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3.
Arthroscopy ; 36(9): 2389-2390, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32891241

RESUMO

A national database in the United States was used to identify increasing age, male sex, smoking, obesity, hyperlipidemia, and vitamin D deficiency as significant independent patient-specific risk factors for rotator cuff repair failure requiring revision repair. Understanding risks for repair failure can help counsel patients, inform treatment strategies, and consider treatment alternatives for patients with symptomatic rotator cuff tears.


Assuntos
Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Artroplastia , Artroscopia , Humanos , Masculino , Resultado do Tratamento , Estados Unidos
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(9): 1177-1183, 2020 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-32929913

RESUMO

Objective: To assess the effect of microfracture and biomimetic hydrogel scaffold on tendon-to-bone healing in a rabbit rotator cuff tear model. Methods: Gelatin and methacrylic anhydride were used to synthesize gelatin methacryloyl (GelMA). Then the GelMA were treated with ultraviolet rays and vacuum freeze-drying method to obtain a biomimetic hydrogel scaffold. The morphology of the scaffold was observed by gross observation and scanning electron microscope. Degradation of the scaffold was determined at different time points. Twenty-four adult New Zealand rabbits, weighting 2.8-3.5 kg and male or female, were surgically created the bilateral acute rotator cuff tear models. One shoulder was treated with microfractures on the footprint and transosseous suture (control group, n=24). The other shoulder was treated with the same way, except for putting the scaffold on the footprint before transosseous suture (experimental group, n=24). The general conditions of rabbits were observed postoperatively. Tendon-to-bone healing was evaluated by gross observation, Micro-CT, HE staining, and bio-mechanical testing at 4 and 8 weeks after operation. Results: The scaffold was white and has a porous structure with pore size of 31.7-89.9 µm, which degraded slowly in PBS solution. The degradation rate was about 95% at 18 days. All the rabbits survived to the completion of the experiment. Micro-CT showed that there was no obvious defect and re-tear at the tendon-to-bone interface in both groups. No difference was found in bone mineral density (BMD), tissue mineral density (TMD), and bone volume/total volume (BV/TV) between the two groups at 4 and 8 weeks postoperatively ( P>0.05). HE staining showed that the fibrous scar tissue was the main component at the tendon-to-bone interface in the control group at 4 and 8 weeks postoperatively; the disorderly arranged mineralized cartilage and fibrocartilage formation were observed at the tendon-to-bone interface in the experimental group at 4 weeks, and the orderly arranged cartilage formation was observed at 8 weeks. Besides, the tendon maturation scores of the experimental group were significantly higher than those of the control group at 4 and 8 weeks ( P<0.05). There was no significant difference in the ultimate load to failure and stiffness between the two groups at 4 weeks ( P>0.05); the ultimate load to failure at 8 weeks was significantly higher in the experiment group than in the control group ( t=4.162, P=0.009), and no significant difference was found in stiffness between the two groups at 8 weeks ( t=2.286, P=0.071). Conclusion: Compared with microfracture alone, microfracture combined with biomimetic hydrogel scaffold can enhance tendon-to-bone healing and improve the ultimate load to failure in rabbits.


Assuntos
Fraturas de Estresse , Lesões do Manguito Rotador , Animais , Fenômenos Biomecânicos , Biomimética , Hidrogéis , Masculino , Coelhos , Manguito Rotador , Tendões , Cicatrização
5.
Sports Health ; 12(5): 478-487, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32758080

