The influence of sex is a neglected focus in rotator cuff repair: A systematic review and meta-analysis.

PURPOSE: Rotator cuff (RC) disorders are the most common cause of shoulder disability. The aim of this study was to quantify the evidence on the sex-related differences in RC repair. METHODS: A systematic review of the literature was performed in January 2023 in PubMed, Wiley Cochrane Library and Web of Science on research articles on humans with RC tears treated surgically. A meta-analysis was performed to compare results in men and women. The Downs and Black score and the modified Coleman methodology score (MCMS) were used to assess the retrieved studies. RESULTS: A total of 39,909 patients were enroled in the 401 studies analysed (45% women, 55% men). A trend toward more sex-balanced recruitment was observed over time. Only 4% of the studies on 1.5% of the documented patients presented disaggregated outcome data and were quantitatively analysed. A tendency for lower range of motion values after surgery was found for external shoulder rotation in women, with 39.9° ± 6.9° versus 45.3° ± 4.1° in men (p = 0.066). According to Downs and Black scores, four studies were good and 12 fair, with a main MCMS score of 69/100. CONCLUSION: There is a lack of awareness on the importance to document women- and men-specific data. Only 4% of the articles disaggregated data, and it was possible to analyse only 1.5% of the literature population, a sample which cannot be considered representative of all patients. The lack of disaggregated data is alarming and calls for action to better study men and women differences to optimise the management of RC tears. This will be necessary to provide sex-specific information that could be of clinical relevance when managing RC repair. LEVEL OF EVIDENCE: Level IV.

Patients with rotator cuff tears present a psychological impairment, not only a functional deficit: a systematic review.

INTRODUCTION: Psychological factors impact patients with rotator cuff tears (RCT) in terms of pain level, shoulder function, sleep disturbance, and quality of life (QoL). The aim of this study was to quantify the prevalence of psychological factors in those patients, evaluate their influence on patient-reported outcomes (PROMs), and assess the possible improvement with surgical treatment. METHODS: The literature search was performed on PubMed, Web of Science, Wiley Cochrane Library up to January, 2023. INCLUSION CRITERIA: RCT treated with arthroscopic rotator cuff reconstruction (ARCR), description of psychological variables evaluated with validated questionnaires, descriptions of PROMs. RESULTS: Thirty-nine studies included 7021 patients. Depression was found in eight studies (19.2%), anxiety in 6 (13.0%), sleep disturbance in seven (71.3%), and distress in three studies (26.4%). Studies evaluating the relationship between psychological impairment and pain documented more pain and impaired shoulder function before and after ARCR in patients with altered psychological status. DISCUSSION: An impaired psychological status has an important impact on patients' perception of their disease. RCT patients with psychological alterations often experience more pain and reduced shoulder function, thus having worse QoL. CONCLUSION: This study underlines that psychological impairment largely affects RCT patient condition and treatment outcome, which underlines the importance of a multidisciplinary biopsychosocial intervention to achieve better results.

Quality of Life from Return to Work and Sport Activities to Sexual Dysfunction after Surgical Treatment of Pelvic Ring Fractures.

BACKGROUND: Pelvic ring fractures are life-threatening injuries that have a severe impact on patients' lives. The aim of this clinical study was to evaluate the outcome of surgical treatment in terms of Quality of Life (QoL), return to work, functional results and sport activities, and post-operative sexual dysfunction. METHODS: A retrospective study with patients retrieved from a Level 1 Trauma Center was performed. Minimum patient follow-up was 12 months: QoL was evaluated with the SF-12 (Short Form Survey) questionnaire, return to work with the Workplace Activity Limitation Survey (WALS), functional outcomes and sport activities with the Harris Hip Score and Tegner activity score, respectively, and sexual function damage with a 0-10 NRS. RESULTS: Seventy-six patients (41 males and 35 females) were enrolled, with a mean age at surgery of 56.4 years (18-89 years). Overall, their quality of life remained significantly affected, with male patients reporting worse WALS outcomes (p = 0.036), sexual damage (p = 0.001), and SF-12 Bodily Pain (p = 0.046) than females. In particular, 70.7% of men and 45.7% of women reported sexual limitations, and only 53.7% returned to their job, with 35.2% losing their job as a consequence of the pelvic ring disruption. CONCLUSIONS: An important deterioration in general health state, return to work, and sexual function was documented in patients treated surgically for pelvic trauma, especially in male patients. There are disabling secondary sequels at all levels beyond the mere functional scores, and both patients and clinicians should be aware and have the correct expectations.

Arthroscopic rotator cuff repair: patients with physically demanding work have significantly worse time to return to work, level of employment, and job loss.

