scholarly journals Do We have Arguments in Decision Making: Conservative or Surgical Treatment in Painful Degenerative Large Rotator Cuff Tears?

2020 ◽  
Author(s):  
Karl Vincent ◽  
Olivier Gagey ◽  
Charlotte Leboeuf-Yde
Keyword(s):  
Clinical Trials ◽  
Rotator Cuff ◽  
Randomized Clinical Trials ◽  
Functional Disability ◽  
Surgical Repair ◽  
Rotator Cuff Tears ◽  
Long Term Results ◽  
Cochrane Library ◽  
Clinical Difference

Abstract Background and Hypotheses: The contemporary research literature indicates that there is no significant clinical difference in terms of improvement of pain and functional disability between surgical repair and rehabilitation treatment for degenerative rotator cuff tears. It could be hypothesized that rehabilitation, which is cheaper and causes few complications, is preferable for smaller lesions, whereas surgical repair might be needed for the larger lesions. The purpose of our review was to assess whether the size of the tear, particularly the large or massive, plays a major role in terms of long-term clinical results for rehabilitation compared to surgical repair.Method: We searched the literature on PubMed, Embase, PEDro, and Cochrane Library database up to March 2020 for randomized controlled clinical trials that compared long term results for surgical vs. rehabilitation concerning large or massive degenerative rotator cuff tears. A systematic, critical review process was planned using a slightly modified SIGN checklist. The review methodology followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and was submitted to PROSPERO and registered under the number CRD42020146161.Results: We found no randomized clinical trials that had dealt with this subject.Conclusion: There is no evidence that would help to choose between surgical repair or rehabilitation in case of large or massive rotator cuff degenerative tears. The reason for this is probably that large tears may be relatively painless since they often occur after retirement and therefore are relatively rarely seen in clinical practice. To obtain enough study subjects, it would therefore be necessary to study this question in multicenter randomized clinical trials.

Long-term survivorship and outcomes after surgical repair of full-thickness rotator cuff tears

2011 ◽  
Vol 20 (4) ◽  
pp. 591-597 ◽  
Author(s):  
Peter J. Millett ◽  
Marilee P. Horan ◽  
Katie E. Maland ◽  
Richard J. Hawkins
Keyword(s):  
Rotator Cuff ◽  
Surgical Repair ◽  
Rotator Cuff Tears ◽  
Full Thickness

Teres major tendon transfer in the treatment of irreparable posterosuperior rotator cuff tears

2018 ◽  
Vol 100-B (3) ◽  
pp. 309-317 ◽  
Author(s):  
A. Kolk ◽  
J. F. Henseler ◽  
F. J. Overes ◽  
J. Nagels ◽  
R. G. H. H. Nelissen
Keyword(s):  
Rotator Cuff ◽  
Latissimus Dorsi ◽  
Tendon Transfer ◽  
Rotator Cuff Tears ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Teres Major ◽  
Pain At Rest

Aims Since long-term outcome of teres major tendon transfer surgery for irreparable posterosuperior rotator cuff (RC) tears is largely unknown, the primary aim of this study was to evaluate the long-term outcome of the teres major transfer. We also aimed to report on the results of a cohort of patients with a similar indication for surgery that underwent a latissimus dorsi tendon transfer. Patients and Methods In this prospective cohort study, we reported on the long-term results of 20 consecutive patients with a teres major tendon transfer for irreparable massive posterosuperior RC tears. Additionally, we reported on the results of the latissimus dorsi tendon transfer (n = 19). The mean age was 60 years (47 to 77). Outcomes included the Constant score (CS), and pain at rest and during movement using the Visual Analogue Scale (VAS). Results At a mean of ten years (8 to 12) following teres major transfer, the CS was still 23 points (95% confidence interval (CI) 14.6 to 30.9, p < 0.001) higher than preoperatively. VAS for pain at rest (21 mm, 95% CI 4.0 to 38.9, p = 0.016) and movement (31 mm, 95% CI 16.0 to 45.1, p < 0.001) were lower than preoperatively. We also found an increase in CS (32 points, 95% CI 23.4 to 40.2, p < 0.001) and reduction of pain (26 mm, 95% CI 9.9 to 41.8, p = 0.001) six years after latissimus dorsi transfer. Conclusion Teres major tendon transfer is a treatment option to gain shoulder function and reduce pain in patients with an irreparable posterosuperior RC tear at a mean follow-up of ten years. The teres major tendon might be a valuable alternative to the commonly performed latissimus dorsi tendon transfer in the treatment of irreparable posterosuperior RC tears. Cite this article: Bone Joint J 2018;100-B:309–17.

scholarly journals Adverse Events Associated With Anti-IL-23 Agents: Clinical Evidence and Possible Mechanisms

