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2.
Medicine (Baltimore) ; 99(18): e20027, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358381

RESUMO

BACKGROUND: The optimal treatment for symptomatic, nontraumatic rotator cuff tear is unknown. The primary aim of this randomized controlled trial is to compare functional improvement after surgical and conservative treatment of nontraumatic rotator cuff tears. METHODS: This is a single-centre, randomized clinical trial with a follow-up of 12 months. Patients older than 18 years with magnetic resonance imaging - confirmed nontraumatic rotator cuff tears that are suitable for either surgery or nonsurgery treatment is enrolled. The primary outcome is Constant score. Secondary outcome measures include visual analog scale (VAS) score, patient satisfaction, and American Shoulder and Elbow Surgeons (ASES) score. All scores are assessed by an independent observer who is blinded to the allocation of groups. RESULTS: The study will provide much needed data on surgical vs nonsurgical treatment for nontraumatic rotator cuff tears. Results of this study may help patients, clinicians, and policy makers assess the pivotal question on comparative effectiveness of surgery vs nonsurgical for rotator cuff tears. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5442).


Assuntos
Lesões do Manguito Rotador/terapia , Corticosteroides/uso terapêutico , Analgésicos/uso terapêutico , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Satisfação do Paciente , Modalidades de Fisioterapia , Amplitude de Movimento Articular , Projetos de Pesquisa , Lesões do Manguito Rotador/cirurgia , Método Simples-Cego
3.
Zhongguo Gu Shang ; 33(4): 312-6, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32351083

RESUMO

OBJECTIVE: To explore the feasibility of arthroscopic humeral ending insertion of rotator cuff, and to provide a scheme for the treatment of giant rotator cuff tears. METHODS: From February 2014 to April 2018, 40 patients with giant rotator cuff tears were operated on and divided into two groups. The study group consisted of 20 patients, including 8 males and 12 females, aged 42 to 82(57.55±8.90) years, with a course of 1 h to 2 years;the treatment of giant rotator cuff tears was carried out by using the technique of rotator cuff moving inward at the humeral head stop and reconstructing complete rotator cuff. The control group consisted of 20 patients, including 10 males and 10 females, aged 45 to 75 (57.75±9.10) years, with a course of 1 h to 5 years;after traditional cleaning, part of the rotator cuff was sutured or in situ high tension suture was used to treat the huge rotator cuff tear. The clinical effect of the two groups was evaluated by VAS, constant and UCLA. RESULTS: All patients were followed up for 12 to 14 months. The VAS, Constant score, UCLA score before operation of two groups were significantly improved compared with those before operation (P<0.05);the VAS, Constant score, UCLA score and excellent effect of the study group were significantly better than those of the control group (P<0.05). CONCLUSION: Arthroscopic transposition of rotator cuff and humerus ending insertion is a feasible method for the treatment of giant rotator cuff tears, which relieves shoulder pain and improves function satisfactorily.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento
4.
Zhongguo Gu Shang ; 33(4): 348-52, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32351089

RESUMO

OBJECTIVE: To evaluate the clinical effect of arthroscopic 360° capsular release with concomitant rotator cuff repair for patients with rotator cuff tears in global stiff shoulder. METHODS: From December 2016 to December 2018, 247 patients full-thickness rotator cuff tear were treated with arthroscopic rotator cuff repair. Among them, 42 patients (17%) with global limitation of shoulder movement were treated with arthroscopic 360° capsular release operation at the same time of rotator cuff repair. The function of shoulder was evaluated by Constant-Murley score and visual analogue scales (VAS), flexion, abduction and external rotation on body side before and after operation. Sugaya classification was used to evaluatethe healing of rotator cuff. The number of shoulder dislocations during follow-up was recorded. RESULTS: Thirty nine of the 42 patients were followed up for 12 to 36 (22±6) months. The patients were 43 to 73 (57±7) years old at the time of operation. The Constant- Murley score increased from (43.6±6.3) before operation to (87.5±2.8) at final follow-up (P<0.001). VAS score decreased from (7.2±1.5) before operation to (1.0±0.9) at final follow-up (P<0.001). The flexion of shoulder increased from (46±14)° before operation to (148±11)° after operation (P<0.001), the abduction from (36±6)° before operation to (121±10)° after operation (P<0.001), and the external rotation on body side from (5±10)° before operation to (42±8)° after operation(P<0.001). One year after the operation, MRI showed thatⅠ-Ⅲ of Sugaya classification was clinical healing, 38 cases in total. CONCLUSION: Arthroscopic 360° capsular release with concomitant rotator cuff repair was used to treat rotator cuff tear in global stiff shoulder. Themain observation indexes were improved after operation, and the clinical effect was definite.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Adulto , Idoso , Artroscopia , Humanos , Liberação da Cápsula Articular , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Manguito Rotador , Lesões do Manguito Rotador/cirurgia , Ombro/cirurgia , Resultado do Tratamento
5.
PLoS One ; 15(4): e0230235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240199

