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1.
Jt Dis Relat Surg ; 32(3): 786-791, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34842115

RESUMO

Tuberculosis (TB) infection is a common health problem in low socioeconomic populations in developing countries. Osteoarticular TB is a disease that rarely occurs outside the vertebral column and is often diagnosed late or misdiagnosed, particularly in non-weight bearing joints. A 51-year-old female patient with Behçet's disease presented with shoulder TB following rotator cuff repair surgery, leading to joint resection as a result of recurrent infections with no reproduction in culture samples due to delayed diagnosis. Surgical excision was proposed for the treatment of draining a mass with a sinus tract opening into the joint on the anterior aspect of the right shoulder. A diagnosis was able to be reached after 13 operations, based on the presence of TB bacilli in the pathological examination of the samples. In conclusion, TB should be considered in the absence of reproduction in culture samples taken during persistent post-surgical infections.


Assuntos
Síndrome de Behçet , Mycobacterium tuberculosis , Lesões do Manguito Rotador , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Ombro
2.
Zhongguo Gu Shang ; 34(11): 1040-3, 2021 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-34812022

RESUMO

OBJECTIVE: To investigate the method and clinical effects of modified anchor insertion with single-row suture arthroscopic rotator cuff repair for aged patients with rotator cuff tear. METHODS: From March 2016 to February 2020, 96 aged patients with rotator cuff tears were retrospectively analyzed, including 29 males and 67 females, aged from 65 to 85 years, with a mean of (68.8±3.9) years. Patients were treated with modified anchor insertion with single-row suture arthroscopic rotator cuff repair technique. Before and after operation, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder joint function, visual analogue scale (VAS)was used to evaluate patients' pain. Among them, 32 patients underwent magnetic resonance examination one year postoperatively. RESULTS: All operations were completed and the patients were followed up from 11 to 42 months, with a mean of (21.4±7.5) months. The UCLA score increased from preoperative 12.22±3.30 to final follow-up 31.30±2.49 (t=45.21, P<0.01);ASES score increased from preoperative 8.60±1.88 to final follow-up 12.60±0.84 (t=19.05, P<0.01);and the VAS decreased from preoperative 5.00 (2.00 to 8.00)scores to final follow-up 1.00 (0.00 to 3.00)scores (Z=-12.22, P<0.05). One year after operation, one of the 32 patients who underwent MRI showed that the repaired rotator cuff was torn again, but it did not affect the normal life and did not operate again. During the final follow-up, no anchor extraction was found in all 96 aged patients. CONCLUSION: Modified anchor insertion with single-row suture arthroscopic rotator cuff repair technique for rotator cuff tear in aged patients could achieve satisfactory results and effectively reduce the anchor extraction rate.


Assuntos
Lesões do Manguito Rotador , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento
3.
J Healthc Eng ; 2021: 3088160, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34733453

RESUMO

In this paper, we have evaluated the clinical efficacy of rotator cuff surgery combined with Chinese medicine Buyang Huanwu Decoction (adding medicine) in the treatment of patients with rotator cuff injury. For this purpose, sixty patients with rotator cuff injury and shoulder arthroscopic surgery were selected in this hospital (where 57 cases were finally screened). The patients were divided into a control group (28 cases) and a study group (29 cases) by the envelope method. The control group received conventional treatment after the operation, whereas the study group was combined with Buyang Huanwu Decoction after the operation. The clinical efficacy of the two groups, particularly after treatment, was compared in terms of self-care ability and Constant-Murley scores before and after treatment, that is, 4 w, 8 w, and 12 w. The total effective rate of treatment in the study group was significantly higher than that of the control group after 4 weeks of treatment (P < 0.05). There was no significant difference in the FIM self-care scores of the two groups before treatment (P > 0.05). In the study group patients, after treatment for 4 w and 8 w, the FIM self-care score was significantly improved (P < 0.05). The FIM self-care score of the patients in the study group, after 12 w of treatment, had no significant difference compared with the control group (P > 0.05). The Constant-Murley scores of the two groups were compared before treatment where no significant difference is observed (P > 0.05) and the Constant-Murley score of the study group patients was significantly higher than that of the control group, after 4 w and 8 w treatment (P < 0.05). Additionally, Constant-Murley score of the study group was not significantly higher than that of the control group after 12 w of treatment difference (P > 0.05). The proposed combined treatment program has value of promotion and implementation in the clinical treatment of patients with rotator cuff injury.


