Personalized, Predictive, Participatory, Precision, and Preventive (P5) Medicine in Rotator Cuff Tears

Rotator cuff (RC) disease is a common musculoskeletal disorder of the shoulder entailing pain, with reduced functionality and quality of life. The main objective of this study was to present a perspective of the current scientific evidence about personalized, predictive, participatory, precision, and preventive approaches in the management of RC diseases. The personalized, predictive, participatory, precision and preventive (P5) medicine model is an interdisciplinary and multidisciplinary approach that will provide researchers and clinicians with a comprehensive patrimony of knowledge in the management of RC diseases. The ability to define genetic predispositions in conjunction with the evaluation of lifestyle and environmental factors may boost the tailoring of diagnosis and therapy in patients suffering from RC diseases.

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Outcomes of the Star Repair for Large and Massive Rotator Cuff Tears: A Modified Triple-Row Technique

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120952998 ◽

2020 ◽

Vol 8 (9) ◽

pp. 232596712095299

Author(s):

Mohamed G. Morsy ◽

Hesham M. Gawish ◽

Mostafa A. Galal ◽

Ahmed H. Waly

Keyword(s):

Quality Of Life ◽

Rotator Cuff ◽

Rotator Cuff Tears ◽

Functional Evaluation ◽

Massive Rotator Cuff Tears ◽

Health Related ◽

The Mean ◽

Cuff Repair ◽

Disease Specific

Background: Large and massive rotator cuff repairs constitute a true challenge for arthroscopic shoulder surgeons. Retear rates as high as 20% have been reported after arthroscopic double-row and suture-bridge techniques used for these tears. Hypothesis: A modified triple-row repair will provide satisfactory clinical results with lower risk for retear. Study Design: Case series; Level of evidence, 4. Methods: Between March 2016 and August 2017, a total of 52 patients with large and massive rotator cuff tears received a modified triple-row cuff repair. A middle repositioning anchor was inserted between the medial and the lateral rows. The middle anchor sutures were loaded to lateral knotless anchors in a star-shaped configuration. Functional evaluation was performed using the American Shoulder and Elbow Surgeons score, University of California, Los Angeles score, Constant-Murley score, and Simple Shoulder Test. Subjective evaluation was carried out using a visual analog scale for pain and a subjective shoulder value score. Health-related as well as disease-specific quality-of-life scores were also used. Retear rates were assessed by means of musculoskeletal ultrasonography. Patients were evaluated for a minimum of 24 months. Results: This study included 34 female and 18 male patients with a mean age of 57.17 ± 6.7 years. There were 35 patients (67.3%) with large tears and 17 patients (32.7%) with massive tears. Significant improvement from preoperative values was seen in all functional and subjective scores ( P < .001). The mean forward flexion was 163° ± 9.7°, and the mean lateral abduction was 159.4° ± 9.4°. All patients had excellent scores on the general health-related and disease-specific quality-of-life scales. No retears were reported at the end of the follow-up period. Conclusion: The star-shaped, modified triple-row cuff repair is a valid and effective solution for surgical management of large and massive rotator cuff tears, providing excellent results and low risk for retears.

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Large to massive rotator cuff tendon tears: a protocol for a systematic review investigating the effectiveness of exercise therapy on pain, disability and quality of life

HRB Open Research ◽

10.12688/hrbopenres.13242.2 ◽

2021 ◽

Vol 4 ◽

pp. 75

Author(s):