RESUMO

BACKGROUND: Rotator cuff tears are a common cause of shoulder pain and can result in prolonged periods of pain, disability and absence from work. Rotator cuff repair surgery is increasingly used in an attempt to resolve symptoms but has failure rates of around 40%. There is a pressing need to improve the outcome of rotator cuff repairs. Patch augmentation increasingly being used within the NHS in an attempt to reduce repair failures. The aim of this survey was to determine current UK practice and opinion relating to the factors that influence choice of patch, current patient selection and willingness to assist with generation of improved evidence. METHODS: An online survey was sent to the surgeon members of the British Elbow and Shoulder Society (BESS). Questions covered respondent demographics, experience with patches, indications for patch augmentation and willingness to be involved in a randomised trial of patch augmented rotator cuff surgery. RESULTS: The response rate was 105/550 (19%). 58% of respondents had used a patch to augment rotator cuff surgery. 70% of patch users had undertaken an augmented repair within the last 6 months. A wide surgical experience in augmentation was reported (ranging 1 to 200 implants used). However, most surgeons reported low volume usage, with a median of 5 rotator cuff augmentation procedures performed. At least 10 different products had been used. Most of the patches used were constructed from human decellularised dermis tissue, although porcine derived and synthetic based patches had also been used. Only 3-5% stated they would undertake an augmented repair for small tears across ages, whereas 28-40% and 19-59% would do so for large or massive tears respectively. When assessing patient suitability, patient age seemed relevant only for those with large and massive tears. Half of the surgeons reported an interest in taking part in a randomised controlled trial (RCT) evaluating the role of patch augmentation for rotator cuff surgery, with a further 22% of respondent's undecided. CONCLUSIONS: A variety of patches have been used by surgeons to augment rotator cuff repair with a wide range of operator experience. There was substantial uncertainty about which patch to use and differing views on which patients were most suitable. There is a clear need for robust clinical evaluation and further research in this area.


Assuntos
Artroplastia/métodos , Artroscopia/métodos , Tomada de Decisão Clínica/métodos , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Idoso , Idoso de 80 Anos ou mais , Animais , Cotovelo/lesões , Cotovelo/inervação , Cotovelo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes , Manguito Rotador/inervação , Manguito Rotador/patologia , Lesões do Manguito Rotador/patologia , Ombro/inervação , Ombro/patologia , Ombro/cirurgia , Dor de Ombro/prevenção & controle , Dor de Ombro/cirurgia , Inquéritos e Questionários , Suínos , Resultado do Tratamento , Incerteza , Reino Unido
6.
Bone Joint J ; 102-B(3): 360-364, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114808

RESUMO

AIMS: The aim of this study was to examine the recent trend in delivery of arthroscopic subacromial decompression (ASD) in Scotland and to determine if this varies by geographical location. METHODS: Scottish Morbidity Records were reviewed retrospectively between March 2014 and April 2018 to identify records for every admission to each NHS hospital. The Office of Population Censuses and Surveys (OPCS-4) surgical codes were used to identify patients undergoing primary ASD. Patients who underwent acromioclavicular joint excision (ACJE) and rotator cuff repair (RCR) were identified and grouped separately. Procedure rates were age and sex standardized against the European standard population. RESULTS: During the study period the number of ASDs fell by 649 cases (29%) from 2,217 in the first year to 1,568 in the final year. The standardized annual procedure rate fell from 41.6 (95% confidence interval (CI) 39.9 to 43.4) to 28.9 (95% CI 27.4 to 30.3) per 100,000. The greatest reduction occurred between 2017 and 2018. The number of ACJEs rose from 41 to 188 (a 3.59-fold increase). The number of RCRs fell from 655 to 560 (-15%). In the year 2017 to 2018 there were four (28.6%) Scottish NHS board areas where the ASD rate was greater than 3 standard deviations (SDs) from the national average, and two (14.3%) NHS boards where the rate was less than 3 SDs from the national average. CONCLUSION: There has been a clear decline in the rate of ASD in Scotland since 2014. Over the same period there has been an increase in the rate of ACJE. The greatest decline occurred between 2017 and 2018, corresponding to the publication of epidemiological studies demonstrating a rise in ASD, and awareness of studies which questioned the benefit of ASD. This paper demonstrates the potential impact of information from epidemiological studies, referral guidelines, and well-designed large multicentre randomized controlled trials on clinical practice. Cite this article: Bone Joint J 2020;102-B(3):360-364.