Assuntos
Medicamentos de Ervas Chinesas , Lesões do Manguito Rotador , Artroscopia , Medicamentos de Ervas Chinesas/uso terapêutico , Humanos , Amplitude de Movimento Articular , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/tratamento farmacológico , Resultado do Tratamento
4.
BMC Musculoskelet Disord ; 22(1): 925, 2021 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-34732189

RESUMO

BACKGROUND: The study aimed to explore the additional value of repair of Lafosse I subscapularis injury compared with debridement in anterosuperior rotator cuff injury. METHODS: The prospective study was conducted on a total of 41 patients with supraspinatus tendon tear combined with Lafosse I subscapularis injury. Eighteen patients were divided into the repair group and 23 patients were divided into the non-repair group. The two groups were compared for intraoperative parameters, pain score, range of motion of the shoulder joint, shoulder joint function and quality of life (QoL) at pre-operation, 3 and 6 months postoperatively and the final follow-up visit. RESULTS: The width of supraspinatus tendon tear did not exceed 3 cm and did not retract beyond the glenoid in among patients. There was no statistical difference of preoperative data between two groups, including age, course of disease, positive Jobe test, positive Bear-hug test, positive Lift-off test, Patte stage, longitudinal tear and pain severity (P > 0.05). Compared to preoperative levels, the severity of pain, ASES scores and EQ-5D-3L scores were significantly lower at 3 and 6 months postoperatively and the final position (P < 0.05). However, there was no statistical difference in pain severity, ASES scores and EQ-5D-3L scores between repair group and non-repair group (P > 0.05). Similarly, compared to preoperative levels, the range of motion of shoulder joint was significantly improved after operation, including internal rotation, external rotation, forward flexion and elevation (P < 0.05). However, there was no statistical difference in range of motion of shoulder joint between repair group and non-repair group (P > 0.05). CONCLUSION: Operative treatment can effectively lessen severity of pain in the patients, improve shoulder joint function, increase the range of motion of the shoulder joint and enhance the QoL in treating anterosuperior rotator cuff injury. However, repair of subscapularis brings no benefit compared to debridement in treating supraspinatus tendon tear combined with Lafosse I subscapularis injury.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroscopia , Humanos , Estudos Prospectivos , Qualidade de Vida , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento
5.
Acta Chir Orthop Traumatol Cech ; 88(5): 369-374, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34738896