RESUMO

CONTEXT: Shoulder injuries are highly prevalent in sports involving the upper extremity. Some risk factors have been identified in the literature, but consensus is still lacking. OBJECTIVES: To identify risk factors of overuse shoulder injury in overhead athletes, as described in the literature. DATA SOURCES: A systematic review of the literature from the years 1970 to 2018 was performed using 2 electronic databases: PubMed and Scopus. STUDY SELECTION: Prospective studies, written in English, that described at least 1 risk factor associated with overuse shoulder injuries in overhead sports (volleyball, handball, basketball, swimming, water polo, badminton, baseball, and tennis) were considered for analysis. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Data were extracted from 25 studies. Study methodology quality was evaluated using the Modified Coleman Methodology Score. RESULTS: Intrinsic factors, previous injury, range of motion (lack or excess), and rotator cuff weakness (isometric and isokinetic) highly increase the risk of future injuries. Additionally, years of athletic practice, body mass index, sex, age, and level of play seem to have modest influence. As for the effect of scapular dysfunction on shoulder injuries, it is still controversial, though these are typically linked. Extrinsic factors, field position, condition of practice (match/training), time of season, and training load also have influence on the occurrence of shoulder injuries. CONCLUSION: Range of motion, rotator cuff muscle weakness, and training load are important modifiable factors associated with shoulder injuries. Scapular dysfunction may also have influence. The preventive approach for shoulder injury should focus on these factors.


Assuntos
Traumatismos em Atletas/fisiopatologia , Transtornos Traumáticos Cumulativos/fisiopatologia , Lesões do Ombro/fisiopatologia , Traumatismos em Atletas/prevenção & controle , Transtornos Traumáticos Cumulativos/prevenção & controle , Humanos , Amplitude de Movimento Articular/fisiologia , Fatores de Risco , Manguito Rotador/fisiopatologia , Escápula/fisiopatologia , Lesões do Ombro/prevenção & controle
6.
Arthroscopy ; 36(8): 2069-2070, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747055

RESUMO

Local, arthroscopic harvest of mesenchymal stem cells is of interest due to their potential to augment healing. The high rates of retear after rotator cuff repair are a significant concern, and solutions, such as augmentation with mesenchymal stem cells, are being sought. The subacromial bursa of the shoulder is a potential source of cells to augment healing.


Assuntos
Células-Tronco Mesenquimais , Lesões do Manguito Rotador , Bolsa Sinovial , Humanos , Manguito Rotador , Ombro
7.
Arthroscopy ; 36(8): 2089-2090, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747056

RESUMO

Anteroposterior tear length, hyperlipidemia, and muscle fatty degeneration lead to retear after arthroscopic rotator cuff repair and to subsequent revision surgery. The challenge is to develop methods to prevent these adverse effects after surgery.


Assuntos
Artroscopia , Lesões do Manguito Rotador/cirurgia , Humanos , Reoperação , Estudos Retrospectivos , Manguito Rotador , Resultado do Tratamento
8.
Arthroscopy ; 36(8): 2091-2093, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747057

RESUMO

Shoulder rotator cuff repair results in significantly improved outcomes compared with conservative treatment, but some repairs result in retear and, worst of all, enlarged retears (i.e., tears larger after surgery than primarily). Elevated serum total cholesterol and low-density lipoprotein levels and fatty infiltration of the infraspinatus are significantly related to symptomatic failed rotator cuff repair. Hypertension could also be a risk factor. In such cases, nonoperative treatment, reverse shoulder prosthesis (in older patients), or alternative joint-preserving procedures (superior capsular reconstruction, subacromial balloon spacer, multiple-tendon interposition autografts, augmentation of the long head of the biceps, or tendon transfers such as latissimus dorsi transfer and lower trapezius transfer) could be considered or are worthy of future investigation.


Assuntos
Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Idoso , Artroplastia , Artroscopia , Humanos , Reoperação
9.
Sports Health ; 12(5): 495-500, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32720852

