Open Rotator Cuff Repair Research Articles

Assessment of the Impact of Gabapentin on Postoperative Pain Following Shoulder Open Rotator Cuff Repair: A Double-Blind Clinical Trial

BackgroundGabapentin is an anticonvulsant used for managing neuropathic pain. Its effectiveness and dosing strategies for postoperative pain, particularly in open shoulder rotator cuff repair, are still debated. This study assesses gabapentin ‘s impact on postoperative pain intensity in open rotator cuff repair. MethodsSixty eligible patients were randomly distributed into two groups: placebo and gabapentin. The gabapentin group received a daily dose of 600 mg, administered in two divided increments, beginning three days before the surgery and continuing for one week postoperatively. Pain intensity, assessed via the Visual Analog Scale (VAS), was the primary endpoint during the first postoperative week. Secondary aims conducted on both groups included quantifying opioid consumption, evaluation of side effects attributed to gabapentin and opioids, assessment of sleep quality, and patients’ satisfaction levels with the employed approach. ResultPostoperative pain in the gabapentin group significantly decreased from the first twenty-four hours until the fourth day post-surgery (p<0.002), accompanied by reduced opioid consumption (P=0.02). Following discharge, the prevalence of nocturnal sleep disruptions and oxycodone consumption in the gabapentin group notably decreased compared to the placebo group, alongside a significant improvement in sleep quality and duration until the fifth day, as well as overall satisfaction with the pain management approach seen within the gabapentin group (P=0.003). ConclusionAdministering gabapentin perioperatively at 600 mg daily and divided over a minimum duration of four days postoperatively may significantly reduce postoperative pain intensity and opioid consumption in open shoulder rotator cuff repair surgery patients.

Outcome of mini open anterolateral rotator cuff repair by suture anchor

Background: Rotator cuff tears are a prevalent cause of shoulder pain and dysfunction, necessitating effective surgical interventions to restore function and alleviate symptoms. The mini open anterolateral rotator cuff repair technique using suture anchors has emerged as a promising approach, combining the advantages of arthroscopic and open surgery. This study aimed to evaluate the outcomes of mini open anterolateral rotator cuff repair with suture anchors, focusing on pain relief, range of motion, functional outcomes, complications, and radiographic assessments. Methods: A retrospective analysis was conducted on 30 patients who underwent mini open anterolateral rotator cuff repair. Patient demographics, surgical details, postoperative outcomes, complications, and radiographic findings were evaluated. Results: The average pain score significantly decreased from 7.8 (SD=1.2) preoperatively to 2.3 (SD=0.8) postoperatively (p&lt;0.001). Range of motion improved with an average increase from 60 to 150 degrees of abduction and from 50 to 140 degrees of flexion (p&lt;0.001). Functional outcomes, assessed by the American Shoulder and Elbow Surgeons (ASES) score, increased from 45 to 85 points (p&lt;0.001). Complications, including joint stiffness, pain, and re-tears, were effectively managed. Radiographic assessments demonstrated satisfactory healing and alignment in the majority of patients. Conclusions: Mini open anterolateral rotator cuff repair with suture anchors is an effective and safe surgical approach for managing rotator cuff injuries, leading to improved clinical outcomes and favorable radiographic findings. Further research is warranted to validate these findings and optimize treatment strategies.

Evaluating the Effect of Rotator Cuff Repair With Concomitant Distal Claviculectomy on 2 and 4 Year Reoperation Rates.

The current literature has differing views on the efficacy of concomitant distal claviculectomy (DC) during rotator cuff repair (RCR) in preventing revision surgery. Our aim was to investigate the revision surgery rate between RCR with DC and RCR without DC. A retrospective cohort analysis was conducted using a national claims database. Patients undergoing open or arthroscopic primary RCR with or without concomitant DC were identified. The primary outcome was 4-year revision surgery rates. Univariate analysis was conducted using chi-square or Student t tests. Multivariable analysis was conducted using logistic regression, and an adjusted number needed to harm was calculated. A total of 131,232 patients met inclusion criteria. After logistic regression, patients undergoing RCR with DC had higher odds of requiring a subsequent DC procedure [OR; 95% CI; P-value (1.49; 1.35-1.64; P < 0.001)] but lower odds of any revision surgery (0.87; 0.80-0.91; P < 0.001) within 4 years than those who underwent RCR without DC. Although associated with a lower rate of overall revision surgeries within 2 and 4 years of RCR, those who underwent RCR with DC were 85% more likely at 2 years and 49% more likely at 4 years to undergo revision surgery of the distal clavicle than those without concomitant DC.