Assuntos
Articulação Acromioclavicular/cirurgia , Artroscopia/tendências , Descompressão Cirúrgica/tendências , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Descompressão Cirúrgica/métodos , Humanos , Incidência , Estudos Retrospectivos , Lesões do Manguito Rotador/epidemiologia , Escócia/epidemiologia
7.
Arthroscopy ; 36(3): 714-715, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32139050

RESUMO

The viscoelastic properties of suture may impact how soft tissue (such as the shoulder rotator cuff tendons) heals to bone and therefore may impact patient outcomes. Thus, it is logical to use suture material less likely to creep and elongate. Suture tape, in particular, may show superior biomechanical properties compared with standard sutures. However, in cadaveric studies, failure generally occurs at the tissue interface, rather than the suture material (or anchor). Thus, the quality and thickness of local tissue must be taken into consideration when determining postoperative rehabilitation or return to activity. Clinical outcome studies comparing suture materials remain elusive, but there is little reason not to use stronger suture material, and this is an option within the surgeon's control.


Assuntos
Lesões do Manguito Rotador/cirurgia , Ombro/cirurgia , Fenômenos Biomecânicos , Humanos , Manguito Rotador/cirurgia , Técnicas de Sutura , Suturas
8.
Instr Course Lect ; 69: 551-574, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017751

RESUMO

Rotator cuff repair can be challenging because of the compromised state of the tendon tissue. These challenges range from simply degenerative tendons to complete tendon loss in patients which can impair soft-tissue healing. Various grafts and patches are currently available to help address these challenges. The ideal solution for the treatment of irreparable rotator cuff tears or those prone to retear remains controversial. Sometimes augmentation with a patch is appropriate. However, at times a completely retracted and immobile tendon remnant is found. Reconstruction of the superior capsule has demonstrated promising results in several short-term series. The indications for these procedures, the optimal surgical technique, and their limitations are evolving. This chapter discusses the current literature related to bioinductive scaffolds, graft augmentation, graft interposition, and superior capsular reconstruction.


Assuntos
Lesões do Manguito Rotador/cirurgia , Manguito Rotador , Artroplastia , Humanos , Tendões , Cicatrização
9.
Medicine (Baltimore) ; 99(4): e18846, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977882

RESUMO

BACKGROUND: Based on the available evidence, it is difficult to make a clinical decision about the best exercise program and to establish the most favorable time to start postoperative treatment after rotator cuff (RC) repair. The aim of this trial is to evaluate the effects of adding a supervised early exercise program to standard treatment for functional improvement and pain relief compared with standard treatment alone in patients with arthroscopic RC repair. METHOD/DESIGN: A total of 118 patients between the ages of 18 and 50 years with arthroscopic RC repair will be randomized to 2 treatment arms. The control group will receive a standard exercise program based on a consensus statement on shoulder rehabilitation developed by the American Society of Shoulder and Elbow Therapists. The intervention group will receive a supervised early exercise program in combination with standard treatment. This supervised exercise program will be based on electromyographic evidence. Three evaluations will be performed: before surgery, at 6 weeks, and at 12 weeks. The primary outcome measure will be the shoulder function by the Constant-Murley questionnaire, and the secondary outcome measures will be the upper limb function by the disabilities of the arm, shoulder, and hand questionnaire; pain by the visual analog scale; and the shoulder range of motion by a goniometer. DISCUSSION: We hypothesize that patients who receive a supervised early exercise program in combination with standard treatment will benefit more in respect to shoulder function, pain reduction, and range of motion than those who receive a standard exercise program. If this is confirmed, our study can be used clinically to enhance the recovery of patients with arthroscopic RC repair. TRIAL REGISTRATION: Brazilian registry of clinical trials UTN number U1111-1224-4143. Registered December 18, 2018.