RESUMO

BACKGROUND: Traditional exercises performed with the shoulder in the position of 90° abduction and external rotation with elbow flexion (90/90) while using a single elastic band showed moderate activity of both the lower trapezius (LT) and infraspinatus (IS) muscle. The purpose of this study was to investigate activity of the teres minor (TMi) and the LT muscles during standing external rotation exercise with the shoulder in the 90/90 position with 2 elastic bands in both the frontal and the scapular plane. HYPOTHESIS: TMi, IS, and LT muscle activities will vary depending on whether the shoulder is positioned in the frontal or scapular plane with the application of 2 elastic bands. Also, the serratus anterior (SA) and teres major (TMa) muscles will produce different muscular activity patterns during exercises performed with 2 elastic bands in the frontal plane compared with the TMi and LT muscles. STUDY DESIGN: Controlled laboratory study. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 21 collegiate baseball players volunteered to participate. The electromyography (EMG) activities of the TMi, IS, LT, SA, TMa, middle deltoid (MD), posterior deltoid, and upper trapezius (UT) muscles were measured with the 90/90 arm position during both isometric and oscillation resistance exercises with 2 elastic bands oriented in the frontal and scapular planes. RESULTS: A significant difference was observed in EMG activity of both the TMi and the LT muscles between single and double elastic band applications in the frontal plane (P < 0.05). In contrast, EMG activity of the IS, SA, and TMa muscles was significantly increased in the scapular plane compared with the frontal plane (P < 0.05). CONCLUSION: The standing 90/90 position effectively increased both TMi and LT muscle EMG activity with the double elastic band in the frontal plane while minimizing UT and MD muscle activity. EMG activity of the IS, SA, and TMa muscles increased with exercise in the scapular plane as compared with the frontal plane. CLINICAL RELEVANCE: Oscillation movement under double elastic band application differentiated external rotator muscle and scapular muscle activities between the frontal and scapular plane during the 90/90 exercise in the frontal plane compared with the scapular plane. Clinicians can utilize each of the scapular and frontal positions based on their desired focus for muscular activation.


Assuntos
Braço/fisiologia , Beisebol/fisiologia , Treinamento de Resistência/instrumentação , Treinamento de Resistência/métodos , Manguito Rotador/fisiologia , Equipamentos Esportivos , Músculos Superficiais do Dorso/fisiologia , Eletromiografia , Humanos , Rotação
10.
Zhongguo Gu Shang ; 33(7): 684-8, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32700497

RESUMO

Rotator cuff repair is a common treatment for rotator cuff tear, which could effectively relieve shoulder pain and improve shoulder movement, and the incidence of rotator cuff retear after rotator cuff repair is still high. The main reason is poor tendon-bone healing in rotator cuff enthesis after rotator cuff repair and could not recover the original histological structure and biomechanical properties. Therefore, the key to solve the problem is how to effectively improve the healing of tendon bone at the end of rotator cuff. With the in-depth study of rotator cuff enthesis, various treatments have made great progress on improving tendon to bone healing of rotator cuff. Our study will discuss the researchprogress on tendon to bone healing of rotator cuff in recent years from three following aspects to provide some guidance for the clinical treatment of rotator cuff tear:the factors affecting the tendon to bone healing of rotator cuff, the recovery of tendon to bone interface promoting the tendon to bone healing of rotator cuff and the application of tissue engineering in tendon to bone healing.


Assuntos
Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Artroplastia , Humanos , Tendões/cirurgia , Cicatrização
11.
Zhonghua Wai Ke Za Zhi ; 58(8): 631-635, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727196

RESUMO

Objective: To examine the short-term outcomes of modified load-sharing rip-stop repair (mLSRS) and suture-bridge repair (SB) for large rotator cuff tear. Methods: The clinical data of patients who underwent shoulder arthroscopy for large rotator cuff repair at Department of Orthopedic, China Academy of Chinese Medical Sciences Wang Jing Hospital from January 2017 to December 2018 were collected. Totally 111 patients (39 in mLSRS group and 72 in SB group) were included in the study. There were 45 males and 66 females, aged (58.0±6.9)years (range: 40 to 72 years).A total of 39 pairs of patients were successfully matched by propensity score matching. The pain of shoulder joint was assessed by visual analogy score (VAS) , the shoulder function was assessed by Constant-Murley score, the abduction strength of bilateral shoulder joint was assessed by 90˚ force assessment method of upper limb on the plane of scapula, and the healing of rotator cuff on the operative side was assessed by sugaya ultrasonic classification standard. The difference of short-term outcome between the two groups were compared using t test, χ(2) test, Mann-Whitney U test, repeated measures design anova and multivariate analysis of variance. Results: At the 4th week after surgery, the VAS of mLSRS group was significantly lower than SB group(1 (2) vs. 2 (2) , F=5.32, P=0.02). One year after surgery, Constant-Murley score of two groups were significantly higher than those before surgery, but there was no significant difference between two groups(89.1±5.7 vs. 87.6±7.3, t=1.00, P=0.32). Abductor strength of affected limbs were lower than that of the opposite side, but there were no statistically significant differences between two groups(4.28±1.61 vs. 4.54±1.64, t=-0.70, P=0.49). According to the Sugaya classification, 32 cases in mLSRS group were healed while 7 cases were not healed,30 cases in SB group were healed while 9 cases were not healed(χ(2)=0.32, P=0.58). Conclusion: The use of mLSRS fixation construct on large rotator cuff tear can reduce pain and the short-term outcome is reliable.