Kathryn Fahy ◽

Rose Galvin ◽

Jeremy Lewis ◽

Karen McCreesh

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Rotator Cuff ◽

Rotator Cuff Tears ◽

Response To Treatment ◽

Exercise Interventions ◽

Rotator Cuff Tendon ◽

Pain Disability ◽

Tendon Tears

Background: Chronic non-traumatic rotator cuff tendon tears are inextricably linked with the natural process of aging often resulting in severe disability, poor quality of life and an added burden to the health care system. The occurrence of rotator cuff tendon tears increases exponentially with every decade of life to approximately 60% in individuals over 80 years of age. Exercise is a commonly prescribed intervention although research on its efficacy is in its infancy and often conflicting. The purpose of this systematic review is to investigate the effectiveness of exercise interventions for people diagnosed with large to massive rotator cuff tendon tears. Methods: This systematic review will adhere to the PRISMA reporting guidelines. A comprehensive search of five databases will be conducted. Randomised clinical trials (RCT) or quasi-randomised control trials will be included if they evaluate exercise as the core intervention or as part of the intervention in the management of large to massive rotator cuff tears. To quantify response to treatment we will compare changes in pain, disability and quality of life (QoL). The Consensus on Exercise Reporting Template (CERT) will be used to characterise the different types of exercise intervention. The Cochrane Risk of Bias Tool will be used to assess study quality. A narrative synthesis with meta-analysis will be performed, and the certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Discussion: This review will synthesise the totality of GRADE A and B evidence on the effectiveness of exercise for large to massive rotator cuff tendon tears. It will provide clinically important information and guidance for immediate implementation by clinicians, health policymakers and may be used to guide future research. PROSPERO registration: 244502 (24/03/2021)

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Functional outcomes and health-related quality of life after open repair of rotator cuff tears: a prospective cohort study

Clinical Trials in Orthopedic Disorders ◽

10.4103/2542-4157.227045 ◽

2018 ◽

Vol 3 (1) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Joel Galindo-Avalos ◽

Oscar Medina-Pontaza ◽

Juan López-Valencia ◽

JuanManuel Gómez-Gómez ◽

Avelino Colin-Vázquez ◽

...

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Rotator Cuff ◽

Functional Outcomes ◽

Open Repair ◽

Rotator Cuff Tears ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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A Prospective, Double-Blind, Randomized Clinical Trial Comparing Subacromial Injection of Betamethasone and Xylocaine to Xylocaine alone in Chronic Rotator Cuff Tendinosis

The American Journal of Sports Medicine ◽

10.1177/0363546504267345 ◽

2005 ◽

Vol 33 (2) ◽

pp. 255-262 ◽

Cited By ~ 111

Author(s):

Christine M. Alvarez ◽

Robert Litchfield ◽

Dianne Jackowski ◽

Sharon Griffin ◽

Alexandra Kirkley

Keyword(s):

Quality Of Life ◽

Clinical Trial ◽

Rotator Cuff ◽

Range Of Motion ◽

Rotator Cuff Tears ◽

Time Intervals ◽

Subacromial Injection ◽

Western Ontario Rotator Cuff ◽

Significant Difference

Background Rotator cuff tendinosis is a common problem with significant health and economic effects. Nonoperative management includes the widespread use of subacromial steroid injections despite the lack of evidence of its efficacy. Hypothesis A subacromial injection of betamethasone will be more effective than xylocaine alone in improving the quality of life, impingement sign, and range of motion in patients who have chronic rotator cuff tendinosis or partial rotator cuff tears. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods Patients with rotator cuff tendinosis or partial cuff tear with symptoms longer than 6 months, with failure of 6 weeks of physical therapy and 2 weeks of nonsteroidal anti-inflammatory drugs, who were older than 30 years of age, and who showed > 50% improvement with the Neer impingement test were stratified for Workplace Safety and Insurance Board status and previous injection. Outcome measures—the Western Ontario Rotator Cuff Index; American Shoulder and Elbow Surgeons standardized form; Disabilities of the Arm, Shoulder and Hand; active forward elevation; active internal rotation; active external rotation; and the Neer impingement sign—were assessed at 2, 6, 12, and 24 weeks after injection. The injection into the subacromial space contained either 5 mL of 2% xylocaine alone or 4 mL of 2% xylocaine and 1 mL (6 mg) of betamethasone in an opaque syringe. Results In 58 patients (betamethasone group, n = 30; xylocaine group, n = 28), the authors found no statistically significant difference between the 2 treatment groups for all outcomes and time intervals. The scores for the Western Ontario Rotator Cuff Index at 3 months were xylocaine = 45.4% ± 13% and betamethasone = 56.3% ± 17% (P=. 13). At 6 months, the scores were xylocaine = 51% ± 32% and betamethasone = 59% ± 26% (P=. 38). All other outcomes showed similar values. As well, similar results were found for 2 and 6 weeks after injection. Both groups showed improvement from baseline in all outcomes. Conclusions With the numbers available for this study, the authors found betamethasone to be no more effective in improving the quality of life, range of motion, or impingement sign than xylocaine alone in patients with chronic rotator cuff tendinosis for all follow-up time intervals evaluated.