Assuntos
Artroscopia/reabilitação , Terapia por Exercício/métodos , Lesões do Manguito Rotador/reabilitação , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Lesões do Manguito Rotador/cirurgia , Método Simples-Cego , Resultado do Tratamento
10.
Arch Orthop Trauma Surg ; 140(1): 67-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31616993

RESUMO

PURPOSE: The purpose of this study was to evaluate whether trans-tendon suture bridge repair with tenotomized pathologic biceps tendon augmentation improves mid-term clinical outcomes for high-grade partial articular-sided supraspinatus tendon avulsion (PASTA) lesions or not. METHODS: A retrospective review of a consecutive series of arthroscopic trans-tendon suture bridge repair with tenotomized pathologic biceps tendon augmentation was conducted. Total 115 patients (44 men and 71 women) with minimum 2 years follow-up were enrolled in our study. Their mean age was 59.7 ± 7.6 (38-77) years and mean follow-up were 6.9 ± 2.5 (2 ~ 10) years. Clinical assessment and radiological outcomes using post-operative MRI were evaluated at last follow-up. RESULTS: All these tears were high-grade PASTA lesions in which mean cuff tear size (exposed footprint) was anteroposterior length 15.7 ± 6.3 mm (5-25 mm) and mediolateral width 10.1 ± 3.6 mm 6.4 mm (5-16 mm). At last follow-up, mean pain VAS, ASES, UCLA, and SST scores were improved from pre-operative values of 5, 59, 21, and 7 to post-operative values of 1, 84.4, 29.5, and 9.4, respectively (p value < 0.001). ROM such as forward flexion, abduction, and internal rotation to the back were improved from a pre-operative mean of 148° (±24), 144° (±24), L2 (Buttock-T7) to a post-operative mean of 161° (±10), 160.0° (±12), and T12 (L3-T5), respectively (p value < 0.001). Follow-up MRI showed Sugaya classification type I in 24 patients (20.9%), type II in 78 patients (67.8%), type III in 11 patients (9.6%) and type 4 in 2 patients (1.7%) were found. As complications, shoulder stiffness was found in five patients, Popeye deformity in two patients and retear in two patients. Revision surgery of the retear was performed in 2 patients. At the last follow-up, 17% (20/115 patients) reported occasional discomfort at the extremes of range of motion during a heavy work or sports activities. CONCLUSIONS: In high-grade PASTA lesions, arthroscopic trans-tendon suture bridge repair with tenotomized pathologic biceps tendon augmentation could be a useful treatment modality capable of preserving rotator cuff footprint, providing simultaneous biceps tenodesis, inducing better tendon healing and possibly preventing tendon buckling and residual pain of the conventional trans-tendon repair methods. These specific methods showed satisfactory outcomes and decreased residual shoulder discomfort (17%) at mid-term follow-up. LEVEL OF EVIDENCE: Level IV, Retrospective case study.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões do Manguito Rotador/cirurgia , Técnicas de Sutura , Tendões/cirurgia , Tenotomia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Manguito Rotador/cirurgia
11.
Radiol Med ; 125(1): 39-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31541346

RESUMO

OBJECTIVE: To compare the diagnostic accuracy of dual-energy computed tomography arthrography (DE-CTA) and magnetic resonance arthrography (MRA) of the shoulder in depicting glenoid labral tears. METHODS: This prospective institutional review board-approved study included 47 consecutive patients (28 males, 19 females; mean age of 34.2 years) studied between January 2017 and October 2018. All patients underwent DE-CTA and MRA the same day. Two radiologists (25 and 11 years of experience, respectively), blinded to clinical data, evaluated the presence labral tears on virtual-blended 120 kV standard CTA and on DE-CTA images. A third radiologist (18 years of experience) evaluated the MRA images. Diagnostic accuracy values were calculated by using surgery as standard of reference. Inter-observer and intra-observer agreements were calculated with k statistics. A value of p < 0.05 was considered statistically significant. RESULTS: Surgery revealed the presence of labral tears in 38/47 patients (80.9%). Sensitivity and specificity values in diagnosing labral tears were 84.2% and 77.8% for MRA (Reader 3), 84.2% and 77.8% for CTA (Reader 1), 84.2% and 88.9% for CTA (Reader 2), 89.5% and 88.9% for DE-CTA (Reader 1), and 92.1% and 88.9% for DE-CTA (Reader 2). A nonsignificant increase in AUC values with respect to MRA was obtained by reading the CTA (p = 0.470) and DE-CTA dataset (p = 0.217), respectively. Inter-observer agreements were near perfect for CTA (k = 0.84) and substantial for DE-CTA reading (k = 0.76). Intra-observer agreements were near perfect both for CTA (k = 0.88) and for DE-CTA reading (k = 0.82). CONCLUSION: DE-CTA and MRA were not different in terms of diagnostic performance.