Assuntos
Lesões do Manguito Rotador/cirurgia , Técnicas de Sutura , Adulto , Idoso , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/cirurgia , Artroscopia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Amplitude de Movimento Articular , Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Resultado do Tratamento
12.
Medicine (Baltimore) ; 99(27): e21139, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629749

RESUMO

INTRODUCTION: Most symptomatic large-to-massive rotator cuff tears (RCTs) should be operated, but the surgical reparability depended on the degree of rotator cuff muscle atrophy or fatty infiltration. The orthopedic surgeons will decide whether the teared stump is reparable during the surgery, but preoperative evaluation can be done by some assessment tools. Magnetic resonance imaging (MRI) was used in recent studies to predict the reparability of large-to-massive RCTs, but the clinical availability was not as good as ultrasound. We hypothesize that the ultrasound elastography can predict the reparability of large-to-massive RCTs. METHODS: This is a prospective observational study and participants with large-to-massive RCTs who are going to have surgeries will be included. Out investigators will evaluate the shoulder passive range of motion (ROM) and strength of all participants. Participants' degree of shoulder pain and activities of daily living (ADLs) will be assessed by American Shoulder and Elbow Surgeons (ASES) score. The ultrasound elastography will be used to evaluate the tissue quality of supraspinatus muscle and infraspinatus muscle. To test the reliability of the ultrasound elastography, two physicians will perform the ultrasound elastography independently and twenty participants will be selected for the reliability test. Besides, MRI will be used to evaluate the size of tear, the degree of tendon retraction, fatty infiltration of rotator cuff muscles, and muscle atrophy. Finally, the orthopedic surgeons will perform surgeries and decide whether the teared stump can be completely repaired intraoperatively. The primary analysis is the predictive validity of ultrasound elastography for the reparability of large-to-massive RCTs. Before the predictive validity of ultrasound elastography is measured, our investigators will assess the reliability of ultrasound elastography when administered to cases with large-to-massive RCTs, and we will check the correlations between the findings of ultrasound elastography and MRI. DISCUSSION: The outcome will provide the evidence of ultrasound elastography for preoperative evaluation of large-to-massive RCTs. The relationships between the findings of ultrasound elastography and MRI will also be examined for further analysis. TRIAL REGISTRATION: Clinicaltrials.gov NCT03682679. Date of Registration: 25 September 2018, https://clinicaltrials.gov/ct2/show/NCT03682679?cond=rotator+cuff&cntry=TW&draw=2&rank=1.


Assuntos
Lesões do Manguito Rotador/diagnóstico por imagem , Ruptura/cirurgia , Ombro/fisiopatologia , Atividades Cotidianas , Tecido Adiposo/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Atrofia Muscular/patologia , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Reprodutibilidade dos Testes , Manguito Rotador/patologia , Lesões do Manguito Rotador/patologia
13.
Arthroscopy ; 36(7): 1811-1812, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32624118

RESUMO

A variety of metrics have been developed for the purposes of understanding how to use and interpret patient self-reported functional outcome scores after treatment. Among these, the maximal outcome improvement (MOI) can now be added to the list. Limitations of other metrics including the minimal clinically important difference, patient acceptable symptomatic state, and substantial clinical benefit are ceiling effects if starting function is relatively high. The MOI now provides a measure of improvement based on the patient's total range of possible improvement to determine whether a satisfactory state was achieved. The value of the other measures, such as the minimal clinically important difference, is in interpreting studies comparing treatments to determine clinical significance as opposed to statistical significance, as well as performing sample size calculation for prospective studies, but may be limited in interpreting the outcomes of individual patients. The MOI provides a metric-in this case for patients after arthroscopic rotator cuff repair-that can be easily used in the clinic for assessment of improvement in an individual patient's function without limitations resulting from how good or bad his or her initial function is.


