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1.
Medicina (Kaunas) ; 57(5)2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-34067980

RESUMO

Background and Objectives: The purpose of this study was to investigate the effects of microcurrent stimulation on pain, shoulder function, and grip strength in patients with rotator cuff repair. Materials and Methods: This randomized single-blind controlled trial was conducted on inpatients of the rehabilitation department, and included 28 patients who underwent rotator cuff repair. Participants were randomly assigned to the experimental group (n = 14), treated with microcurrent stimulation, and the control group (n = 14), treated with false microcurrent stimulation. The microcurrent stimulation administered to the experimental group underwent general physical therapy and microcurrent stimulation three times a week for 4 weeks. Results: Changes in pain, range of motion in shoulder, simple shoulder test, and grip strength were assessed before and after the intervention. Both groups showed a significant decrease in pain and shoulder function (t = 27.412, 22.079, 19.079, and 18.561; p < 0.001), and grip strength showed a significant increase (t = -8.251 and -9.946; p < 0.001). The experimental group that underwent microcurrent stimulation exhibited a significant effect on pain, shoulder function, and grip strength compared with the control group that underwent false microcurrent stimulation (t = -2.17, -2.22, and 2.213; p = 0.039, 0.035, and 0.036). Conclusions: This study confirmed that microcurrent stimulation is effective for the treatment of rotator cuff repair patients.


Assuntos
Lesões do Manguito Rotador , Ombro , Força da Mão , Humanos , Amplitude de Movimento Articular , Manguito Rotador , Lesões do Manguito Rotador/cirurgia , Ombro/cirurgia , Dor de Ombro/terapia , Método Simples-Cego , Resultado do Tratamento
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(6): 667-672, 2021 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-34142490

RESUMO

Objective: To investigate the effect of asymptomatic hyperuricemia on the effectiveness of arthroscopic rotator cuff repair. Methods: The clinical data of 80 patients who underwent arthroscopic rotator cuff repair and met the selection criteria between March 2018 and December 2019 were retrospectively analyzed. According to the serum uric acid level, the patients were divided into hyperuric acid group (46 cases, the serum uric acid level was more than 417 µmol/L in males and was more than 357 µmol/L in females) and normal group (34 cases, serum uric acid level was lower than the above standard). There was no significant difference in gender, age, side, body mass index, blood glucose level, total cholesterol level, rotator cuff tear size, and preoperative shoulder motion, visual analogue scale (VAS) score, University of California-Los Angeles (UCLA) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and other general data between the two groups ( P>0.05). The range of motion of abduction, forward flexion, and external rotation at 90° abduction were recorded and compared between the two groups before operation and at last follow-up; the improvement of shoulder pain was evaluated by VAS score; the improvement of shoulder function was evaluated by UCLA score, Constant score, and ASES score; and the shoulder joint MRI grade was evaluated according to Sugaya evaluation criteria. Results: All patients were followed up 9-16 months, with an average of 11.9 months; there was no significant difference in the follow-up time between the two groups ( t=0.968, P=0.336). There were 2 cases of retear in the hyperuric acid group (including 1 case of severe tear) and 1 case of light retear in the normal group. The remaining patients in the two groups had no early-related complications. At last follow-up, the range of motion of the shoulder joints (abduction, forward flexion, external rotation at 90° abduction), VAS score, UCLA score, Constant score, and ASES score of the two groups were significantly improved when compared with preoperative ones ( P<0.05); the above indicators in the normal group were significantly better than those in the hyperuric acid group ( P<0.05). The MRI grade of the shoulder joint in the normal group was significantly better than that in the hyperuric acid group ( Z=-2.000, P=0.045). Conclusion: Compared with patients with normal serum uric acid level, asymptomatic hyperuricemia can lead to worse recovery after arthroscopic rotator cuff repair in patients with rotator cuff tears.