RESUMO

PURPOSE OF THE STUDY To compare the functional and radiological results of the total arthroscopic treatment (TAT) performed due to the rotator cuff (RC) tear problem with the results of the arthroscopically assisted mini-open surgery (AAMOS). MATERIAL AND METHODS This study conducted over a two-year period included all had TAT or AAMOS. Patients were included in the study if they had undergone arthroscopic or mini-open rotator cuff repair, with a minimum of 2 years' follow-up. Patients were divided into two groups in terms of the surgical technique performed. Patients who had TAT was included into the group 1 and, AAMOS group 2. Exclusion criteria included other significant intra-articular pathology such as SLAP lesions or glenohumeral arthrosis, previous rotator cuff surgery, massive rotator cuff tears (>5 cm), and neurologic disorders such as brachial plexopathy or suprascapular neuropathy. Every patient underwent magnetic resonance imaging evaluation before surgery and at last follow-up after surgery. Acromion typed of patients were recorded. Patients were questioned for ASES and Constant score. RESULTS Fifty-eight shoulders were included in the study. Twenty-eight patients were female and 30 were male. The mean age was 55.63 ± 8.06 years. Both groups had 29 patients per each. Mean follow-up period was 26.26 ± 11.46 months. There was no statistically significant difference between the mean age and gender distribution of the groups (p > 0.05). No statistically significant difference in the follow-up period between two groups (p > 0.05). No statistically significant difference was found between the postoperative ASES measurements between the two groups (p > 0.05). There was no statistically significant difference in postoperative Constant measurements between the two groups (p > 0.05). There was no statistically significant difference between the Acromion types between the two groups (p > 0.05). No statistically significant difference was found between the both groups in terms of accompanying shoulder pathology and AC joint degeneration (p > 0.05). In the postoperative MRIs of the patients, 7 patients in the Group 2 and 6 patients in the Group 1 were found to have recurrent tears. No statistically significant difference was found (p > 0.05). DISCUSSION When compared their patients who underwent RC repair by AAMOS intervention with those treated with TAT intervention and stated that the results were satisfactory for both groups and close to each other during their 2-year follow-up regardless of the tear diameter. Rotator cuff repairing with TAT is becoming a popular method of shoulder surgery. Initial reports of outcomes with this technique have indicated similar results when compared with open techniques, with less perioperative morbidity. Patients with RC tears treated by TAR, the shoulder range of motion was achieved in a shorter time and the rate of development of fibrous ankylosis was found to be lower. We performed the same configuration for the repair technique that may avoid to differ the results. Additionlay, all patients in study had the same rehabilitation protocol not to differ the results. Our study demonstrated similar results, with no differences noted in clinical outcomes between the TAT and the AAMOS for all scoring scales evaluated. Our experience with TAT notes a steep learning curve for proper technique. Certainly, surgeons may attempt a TAT, knowing that the patient's long-term outcome will not differ if the AAMOS is needed. CONCLUSIONS It must be kept in mind that both surgical methods may provide satisfactory results; the decision regarding which method should be used must be based on the skills, experience and technical oppurtunities of the orthopedic surgeon. However, any of the surgical technique is chosen, smilar excellent clinical results can be achieved. Key words: rotator cuff, mini-open surgery, total arthroscopic repair, cuff tear, Constant score, ASES score.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Acrômio , Artroscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento
6.
Arthroscopy ; 37(11): 3238-3240, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34740403

RESUMO

Rotator cuff repair may result in significant postoperative pain. Although opioids were once the gold standard, addiction and other side effects are of significant concern. Nonsteroidal anti-inflammatory drugs reduce pain, sleep disturbance, and need for opioids, but they may impair soft tissue healing. The use of gabapentinoids is equivocal. Intralesional analgesia carries a risk of glenohumeral chondrolysis. Cryotherapy is beneficial, but it is often not covered by insurance companies. Suprascapular nerve block addresses innervation of only 70% versus interscalene block, but the latter has a higher incidence of unintended, temporary motor and sensory deficits of the upper extremity and hemidiaphragmatic paresis, despite similar pain scores. Although neurodeficits and diaphragmatic hemiparesis resolve by 3 weeks, temporary complications affect length of hospital stay, initiation of physical therapy, and patient satisfaction. These variables contribute to the challenge of postoperative pain control amid a growing wave of modalities aimed at improving the extent and duration of patient-focused analgesia, especially the application of continuous block infusions.


Assuntos
Bloqueio do Plexo Braquial , Lesões do Manguito Rotador , Anestésicos Locais , Artroscopia , Diafragma , Humanos , Dor Pós-Operatória/tratamento farmacológico , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Ombro/cirurgia
7.
Am J Sports Med ; 49(13): 3656-3668, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34623941