Assuntos
Artroscopia , Diferença Mínima Clinicamente Importante , Feminino , Seguimentos , Humanos , Estudos Prospectivos , Manguito Rotador , Ombro , Resultado do Tratamento
14.
Arthroscopy ; 36(7): 1843-1844, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32624120

RESUMO

When there is remnant tendon stump on the footprint in rotator cuff tear, preserving the whole insertion structure and reattaching the rotator cuff to the footprint or tendon stump results in a better rotator cuff-greater tuberosity connection.


Assuntos
Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Animais , Artroplastia , Coelhos , Tendões/cirurgia , Cicatrização
15.
Arthroscopy ; 36(9): 2362-2363, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32610073

RESUMO

Hospitals operate at a financial loss when performing rotator cuff repair in Medicare patients because of high direct costs, high indirect costs, and low reimbursement. Surgeon reimbursement has been stagnant since 2005 despite increased cost and complexity of our labors. Reimbursement poorly reflects the complexity of shoulder surgery. It is essential that we advocate for reimbursement that matches the high complexity of the procedures we perform and the evidence-based societal value we provide.


Assuntos
Lesões do Manguito Rotador , Cirurgiões , Artroscopia , Humanos , Medicare , Pacientes Ambulatoriais , Manguito Rotador , Estados Unidos
17.
Orthop Clin North Am ; 51(3): 383-389, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498957

RESUMO

Traditionally, total shoulder arthroplasty is performed through the deltopectoral approach with violation of the subscapularis tendon. In order to reduce the incidence of postoperative subscapularis dysfunction, the subscapularis-sparing approach, performed entirely through the rotator interval, was developed. This technique allows earlier rehabilitation and may potentially prevent subsequent subscapularis insufficiency and clinical failures.


Assuntos
Artroplastia do Ombro/métodos , Artropatias/cirurgia , Articulação do Ombro/cirurgia , Artroplastia do Ombro/reabilitação , Humanos , Artropatias/diagnóstico por imagem , Manguito Rotador/cirurgia , Articulação do Ombro/diagnóstico por imagem
19.
Arthroscopy ; 36(6): 1515-1516, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32503768

RESUMO

Arthroscopy is a powerful tool in the management of the painful total shoulder arthroplasty and should be considered when evaluating cases in which a clear cause of pain is not present. Patients may present with a painful shoulder arthroplasty due to a number of causes-occult infection, instability, component loosening, malposition, or rotator cuff pathology. In certain cases, advanced imaging may not be diagnostic, given the presence of metal artifact. It is our routine clinical practice to evaluate arthroscopically such cases in which the diagnosis is not readily evident. The most common indication for shoulder arthroscopy is pain with no clear cause or loss of motion (39%), followed by biopsy to rule out occult infection (25%), and finally rotator cuff assessment (19%).


Assuntos
Artroplastia do Ombro , Lesões do Manguito Rotador , Articulação do Ombro/cirurgia , Artroplastia , Artroscopia , Humanos , Manguito Rotador/cirurgia
20.
Arthroscopy ; 36(6): 1552-1554, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32503770

RESUMO

Recurrent rotator cuff tears are a frequent cause of shoulder disability. To repair a rotator cuff, the surgeon faces both mechanical and biological challenges. Patch use as a scaffold for rotator cuff repair is well-described, as is biological augmentation, with clinical indications and efficacy being the subjects of ongoing study. However, a clinical report of dermal allograft patch augmentation combined with attempts at supercharging the biology is novel. This technique would benefit from controlled, prospective studies, with tight inclusion criteria.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Aloenxertos , Humanos , Estudos Prospectivos , Ombro
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