Shoulder rehabilitation exercises with kinematic biofeedback after arthroscopic rotator cuff repair: proposal for treatment (Preprint)

UNSTRUCTURED Background: The recovery of scapular and gleno-humeral physiological kinematic parameters, as well as sensorimotor control of movement, plays a primary role in the rehabilitation after arthroscopic rotator cuff repair. A highly customized rehabilitation approach is required to achieve this aim. Biofeedback can be a useful tool but there is poor evidence of its use in the rehabilitation after arthroscopic rotator cuff tear repair. Objective: This article describes an exercise-based program (ISEO-Program) for the recovery of scapular kinematics of patients arthroscopically treated for rotator cuff tear. Methods: The program integrates a conventional rehabilitation program with the use of the ISEO (INAIL Shoulder and Elbow Outpatient protocol), a motion analysis system based on inertial wearable sensors positioned over the thorax, scapula, humerus and forearm. ISEO can return a visual biofeedback of humerus angles over time or of the scapula-humeral coordination, with the possible overlap of patient-specific or asymptomatic subjects’ reference values. Results and conclusions: A set of 12 progressive exercises were defined, divided in four groups based on humerus and scapula movements, each comprising from two to four drills of increasing complexity. Exercises can require the use of ball, stick, rubber band and towels. For each drill, the neuromotor goal and type of visual biofeedback is specified.

UHMWPE suture induced pseudotumor following arthroscopic rotator cuff repair: A case report

UHMWPE suture shows excellent biocompatibility and complication associated with suture debris had not been described before in shoulder surgery. In this study, a case of a 38-year-old man with a wear debris pseudotumor mimicking osteochondromatosis in the subacromial bursa five years after arthroscopic rotator cuff repair using a composite braid suture (a polydioxanone core with a sleeve of UHMWPE) was presented. Histological examination confirmed the presence of suture fragments surrounded with the osteochondral layer without inflammatory reactions. The present study implies the potential risk of free fragmented remnants from the UHMWPE suture. Because of the silent nature of the histological response, a high index of suspicion should be necessary to disclose the chanciness of its use.

The Evolution of Arthroscopic Rotator Cuff Repair

Over the past 30 years, arthroscopic rotator cuff repair (ARCR) has evolved to become the gold standard in treating rotator cuff pathology. As procedural concepts of ARCR continue to improve, it is also continually compared with the open rotator cuff repair as the historical standard of care. This review highlights the evolution of ARCR, including a historical perspective; the anatomic, clinical, and surgical implications of the development of an arthroscopic approach; how arthroscopy improved some of the problems of the open approach; adaptations in techniques and technologies associated with ARCR; future perspectives in orthobiologics as they pertain to ARCR; and lastly, the clinical improvements, or lack of improvements, with all of these adaptations.