RESUMO

BACKGROUND: In shoulders with irreparable massive rotator cuff tears (RCTs) with high-grade fatty degeneration (Goutallier stage 3 or 4) of the supraspinatus tendon and low-grade fatty degeneration (Goutallier stage 1 or 2) of the infraspinatus tendon (ISP), arthroscopic patch grafting (PG) has been reported as superior to partial repair (PR) regarding the ISP retear rate at short-term to midterm follow-up. However, the longer term outcomes are unclear. PURPOSE: To compare clinical and structural outcomes in the PG and PR groups at a minimum of 7 years postoperatively. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We evaluated 24 patients in the PG group and 24 patients in the PR group. We primarily used the Constant score for clinical outcomes and performed magnetic resonance imaging for structural outcomes in the PG and PR groups. The risk factors for a retear of the ISP were identified by univariate and multivariate (forward stepwise selection method) logistic regression analyses. We primarily compared values at midterm follow-up (<4 years) with values at the final follow-up (minimum 7 years) for each patient. RESULTS: The mean midterm and final follow-up times for the PG group were 41.0 and 95.1 months, respectively, compared with 35.7 and 99.3 months, respectively, for the PR group. We found significant differences for the midterm and final follow-up Constant total scores in the PG and PR groups (midterm follow-up: 79.1 vs 69.9, respectively [P = .001]; final follow-up: 76.0 vs 65.3, respectively [P = .006]) and in the Constant strength scores (midterm follow-up: 14.6 vs 8.5, respectively [P < .001]; final follow-up: 13.1 vs 8.3, respectively [P = .001]). Treatment group (PR) was a significant predictor of an ISP retear in the logistic regression analysis (odds ratio, 3.545; P = .043). CONCLUSION: Patients with low-grade massive RCTs treated with PG or PR improved significantly in terms of clinical outcomes at the midterm and final follow-up time points. However, Constant scores were significantly better in the PG group at the final follow-up.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroscopia , Autoenxertos , Fáscia , Seguimentos , Humanos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento
8.
Orthopedics ; 44(6): 333-340, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34618647

RESUMO

Biceps tenodesis and tenotomy are increasingly being used as treatment options for shoulder pathology, but patient satisfaction remains largely unstudied. A systematic review of the MEDLINE database was conducted to identify clinical outcome studies on isolated biceps tenodesis or tenotomy that reported patient satisfaction. Within the 15 investigations that were included, the indication for tenotomy was rotator cuff pathology, whereas the indication for tenodesis was biceps pathology or type 2 superior labral tear from anterior to posterior. Patients undergoing tenotomy were 13.6 years older than those undergoing tenodesis (P<.001). Patient satisfaction was high following both procedures, at 85.6% following tenotomy and 92.3% following tenodesis. [Orthopedics. 2021;44(6):333-340.].


Assuntos
Lesões do Manguito Rotador , Tenodese , Artroscopia , Humanos , Músculo Esquelético/cirurgia , Satisfação do Paciente , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Tenotomia
9.
Am J Sports Med ; 49(13): 3680-3686, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34652242

RESUMO

BACKGROUND: Biologic augmentation via extracellular matrix (ECM) scaffolds has been utilized to address rotator cuff tears with poor-quality tissue. PURPOSE: To evaluate the cellular changes in graft explants taken from patients treated with porcine dermal grafts for rotator cuff tears. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Four graft biopsy specimens were obtained from patients treated with porcine dermal grafts in an interposition technique for rotator cuff tears and compared with a nonimplanted graft and a normal rotator cuff specimen. Biopsy of the graft site was performed at 18 days, 3 months, 7 months, and 10.5 months after implantation. Hematoxylin and eosin staining was used to evaluate for cellular and vascular changes. Picrosirius red (PSR) stain with 90° polarized light was performed to evaluate collagen fibril size and orientation. All biopsy specimens were analyzed by a pathologist. RESULTS: There was evidence of progressive remodeling of the porcine dermal grafts. The most mature grafts demonstrated vessel infiltration and extensive remodeling without evidence of inflammation, foreign body reaction, or tissue rejection. PSR demonstrated increased organization of collagen domains, resembling normal tendon by 10.5 months postoperatively. CONCLUSION: This series suggests that ECM grafts may serve as an effective scaffold for host cell infiltration, collagen reorganization, and vascularization as a result of histologic changes demonstrated with retrieval of specimens from patients with rotator cuff tears that were augmented with porcine dermal grafts.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Animais , Colágeno , Humanos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Transplante de Pele , Suínos , Tendões
10.
BMC Musculoskelet Disord ; 22(1): 838, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34592991