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A Randomized Clinical Trial Comparing Open to Arthroscopic Acromioplasty With Mini-Open Rotator Cuff Repair for Full-Thickness Rotator Cuff Tears: Disease-Specific Quality of Life Outcome at an Average 2-Year Follow-Up

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)79407-0 ◽

2009 ◽

Vol 2009 ◽

pp. 110-111

Author(s):

B.F. Morrey

Keyword(s):

Quality Of Life ◽

Clinical Trial ◽

Rotator Cuff ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Cuff Repair ◽

Mini Open ◽

Disease Specific

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Costs, quality of life and cost-effectiveness of arthroscopic and open repair for rotator cuff tears

The Bone & Joint Journal ◽

10.1302/0301-620x.98b12.bjj-2016-0121.r1 ◽

2016 ◽

Vol 98-B (12) ◽

pp. 1648-1655 ◽

Cited By ~ 13

Author(s):

J. Murphy ◽

A. Gray ◽

C. Cooper ◽

D. Cooper ◽

C. Ramsay ◽

...

Keyword(s):

Quality Of Life ◽

Cost Effectiveness ◽

Rotator Cuff ◽

Open Repair ◽

Rotator Cuff Tears

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How Comprehensive and Efficient Are Patient-Reported Outcomes for Rotator Cuff Tears?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117693223 ◽

2017 ◽

Vol 5 (3) ◽

pp. 232596711769322 ◽

Cited By ~ 11

Author(s):

Eric C. Makhni ◽

Jason T. Hamamoto ◽

John D. Higgins ◽

Taylor Patterson ◽

Justin W. Griffin ◽

...

Keyword(s):

Quality Of Life ◽

Life Satisfaction ◽

Rotator Cuff ◽

Patient Reported Outcomes ◽

Short Form ◽

Rotator Cuff Tears ◽

Sf 36 ◽

Patient Reported ◽

Functional Components

Background: Increasing emphasis is placed on patient-reported outcomes (PROs) after common orthopaedic procedures as a measure of quality. When considering PRO utilization in patients with rotator cuff tears, several different PROs exist with varying levels of accuracy and utilization. Hypothesis/Purpose: Understanding which disease-specific PRO may be most efficiently administered in patients after rotator cuff repair may assist in promoting increased patient and physician adoption of these useful scores. Using a novel assessment criterion, this study assessed all commonly used rotator cuff PROs. We hypothesize that surveys with fewer numbers of questions may remain comparable (with regard to comprehensiveness) to longer surveys. Study Design: Systematic review. Methods: Commonly utilized rotator cuff PROs were analyzed with regard to number of survey components, comprehensiveness, and efficiency. Comprehensiveness (maximum score, 11) was scored as the total number of pain (at rest/baseline, night/sleep, activities of daily living [ADLs], sport, and work) and functional (strength, motion/stiffness, and ability to perform ADLs, sport, and work) metrics included, along with inclusion of quality of life/satisfaction metrics. Efficiency was calculated as comprehensiveness divided by the number of survey components. Results: Sixteen different PROs were studied. Number of components ranged from 5 (University of California at Los Angeles score [UCLA]) to 36 (Short Form–36 [SF-36], Japanese Orthopaedic Association score [JOA]). The Quality of Life Outcome Measure for Rotator Cuff Disease (RC-QoL) included all 5 pain components, while 7 PROs contained all 5 functional components. Ten PROs included a quality of life/satisfaction component. The most comprehensive scores were the RC-QoL (score, 11) and Penn (score, 10), and the least comprehensive score was the Marx (score, 3). The most efficient PROs were the UCLA, the Quick Disabilities of the Arm, Shoulder, and Hand score (QuickDASH), and Constant scores. The least efficient scores were the JOA and SF-36 scores. Conclusion: Many commonly utilized PROs for rotator cuff tears are lacking in comprehensiveness and efficiency. Continued critical assessment of PRO quality may help practitioners identify the most comprehensive and efficient PRO to incorporate into daily clinical practice.

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