Assuntos
Hiperuricemia , Lesões do Manguito Rotador , Articulação do Ombro , Artroscopia , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento , Ácido Úrico
3.
Sports Med Arthrosc Rev ; 29(2): 119-129, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33972488

RESUMO

Rotator cuff tears are the most common cause of shoulder disability and can cause significant pain and dysfunction. This systematic review summarizes the latest research on rehabilitation following arthroscopic rotator cuff repair. Studies were eligible for inclusion if they pertained to postoperative rehabilitation following arthroscopic rotator cuff repair and were published between 2003 and 2019 with a level of evidence of 1 or 2. Two blinded reviewers screened, graded, and extracted data from articles and recommendations on various aspects of rehabilitation were summarized. A total of 4067 articles were retrieved from the database search and 22 studies were included for data extraction. We noted similar outcomes between early and delayed mobilization following surgery. Reviewed articles support the use of supervised physical therapy, bracing in 15 degrees external rotation, and adjunctive transcutaneous electrical nerve stimulation for pain management. Early isometric loading improved outcomes in 1 study. Evidence is lacking for exercise prescription parameters and postoperative rehabilitation of the subscapularis.


Assuntos
Lesões do Manguito Rotador/reabilitação , Lesões do Manguito Rotador/cirurgia , Braquetes , Terapia Combinada , Humanos , Manejo da Dor , Modalidades de Fisioterapia , Cuidados Pós-Operatórios
4.
BMC Musculoskelet Disord ; 22(1): 409, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947360

RESUMO

BACKGROUND: Bilateral rotator cuff tears are not uncommon and the timing of the surgical treatment of both shoulders is debated. In the present study, we aimed to compare the clinical outcomes of patients who underwent single-stage or staged bilateral arthroscopic rotator cuff repair. METHODS: From March 2013 to May 2018, a retrospective review on all patients who underwent bilateral arthroscopic rotator cuff repair at our department was performed. Patients were separated into 2 groups: single-stage and staged. The minimum follow-up period was 2 years. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, Constant-Murley (Constant) score, the range of motion (ROM) of the shoulder and the hospitalization costs were evaluated for comparison between the two groups before and after the operation. Differences between groups were assessed using t-tests and ANOVA. RESULTS: All 51 patients completed follow-up of 2 years, single stage (n = 24) and staged group (n = 27). There was no significant difference in the VAS, ASES, UCLA and Constant scores between the single-stage group and the staged group before the operation. Postoperative clinical scores were significantly improved in both groups (P < 0.05). All outcome scores were significantly different between the two groups at 6 months postoperatively, and the staged scored better than the single-stage (P < 0.05). At 12, 18, and 24 months after the operation, the outcome scores were not significantly different between the two groups. At follow-up, the ROM of the shoulder was not significantly different between the two groups. In the single-stage group, the outcome scores and ROM were similar for both shoulders and comparable to the staged group. We also found significant cost savings in the single-stage group (4440.89 ± 130.55 USD) compared to the staged group (5065.73 ± 254.76 USD) (p < 0.05). CONCLUSIONS: Patients receiving single-stage or staged bilateral arthroscopic rotator cuff repair showed similarly good clinical outcomes at follow-ups longer than 6 months. Moreover, good outcomes were observed on both sides of the single-stage group.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Artroscopia , Seguimentos , Humanos , Amplitude de Movimento Articular , Estudos Retrospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(18): e25797, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950977