Assuntos
Artrografia/métodos , Imagem por Ressonância Magnética/métodos , Lesões do Manguito Rotador/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Área Sob a Curva , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Lesões do Manguito Rotador/cirurgia , Sensibilidade e Especificidade
12.
J Orthop Res ; 38(1): 139-149, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31441099

RESUMO

Secondary joint damage is the process by which a single injury can lead to detrimental changes in adjacent tissue structures, typically through the spread of inflammatory responses. We recently developed an in vitro model of secondary joint damage using a murine rotator cuff explant system, in which injuries to muscle and bone cause massive cell death in otherwise uninjured tendon. The purpose of the present study was to test the ability cytokine-targeted and broad-spectrum therapeutics to prevent cell death and tissue degeneration associated with secondary joint damage. We treated injured bone-tendon-muscle explants with either interleukin-1 receptor antagonist, etanercept, or dexamethasone (DEX) for up to 7 days in culture. Only the low-dose DEX treatment was able to prevent cell death and tissue degeneration. We then identified a critical window between 24 and 72 h following injury for maximal benefit of DEX treatment through timed administration experiments. Finally, we performed two tendon-only explant studies to identify mechanistic effects on tendon health. Interestingly, DEX did not prevent cell death and degeneration in a model of cytokine-induced damage, suggesting other targets of DEX activity. Future studies will aim to identify factors in joint inflammation that may be targeted by DEX treatment, as well as to investigate novel delivery strategies. Statement of clinical significance: Overall, this work demonstrates beneficial effects of DEX administration on preventing tenocyte death and extracellular matrix degeneration in an explant model of secondary joint damage, supporting the clinical use of low-dose glucocorticoids for short-term treatment of joint inflammation. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:139-149, 2020.


Assuntos
Dexametasona/uso terapêutico , Lesões do Manguito Rotador/prevenção & controle , Animais , Morte Celular/efeitos dos fármacos , Citocinas/antagonistas & inibidores , Citocinas/fisiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Lesões do Manguito Rotador/cirurgia , Estresse Mecânico
13.
J Shoulder Elbow Surg ; 29(1): 86-94, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31427227

RESUMO

BACKGROUND: Reverse total shoulder arthroplasty (RSA) is a widely accepted treatment for irreparable massive rotator cuff tear (mRCT) and cuff tear arthropathy (CTA), but its impact on activities of daily living (ADLs) remains unclear. METHODS: We retrospectively analyzed 77 patients (age range, 54-87 years; follow-up range, 36.1-120.3 months) with irreparable mRCT and CTA treated by medialized RSA between 2008 and 2015. Ten activities considered essential for daily living were selected and scored from 0 to 3. RESULTS: The mean visual analog scale scores during motion and University of California at Los Angeles and Constant scores significantly improved at final follow-up (all P < .001). Active forward flexion, external rotation at the side, and internal rotation to the posterior (IRp) were 92.5%, 79.6%, and 48.4% of the contralateral side, respectively, at final follow-up. Active forward flexion and external rotation at the side recovered within 6 months after surgery, similar to the level at final follow-up, but IRp did not reach the preoperative status until final follow-up. ADLs with mean scores of less than 2.0 at final follow-up were "wash the opposite shoulder," "wash the opposite axilla," "use a back pocket," "manage the toilet," and "wash the back" (only 36.4% of patients were able to wash their back at final follow-up). CONCLUSIONS: RSA for irreparable mRCT and CTA showed satisfactory clinical outcomes. However, IRp was associated with a limited range compared with the other shoulder motions; therefore, all ADLs associated with internal rotation demonstrated lower recovery rates than expected.


