The influence of diabetes mellitus on rotator cuff repair: A systematic review and meta-analysis

2020 ◽  
Vol 23 ◽  
Author(s):  
Xiaomin Lu ◽  
He Sun ◽  
YiSheng Xu ◽  
Xuewei Cao
Keyword(s):  
Diabetes Mellitus ◽  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Clinical Studies ◽  
Rotator Cuff Repair ◽  
Meta Analysis ◽  
Japanese Orthopaedic Association ◽  
Cochrane Library ◽  
Significant Difference ◽  
Cuff Repair

Background: : Clinical outcomes after rotator cuff repair associated with diabetes mellitus(DM) are generally favorable, but no study has attempted to establish the influence of DM on outcomes after rotator cuff repair. Purpose: To conduct a meta-analysis of clinical studies evaluating patient outcomes between people with DM and people without DM after rotator cuff repair. Study Design: Meta-analysis. Methods: A literature search of the Embase, PubMed, and Cochrane Library databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Cohort studies and case-control studies about clinical outcomes after rotator cuff repair comparing people with DM and people without DM were included. Statistical analysis was performed with RevMan (v 5.3.3). Results: Nine clinical studies that met the inclusion criteria were identified and included a total of 314 patients treated with DM and 1092 patients without DM. The failure rate was significantly higher in the DM group than in Non-DM group (23.97% compared with 16.60%, OR: 2.39; 95% CI, 1.69–3.37; p < 0.001). The postoperative retear rate and showed a significant difference between the two groups (24.5% and 13.7%; OR: 2.41; 95% CI, 1.57–3.71; p<0.001). The DM group showed a higher rate of postoperative unhealed cuff than the Non-DM group(41.81% and 25.23%; OR: 2.14; 95% CI, 1.69–3.37; p=0.01).Postoperative Range of motion(ROM) at 12 months after surgery show a significant difference in the range of external rotation between two groups (WMD: -6.02; 95% CI, -7.54 to -4.50; p<0.001).The preoperative Japanese Orthopaedic Association (JOA) score, the comparison of pre- and post-operative JOA scores showed a significant difference in the DM and Non-DM group(p<0.001). The postoperative JOA score, the pre- and post-operative muscle strength, the pre- and postoperative visual analog scale (VAS) show significant difference between the the DM and Non-DM group(p<0.001). The postoperative infection rates, the rates of postoperative shoulder stiffness, the preoperative ROM, the postoperative ROM at 6 months, the postoperative ROM at 12 months of forward flexion and abduction, the American Shoulder and Elbow Surgeons score, the University of California, Los Angeles scores, and the preoperative Constant-Murley scores show no significant difference between the two groups. Conclusion: This meta-analysis indicates that DM may be relative to a higher rate of shoulder retear and cuff unhealing. However, patients with DM can achieve great clinical outcomes after cuff repair, compared to patients without DM.

Use of Suture Tapes Versus Conventional Sutures for Arthroscopic Rotator Cuff Repairs: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652199831
Author(s):  
Khalis Boksh ◽  
Aziz Haque ◽  
Ashwini Sharma ◽  
Pip Divall ◽  
Harvinder Singh
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Clinical Studies ◽  
Rotator Cuff Repair ◽  
Meta Analysis ◽  
Gap Formation ◽  
Load To Failure ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Suture Tape

