients with small delaminated rotator cuff tears (stage 1) involving only the supraspinatus can be treated with an SR cuff repair with a high chance of tendon healing. These results suggest that SR cuff repair may be insufficient to treat delaminated chronic cuff tears. To improve the anatomic outcomes of rotator cuff repairs, surgeons should consider treating delaminated tears with a double-row or double-layer repair.

scholarly journals Inducible endogenous stem cells within human rotator cuff muscle to promote muscle regeneration after rotator cuff repair

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0033
Author(s):  
Carlin Lee ◽  
Meng Yao Liu ◽  
C. Benjamin Ma ◽  
Xuhui Liu ◽  
Brian Feeley
Keyword(s):  
Rotator Cuff ◽  
Fatty Infiltration ◽  
Muscle Quality ◽  
Medical Attention ◽  
Full Thickness ◽  
Differentiation Potential ◽  
Fibrotic Tissue ◽  
Partial Tears ◽  
Beige Fat ◽  
Tear Size

Objectives: Rotator cuff (RC) tears are the most common upper extremity injury, with over two million Americans seeking medical attention annually. Secondary muscle degradation following RC tears, including atrophy and fatty infiltration (FI), are critical factors that directly determine the clinical outcome of patients with this injury In mouse studies, the importance of fibro/adipogenic (FAP) cells in the development of FI after RC tears has been shown, determining that these cells are the predominant cell line responsible for the development of FI. FAP cells have garnered considerable interest in mediating both positive and negative effects on muscle cells. In regenerative conditions, FAPs stimulate satellite cell (SC) growth and differentiation, but in degenerative states, these cells differentiate into fat and fibrotic tissue. Additionally, FAPs have the ability to express factors consistent with beige fat, which may have important regenerative potential. In this study, we harvested samples from supraspinatus muscle in patients undergoing RC repair to determine for 1) the presence of FAP cells; 2) the presence of satellite cells; and 3) the ability of FAPs to differentiate into fat and/or fibrotic tissue. We hypothesized that both FAPs and SC would increase, and FAPs would display considerable cell plasticity and have the ability to differentiate into beige fat, adipocytes, and fibroblasts. Methods: The study was approved by the institutional IRB. At the time of surgery, a 3mm × 3 mm Supraspinatus (SS) and Deltoid (DL) biopsy was collected during surgery from 20 different clinical cases (Average age was 65 years, with 15 men and 5 women). Half of the biopsy was used for histology and half for Flow cytometry. For the vitro analysis, FAPs were isolated from human specimens using BD Aria II with PI live and Dead staining, and further isolated using CD31-, CD45-, CD184-, CD29-. CD56-, CD34+, CD140a + markers. SCs were sorted with PI live and dead staining, and further isolated using CD31-, CD45-, CD184+, CD29-, CD56+, CD34-, CD140a + markers. FAPs were cultured in 24 wells cell culture plates in standard media (F10+20%FBS+1% Antibiotics), Fibrogenic media (10ng/ml TGFβ-1) and Adipogenic media (stempro kit) for 2 weeks. For the Amibegron treatment group, FAPs were cultured in adipogenic media for 2 weeks first and switch to Adipogenic media with 10uM Amibegron (Sigma). FAPs were fixed with 4% PFA and stained with collagen I for quantify fibrosis index and perilipin A for Adipogenic index. The Paired ANOVA was used for statistical comparisons between groups, with p<0.05. Data are presented as mean +/- standard deviation. Results: A total of 20 patients were included in the study with different tear sizes. While SC number did not increase when comparing tear sizes, FAP cell number increased with increasing tear sizes. Patients with RC tears all had significantly more FAPs (7.8+/-2% vs 1.3 +/- .4%, p<0.05) compared to patients with partial tears. When divided by tear size, patients with medium and large tears had more FAPs compared to partial and small tears, a difference that was statistically significant. Histological analysis demonstrated that muscle architecture was preserved, but those with full thickness tears had more fat and fibrosis, with increased FAPs (Stained Red, Figure 2). FAPs from patients with full thickness tears had increased ability to differentiate into adipocytes and fibroblasts compared to partial tears (Figure 3), and had increased expression of UCP-1 (P<0.05). FAPs that were isolated from full thickness tears demonstrated increased expression of several promyogenic factors including IGF-1 and follistatin. Conclusions: Patients with full thickness RC tears have increased FAPs compared to control muscle and partial tears. FAPs from full thickness tears increase with tear size and have more differentiation potential compared. This data confirms that these cells are likely the cellular source for FI in humans, but that they also may serve a regenerative potential as they show differentiation plasticity and expression markers consistent with a beige fat phenotype. The fact that FAPS are able to differentiate and express pro-myogenic factors such as IGF-1 and follistatin suggest that they may serve as an endogenous stem cell source for improving muscle quality after RC repair.

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