RESUMO

BACKGROUND: Although rotator cuff syndrome is common and extensively studied from the perspective of producing healed tendons, influence of gender on patient-reported outcomes is less well examined. As activity and role demands may vary widely between men and women, clarity on whether gender is an important factor in outcome would enhance patient education and expectation management. Our purpose was to determine if differences exist in patient-reported outcomes between men and women undergoing rotator cuff surgery. METHODS: One hundred forty-eight participants (76 W:72 M) aged 35-75 undergoing surgery for unilateral symptomatic rotator cuff syndrome were followed for 12 months after surgery. Demographics, surgical data, and the Western Ontario Rotator Cuff (WORC) scores were collected. Surgery was performed by two fellowship-trained shoulder surgeons at a single site. RESULTS: There were no gender-based differences in overall WORC score or subcategory scores by 12 months post-op. Pain scores were similar at all time points in men and women. Women were more likely to have dominant-arm surgery and had smaller rotator cuff tears than men. Complication rates were low, and satisfaction was high in both groups. CONCLUSION: Patient gender doesn't appear to exert an important effect on patient-reported rotator cuff outcomes in this prospective cohort. Further work examining other covariates as well as the qualitative experience of going through rotator cuff repair should provide greater insight into factors that influence patient-reported outcomes.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroplastia , Artroscopia , Feminino , Humanos , Masculino , Estudos Prospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Ombro , Resultado do Tratamento
11.
Arthroscopy ; 37(10): 3049-3052, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34602147

RESUMO

Rotator cuff repair is performed to effect healing of the enthesis; to restore shoulder comfort, strength, and function; to prevent tear propagation; and to prevent progression of atrophic muscle changes (fatty degeneration, fatty infiltration, and fatty atrophy) that eventually occur. Non-retracted and moderately retracted rotator cuff tears usually heal after repair, and muscle atrophy may recover over time. It follows that early rotator cuff repair is beneficial for many patients with chronic but reparable rotator cuff tears. Diagnostic ultrasound can provide quantitative information about the recovery of both muscle and tendon and represents a viable alternative to magnetic resonance imaging for evaluating healing after rotator cuff repair.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Humanos , Atrofia Muscular/diagnóstico por imagem , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/patologia , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/patologia , Lesões do Manguito Rotador/cirurgia , Tendões , Ultrassonografia
12.
Arthroscopy ; 37(10): 3070-3071, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34602148

RESUMO

Subscapularis tears can sometimes be difficult to identify arthroscopically. Burkart recognized this and described the "comma sign," an arc formed by a portion of the superior glenohumeral ligament/coracohumeral ligament complex, to help identify the subscapularis when it is torn and retracted. The comma sign marks the superolateral corner of the torn subscapularis tendon. In the majority of cases, the comma sign can be identified on preoperative magnetic resonance imaging. Magnetic resonance imaging findings of a comma sign include a predominantly low T1 and T2 signal intensity band of soft tissue, situated anterior and medial to the anterior glenoid labrum, extending vertically immediately lateral to the base of the coracoid, and bridging the subscapularis and supraspinatus fossa. Knowing that a comma sign is present before an arthroscopic subscapularis repair should help surgeons identify and secure the leading edge of the subscapularis for repair.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Artroscopia , Humanos , Imageamento por Ressonância Magnética , 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
13.
Arthroscopy ; 37(10): 3079-3080, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34602149

RESUMO

Acromioplasty is a well-known, simple, and reproducible surgical technique that is used in isolation or in combination with other arthroscopic procedures. The clinical value of acromioplasty combined with arthroscopic rotator cuff repair has been largely investigated. Main theoretical benefits lie in the opportunity to improve the visualization, decrease abrasive wear with prominent acromial morphology, and release natural growth factors. On the other hand, acromioplasty and release of the coracoacromial ligament may weaken the insertion of the deltoid muscle, induce scar formation in the subacromial space, theoretically limiting shoulder mobility, and increase risk of anterior-superior humeral escape, especially in patients with large to massive rotator cuff tears. Clinical studies report conflicting results. My results show no differences in clinical outcomes in rotator cuff repairs with or without subacromial decompression, regardless of the acromial morphology. At the same time, I do believe that confirmatory studies are always necessary, especially if the aim is to disprove the usefulness of a common practice.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Acrômio/cirurgia , Artroplastia , Artroscopia , Humanos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia
14.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1341-1351, 2021 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-34651491