Assuntos
Atividades Cotidianas , Artroplastia do Ombro , Amplitude de Movimento Articular , Lesões do Manguito Rotador/cirurgia , Artropatia de Ruptura do Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Rotação , Lesões do Manguito Rotador/fisiopatologia , Artropatia de Ruptura do Manguito Rotador/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
14.
J Orthop Res ; 38(1): 82-91, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31441073

RESUMO

To evaluate the effect of local parathyroid hormone (PTH) administration on rotator cuff tendon-to-bone healing in a rat model compared with systemic PTH injection and untreated controls. PTH-alginate scaffold was prepared and sustained release of PTH was confirmed. Bilateral supraspinatus tendon repairs were performed in 39 rats (group 1, supraspinatus repair only; group 2, supraspinatus repair with systemic PTH injection; group 3, supraspinatus repair with local PTH administration via an absorbable scaffold; n = 13 each). Biomechanical (cross-sectional area, mode of failure, load to failure, and ultimate stress: right side) and histological analyses (hematoxylin and eosin stain, Masson's Trichrome stain Picrosirius red stain, Immunohistochemistry for BMP2, PTH1R, ColI, and ColIII: Left side) were performed to evaluate tendon-to-bone healing quality at 8 weeks after repair, and blood test (osteocalcin and procollagen type I N-terminal pro-peptide [PINP] levels) was performed in all rats. There was no intergroup difference in the healing failure rate (p = 0.910) or failure mode (p = 0.585). Biomechanically, subjects in groups 2 and 3 exhibited significantly larger cross-sectional areas and higher ultimate failure loads and ultimate stress than those in group 1 (all p < 0.05); however, no differences were noted between groups 2 and 3 (all p > 0.05). Histologically, groups 2 and 3 exhibited more organized tendon-to-bone interface structures with higher density, parallel orientation, and collagen fiber continuity than group 1 (all p < 0.05 except collagen fiber continuity in group 1 vs. 2); however, no differences in histological parameters between groups 2 and 3 (all p > 0.05). The protein levels of bone morphogenic protein 2, PTH 1 receptor, and collagen I and III and the serum level of PINP were increased in groups 2 and 3 versus group 1 (all p < 0.05) without showing differences between groups 2 and 3 (all p > 0.05). Local PTH administration using an absorbable scaffold improved the biomechanical and histological outcomes of rotator cuff tendon-to-bone healing comparable with systemic PTH injection at 8 weeks after repair in a rat model. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:82-91, 2020.


Assuntos
Osso e Ossos/fisiopatologia , Hormônio Paratireóideo/administração & dosagem , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/fisiopatologia , Tendões/fisiopatologia , Cicatrização/efeitos dos fármacos , Animais , Fenômenos Biomecânicos , Osso e Ossos/patologia , Imuno-Histoquímica , Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue , Ratos , Ratos Sprague-Dawley , Lesões do Manguito Rotador/tratamento farmacológico , Lesões do Manguito Rotador/patologia , Lesões do Manguito Rotador/fisiopatologia , Tendões/patologia
15.
J Orthop Res ; 38(1): 219-227, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31517408

RESUMO

Re-tearing after arthroscopic rotator cuff repair (ARCR) frequently occurs, and high stiffness of the rotator cuff may be one of the factors. We investigated changes in stiffness of the supraspinatus muscle and tendon after ARCR as measured by shear wave elastography (SWE) with B-mode ultrasound, and compared the supraspinatus muscle stiffness of patients with recurrent tears and patients with healed rotator cuffs. Sixty patients with supraspinatus tears requiring ARCR underwent serial SWE of their supraspinatus muscles and repaired tendons. SWE was performed before surgery (Pre-Op) and at 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, and 6 months after surgery. Additionally, the repaired rotator cuffs were evaluated using magnetic resonance imaging at 6 months after surgery to classify patients into a healed rotator cuff group and a recurrent tear group. Differences in SWE values between the groups were assessed at each time point. The SWE value of the repaired tendon at 1 week after ARCR was significantly greater than at 3 and 6 months. The SWE value for the supraspinatus muscle at 1 month after ARCR surgery in the healed group was lower than at Pre-Op and 4, 5, and 6 months after surgery, and it was also lower than that at 1 month after surgery in the re-tear group. There were no significant differences between time points in the SWE values of the supraspinatus muscle in the re-tear group. The SWE value of the muscle in the re-tear group was greater than in the healed group at 1 month after surgery (p < 0.05). Increased SWE values at 1 month after ARCR may predict recurrent rotator cuff tears after surgery rather than evaluating the tendon. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:219-227, 2020.