Rotator Cuff Repair: Racial Disparities in Operative Time and Utilization of Arthroscopic Techniques.

Background Racial disparities are prevalentwithin the field of orthopedics and include the utilization of varying resources as well as outcomes following surgery. This study investigates racial differences between Black and White patients in the surgical treatment of rotator cuff repair (RCR) and 30-day postoperative complications following RCR. Materials and methods Data were drawn from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to create a study population consisting of Black and White patients who underwent RCR between 2015 and 2019. A bivariate analysis was conducted to compare patient demographics and comorbidities. Multivariate logistic regression, controlling for all significantly linked patient demographics and comorbidities, was performed to examine the relationships between Black race and complications. Results Our analysis included 32,073 patients, of whom 3,318 (10.3%) were Black and 28,755 (89.7%) were White. The female gender, younger age groups, greater BMI groups, ASA classification ≥3, cigarette use, and comorbid congestive heart failure (CHF), diabetes, and hypertension were all significantly associated with patients who identified as Black. We found no significant differences in 30-day postoperative complications between Black and White patients. Furthermore, Black patients were found to be independently associated with a greater likelihood of undergoing arthroscopic RCR versus open RCR, as well as experiencing a longer total operation time of ≥80 minutes. Conclusions We report no differences in 30-day postoperative complications between Black and White patients undergoing RCR between 2015 and 2019. However, Black race was independently associated with higher rates of arthroscopic RCR and longer operative times.

Regional differences in reimbursement, volume, and patient characteristics exist for rotator cuff repairs: a temporal analysis from 2013 to 2021

Prior studies have demonstrated declining reimbursement and changing procedural utilization across multiple orthopedic subspecialties, yet a comprehensive examination of this has not been performed for rotator cuff repair, particularly at a geographic level. The purpose of this study was to evaluate changes in reimbursement, utilization, and patient populations for open and arthroscopic rotator cuff repairs (RCR) from 2013 to 2021 at a national and regional level. The Medicare Physician and Other Practitioners database from years 2013 to 2021 were queried to extract all episodes of open chronic RCR, open acute RCR, and arthroscopic RCR. Utilization was measured as procedural volume per 10,000 Medicare beneficiaries. Inflation-adjusted reimbursement, utilization, surgeon information, and patient characteristics were extracted for each procedure for each year. Data was stratified geographically based on US Census regions and rural-urban commuting codes. Kruskal-Wallis tests and linear regressions were performed to compare geographical areas. Between 2013 and 2021, arthroscopic RCR utilization increased by 9.4% (11.0/10,000 to 12.0/10,000), while open chronic RCR utilization decreased by 58.8% (2.0/10,000 to 0.8/10,000). During that time, average inflation-adjusted reimbursement declined by 10.0% and 11.3% for arthroscopic and open chronic RCR, respectively. The increase in utilization and decrease in reimbursement was greatest in the Midwest. In 2021, arthroscopic RCR utilization was 12.0/10,000, while average reimbursement for was $846.87, nationally. Utilization was highest in the South (14.5/10,000) and lowest in the Northeast (8.1/10,000) (p<0.001). Alternatively, reimbursement was highest in the Northeast ($904.60) and lowest in the South ($830.80) (p<0.001). The proportion of patients who were male, Medicaid eligible, or non-White was highest in the West (p<0.001). Patients in the West also had the fewest comorbidities. Increased patient comorbidities, when controlling patient demographics, was associated with lower reimbursement nationally and within the Northeast (p<0.001). Geographical discrepancies in rotator cuff repair utilization and reimbursement exist. The South consistently demonstrates the highest utilization of RCR, while also having the lowest reimbursement. Alternatively, the Northeast has the lowest utilization but the highest reimbursement. Increased patient population comorbidities were associated with reduced RCR reimbursement for surgeons in the Northeast, but not in other regions.