RESUMO

ABSTRACT: To compare the postoperative effects of arthroscopy for rotator cuff injury with patients in the lateral-lying position (LLP) and beach chair position (BCP), and to identify factors influencing these effects.Data from patients with rotator cuff injuries who underwent shoulder arthroscopy in the LLP (n = 115, 53.24%) or BCP (n = 101, 46.76%) between January 2013 and 2016 and were followed for >3 years were analyzed. The American Shoulder and Elbow Surgeons shoulder score, University of California at Los Angeles shoulder score (UCLASS), and visual analog scale (VAS) score were used to evaluate patients' shoulder function and pain preoperatively and at the last follow-up examination. The abduction and lateral rotation angles were measured. The influences of patient characteristics were compared between the LLP and BCP subgroups defined by UCLASSs (excellent, good, acceptable, poor).Postoperative injury characteristics, UCLASSs, and VAS scores were better in the LLP group than in the BCP group (all P < .05). Among patients with good UCLASSs, preoperative pain duration was longer in the LLP group than in the BCP group (P < .05); among those with acceptable UCLASSs, this duration was longer in the BCP group than in the LLP group (P < .05). The preoperative flexion angle differed between groups (P < .05). Among patients with excellent and good UCLASSs, the postoperative external rotation angle was greater in the LLP group than in the BCP group (P < .05). The LLP group contained more excellent UCLASSs than did the BCP group (P < .05). It also contained more small, medium, and large tear cases than did the BCP group (all P < .05).The effect of arthroscopy for rotator cuff injury was better when the operation was performed with the patient in the LLP. Either position is suitable for the arthroscopic treatment of partial rotator cuff tears. The LLP is more suitable in cases of small and medium-sized tears and those with large preoperative lateral rotation angles. The BCP should be used for patients with large preoperative flexion angles.


Assuntos
Artralgia/cirurgia , Artroscopia/métodos , Posicionamento do Paciente/métodos , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Amplitude de Movimento Articular , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/diagnóstico , Índice de Gravidade de Doença , Resultado do Tratamento
6.
BMC Health Serv Res ; 21(1): 516, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049554

RESUMO

BACKGROUND: How much does the medical malpractice system affect treatment decisions in orthopaedics? To further this inquiry, we sought to assess whether malpractice liability is associated with differences in surgery rates among elderly orthopaedic patients. METHODS: Medicare data were obtained for patients with a rotator cuff tear or proximal humerus fracture in 2011. Multivariate regressions were used to assess whether the probability of surgery is associated with various state-level rules that increase or decrease malpractice liability risks. RESULTS: Study results indicate that lower liability is associated with higher surgery rates. States with joint and several liability, caps on punitive damages, and punitive evidence rule had surgery rates that were respectively 5%-, 1%-, and 1%-point higher for rotator cuff tears, and 2%-, 2%- and 1%-point higher for proximal humerus fractures. Conversely, greater liability is associated with lower surgery rates, respectively 6%- and 9%-points lower for rotator cuff patients in states with comparative negligence and pure comparative negligence. CONCLUSIONS: Medical malpractice liability is associated with orthopaedic treatment choices. Future research should investigate whether treatment differences result in health outcome changes to assess the costs and benefits of the medical liability system.


Assuntos
Imperícia , Lesões do Manguito Rotador , Idoso , Estudos de Coortes , Humanos , Úmero , Medicare , Manguito Rotador , Lesões do Manguito Rotador/cirurgia , Estados Unidos/epidemiologia
7.
BMC Musculoskelet Disord ; 22(1): 499, 2021 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-34051761

RESUMO

BACKGROUND: Surgical treatment of full-thickness rotator cuff (RC) tears is associated with generally good results. There is no consensus regarding treatment of partial thickness tears that fail conservative treatment. The purpose of this study was to look at the efficacy and confirm the safety of dual injection PRP into the shoulder of patients with rotator cuff pathology who have failed conservative treatment with followup to two years. METHODS: Seventy-one shoulders with MRI confirmed, rotator cuff pathology who failed conservative treatment, had dual PRP injection into the rotator cuff. Global improvement, Quick DASH and VAS scores were collected at 6, 12, and 24 months after treatment and comparison of means was used to analyze changes. RESULTS: No adverse events were seen in any patient. Based on global rating scores positive results were seen in 77.9 % of patients at 6 months, 71.6 % at 1 year, and 68.8 % of patients at 2 years. Mean VAS scores improved from 50.2 [CI 44.4-56.0] pre-injection to 26.2 [CI 19.5-32.9] at 6 months, 22.4[CI 16.1-28.7] at 1 year and 18.2 [CI 12.3-24.1] at 2 years (p < 0.0001 for all). The mean Q- DASH scores (0-100, 100 worse) improved from 39.2 [CI 34.3-44.1] for all patients before treatment to 20.7[CI 15.0-26.4] at 6 months, 18.0[CI 12.9-23.1] at 1 year, and 13.8 [CI 8.4-18.8] at 2 years (p < 0.0001 for all). No patient with partial tear had clinical evidence of progression to full thickness tear. When separated into subgroups based on rotator cuff status, all subgroups showed improvement. Patients in the > 50 % partial tear group had the best overall improvement based on Global Rating scores while those in the tendinitis group had the poorest outcomes. CONCLUSIONS: PRP injection is a safe and effective treatment for RC cuff injury in patients who have failed conservative treatment of activity modification and physical therapy without deterioration of results two years after treatment. Better results are obtained with greater structural tendon damage than in shoulders with inflammation without structural damage. TRIAL REGISTRATION: This is not a clinical trial.