2021 ◽  
Vol 12 ◽  
Author(s):  
Yi Ru ◽  
Xiaojie Ding ◽  
Ying Luo ◽  
Hongjin Li ◽  
Xiaoying Sun ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Adverse Event ◽  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
The Cochrane Library ◽  
Specific Symptoms

BackgroundAnti-interleukin (IL)-23 agents are widely used for autoimmune disease treatment; however, the safety and risks of specific symptoms have not been systematically assessed.ObjectivesThe aim of this study was to summarize the characteristics and mechanisms of occurrence of five immunological and non-immunological adverse events caused by different anti-IL-23 agents.MethodsThe Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched for eligible randomized clinical trials published from inception through May 1, 2020. Randomized clinical trials that reported at least one type of adverse event after treatment were included, regardless of sex, age, ethnicity, and diagnosis. Two investigators independently screened and extracted the characteristics of the studies, participants, drugs, and adverse event types. The Cochrane Handbook was used to assess the methodological quality of the included randomized clinical trials. Heterogeneity was assessed using the I2 statistic. Meta-regression was applied to determine the sources of heterogeneity, and subgroup analysis was used to identify the factors contributing to adverse events.ResultsForty-eight studies were included in the meta-analysis, comprising 25,624 patients treated with anti-IL-23 agents. Serious immunological or non-immunological adverse events were rare. Anti-IL-12/23-p40 agents appeared to cause adverse events more easily than anti-IL-23-p19 agents. The incidence of cancer did not appear to be related to anti-IL-23 agent treatment, and long-term medication could lead to mental diseases. The prevention of complications should be carefully monitored when administered for over approximately 40 weeks to avoid further adverse reactions, and the incidence of infection was the highest among general immunological adverse events.ConclusionsThe application of anti-IL-23 agents induced a series of immunological and non-immunological adverse events, but these agents tend to be well-tolerated with good safety profiles.

scholarly journals Complete and partial repair of massive rotator cuff tears provide sustainable long term improvement in clinical scores

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0000
Author(s):  
Marion Besnard ◽  
Benjamin Freychet ◽  
Julien Clechet ◽  
Yannick Carrillon ◽  
Arnaud Godenèche
Keyword(s):  
Rotator Cuff ◽  
Fatty Infiltration ◽  
Arthroscopic Repair ◽  
Rotator Cuff Tears ◽  
Long Term Results ◽  
Massive Rotator Cuff Tears ◽  
Clinical Scores ◽  
Goutallier Classification

Objectives: The aim was to report results of arthroscopic repair of 86 massive cuff tears and decided to assess whether or not clinical scores were maintained 5 years later. Methods: Of the initial series of 86 shoulders, 2 patients died, 16 were lost to follow-up and 4 had a repeat surgery. Therefore, it was possible to reevaluate 64 patients. Repairs were complete in 44 cases and partial in 20 cases. Seventeen shoulders were pseudoparalytic. Tears with fatty degeneration at stage 4 or higher according to the Goutallier classification were not eligible for repair. Preoperatively, the Constant Score (CS), shoulder strength, location of the tear, tendon retraction and degree of fatty infiltration were assessed. Patients were assessed at 8.1±0.6 years [7.1-9.3] using absolute and age- and sex-adjusted CS, the subjective shoulder value (SSV) and the simple shoulder test (SST). Results: The absolute CS was 80.0±11.7 at the first follow-up (at 2-5 years) and decreased to 76.7±10.2 at the last follow-up (at 7-10 years) (p<0.001). The adjusted CS was 99.7±15.9 at the first follow-up and remained at 98.8±15.9 at the last follow-up (ns.). In terms of the other criteria, strength decreased over time (p<0.001) but pain, SSV and SST remained the same. Partial repairs had less strength at the first and last follow-up (p<0.05). Pseudoparalytic shoulders had a lower absolute and adjusted CS at the last follow-up (p<0.05) but the improvement in CS was greater (p=0.014). Conclusion: Partial and complete arthroscopic repair provide good long-term results in patients with massive rotator cuff tears, regardless of the location of the tear, the degree of fat infiltration (I to III according to the Goutallier classification) and even in case of a pseudoparalytic shoulder.

scholarly journals Update on surgical repair in functional mitral valve regurgitation.