Incidence and risk factors for shoulder stiffness after open and arthroscopic rotator cuff repair.

The aim of this study was to estimate the incidence of stiffness during the first 6 months after rotator cuff repair and to evaluate postoperative stiffness with respect to its risk factors and its influence on the outcome at 6 months postoperatively. In a prospective cohort of 117 patients (69 women, 48 men; average age 59) from our institutional rotator cuff registry, who underwent either arthroscopic (n = 77) or open (n = 40) rotator cuff repair, we measured shoulder range of motion (ROM) at 3 and 6 months post-surgery. We evaluated the incidence of stiffness and analyzed functional outcomes, comparing various preoperative and intraoperative factors in patients with stiffness to those without at the 6-month mark. Shoulder stiffness was observed in 31% of patients (36/117) at 3 months postoperatively, decreasing to 20% (23/117) at 6 months. No significant link was found between stiffness at 6 months and demographic factors, preoperative stiffness, tear characteristics, or the type of repair. Notably, patients undergoing arthroscopic repair exhibited a 4.3-fold higher risk (OR 4.3; 95% CI 1.2-15.6, p = 0.02) of developing stiffness at 6 months compared to those with mini-open repair. Despite these differences in stiffness rates, no significant variation was seen in the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, or Visual Analog Scale (VAS) scores at 6 months between the groups. The incidence of postoperative shoulder stiffness following rotator cuff repair was substantial at 31% at 3 months, reducing to 20% by 6 months. Mini-open repair was associated with a lower 6-month stiffness incidence than arthroscopic repair, likely due to variations in rehabilitation protocols. However, the presence of stiffness at 6 months post-surgery did not significantly affect functional outcomes or pain levels.

The Effect of Concomitant Biceps Tenodesis on Revision Surgery Rates After Primary Rotator Cuff Repair.

We aimed to use a national database to compare the 4-year revision surgery rates after rotator cuff repair (RCR) in patients with concomitant biceps tenodesis (BT) versus those without BT. A retrospective cohort analysis was conducted using the PearlDiver database from 2015 to 2017. Patients undergoing primary open and arthroscopic RCR with and without BT were identified. Demographic variables, 90-day complications, and 2- and 4-year revision surgery rates were analyzed, and a multivariable logistic regression was conducted. Of the 131,155 patients undergoing RCR, 24,487 (18.7%) underwent concomitant BT and 106,668 (81.3%) did not. After controlling for comorbidities and demographics, patients with concomitant BT were associated with lower odds of all-cause revision (OR; P-value [0.77; P < 0.001]), revision BT (0.65; P < 0.001), revision RCR (0.72; P < 0.001), and shoulder arthroplasty (0.81; P = 0.001) within 4 years when compared with those without concomitant BT. In our analysis, patients undergoing primary RCR with concomitant BT had 35% reduced odds of revision BT and 23% reduced odds of any all-cause revision within 4 years when compared with those without concomitant BT. This suggests that tenodesis at the time of primary RCR may be associated with a reduction in the utilization of ipsilateral shoulder revision surgery rates.

Anchorless Arthroscopic Transosseous Rotator Cuff Repair.