Assuntos
Plasma Rico em Plaquetas , Lesões do Manguito Rotador , Seguimentos , Humanos , Estudos Prospectivos , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia
8.
Clin Interv Aging ; 16: 645-653, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33907386

RESUMO

Purpose: Ultrasound elastography has been used to evaluate the skeletal muscle stiffness as a biomarker for sarcopenia assessment. However, there is no consensus with respect to the size and location of the region of interest in assessing such fat infiltrated muscle. The objective of this study was to determine which cross-sectional area should be measured in torn disuse muscle with fat infiltration to accurately measure muscle activity using real-time tissue elastography (RTE). Methods: Twenty-seven patients, whose rotator cuff muscle with torn tendon was successfully repaired, were followed by programmed rehabilitation. RTE measurements of the supraspinatus muscle were obtained during muscle contraction before and one-year after surgery so that the activity value was defined as the difference between elastography measurements at rest and elastography measurements during contraction. Given that the patients with successfully repaired and completed rehabilitation showed an increased activity value, the sensitivity for three regions of interest; posterior portion of the anterior-middle subregion (AM-p), anterior region (AR), and whole cross-sectional area of the supraspinatus (whole) were compared with the number of patients showing an increase in activity values as sensitivity analysis. Results: The sensitivity showing an increase in activity values was 74.1% for the AM-p area, 70.4% for the AR area, and 81.5% for the whole area. Intraclass correlation coefficient1,3 was 0.87-0.97 for the AM-p area, 0.88-0.98 for the AR area and 0.92-0.99 for the whole area. Conclusion: The whole cross-sectional area is suitable to measure muscle activity in muscle with fat infiltration. The results in this study will provide some beneficial information when ultrasound elastography is used for the assessment of sarcopenia muscle with fat infiltration.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Lipídeos/fisiologia , Músculo Esquelético/fisiologia , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Lesões do Manguito Rotador/reabilitação , Lesões do Manguito Rotador/cirurgia , Sensibilidade e Especificidade , Índices de Gravidade do Trauma
9.
Arthroscopy ; 37(5): 1411-1413, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33896496

RESUMO

Large and massive rotator cuff tears are not always reparable and present a difficult clinical problem. If surgery is warranted surgical options range from arthroscopic debridement, partial repairs, degradable spacers, tendon transfers, and more superior capsular reconstruction. The rotator cable is formed by the deep layer of the coracohumeral ligament and the crescent structure running from the anterior insertion site of the supraspinatus to the inferior border of the infraspinatus. The role of the rotator cable is not clear but seems to play a role in reducing tendon stress and influence glenohumeral kinematics. In this laboratory-based cadaver study the anterior cable was reconstructed with semitendinosus allograft treating large "irreparable" rotator cuff defects. Reconstruction resulted in reduced superior migration and subacromial contact forces without inhibiting range of motion.