PURPOSE: The purpose of this study was to determine the results of arthroscopic rotator cuff repair (ARCR) in terms of return to work (RTW). METHODS: Inclusion criteria were working patients who underwent ARCR for rotator cuff rupture at the study site between 2008 and 2020 and minimum 12 months of follow-up. Patients were stratified based on the physical demand of their work according to the Canadian Classification and Dictionary of Occupations. The primary outcomes were time to RTW, level of employment (LoE), change of tasks, and work loss. Secondary outcomes included the return to sports activities, EQ-VAS, EQ-5D-5L, DASH, and Oxford Shoulder Score. RESULTS: Three-hundred and eighty-three patients were enrolled; at the follow-up evaluation, fifty-three patients (13.8%) lost their job, with a percentage of 34.4% (eleven patients) in the heavy-work category, and five patients (1.3%) chose early retirement. Other twenty-six patients (6.8%) had to lower their level of employment, and twenty patients (5.2%) changing their tasks, with 279 patients (72.9%) returning to their previous work activity. RTW was obtained at a mean time of 4.7 ± 4.6 months, ranging from 3.8 ± 3.1 months in the sedentary work vs 5.8 ± 2.8 months in the very heavy-work category (p = 0.015). The mean EQ-VAS score was 77.3 ± 18 points, the mean Oxford Shoulder Score was 43.4 ± 7.2 points, and the mean DASH score was 9.9 ± 14.5 points; 75.3% returned to their previous level of sport activity. CONCLUSIONS: The success of ARCR in terms of RTW is not always complete and varies significantly based on the physical demand of the patient's job. Patients with physically demanding work have a significantly higher time to RTW, reduction of the LoE, and job loss rate, thus affecting the possibility to have a satisfactory return to their previous life. The findings are of clinical relevance since they can help the surgeons to give their patients reliable expectations and to correctly plan the post-operative management. LEVEL OF EVIDENCE: IV.

Quality of life from return to work and sports activities to sexual dysfunction after surgical treatment of acetabular fractures.

INTRODUCTION: To evaluate the outcomes of patients treated for acetabular fractures in terms of Quality of Life (QoL), return to work, functional outcome, sports activities, and post-operative sexual dysfunction. MATERIALS AND METHODS: The database of a level 1 trauma center was used to investigate the results of patients treated for acetabular fractures from 2010 to 2020. The minimum patient follow-up was 12 months. QoL was evaluated with the SF-12 questionnaire, return to work with the Workplace Activity Limitation Survey (WALS), functional outcomes and sports activities with Harris Hip Score (HHS) and Tegner activity scores, respectively, and the sexual function damage with a 0-10 NRS. RESULTS: Sixty-five patients (44 men, 21 women) were enrolled, mean age at surgery of 53.4 years (20-85 years). The HHS and Tegner scores were 79.0 ± 19.4 and 2.6 ± 1.5, respectively, and 18.5% of patients underwent THA after 21.3 ± 28.6 months. QoL evaluated with the SF-12 showed the worst results in terms of Bodily Pain and Role Physical; 35.4% of the patients who were working before the trauma lost their job, and one third was affected at sex functional level. Sex was found to influence significantly both Harris Hip Score (p < 0.05) and Tegner activity score (p < 0.05), with men reporting better scores. On the other hand, men presented a higher impact in terms of job loss and sexual dysfunction. CONCLUSION: Acetabular fractures affect patients' life as a whole, beyond the mere functional outcomes, often leading to a high rate of job loss and a significant probability of sexual functional worsening, especially for men. A significant number of patients also underwent THA at an early follow-up. Further efforts should aim at optimizing the surgical management, to improve functionality and the entire QoL sphere of patients affected by acetabular fractures.

3D printing in shoulder surgery.

Three-dimensional (3D) printing is a novel modality with the potential to make a huge impact in the surgical field. The aim of this paper is to provide an overview on the current use of 3D printing in shoulder surgery. We have reviewed the use of this new method in 3 fields of shoulder surgery: shoulder arthroplasty, recurrent shoulder instability and orthopedic shoulder traumatology. In shoulder arthroplasty, several authors have shown that the use of the 3D printer improves the positioning of the glenoid component, even if longer clinical follow-up is needed to determine whether the cost of this system rationalizes the potential improved functional outcomes and decreases glenoid revision rates. In the treatment of anterior shoulder instability, the literature agrees on the fact that the use of the 3D printing can: enhance the dept and size of bony lesions, allowing a patient tailored surgical planning and potentially reducing operative times; allow the production of personalized implants to restore substantial bone loss; restore glenohumeral morphology and instability. In orthopedic trauma, the use of 3D printing can be helpful to increase the understanding of fracture patterns, facilitating a more personalized planning, and can be used for resident training and education. We can conclude the current literature regarding the use of 3D printed models in orthopedic surgery agrees finding objective improvements to preoperative planning and to the surgical procedure itself, by shortening the intraoperative time and by the possibility to develop custom-made, patient-specific surgical instruments, and it suggests that there are tangible benefits for its implementation.

The role of adipose derived stem cells in the treatment of rotator cuff tears: from basic science to clinical application.

Over the last decade, regenerative medicine has become increasingly popular throughout the scientific community. The poor healing capacity at the tendon-bone interface makes the rotator cuff an appealing target for biologic agents. Adipose derived stem cells are mesenchymal cells with the capacity for self-renewal and multipotential differentiation. They have been recently proposed, both in isolation and as adjuvants to existing surgical therapies, for the treatment of rotator cuff tears. Several studies have been carried out in this research field, starting from the biological characteristics of adipose derived stem cells, their preparation and culture, up to the application in the experimental field on animal models and on humans. The purpose of this study was to provide a state of the art about the current basic science and clinical literature for the effectiveness of adipose derived stem cells in the treatment of rotator cuff tears.