Background: Various suture materials are available for arthroscopic rotator cuff repair. More recently, suture tapes have become popular as they are perceived to be easier to use with less soft tissue irritation. However, little is known about their biomechanical and clinical properties compared with conventional sutures in rotator cuff repairs. Purpose: To perform a systematic review and meta-analysis on whether suture tapes are biomechanically superior to conventional sutures in arthroscopic rotator cuff repairs and whether this translates to superior functional outcomes and a lower incidence of retears. Study Design: Meta-analysis. Methods: The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: (rotator cuff repair OR arthroscopic rotator cuff repair) AND (“tape” OR “wire” OR “cord” OR “suture”). Data pertaining to certain biomechanical properties (contact area, contact pressure, gap formation, load to failure, and stiffness), retears, and patient-reported outcome measures (PROMs) were extracted. The pooled outcome data were analyzed by random- and fixed-effects models. Results: After abstract and full-text screening, 7 biomechanical and 6 clinical studies were included. All biomechanical studies were on animals, with 91 suture tapes and 91 conventional sutures compared. Suture tapes had higher contact pressure (mean difference [MD], 0.04 MPa; 95% CI, 0.01-0.08; P = .02), higher load to failure (MD, 52.62 N; 95% CI, 27.34-77.90; P < .0001), greater stiffness (MD, 4.47 N/mm; 95% CI, 0.57-8.38; P = .02), and smaller gap formation (MD, −0.30 mm; 95% CI, −0.45 to −0.15; P < .0001) compared with conventional sutures. From the clinical analysis of the 681 rotator cuff repairs treated with a suture tape (n = 380) or conventional suture (n = 301), there were no differences in retear rates between the groups (16% vs 20% suture tape and wire, respectively; P = .26) at a mean of 11.2 months. Qualitatively, there were no differences in PROMs between the groups at a mean of 36.8 months. Conclusion: Although biomechanically superior, suture tapes showed similar retear rates and postoperative function to conventional sutures. However, higher-quality clinical studies are required to investigate whether there are no true differences.

Healing rate and clinical outcomes of xenografts appear to be inferior when compared to other graft material in rotator cuff repair: a meta-analysis

2016 ◽  
Vol 1 (6) ◽  
pp. 321-328 ◽  
Author(s):  
Yohei Ono ◽  
Diego Alejandro Dávalos Herrera ◽  
Jarret M Woodmass ◽  
Richard S Boorman ◽  
Gail M Thornton ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Healing Rate ◽  
Meta Analysis ◽  
Graft Material ◽  
Cuff Repair

scholarly journals Clinical and Structural Outcomes After Rotator Cuff Repair in Patients With Diabetes: A Meta-analysis

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712094849 ◽  
Author(s):  
Lingdi Yang ◽  
Jun Zhang ◽  
Dengfeng Ruan ◽  
Kun Zhao ◽  
Xiao Chen ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Constant Score ◽  
Meta Analysis ◽  
Random Effects Model ◽  
Patients With Diabetes ◽  
Cuff Repair ◽  
Retear Rate

Background: The impact of diabetes on clinical and structural outcomes after rotator cuff repair remains controversial. Purpose/Hypothesis: The purpose of this study was to compare clinical outcomes and retear rates after rotator cuff repair in patients with and without diabetes. Our hypotheses were that adequate control of diabetes would decrease the retear rate after rotator cuff repair and that patients with diabetes would have worse clinical outcomes. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Embase, and Cochrane Library databases were searched for studies comparing outcomes in patients with and without diabetes after full-thickness rotator cuff repair. Clinical outcome analysis included the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and the University of California–Los Angeles shoulder rating scale; we compared preoperative, postoperative, and change in functional scores from baseline to final follow-up among the included studies. The pooled relative risk was calculated using a random-effects model for retear rates. Clinical outcomes were also pooled using a random-effects model. Results: Overall, 10 studies were included. Compared with patients without diabetes, patients with diabetes had a worse preoperative ASES score ( P = .009) as well as worse postoperative Constant score (final follow-up range, 9-103 months; P = .0003). However, there was no significant difference in the absolute mean change in clinical outcomes between patients with and without diabetes. Diabetes was associated with a higher retear rate (19.3% in patients without diabetes vs 28.2% in patients with diabetes; P < .0001). The retear rate according to the severity of sustained hyperglycemia in the subgroup analysis was 14.6% in patients without diabetes, versus 22.7% in patients with well-controlled diabetes (<7.0% of preoperative serum HbA1c level; P = .12) and 40.0% in patients with uncontrolled diabetes (HbA1c level ≥7.0%; P < .00001). Conclusion: This meta-analysis suggests that diabetes mellitus is associated with an increased risk of retears after rotator cuff repair, and improved blood glucose control may reduce the risk of retears in patients with diabetes mellitus. Although effective glycemic control was associated with a decreased risk of retears in patients with diabetes, we could not prove causation because of potential bias and confounding in the included studies.