Assuntos
Músculos Isquiossurais , Lesões do Manguito Rotador , Aloenxertos , Humanos , Amplitude de Movimento Articular , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia
10.
Arthroscopy ; 37(5): 1455-1457, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33896500

RESUMO

The available evidence shows that arthroscopic repair using either the transtendon in situ repair technique or the tear completion and subsequent repair technique are associated with favorable results in the short term. Likewise, the location of the lesions (articular or bursal) does not seem to significantly influence the clinical results, regardless of the technique used. Specifically with regard to the surgical technique of choice in the case of deciding to complete the tear and then repair it, it remains to be defined more clearly in future investigations whether it is better to repair with a single- or double-row technique, whether associated subacromial decompression has any advantage and what the results of this technique are in the subgroup of athletes, especially in competitive and overhead athletes in whom repair of rotator cuff tears has shown unfavorable outcomes mainly at the expense of a low return to the same level of sport.


Assuntos
Lesões do Manguito Rotador , Cirurgiões , Artroscopia , Seguimentos , Humanos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia
11.
Artigo em Inglês | MEDLINE | ID: mdl-33917277

RESUMO

Sleep disturbances are very common in patients with rotator cuff injury. Improvement of sleep quality in these patients can be considered a significant factor for healing in conjunction with surgery. The primary objective of this prospective study was to evaluate changes in sleep quality after surgery in patients with rotator cuff repair by analyzing the PSQI (Pittsburgh Sleep Quality Index) score. The secondary aim was to evaluate the improvement in quality of life in terms of functional limitations and shoulder pain after surgery. Fifty-eight patients with rotator cuff tears treated by arthroscopic surgery were included. All the patients completed the PSQI, the 36-Item Short Form Survey (SF-36), the Simple Shoulder Test (SST), the American Shoulder and Elbow Surgeons Shoulder Score (ASES), the Oxford Shoulder Score (OSS) and the Constant-Murley Score (Constant) before and at one, three and six months after surgery. Overall improvement in all the scores analyzed (p < 0.001) was found. Preoperative and postoperative PSQI scores correlated with SF-36, SST, ASES and Constant scores at each follow-up. Preoperative and one-month postoperative OSS correlated with the PSQI score. Using the Friedman test, we found an overall improvement in all score analyses (p < 0.001). The results prove that after rotator cuff repair, sleep disturbances improve three to six months after surgery improving the quality of life of these patients.


Assuntos
Qualidade de Vida , Lesões do Manguito Rotador , Artroscopia , Humanos , Estudos Prospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Sono , Resultado do Tratamento
12.
BMJ Open ; 11(4): e045702, 2021 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888530

RESUMO

INTRODUCTION: In the field of arthroscopic rotator cuff repair (ARCR), reporting standards of published studies differ dramatically, notably concerning adverse events (AEs). In addition, prognostic studies are overall methodologically poor, based on small data sets and explore only limited numbers of influencing factors. We aim to develop prognostic models for individual ARCR patients, primarily for the patient-reported assessment of shoulder function (Oxford Shoulder Score (OSS)) and the occurrence of shoulder stiffness 6 months after surgery. We also aim to evaluate the use of a consensus core event set (CES) for AEs and validate a severity classification for these events, considering the patient's perspective. METHODS AND ANALYSIS: A cohort of 970 primary ARCR patients will be prospectively documented from several Swiss and German orthopaedic clinics up to 24 months postoperatively. Patient clinical examinations at 6 and 12 months will include shoulder range of motion and strength (Constant Score). Tendon repair integrity status will be assessed by ultrasound at 12 months. Patient-reported questionnaires at 6, 12 and 24 months will determine functional scores (subjective shoulder value, OSS), anxiety and depression scores, working status, sports activities, and quality of life (European Quality of Life 5 Dimensions 5 Level questionnaire). AEs will be documented according to a CES. Prognostic models will be developed using an internationally supported regression methodology. Multiple prognostic factors, including patient baseline demographics, psychological, socioeconomic and clinical factors, rotator cuff integrity, concomitant local findings, and (post)operative management factors, will be investigated. ETHICS AND DISSEMINATION: This project contributes to the development of personalised risk predictions for supporting the surgical decision process in ARCR. The consensus CES may become an international reference for the reporting of complications in clinical studies and registries. Ethical approval was obtained on 1 April 2020 from the lead ethics committee (EKNZ, Basel, Switzerland; ID: 2019-02076). All participants will provide informed written consent before enrolment in the study. TRIAL REGISTRATION NUMBER: NCT04321005. PROTOCOL VERSION: Version 2 (13 December 2019).