RESUMO

Objective: To summarize the research progress of interfacial tissue engineering in rotator cuff repair. Methods: The recent literature at home and abroad concerning interfacial tissue engineering in rotator cuff repair was analysed and summarized. Results: Interfacial tissue engineering is to reconstruct complex and hierarchical interfacial tissues through a variety of methods to repair or regenerate damaged joints of different tissues. Interfacial tissue engineering in rotator cuff repair mainly includes seed cells, growth factors, biomaterials, oxygen concentration, and mechanical stimulation. Conclusion: The best strategy for rotator cuff healing and regeneration requires not only the use of biomaterials with gradient changes, but also the combination of seed cells, growth factors, and specific culture conditions (such as oxygen concentration and mechanical stimulation). However, the clinical transformation of the relevant treatment is still a very slow process.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroplastia , Humanos , Regeneração , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Engenharia Tecidual
15.
J Shoulder Elbow Surg ; 30(12): 2691-2697, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34537339

RESUMO

BACKGROUND: The pain control efficacy, postoperative opioid requirements, and costs among patients undergoing major shoulder surgery using different perioperative analgesia modalities have been topics of active debate. Several studies have compared periarticular injection (PAI) to interscalene block (ISB) in shoulder arthroplasty, but there is a paucity of data comparing them in arthroscopic rotator cuff repair. METHODS: Patients aged 18-80 years with full-thickness rotator cuff tears and undergoing primary arthroscopic rotator cuff repair at 2 different shoulder centers were screened and subsequently randomized to receive either periarticular injection (PAI) of liposomal bupivacaine mixed with 0.25% bupivacaine (n = 41) or single-shot interscalene nerve block (ISB) (n = 36). Visual analog scale (VAS) pain scores, oral morphine equivalent (OME) use, Single Assessment Numerical Evaluation (SANE) scores, and costs were collected. Differences with P <.05 were considered statistically significant. RESULTS: Day of surgery VAS score and OME usage were significantly reduced with ISB vs. PAI (0.69 vs. 4.65, P < .001, and 18.66 vs. 34.39, P < .001, respectively). There were no significant differences between groups regarding VAS score on postoperative days (PODs) 1-3; however, OME usage on PODs 1 (50.5 vs. 38.8, P = .03) and 2 (48.1 vs. 37.8, P = .04) was significantly more in the ISB group. At POD 3, VAS score (4.13 vs. 3.97, P = .60) and OME use (28.60 vs. 31.16, P = .51) were similar. At 6 and 12 weeks, there were also no significant differences between groups regarding VAS and OME use. There was no difference in SANE score at 12 weeks following surgery between groups and no difference between average 12-week cumulative OME use between groups. The average charge for the PAI was $455, and the average charge for ISB was $745. CONCLUSION: Both ISB and PAI provide acceptable pain control following arthroscopic rotator cuff repair. Patients have less pain on the day of surgery with ISB, but rebound pain is significant after the block wears off, resulting in substantially increased opioid use in the first 2 PODs. However, cumulative opioid use between groups was similar. There were also no significant differences at the end of the 12-week episode of care in any of the other variables studied. The charge per patient for PAI is approximately $300 less than ISB. Thus, PAI may offer surgeons and patients an effective postoperative analgesic modality as an alternative to ISB.