Rotator cuff repair techniques have evolved over time. The original techniques were open procedures, then surgeons adopted arthroscopic repair procedures with anchors and implants. Today, rotator cuff repair has evolved to be performed as an arthroscopic transosseous technique that is again performed without the use of anchors. In this video, the 5 essential steps of arthroscopic transosseous repair will be demonstrated. (1) Position the patient in either the beach chair or lateral decubitus position. (2) Utilize 4-portal arthroscopy, which allows a consistent vantage point while having 3 other portals for instrumentation. (3) Perform just enough bursectomy to expose the rotator cuff. (4) Anatomically reduce the rotator cuff anatomy where possible. (5) Triple-load the transosseous tunnels with high-strength sutures in order to maximize the biomechanical strength of the repair. Alternative surgical techniques include open rotator cuff repair and single and double-row rotator cuff repair using anchors. The goal of any rotator cuff repair is to anatomically restore the rotator cuff. The fundamental principles include a strong initial biomechanical fixation, cuff footprint anatomy restoration, and maximization of biological factors to promote healing of the rotator cuff. Rotator cuff repair was originally performed as an open procedure, which allows for direct visualization of the tear and repair; however, open repair requires some level of deltoid splitting, which can potentially affect postoperative early mobilization. Single-row and double-row cuff repairs can both be performed arthroscopically. Proponents of the double-row procedure prefer that technique for its footprint restoration and stronger biomechanical fixation; however, the double-row procedure can result in overtensioning of the repair and can lead to medial-based rotator cuff failures. Proponents of the single-row procedure prefer that technique for its ease of operation, fewer implants, lower cost, and low repair tension; however, the single-row procedure fixes the tendon at a single point, limiting the repaired footprint, and can be associated with lower fixation strength. The arthroscopic transosseous rotator cuff repair achieves all of the above goals as it provides strong initial fixation and anatomic footprint restoration, which allows maximal patient biology for healing. There are numerous studies that can attest to the success of arthroscopic transosseous repair. Some of the benefits include decreased health-care costs and postoperative pain levels. In a 2016 study of 109 patients undergoing arthroscopic transosseous rotator cuff repair, Flanagin et al. reported a mean American Shoulder and Elbow Surgeons (ASES) score of 95 and a failure rate of 3.7% at mid-term follow-up1. Similarly, in a study comparing transosseous repair to transosseous equivalent repair, Srikumaran et al. reported that patients undergoing transosseous repair had a mean ASES score of 92 and a failure rate of 14%, with no significant differences between treatment groups2. Finally, in a study assessing the results of arthroscopic transosseous rotator cuff repair at >10 years postoperatively, Plachel et al. reported a mean ASES score of 92 and a failure rate of 27%3. Compared with conventional rotator cuff with anchors, the transosseous cuff repair can lead to cut-out of the repair sutures from the bone.Use a 4-portal arthroscopy technique, which will help the surgeon visualize all tear configurations while instrumenting them.Perform just enough bursectomy, in order to preserve the growth factors for cuff healing.Take care to minimize tuberosity trauma as a result of burring.Prepare the transosseous tunnels with a wide bone bridge.Load each tunnel with 3 high-strength sutures in order to maximize repair strength.Restore the rotator cuff footprint to facilitate tissue healing. ASES = American Shoulder and Elbow SurgeonsRCR = rotator cuff repairATRCR = arthroscopic transosseous rotator cuff repairARCR = arthroscopic rotator cuff repairPDS = polydioxanone sutureROM = range of motionSSV = Subjective Shoulder ValueFF = forward flexionOR = operating roomFU = follow-up.

Comparison of Outcomes between Open and Arthroscopic Rotator Cuff Repair.

The objective of this retrospective cohort study is to evaluate the long-term clinical and functional outcomes of two surgical techniques for rotator cuff repair, namely, open and arthroscopic methods. A total of 100 patients diagnosed with rotator cuff tears and treated at Seyhan State Hospital in the past five years were enrolled, considering the same inclusion criteria for both groups. The study groups consisted of 50 patients who underwent open rotator cuff repair and 50 patients who underwent arthroscopic rotator cuff repair. We used the SPSS programme to analyse the data, focusing on parameters such as postoperative recovery time, functional capacity scores, pain levels measured by the VAS scale, quality of life evaluated by the SF-36 scores, and complication rates. Both methods resulted in similar recovery times and functional capacity scores, but patients treated with the open method reported slightly lower pain levels (average VAS score: 2.8) compared to those treated with the arthroscopic method (average VAS score: 3.1). The study also found slightly better quality of life scores in the arthroscopic group (average SF-36 score: 71.4) compared to the open surgery group (average SF-36 score: 68.7). The complications rates were lower in the arthroscopic group (2%) than in the open surgery group (4%), but these differences were not statistically significant. The study suggests that, while there are no significant differences in terms of clinical outcomes between the two surgical methods, short-term pain levels may be influenced by the more frequent application of acromioplasty in arthroscopic methods. Therefore, the choice of the surgical method should be made based on the unique characteristics, including the location and size, the patient's overall health status, and the surgeon's experience. These findings should be used as a guide and not as absolute results.