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroscopia , Estudos de Coortes , Humanos , Estudos Multicêntricos como Assunto , Qualidade de Vida , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Suíça , Resultado do Tratamento
13.
Medicina (Kaunas) ; 57(3)2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33801508

RESUMO

Background and Objectives: Superior capsular reconstruction (SCR) with the use of a fascia lata autograft or a dermal allograft is an established treatment in treating irreparable rotator cuff (RC) tears. The long head of the biceps tendon (LHBT) has been recently proposed as an alternative graft for SCR. The purpose of this study was to present the surgical techniques and clinical studies utilizing the LHBT for SCR. Material and Methods: Medline, Scopus, and the Cochrane library were searched for relevant studies up to December 2020. The primary outcomes were pain intensity improvement and the incidence of RC and LHBT graft retears. Secondary outcomes were functional scores and acromiohumeral distance (AHD) improvements. Results: Nine studies described surgical techniques of SCR using the LHBT, and four clinical studies reported the outcomes of the technique. The mean pain intensity improved from 4.9 ± 2.3 to 1.6 ± 1.5 in terms of the visual analog scale, exceeding the minimum clinically important difference for adequate pain relief. Significant improvements were also noted in functional scores and AHD. When compared with other repair techniques for massive RC tears, i.e., the double-row repair, the transosseous-equivalent technique with absorbable patch reinforcement, and the traditional SCR with a fascia lata autograft, there were no significant differences in pain and function improvements. Conclusion: SCR using the LHBT is a useful treatment option for massive RC tears; it is equally effective with the traditional SCR and other established techniques. It presents numerous advantages being a safe, easy, time-saving, and cost-effective method. The only precondition for the technique is the presence of an intact LHBT. Additional clinical trials are necessary to determine which treatment is superior for treating massive RC tears, as well as to evaluate the long-term results of the technique.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Humanos , Manguito Rotador , Lesões do Manguito Rotador/cirurgia , Ombro , Tendões
14.
Medicina (Kaunas) ; 57(4)2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33804946

RESUMO

Background and objectives: Massive rotator cuff tears compromise shoulder mobility function and cannot be directly repaired. Latissimus dorsi tendon transfer (LDTT) is a therapeutic alternative suitable for the treatment of rotator cuff tears that helps to restore external shoulder rotation. Cadaver models have been used for studying the effects of LDTT and procedural variations, but, to the best of our knowledge, none of them have been validated. The aim of our study was to validate a novel cadaver model while verifying the effects of LDTT on external rotation. Materials and Methods: Two groups were included in the study: a cadaver group and a control group made up of healthy volunteers, which were used for the validation of the cadaver model. Baseline external rotation measurements were performed with both groups, after which a massive rotator cuff tear was inflicted and repaired with LDTT in the cadaver group. Their postoperative external rotation was evaluated using three different tests. Results: No statistically significant differences were found between the baseline measurements of the two groups, and postoperative external rotation was significantly higher after LDTT in all cases but one. Conclusions: Cadaver models were validated, since they had a similar preoperative external rotation to healthy volunteers. Moreover, they allowed us to demonstrate the effect of LDTT on external shoulder rotation.


Assuntos
Lesões do Manguito Rotador , Músculos Superficiais do Dorso , Cadáver , Humanos , Amplitude de Movimento Articular , Rotação , Lesões do Manguito Rotador/cirurgia , Transferência Tendinosa , Resultado do Tratamento
15.
BMC Musculoskelet Disord ; 22(1): 331, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-33820538