Assuntos
Bloqueio do Plexo Braquial , Lesões do Manguito Rotador , Anestésicos Locais/uso terapêutico , Artroscopia , Bupivacaína , Humanos , Injeções Intra-Articulares , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/tratamento farmacológico , Lesões do Manguito Rotador/cirurgia
16.
Am J Sports Med ; 49(13): 3669-3679, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34554882

RESUMO

BACKGROUND: Tenocytes derived from tendons have been reported to be effective in the treatment of rotator cuff tears through the expression of extracellular matrix proteins. Human dermal fibroblasts, known to express collagen types I and III as tenocytes do, may likely be substitutes for tenocytes to enhance healing rotator cuff tears. PURPOSE: To demonstrate the capability of human dermal fibroblasts to enhance healing of rotator cuff tears. STUDY DESIGN: Controlled laboratory study. METHODS: The cellular properties and expression profiles of growth factors were compared between human dermal fibroblasts and tenocytes. In both cell types, a series of extracellular matrix proteins were analyzed along with matrix metalloproteinases and tissue inhibitors of metalloproteinases involved in the collagenolytic system. A total of 35 rabbits were divided into 5 groups: normal (n = 2), saline control (n = 9), fibrin control (n = 9), low dose of human fibroblasts (HF-LD; n = 9), and high dose of human fibroblasts (HF-HD; n = 6). Cells were injected into the sutured lesions at 6 weeks after creation of bilateral rotator cuff tears, followed by histological and biomechanical analyses at 12 weeks. RESULTS: Human dermal fibroblasts exhibited a protein expression pattern similar to that of tenocytes. More specifically, the expression levels of collagen types I and III were comparable between fibroblasts and tenocytes. The histological analysis of 30 surviving rabbits showed that collagen fibers were more continuous and better oriented with a more mature interface between the tendon and bone in the sutured lesions in the HF-LD and HF-HD groups. Most importantly, biomechanical strength, measured using the load to failure at the injection site, was 58.8 ± 8.9 N/kg in the HF-HD group, increasing by approximately 2-fold (P = .0003) over the saline control group. CONCLUSION: Human dermal fibroblasts, showing cellular properties comparable with tenocytes, effectively enhanced healing of chronic rotator cuff tears in rabbits. CLINICAL RELEVANCE: Human dermal fibroblasts can be used in place of tenocytes to enhance healing of rotator cuff tears.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Animais , Fenômenos Biomecânicos , Fibroblastos , Humanos , Coelhos , Manguito Rotador/cirurgia , Tendões , Cicatrização
17.
Am J Sports Med ; 49(12): 3173-3183, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34494901

RESUMO

BACKGROUND: Despite advances in surgical techniques, the use of maximal repair to treat large or massive rotator cuff tears results in a high retear rate postoperatively. Currently, no randomized controlled trials have compared the outcomes of maximal repair with interposition dermal allograft bridging reconstruction. HYPOTHESIS: We hypothesized that large or massive rotator cuff tendon tears reconstructed using bridging dermal allograft would have better clinical outcomes 2 years postoperatively, as measured using the Western Ontario Rotator Cuff (WORC) index, than would those receiving the current gold standard treatment of debridement and maximal repair alone. We also expected that patients treated via bridging reconstruction using dermal allograft would have fewer postoperative failures as assessed using postoperative magnetic resonance imaging scans. STUDY DESIGN: Randomized controlled trial; Level of evidence 1. METHODS: A sample size of 30 patients (determined using a priori sample size calculation) with massive, retracted rotator cuff tears were randomly allocated to 1 of 2 groups: maximal repair or bridging reconstruction using dermal allograft. All patients completed questionnaires (WORC and Disabilities of the Arm, Shoulder and Hand [DASH]) preoperatively and postoperatively at 3 months, 6 months, 1 year, and 2 years. The primary outcome of this study was the WORC index at 2 years. Secondary outcomes included healing rate, progression of rotator cuff arthropathy, and postoperative acromiohumeral distance in both groups. RESULTS: Patients treated via bridging reconstruction using dermal allograft had better postoperative WORC and DASH scores (23.93 ± 24.55 and 15.77 ± 19.27, respectively) compared with patients who received maximal repair alone (53.36 ± 31.93 and 34.32 ± 23.31, respectively). We also noted increased progression to rotator cuff arthropathy in the maximal repair group with an increased retear rate when compared with the reconstruction group (87% and 21%, respectively; P < .001). The acromiohumeral distance was maintained in the reconstruction group but significantly decreased in the maximal repair group. CONCLUSION: Rotator cuff bridging reconstruction using a dermal allograft demonstrated improved patient-reported outcomes as measured using the WORC index 2 years postoperatively. This technique also showed favorable structural healing rates and decreased progression to arthropathy compared with maximal repair. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01987973).