Assuntos
Artroscopia/métodos , Técnicas de Imagem por Elasticidade/métodos , Músculo Esquelético/fisiopatologia , Lesões do Manguito Rotador/cirurgia , Tendões/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Lesões do Manguito Rotador/fisiopatologia , Fatores de Tempo
16.
J Shoulder Elbow Surg ; 29(1): 146-149, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31401127

RESUMO

BACKGROUND: The American Shoulder and Elbow Surgeons (ASES) shoulder score and the Single Assessment Numeric Evaluation (SANE) measure shoulder function. Relative to the ASES questionnaire, the SANE questionnaire is shorter and easier to score. We sought to determine (1) the correlation between ASES and SANE scores preoperatively and at 2 years postoperatively in patients undergoing rotator cuff repair (RCR) or shoulder arthroplasty and (2) the correlation between the change in ASES scores and change in SANE scores. METHODS: We reviewed the records of 107 patients who underwent RCR (n = 74) or shoulder arthroplasty (n = 33), which included patients undergoing total shoulder arthroplasty (n = 18) and reverse total shoulder arthroplasty (n = 15), at our institution from 2014 to 2015 and who completed the ASES and SANE questionnaires preoperatively and at least 2 years postoperatively. Pearson correlation coefficients were calculated to determine the relationship between SANE and ASES scores in RCR patients and arthroplasty patients (both total shoulder arthroplasty and reverse total shoulder arthroplasty) at each time point. RESULTS: In the RCR group, correlations between SANE and ASES scores were moderately positive preoperatively (r = 0.30) and strongly positive postoperatively (r = 0.86). In the arthroplasty group, correlations between SANE and ASES scores were moderately positive preoperatively (r = 0.46) and strongly positive postoperatively (r = 0.78). CONCLUSION: SANE scores correlate positively with ASES scores postoperatively in patients undergoing RCR. Therefore, SANE scores, together with clinician-based and combination scores, can be used to assess postoperative shoulder function in these patients.


Assuntos
Artroplastia do Ombro , Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Inquéritos e Questionários/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Período Pós-Operatório , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Resultado do Tratamento , Adulto Jovem
17.
J Shoulder Elbow Surg ; 29(1): 157-166, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31401128

RESUMO

BACKGROUND: The purpose of this study was to evaluate the biomechanical and histologic properties of rotator cuff repairs using a vented anchor attached to a bioresorbable interpositional scaffold composed of aligned PLGA (poly(l-lactide-co-glycoside)) microfibers in an animal model compared to standard anchors in an ovine model. METHODS: Fifty-six (n = 56) skeletally mature sheep were randomly assigned to a repair of an acute infraspinatus tendon detachment using a innovative anchor-PLGA scaffold device (Treatment) or a similar anchor without the scaffold (Control). Animals were humanely euthanized at 7 and 12 weeks post repair. Histologic and biomechanical properties of the repairs were evaluated and compared. RESULTS: The Treatment group had a significantly higher fibroblast count at 7 weeks compared to the Control group. The tendon bone repair distance, percentage perpendicular fibers, new bone formation at the tendon-bone interface, and collagen type III deposition was significantly greater for the Treatment group compared with the Control group at 12 weeks (P ≤ .05). A positive correlation was identified in the Treatment group between increased failure loads at 12 weeks and the following parameters: tendon-bone integration, new bone formation, and collagen type III. No statistically significant differences in biomechanical properties were identified between Treatment and Control Groups (P > .05). CONCLUSIONS: Use of a vented anchor attached to a bioresorbable interpositional scaffold composed of aligned PLGA microfibers improves the histologic properties of rotator cuff repairs in a sheep model. Improved histology was correlated with improved final construct strength at the 12-week time point.