RESUMO

BACKGROUND: Irreparable rotator cuff tears are common and difficult to treat. Techniques for "filling the loss of substance" require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula. METHODS: This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SS) and upper infraspinatus (IS) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed. We proceeded to the same technique under arthroscopy for a 73 years old patient whom we treated for a painful shoulder with irreparable cuff tear. We inserted a GRAST graft using arthroscopy. RESULTS: The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases. CONCLUSION: This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial "spacer" effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Idoso , Artroscopia , Fenômenos Biomecânicos , Humanos , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Tendões/cirurgia
16.
J Surg Orthop Adv ; 30(1): 24-29, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33851910

RESUMO

Our study examines the effect of comorbidities on rotator cuff repair (RCR) postoperative costs and complication rates. A retrospective review of patients receiving RCRs from 2008-2016 using the PearlDiver database was performed. We evaluated the effect of major comorbidities on postoperative costs and complications within one year of surgery. In total, 8,747 patients underwent RCR. Patients with no comorbidities had a 6-month and 12-month postoperative cost of $3,534 and $3,853, respectively. Patients with one comorbidity had 6-month postoperative costs ranging from $2,623 to $3,466 and 1-year postoperative costs ranging from $2,992 to $5,906. Patients with 3+ comorbidities receiving arthroscopic RCR had the highest complication rates at 1-, 3- and 6-month intervals (11.8%, 19.7% and 26.8%, respectively) compared to those with no comorbidities (8.1% [p = 0.139], 12.7% [p = 0.022] and 15.9% [p = 0.001], respectively). Patients with isolated comorbidities likely require similar healthcare utilization to those without, but patients with 3+ comorbidities risk greater complications and higher post-operative costs. (Journal of Surgical Orthopaedic Advances 30(1):024-029, 2021).


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroscopia , Comorbidade , Humanos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Lesões do Manguito Rotador/epidemiologia , Lesões do Manguito Rotador/cirurgia
17.
Arthroscopy ; 37(4): 1084-1085, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812513

RESUMO

Surgeons must rely on cost and charge data to inform a patient outcome-optimized value-based approach to arthroscopic rotator cuff repairs. Using biologic and regenerative procedures to augment repairs only when necessary and optimizing anchor number are 2 obvious ways surgeons can help control cost of these procedures. Addition of biologics, such as patches and tissue augmentation, nearly doubled the charges for the procedure.


Assuntos
Lesões do Manguito Rotador , Cirurgiões , Procedimentos Cirúrgicos Ambulatórios , Artroscopia , Humanos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia
18.
Arthroscopy ; 37(4): 1126-1127, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812517

RESUMO

The topic of superior capsular reconstruction remains controversial. Whereas identifying the best time-zero graft configuration for this procedure remains important, the success or failure of the procedure will be dependent on the biology, not just the bench performance. Any conforming object placed in the subacromial space at time zero could center the humeral head and decrease superior translation compared with a massive rotator cuff tear but may not restore translation to normal. It does appear that a thicker graft is better in this regard, but how much thicker is better is unclear. Most of all, whether the mechanical benefits of a thicker graft will be offset by a thicker and potentially less biologically compatible construct is also unclear. In most orthopaedic settings, autografts remain consistently superior to allografts. The contrast in results may be better explained by biology, and the excellent superior capsular reconstruction results reported with autograft have not been replicated universally with dermal allograft.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Aloenxertos , Biologia , Fascia Lata , Humanos , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia
19.
Am J Sports Med ; 49(4): 899-908, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33719604