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Aloenxertos , Humanos , Estudos Prospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Tendões
18.
Am J Sports Med ; 49(12): 3196-3201, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34528841

RESUMO

BACKGROUND: Arthroscopic treatment of calcifying tendinitis of the shoulder reveals good to excellent results. However, whether the tendon needs to be repaired after removal of the calcific deposit or simply debrided remains unclear. PURPOSE: To evaluate the structural and clinical results after arthroscopic calcific deposit removal with additional rotator cuff repair or rotator cuff debridement. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 44 patients (46 shoulders) were enrolled in this retrospective cohort study with a mean follow-up of 58.4 months. Patients underwent arthroscopic removal of a calcific deposit and bursectomy after failed nonoperative treatment. A total of 22 patients received additional rotator cuff repair irrespective of the degree of debridement (the repair group), whereas 22 patients received a simple rotator cuff debridement without additional repair (the debridement group). Groups were comparable in sex, age, and size and consistency of the deposits according to the Gärtner and Bosworth classifications. Clinical evaluation was performed by the Constant score, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, and numerical rating scales for pain, function, and satisfaction. In 29 patients (14 in the debridement group and 15 in the repair group), additional magnetic resonance imaging at follow-up was performed to evaluate the structural results using the Sugaya classification. RESULTS: All patients were satisfied with the results of surgery; 100% of the repair group and 95.7% of the debridement group reported they would undergo the surgical procedure again. Comparison of the clinical results showed significantly better results in the repair group versus the debridement group for the Constant score (86.2 vs 80.6, respectively; P = .04), the ASES score (98.3 vs 88.9; P = .004), the Simple Shoulder Test (11.6 vs 10; P = .005), and the numerical rating scales for pain (0.1 vs 0.8; P = .007), function (9.6 vs 8.8; P = .008), and satisfaction (9.8 vs 9.1; P = .036). Comparison of the postoperative tendon integrity showed 80% Sugaya grade I in the rotator cuff repair group and 64% Sugaya grade II in the debridement group, with a statistically significant difference in favor of the repair group (P = .004). Postoperative clinical evaluation revealed no positive O'Brien tests in the repair group, whereas approximately one-third of the debridement group showed a positive O'Brien test during examination. CONCLUSION: Arthroscopic removal of calcific deposits with rotator cuff debridement or cuff repair showed good to excellent clinical and structural midterm results. However, patients who underwent additional repair of the tendon defect had significantly better clinical results as well as better structural results in terms of tendon integrity.


Assuntos
Lesões do Manguito Rotador , Tendinopatia , Artroscopia , Estudos de Coortes , Desbridamento , Humanos , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Ombro , Tendinopatia/cirurgia , Resultado do Tratamento
19.
BMC Musculoskelet Disord ; 22(1): 749, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465332

RESUMO

BACKGROUND: Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing. METHODS: A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ2. The association between retear rate after surgery and patients' age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used. RESULTS: Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3-6 months follow-up, 16% at 6-12 months follow-up, 21% at 12-24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures). CONCLUSIONS: Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroplastia , Artroscopia , Humanos , Imageamento por Ressonância Magnética , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/epidemiologia , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento
20.
Arthroscopy ; 37(9): 2743-2744, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34481616

RESUMO

Overtension repair of rotator cuff tear may predispose to the failure of postoperative integrity of the rotator cuff tendon. Surgeons should consider the size of the rotator cuff tear and maintain adequate tension for successful rotator cuff repair. Feel the tension on the tendon: too much can poison the outcome.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroscopia , Humanos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Tendões , Resultado do Tratamento
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