scholarly journals Cost-Effectiveness of Supervised versus Unsupervised Rehabilitation for Rotator-Cuff Repair: Systematic Review and Meta-Analysis

2020 ◽  
Vol 17 (8) ◽  
pp. 2852
Author(s):  
Umile Giuseppe Longo ◽  
Alessandra Berton ◽  
Laura Risi Ambrogioni ◽  
Daniela Lo Presti ◽  
Arianna Carnevale ◽  
...  
Keyword(s):  
Systematic Review ◽  
Physical Therapy ◽  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Meta Analysis ◽  
Motor Units ◽  
Vas Score ◽  
Therapy Technique ◽  
Cuff Repair

Background: The objective of the present study was to compare the efficacy between supervised and unsupervised rehabilitation after rotator-cuff (RC) repair in terms of clinical outcomes, visual-analog-scale (VAS) score, range of motion (ROM), and risk of retear. Material: a comprehensive search of Pubmed, CINAHL, Cochrane, EMBASE, Ovid, and Google Scholar databases through a combination of the following keywords with logical Boolean operators: “informed”, “uninformed”, “unsupervised”, “supervised”, “rehabilitation”, “physical therapy”, “physical therapies”, “postoperative period”, “physical-therapy techniques”, “physical-therapy technique”, “exercise”, “exercise therapy”, “rotator cuff”, “rotator-cuff tear”, and “rotator-cuff repair”. For each article included in the study, the following data were extracted: authors, year, study design, sample size and demographic features, RC tear characteristics, clinical outcomes, ROM, VAS score, retear rate, and time of follow-up. Meta-analysis was performed in terms of VAS score. Results: Four randomized control trials with 132 patients were included. One study demonstrated significant improvement in VAS, active ROM, and the activity of the muscle’s motor units at stop and during maximal effort in supervised patients. Another one showed lower retear rates in the supervised group. The remaining two randomized controlled trials did not reveal any significant differences between supervised and unsupervised rehabilitation in terms of clinical outcomes. Moreover, higher costs were described for supervised rehabilitation. The VAS was not significantly different in the two groups (9.9 compared with 8.25, p = 0.23). Conclusions: although several publications address the problem of RC lacerations, there is a paucity of evidence in the literature regarding the effectiveness of supervised and unsupervised rehabilitation protocols. This systematic review and meta-analysis showed no significant differences between the two types of rehabilitation in terms of VAS scores, while outlining the pros and cons of each protocol.

scholarly journals Bilateral single-staged arthroscopic rotator cuff repair is comparable to staged procedures: a retrospective follow up study of 2 years