RESUMO

BACKGROUND: Adipose stem cell-derived exosomes (ASC-Exos) are reported to effectively prevent muscle atrophy and degeneration of torn rat rotator cuff, but their influence on human samples and their potential mechanism are still unclear. PURPOSE: We aimed to investigate the effects of ASC-Exos on the metabolic activities of torn human rotator cuff tendons and explore the potential mechanism behind it. STUDY DESIGN: Controlled laboratory study. METHODS: Diseased supraspinatus tendons were harvested from 15 patients with a mean ± SD age of 65.8 ± 3.2 years who underwent reverse shoulder arthroplasty for chronic rotator cuff tears associated with glenohumeral pathological changes. Each tendon was dissected into 3 × 4 × 4-mm explants: the ones derived from the same tendon were placed into 12-well plates and cultured in complete culture media (control) or in complete culture media supplemented with ASC-Exos for 72 hours. Afterward, the concentrations of cytokines secreted into the culture media-including interleukin 1ß (IL-1ß), IL-6, IL-8, and matrix metalloproteinase 9 (MMP-9)-were measured using enzyme-linked immunosorbent assay (ELISA). Tendons were stained with hematoxylin and eosin and immunohistochemistry (type I and III collagens) for histological analyses. Moreover, the expression of anabolic genes (TIMP-1 and TIMP-3; type I and III collagen encoding) and catabolic genes (MMP-9 and MMP-13) in tendons were measured using real-time quantitative polymerase chain reaction. Phosphorylated AMPKα and Wnt/ß-catenin pathways were assayed by western blotting to explore the potential mechanism of action of ASC-Exos. RESULTS: Secretion of proinflammatory cytokines, including IL-1ß, IL-6, and MMP-9, was significantly reduced in the ASC-Exos group as compared with the control group. Supraspinatus tendons in the ASC-Exos group exhibited superior histological properties, as demonstrated by higher tendon maturing scores and more type I collagen content, but there was no significant difference in type III collagen content between groups. Expression of MMP-9 and MMP-13 genes was decreased in the ASC-Exos group versus the control group. Increased expression of type I and III collagens and an elevated type I/III ratio were found in the ASC-Exos group when compared with the control group. There was no significant difference in the secretion of IL-8 and expression of TIMP-1 and TIMP-3 genes between the ASC-Exos and control groups. Western blotting revealed that ASC-Exos enhanced phosphorylated AMPKα and decreased ß-catenin levels to prevent tendon degeneration. CONCLUSION: ASC-Exos maintained metabolic homeostasis of torn human rotator cuff tendons to improve their histological properties, which might be achieved by enhancing AMPK signaling to suppress Wnt/ß-catenin activity. CLINICAL RELEVANCE: ASC-Exos could be used as an effective biological tool to promote healing in torn human rotator cuff tendons.


Assuntos
Exossomos , Lesões do Manguito Rotador , Animais , Homeostase , Humanos , Ratos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Células-Tronco , Tendões
20.
Medicine (Baltimore) ; 100(10): e24965, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725860

RESUMO

BACKGROUND: There have been no published randomized clinical trial to assess the clinical outcomes between the articular-sided and bursal-sided tears. Therefore, a comparative analysis of evaluating and comparing the functional outcomes following arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tearsis essential. METHODS: This study is a present randomized controlled trial which is conducted in our hospital. Consecutive patients with symptomatic articular-sided or bursal-sided partial-thickness rotator cuff tears underwent arthroscopic repair between June 2020 and January 2022. The institutional review board approved the study proposal (with number 10012030), and informed consent was obtained from all patients. Inclusion criteria were existence of an articular- or bursal-sided tear involving <50% of the tendon thickness-confirmed intraoperatively and treated with arthroscopic debridement with or without other decompression surgery (acromioplasty/distal clavicle resection)-and a minimum follow-up of 2 years. All patients followed the same postoperative rehabilitation program. The patients were assessed at baseline preoperatively, and at 1 year and 2 years postoperatively. Outcome parameters were measured at each respective follow-up, which included active range of motion in forward flexion and abduction of the affected shoulder, pain score as measured on the Numeric Pain Rating Scale, as well as outcome scores in terms of the Constant-Murley Score, and Oxford Shoulder Score. RESULTS: Table 1 and Table 2 describe the data indicators that this article wants to evaluate and collect. CONCLUSIONS: We hypothesize that both groups of patients will show improvement in range of motion, functional outcome scores, and pain at 2 years, and that results would be similar between the two groups. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6496).


Assuntos
Artralgia/cirurgia , Artroscopia , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/fisiopatologia , Braquetes , Desbridamento/métodos , Descompressão Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Masculino , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/reabilitação , Articulação do Ombro/cirurgia , Resultado do Tratamento
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