Outcomes and retear rates after subacromial and glenohumeral injection of a chitosan-based thermosensitive anti-adhesive agent during arthroscopic rotator cuff repair: a propensity score-matched analysis.

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The Greenhouse technique provides lower retear rate and similar outcomes in rotator cuff repair: a prospective randomized controlled trial.

Background:The treatment of full-thickness cartilage lesions of the humeral head in active-duty servicemembers (ADSMs) who have concomitant full-thickness rotator cuff tears and focal cartilage lesions of the humeral head is uncommon and presents clinical challenges.Purpose:To compare the midterm clinical and functional outcomes of ADSMs who underwent isolated arthroscopic rotator cuff repair (ARCR) with those who underwent ARCR and concomitant humeral head microfracture (HHMfx) for focal, full-thickness cartilage lesions of the humeral head.Study Design:Cohort study; Level of evidence, 3.Methods:This was a retrospective analysis of ADSMs from a single duty-station who underwent ARCR for full-thickness rotator cuff tears between January 2014 and June 2019 with a minimum follow-up of 5 years. Patients who underwent ARCR + HHMfx were compared with those who underwent isolated ARCR based on outcome measures including the visual analog scale (VAS), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Statistical analysis was performed using paired t tests to compare preoperative and postoperative outcomes. Minimal clinically important difference (MCID) was also evaluated, but not Patient Acceptable Symptom State or substantial clinical benefit due to the small sample size.Results:A total of 74 patients were eligible for inclusion, with 22 undergoing ARCR + HHMfx and 52 undergoing isolated ARCR. Significant postoperative improvements were observed in all patient-reported outcome measures (P < .0001 for all). Comparisons between the 2 cohorts demonstrated no significant differences in VAS pain scores (0.9 ± 1.6 vs 0.6 ± 1.0, respectively; P = .3045) but significantly improved SANE (90.2 ± 10.7 vs 95.1 ± 6.5; P = .0178) and ASES (91.7 ± 10.9 vs 96.1 ± 5.9; P = .0293) scores in the isolated ARCR group. Among patients in the ARCR + HHMfx group, MCID achievement rates were 90.9% (n = 20) for VAS, 77.3% (n = 17) for SANE, and 95.5% (n = 21) for ASES. All patients within the isolated ARCR group met the MCID thresholds for VAS, SANE, and ASES scores. Range of motion improved, although changes in forward flexion, external rotation, and internal rotation were not statistically significant (P > .05 for all). At the final follow-up, 20 (90.9%) patients in the ARCR + HHMfx group and 48 (92.3%) patients in the ARCR group returned to preinjury work and activity levels (P > .9999). Similarly, 19 (86.4%) patients in the ARCR + HHMfx group and 46 (88.5%) patients in the ARCR group returned to preinjury sports participation (P > .999). One patient (4.6%) in the ARCR + HHMfx group and 2 patients (3.9%) in the ARCR group progressed to total shoulder arthroplasty (TSA). Other complications included stiffness in 1 patient (1.9%) in the ARCR group and retear in 3 patients (5.8%) in the ARCR group.Conclusion:ARCR + HHMfx resulted in significant improvements in pain, function, and patient-reported outcomes at midterm follow-up that were comparable to outcomes for isolated ARCR. Although return-to-work and return-to-sport rates were slightly higher with the isolated ARCR group, this did not reach statistical significance, and the 95% TSA-free survival rate suggests that this combined approach appears to be a viable joint-preserving option for select patients with concomitant rotator cuff tears and focal humeral head cartilage lesions. However, study limitations include the retrospective design, small sample size, and heterogeneity introduced by concomitant procedures.

Defining minimal clinically important difference, patient acceptable symptomatic state and substantial clinical benefit for the visual analog scale pain score after arthroscopic rotator cuff repair

Joint stiffness after arthroscopic rotator cuff repair is a major concern for orthopaedic surgeons. Various antiadhesive agents are commonly administered after rotator cuff repair for its prevention. This study aimed to compare the outcomes among patients injected with different types and amounts of anti-adhesive agents after rotator cuff repair. It was hypothesized that the outcomes might differ depending on the use of the anti-adhesive agent and its type and dose. A total of 267 patients who underwent arthroscopic rotator cuff repair with or without subacromial injection of anti-adhesive agents were enrolled. The first group (group A; 51 patients) were injected with 3mL of poloxamer/sodium alginate-based anti-adhesive agent. The second group (group B; 93 patients) were injected with 3mL of sodium hyaluronate-based anti-adhesive agent. The third group (group C; 82 patients) were injected with 1.5mL of sodium hyaluronate-based anti-adhesive agent. Finally, the last group (group D; 41 patients) who did not use anti-adhesive agents served as the control. The range of motion (ROM) and pain VAS scores were measured preoperatively and at 5weeks, 3months, 6months, and 1year postoperatively. Functional outcomes were evaluated using American Shoulder and Elbow Surgeons and Constant scores, whereas cuff integrity was assessed via MRI or ultrasonography at least 6months postoperatively. All ROM measurements, pain VAS scores, and functional scores were significantly improved regardless of the use, type, and dose of the anti-adhesive agents. In addition shoulder ROM and rotator cuff healing did not significantly differ among the groups (all n.s.). No significant differences were found in the clinical and anatomical outcomes according to the type and dose of the anti-adhesive agents subacromially injected after rotator cuff repair. III.