Assuntos
Osso e Ossos/fisiologia , Lesões do Manguito Rotador/cirurgia , Tendões/fisiologia , Tecidos Suporte , Cicatrização , Implantes Absorvíveis , Animais , Materiais Biocompatíveis/uso terapêutico , Fenômenos Biomecânicos , Osso e Ossos/cirurgia , Contagem de Células , Colágeno Tipo III/metabolismo , Modelos Animais de Doenças , Feminino , Fibroblastos , Osteogênese , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/uso terapêutico , Estudos Prospectivos , Lesões do Manguito Rotador/patologia , Ovinos , Técnicas de Sutura , Tendões/cirurgia
18.
J Shoulder Elbow Surg ; 29(1): 202-209, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31492619

RESUMO

The purpose of this study was to evaluate outcomes of reverse total shoulder arthroplasty (RTSA) in patients aged ≤65 years. MEDLINE, Embase, and PubMed were searched for relevant studies from database inception to September 18, 2018. All studies that evaluated RTSA in patients aged ≤65 years were included. Two independent reviewers screened all studies and performed a quality assessment. In the total of 6 studies reviewed, 245 participants underwent RTSA, with the most common indications being failed rotator cuff repair and rotator cuff tear arthropathy. Postoperative functional outcomes indicated a significant level of improvement across all reported outcomes at a mean follow-up of 49 months (range, 19-140 months) (P < .05). The pooled mean complication rate was 18% (n = 44/245), and this higher rate may be due to 36% of patients undergoing an RTSA for a failed arthroplasty procedure and the inclusion of older studies that lacked modern implants and techniques. Although there is a significant improvement in functional outcomes at midterm follow-up for RTSA in the patients aged ≤65 years, the pooled complication rates are high. However, the results of this systematic review are limited because of the heterogenous patient population undergoing surgery for various indications, including revision arthroplasty. Long-term studies and registry data are required using current modern techniques and implants to provide an accurate assessment of outcomes following RTSA in a young patient population.


Assuntos
Artroplastia do Ombro , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/métodos , Humanos , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Lesões do Manguito Rotador/cirurgia , Artropatia de Ruptura do Manguito Rotador/cirurgia , Fatores de Tempo , Resultado do Tratamento
19.
J Shoulder Elbow Surg ; 29(1): 12-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31627964

RESUMO

BACKGROUND: The patient-related factors for the perceived need for surgery for degenerative rotator cuff tears are not known. The purpose of this study is to examine patient- and tear-specific factors leading to surgery in newly painful degenerative rotator cuff tears. METHODS: Asymptomatic, degenerative rotator cuff tears were followed prospectively to identify the onset of pain and tear enlargement. Newly painful tears were continually monitored with a focus on identifying patient-specific (age, occupation, activity level) and tear-specific (tear type and size, tear progression, American Shoulder and Elbow Surgeons score, muscle degeneration) factors that are associated with surgical intervention. RESULTS: Forty-eight of 169 newly painful shoulders were eventually managed surgically. Factors associated with surgical treatment included younger age (P = .0004), pain development earlier in surveillance (P = .0002), a greater increase in pain (P = .0001), a decline in American Shoulder and Elbow Surgeons score (P < .0001), and a history of contralateral shoulder surgery (P = .0006). Eighty-five of the 169 tears (50%) enlarged either before or within 2 years of pain development. Neither tear type (P = .13), tear enlargement (P = .67) nor tear size (P = .51) was associated with surgery. Neither the severity of muscle degeneration, occupational status, hand dominance, Shoulder Activity Score, nor changes in RAND-12 mental or physical scales differed between groups. DISCUSSION: For newly painful rotator cuff tears, patient-specific factors such as younger age and prior surgery on the contralateral shoulder are more predictive of future surgery than tear-specific factors or changes in tear size over time.


Assuntos
Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/cirurgia , Dor de Ombro/etiologia , Fatores Etários , Idoso , Doenças Assintomáticas , Tomada de Decisões , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/fisiopatologia , Ruptura/complicações , Ruptura/cirurgia , Articulação do Ombro/fisiopatologia , Ultrassonografia
20.
Arthroscopy ; 36(1): 86-87, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31864604

RESUMO

For rotator cuff tear surgery, application of mesenchymal stem cells (MSCs) is a promising new option. Among various MSC sources, synovial tissue contains a high number of MSCs with high chondrogenic potential. Because chondrogenic formation is an important factor in enthesis healing in rotator cuff repair, synovial MSCs derived from the subacromial bursa are superior candidates for the augmentation of rotator cuff tear surgery.


Assuntos
Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Artroplastia , Bolsa Sinovial , Humanos , Ombro
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