2021 ◽  
Author(s):  
Jia Hu ◽  
Alex Lee ◽  
Xiang Wei ◽  
Zhaoyun CHENG ◽  
Anthony Ho ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Medical Therapy ◽  
Poor Prognosis ◽  
Randomized Clinical Trials ◽  
Surgical Repair ◽  
Functional Mitral Regurgitation ◽  
Cochrane Library ◽  
Mitral Repair

Background: Functional mitral regurgitation (FMR) is common in patients with myocardial infarction or dilated cardiomyopathies, and portends a poor prognosis despite guideline-directed medical therapy. Surgical or transcatheter mitral repair for FMR from recent randomized clinical trials showed disappointing or conflicting results. Aims: To provide an update on the role of surgical repair in the management of FMR. Materials & Methods: A literature search was conducted utilizing PubMed, Ovid, Web of Science, Embase and Cochrane Library. The search terms included secondary/functional mitral regurgitation, ischemic mitral regurgitation, mitral repair, mitral replacement, mitral annuloplasty, transcatheter mitral repair, and percutaneous mitral repair. Randomized clinical trials over the past decade were the particular focus of this current review. Results: Recent data underlined the complexity and poor prognosis of FMR. Guideline-directed medical therapy and cardiac resynchronization, when indicated, should always be applied. Accurate assessment of the interplay between ventricular geometry and mitral valve function is essential to differentiate proportionate FMR from the disproportionate subgroup, which could be helpful in selecting appropriate transcatheter intervention strategies. Surgical repair, most commonly performed with an undersized ring annuloplasty, remains controversial. Adjunctive valvular or subvalvular repair techniques are evolving and may produce improved results in selected FMR patients. Conclusion: FMR resulted from complex valve-ventricular interaction and remodeling. Distinguishing proportionate FMR from disproportionate FMR is important in exploring their underlying mechanisms and to guide medical treatment with surgical or transcatheter interventions. Further studies are warranted to confirm the clinical benefit of appropriate surgical repair in selected FMR patients.

scholarly journals The Efficacy of Injections for Partial Rotator Cuff Tears: A Systematic Review

2020 ◽  
Vol 10 (1) ◽  
pp. 51
Author(s):  
Edoardo Giovannetti de Sanctis ◽  
Edoardo Franceschetti ◽  
Ferdinando De Dona ◽  
Alessio Palumbo ◽  
Michele Paciotti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Platelet Rich Plasma ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Therapeutic Modality ◽  
Cochrane Library ◽  
Long Term Follow Up

(1) Background: Even though rotator cuff tears are the most frequent tendon injuries in adults, the effectiveness of conservatively treated partial-thickness tears still remains a matter of debate. The purpose of this review is to compare corticosteroid injections to other drugs in the treatment of partial rotator cuff tears, focusing on the effectiveness of this therapeutic modality in terms of pain and shoulder functionality. (2) Methods: A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE and Cochrane Library databases. All studies comparing the use of corticosteroids and other infiltrative techniques in the treatment of partial lesions (excluding studies that considered subacromial impingement as inclusion criteria) were pooled, data were extracted and statistically analyzed. (3) Results: Nine studies were included in this systematic review. Those studies, composed by a total of 494 shoulders treated, have been published from 1985 to 2019. All compared techniques have shown a significant improvement over baseline condition. PRP (Platelet Rich Plasma) injections have been shown to be significantly more effective in both functional and pain control only in the long term. (4) Conclusions: None of the techniques prevail indisputably on the others. Anyway, the treatment of partial rotator cuff tears with PRP injections seems to lead to significantly better outcomes in terms of pain and shoulder function in long term follow up. Whereas in short and medium term follow up, PRP injections was superior only in terms of shoulder function. The small number of studies on prolotherapy did not enable us to provide an opinion on the outcomes of this technique.

scholarly journals Surgical reconstruction of small and medium rotator cuff tears shows superior long-term results

2021 ◽  
Author(s):  
Barbara Wirth ◽  
Leonie Weinhold ◽  
Ralf Müller-Rath
Keyword(s):  
Rotator Cuff ◽  
Confidence Interval ◽  
Treatment Strategies ◽  
Tendon Healing ◽  
Operative Management ◽  
Mean Difference ◽  
Rotator Cuff Tears ◽  
Long Term Results ◽  
Surgical Reconstruction

Abstract Background Degenerative rotator cuff tears are common in elderly patients. However, the treatment strategies remain controversial. While physiotherapy can lead to pain relief and improved shoulder function, spontaneous tendon healing will not take place and, thus, non-operative management bears the risk of tear progression. Surgical management is the only way to restore the tendon-to-bone interface in spite of a considerable number of retears. Methods The present study reviewed the data provided by randomized controlled trials (RCTs) that have compared physiotherapy with surgical rotator cuff repair. Systematic reviews of this kind have been published before; however, this paper re-analyzes the data, given that Moosmayer et al. recently published an RCT with 10-year follow-up. Such long-term data are comparatively rare in the field of musculoskeletal surgery and therefore a reconsideration of treatment recommendations seems necessary. Results The results show a mean difference in the Constant and Murley score of 6.2 points (95% confidence interval, 2.6; 9.7, P < 0.001) in favor of the surgical groups. The visual analog scale pain score also improved more in the operatively treated patients with a mean difference of −1.4 (95% confidence interval −2.1; −0.8, P < 0.001). Conclusion In summary, this review shows superior clinical results for surgical repair of small- to medium-sized degenerative rotator cuff tears especially in the long term compared to physiotherapy.

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