Minimal clinically important differences in the American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale pain scores after arthroscopic rotator cuff repair

BackgroundArthroscopic rotator cuff repair generally has a good clinical outcome but shoulder stiffness after surgery due to subacromial adhesion is one of the most common and clinically important complications. Sodium hyaluronate (HA) has been reported to be an anti-adhesive agent in a range of surgical procedures. However, there are few reports of the outcomes of arthroscopic rotator cuff repair of the shoulder. This study examined whether a subacromial injection of HA/carboxymethylated cellulose (CMC) affected the postoperative shoulder stiffness and healing of rotator cuff repair, as well as the safety of an injection.MethodsBetween January 2008 and May 2008, 80 consecutive patients with arthroscopic rotator cuff repair were enrolled. The patients were assigned randomly to the HA/CMC injection group (n = 40) or control group (n = 40). All patients were evaluated using the visual analog scale (VAS) for pain, passive range of motion at 2, 6 weeks, 3, 6, 12 months after surgery, and the functional scores at 6, 12 months postoperatively. Cuff healing was also evaluated using CT arthrography or ultrasonography at 6 or 12 months after surgery.ResultsThe HA/CMC injection group showed faster recovery of forward flexion at 2 weeks postoperatively than the control group but the difference was not statistically significant (p = 0.09). There were no significant difference in pain VAS, internal rotation, external rotation and functional scores between two groups at each follow-up period. The functional scores improved 6 months after surgery in both groups but there were no differences between the two groups. The incidence of unhealed rotator cuff was similar in the two groups. There were no complications related to an injection of anti-adhesive agents including wound problems or infections.ConclusionsA subacromial injection of an anti-adhesive agent after arthroscopic rotator cuff repair tended to produce faster recovery in forward flexion with no adverse effects on cuff healing. However, its anti-adhesive effects after rotator cuff repair should be considered carefully with further studies.

Recently there have been several evolving trends in the practice of shoulder surgery. Arthroscopic subacromial decompression has been performed with greater frequency by orthopaedic surgeons, and there has been considerable recent interest in arthroscopic rotator cuff repair. The purpose of this study was to identify trends in practice patterns for subacromial decompression and rotator cuff repair over time and in relation to the location of practice, fellowship training, and declared subspecialty of the surgeon. We reviewed the American Board of Orthopaedic Surgery Part II database to identify patterns in the utilization of open and arthroscopic subacromial decompression and rotator cuff repair among candidates for board certification. All procedures involving only arthroscopic or open subacromial decompression and/or rotator cuff repair from 2004 to 2009 were identified. The rates of arthroscopic and open subacromial decompression and/or rotator cuff repair were compared in terms of year, geographic region, fellowship training, and declared subspecialty of the surgeon. Between 2004 and 2009, 12,136 surgical procedures involving only arthroscopic or open subacromial decompression and/or rotator cuff repair were performed. There were significant differences in treatment with respect to year, geographic region of practice, declared subspecialty, and fellowship training (p < 0.001). There was a significant increase over time in the utilization of arthroscopy among all candidates (p < 0.001). Surgeons with sports medicine fellowship training or a sports-medicine-declared subspecialty performed significantly more subacromial decompressions and rotator cuff repairs arthroscopically than all other candidates (p < 0.001). During this time period, there was a significant decrease in the rate of arthroscopic subacromial decompression, both as an isolated procedure and combined with arthroscopic rotator cuff repair (p < 0.001). From 2004 to 2009, there was a significant shift throughout the United States toward arthroscopic rotator cuff repair and subacromial decompression among young orthopaedic surgeons, with sports medicine fellowship-trained surgeons performing more of their procedures arthroscopically than surgeons with other training. However, there was an increasing frequency of arthroscopic rotator cuff repair performed without subacromial decompression, and, overall, there was a decrease in the frequency of isolated arthroscopic subacromial decompression over time.

The effects of nonsteroidal anti-inflammatory medications after rotator cuff surgery: a randomized, double-blind, placebo-controlled trial.

Rotator cuff tears are common musculoskeletal injuries frequently requiring surgical intervention, yet retears occur at a notable rate. Teriparatide (recombinant human parathyroid hormone, rhPTH) has shown promise in animal studies for enhancing bone and tendon healing. However, limited human data exist on its clinical benefits when used adjunctively in arthroscopic rotator cuff repairs. To investigate whether the systemic administration of teriparatide improves functional outcomes following arthroscopic rotator cuff repair in a triple-blind, randomized controlled trial (RCT). Fifty adult patients (aged 50-80 years) with degenerative rotator cuff tears were randomized (1:1) to receive daily subcutaneous injections of either teriparatide (20 μg) or placebo for 3 months after arthroscopic repair. Blinded evaluators assessed participants at baseline, 6 months, and 1 year. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. Secondary outcomes included range of motion (ROM), Visual Analog Scale (VAS) for pain, nighttime pain, painkiller use, and magnetic resonance imaging (MRI) assessment of tendon integrity (Sugaya classification). Final analyses included 43 participants (rhPTH group = 23, control group = 20). Both the rhPTH and control groups demonstrated significant within-group improvements in ASES scores, ROM, and pain scores from baseline to 1 year (p < 0.0001). However, no significant between-group differences were observed at the 6-month or 1-year follow-up for the ASES score (p = 0.87), ROM in all planes, or VAS pain scores. MRI evaluations at 1 year showed comparable retear rates (8.7% vs. 10%, p = 0.94), indicating no significant advantage of teriparatide in promoting tendon integrity. In this triple-blind RCT, teriparatide did not confer additional benefits over placebo in improving functional outcomes or reducing retear rates 1 year after arthroscopic rotator cuff repair. Larger RCTs that include a broader patient population are required to fully clarify the role of teriparatide in enhancing rotator cuff repair outcomes. Level II. See Instructions for Authors for a complete description of levels of evidence.

Clinical Outcomes of Rotator Cuff Repair With Arthroscopic Capsular Release and Manipulation for Rotator Cuff Tear With Stiffness: A Matched-Pair Comparative Study Between Patients With and Without Stiffness