Reinforcement Techniques in Arthroscopic Repair of Large-to-Massive Rotator Cuff Tears: A Comparative Study of Superior Capsule Reconstruction and Patch Graft Augmentation.

Background: Large-to-massive rotator cuff tears (LMRCTs) present challenges in achieving successful repair due to factors such as muscle atrophy and tendon retraction. Arthroscopic rotator cuff repair (ARCR) with reinforcement techniques like superior capsule reconstruction (SCR) or patch graft augmentation (PGA) has emerged as a less invasive option to improve shoulder joint stability and prevent retear. This study aimed to compare the clinical and radiological outcomes of SCR and PGA as reinforcement techniques for the arthroscopic repair of LMRCTs. Methods: A single-center retrospective study was conducted on patients undergoing LMRCT repair between January 2019 and December 2021. Patients were divided into two groups: those receiving SCR (Group 1) and those receiving PGA (Group 2). Various clinical parameters including range of motion, functional scores, and radiological assessments were evaluated preoperatively and six months postoperatively. Results: Both SCR and PGA techniques demonstrated significant improvements in the range of motion and clinical scores postoperatively. However, Group 2 showed higher postoperative SST and UCLA scores compared to Group 1. Radiologically, there was a slightly higher retear rate in Group 2, although this was not statistically significant. Group 2 also had a shorter mean duration of surgery compared to Group 1. Conclusions: In the arthroscopic repair of LMRCTs, both SCR and PGA techniques exhibit favorable clinical and radiological outcomes. Despite the simplicity of PGA compared to SCR, it offers comparable results with a shorter surgical duration, making it a feasible reinforcement option for surgeons.

Significant Changes in Serum MicroRNAs after High Tibial Osteotomy in Medial Compartmental Knee Osteoarthritis: Potential Prognostic Biomarkers.

High tibial osteotomy (HTO) is an effective alternative for medial compartmental knee osteoarthritis (OA). Circulating microRNAs (miRNAs) are known to serve as OA-related biomarkers. The present study investigated the differential expression of serum miRNAs before and after HTO to identify potential miRNAs as prognostic biomarkers. miRNA-polymerase chain reaction (PCR) arrays were used to screen for miRNAs in the serum at preoperative and 6-month postoperative time points from six patients, and the differentially expressed miRNAs identified in the profiling stage were validated using real-time PCR at post-operative months 6 and 18 in 27 other HTO-treated patients. Among 84 miRNAs involved in the inflammatory process, three (miR-19b-3p, miR-29c-3p, and miR-424-5p) showed differential expression patterns in the profiling stage (p = 0.011, 0.015, and 0.021, respectively). Levels of these three and four other miRNAs (miR-140-3p, miR-454-3p, miR-let-7e-5p, and miR-885-5p) known to be related to OA progression were evaluated in the serum of 27 patients. Only four miRNAs (miR-19b-3p, miR-140-3p, miR-454-3p, and miR-let-7e-5p) were significantly upregulated at postoperative month 6 (p = 0.003, 0.005, 0.004, and 0.004, respectively), and only miR-140-3p was significantly upregulated up to 18 months after operation (p = 0.003). Together, this study reveals the significantly upregulated serum miRNAs after HTO as potential prognostic biomarkers; however, further studies are warranted to elucidate their clinical implications.

Risk factors for sleep disturbance in patients with cervical myelopathy and its clinical significance: a cross-sectional study.

BACKGROUND CONTEXT: Sleep disturbance is highly prevalent in patients with spinal cord injury and is one of the most important clinical issues affecting their quality of life. However, it has not been properly measured or treated in patients with cervical myelopathy (CM), although most typical or atypical symptoms of CM are known to be risk factors for sleep disturbance. In addition, previous studies identified that the presence of sleep disturbance is unintentionally missed under the current evaluation process for degenerative spinal disease without direct investigation using validated tools for sleep. Therefore, studies about sleep disturbances in patients with CM are essential. PURPOSE: The purpose of this study was to investigate the prevalence of sleep disturbance in patients with CM using validated tools and to understand its mechanism by identifying high-risk patients. STUDY DESIGN/SETTING: Cross-sectional study. PATIENT SAMPLE: Consecutive patients diagnosed with CM. OUTCOME MEASURES: Pittsburgh sleep quality index. METHODS: This study was performed on patients diagnosed with CM. Sleep disturbance was determined using the Pittsburgh sleep quality index. Variables associated with sleep disturbance including demographics, lifestyle, medical history, and radiologic parameters were investigated. Independent risk factors related to sleep disturbance were identified using multivariate logistic regression analysis. RESULTS: A total of 203 patients with CM were included in our study. Among them, 126 patients (62.1%) were men, and the mean age was 63.0 years. Despite male predominance, sleep disturbance was identified in 71.4% of patients (145 of 203). Multivariate analysis identified a worse depression scale score, a lower modified Japanese Orthopedic Association score, chronic shoulder joint pain, smaller spinal cord area, and decreased cervical range of motion as independent risk factors for sleep disturbance. CONCLUSIONS: In patients with CM, sleep disturbance was associated with a more severe type of myelopathy. Further studies including polysomnography and measurement of melatonin will be helpful to identify the mechanisms of the sleep disturbance in patients with CM and to improve their quality of life and clinical outcomes.

Analysis of Cervical Spine Alignment and its Relationship with Other Spinopelvic Parameters After Laminoplasty in Patients with Degenerative Cervical Myelopathy.

For patients with kyphosis of the cervical spine, laminoplasty is usually incapable of improving neurological symptoms as it worsens kyphotic alignment. Thus, laminoplasty is not recommended in the presence of kyphotic alignment. Nevertheless, laminoplasty may be selected for myelopathy due to multiple-segment intervertebral disc herniation or ossification of posterior longitudinal ligament despite kyphotic alignment. This study examined whether cervical alignment influences surgical outcomes. Cervical alignment before the surgery was classified into lordosis and non-lordosis, and the non-lordosis group was subclassified into reducible and non-reducible groups to determine the change in cervical alignment before and after the surgery and to analyze its relationship with spinopelvic parameters. The lordosis group showed an increase in upper cervical motion (C0-2 Range of Motion (ROM), C0-2ROM/C0-7ROM) after surgery, while the non-lordosis group exhibited a decrease in C2-7ROM and C0-7ROM. The C0-2ROM was maintained without any reduction in the reducible group, while there was no significant change in cervical alignment and ROM of the non-reducible group. None of these changes showed significant association with the spinopelvic parameters of other sites. However, having a non-reducible type non-lordosis is not a proper indication for laminoplasty, as it does not change the alignment after surgery. Therefore, cervical alignment and reducibility should be identified before surgery.