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chen Wang ◽  
Pu Yang ◽  
Dongfang Zhang ◽  
In-Ho Jeon ◽  
Tengbo Yu ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Single Stage ◽  
Arthroscopic Rotator Cuff Repair ◽  
Significant Difference ◽  
Outcome Scores ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Abstract Background Bilateral rotator cuff tears are not uncommon and the timing of the surgical treatment of both shoulders is debated. In the present study, we aimed to compare the clinical outcomes of patients who underwent single-stage or staged bilateral arthroscopic rotator cuff repair. Methods From March 2013 to May 2018, a retrospective review on all patients who underwent bilateral arthroscopic rotator cuff repair at our department was performed. Patients were separated into 2 groups: single-stage and staged. The minimum follow-up period was 2 years. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, Constant-Murley (Constant) score, the range of motion (ROM) of the shoulder and the hospitalization costs were evaluated for comparison between the two groups before and after the operation. Differences between groups were assessed using t-tests and ANOVA. Results All 51 patients completed follow-up of 2 years, single stage (n = 24) and staged group (n = 27). There was no significant difference in the VAS, ASES, UCLA and Constant scores between the single-stage group and the staged group before the operation. Postoperative clinical scores were significantly improved in both groups (P < 0.05). All outcome scores were significantly different between the two groups at 6 months postoperatively, and the staged scored better than the single-stage (P < 0.05). At 12, 18, and 24 months after the operation, the outcome scores were not significantly different between the two groups. At follow-up, the ROM of the shoulder was not significantly different between the two groups. In the single-stage group, the outcome scores and ROM were similar for both shoulders and comparable to the staged group. We also found significant cost savings in the single-stage group (4440.89 ± 130.55 USD) compared to the staged group (5065.73 ± 254.76 USD) (p < 0.05). Conclusions Patients receiving single-stage or staged bilateral arthroscopic rotator cuff repair showed similarly good clinical outcomes at follow-ups longer than 6 months. Moreover, good outcomes were observed on both sides of the single-stage group.

scholarly journals Systematic Review of Platelet-Rich Plasma for Rotator Cuff Repair: Are We Adhering to the Minimum Information for Studies Evaluating Biologics in Orthopaedics?

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110419
Author(s):  
Madeleine G. DeClercq ◽  
Alyson M. Fiorentino ◽  
Haylie A. Lengel ◽  
Joseph J. Ruzbarsky ◽  
Sara K. Robinson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Whole Blood ◽  
Clinical Studies ◽  
Rotator Cuff Repair ◽  
Platelet Rich Plasma ◽  
Cochrane Library ◽  
Full Thickness ◽  
Minimum Information ◽  
Cuff Repair

Background: The therapeutic efficacy of orthobiologic therapies for rotator cuff repair is difficult to evaluate owing to reporting inconsistences. In response, the Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines were developed to ensure standard reporting on orthobiologic therapies. Purpose: To systematically review clinical studies evaluating platelet-rich plasma (PRP) for full-thickness rotator cuff repair and adherence to MIBO guidelines. Study Design: Scoping review; Level of evidence, 4. Methods: A search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, EMBASE, and the Cochrane Library databases. Inclusion criteria were clinical studies reporting on rotator cuff tears (≥1 cm) surgically repaired with PRP. Patient demographics, biologic intervention, and adherence to the MIBO guidelines were systematically reviewed. Results: A total of 19 studies (1005 patients) were included in this review. Across all studies, 58.5% of the MIBO checklist items for PRP were reported. Out of 47 checklist items, 19 were reported in over 85% of studies, whereas 22 were reported in less than half of studies. Details of whole-blood processing and characteristics, as well as PRP processing and characteristics, were reported inconsistently, and no study provided adequate information to enable the precise replication of preparation protocols for PRP. Conclusion: This systematic review highlights the current reporting deficiencies within the scientific literature of important variables for evaluating PRP for full-thickness rotator cuff repair. There was widespread variability among published studies that evaluate PRP for this application and, more specifically, studies were limited by inconsistent universal reporting of whole-blood and PRP processing and postprocessing characteristics. To improve our understanding of biologic efficacy and to promote repeatability, stricter adherence to the MIBO guidelines is necessary. We propose that the checklist limitations be addressed and that modification of the MIBO guidelines be considered to improve the reporting of individual components within certain categories.

Clinical outcomes in patients with retear after arthroscopic rotator cuff repair: A meta-analysis

2021 ◽  
Author(s):  
Masaki Karasuyama ◽  
Masafumi Gotoh ◽  
Junichi Kawakami ◽  
Nobuya Harada ◽  
Hidehiro Nakamura ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Meta Analysis ◽  
Arthroscopic Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair
Sign in / Sign up

Export Citation Format

Share Document