Short-term efficacy of open surgery versus arthroscopic rotator cuff repair in moderate rotator cuff tears.

To evaluate the clinical efficacy of open versus arthroscopic rotator cuff repair in treating moderate rotator cuff tears. A retrospective study was conducted on 68 patients diagnosed with moderate rotator cuff tears and who were treated surgically at Hangzhou Fuyang Hospital of Traditional Chinese Medicine Orthopedics and Traumatology from September 2021 to April 2023. Patients were categorized based on the surgical methods they received: the minimally invasive group (MIG, n=37, undergoing arthroscopic rotator cuff repair) and the open surgery group (OSG, n=31, undergoing open rotator cuff repair). Operative indicators, perioperative and follow-up pain intensity, shoulder joint scores, range of motion, and complication incidence were compared between the two groups. Additionally, the factors affecting prognosis were also analyzed. The MIG had shorter operative time, shorter hospital stay, smaller incision length, and less intraoperative blood loss than the OSG (all P<0.05). At 6 weeks and 3 months postoperatively, the MIG reported significantly lower Visual Analogue Scale (VAS) scores and higher Constant-Murley scores compared to the OSG (all P<0.05). At the 6-month follow-up, the MIG exhibited higher University of California-Los Angeles scores and Constant scores, as well as greater forward flexion, abduction, and lateral rotation angles than OSG (all P<0.05). The incidence of complications was lower in the MIG compared to the OSG (P<0.05). The binomial logistic regression analysis identified surgical approach as an independent risk factor for postoperative complications (P<0.05). Arthroscopic rotator cuff repair for patients with rotator cuff tears involves minimal trauma and allows for rapid postoperative recovery. Additionally, the procedure helps restore shoulder joint function and improve the range of motion, offering promising clinical applications.

Surgical management for massive rotator cuff tears: a network meta-analysis of randomized controlled trials.

Multiple surgical strategies have been developed for treating massive rotator cuff tears (mRCTs). However, there is still no consensus on the best surgical option for mRCTs. Through a network meta-analysis, we aimed to comprehensively and systematically analyse the evidence in randomized controlled trials to help clinicians make evidence-based clinical decisions for patients with mRCTs. Our study was a network meta-analysis of the surgical management of mRCTs (PROSPERO Registration ID: CRD42023397971). We searched PubMed, EMBASE, Cochrane and Web of Science for randomized controlled trials that examined the efficacy of surgical management for mRCTs up to 3 November 2022. A three-step method was employed for the study process. Study selection, data extraction and risk of bias evaluation were conducted by two independent reviewers. R software (version 4.2.1) and Stata (version 15.1) were used for the data analysis. From 10,633 publications, we included 15 randomized controlled trials (996 participants) for the quantitative analysis. In terms of both long-term and short-term surgical effects, there were no statistically significant differences among surgical interventions such as patch-augmented rotator cuff repair (RCR), RCR with platelet-rich plasma, arthroscopic decompression, bridging reconstruction, arthroscopic RCR with platelet-leukocyte membrane, open RCR, mini-open RCR, arthroscopic debridement, superior capsular reconstruction, arthroscopic suture-spanning augmented repair, subacromial balloon spacer and latissimus dorsi tendon transfer. Based on algorithms, the probability ranking suggests that patch augmentation is the most highly ranked surgical intervention for achieving better short-term surgical outcomes. Furthermore, arthroscopic-associated mini-open RCR was ranked as the highest surgical intervention for achieving better long-term surgical effects. Based on the available data from the included studies, similar surgical efficacies were observed among the reported intervention measures for mRCTs. The patch augmentation technique was found to potentially achieve better short-term surgical outcomes, which is consistent with previous reports. However, the best surgical interventions for achieving long-term surgical effects remain unknown. More high-quality research is needed to evaluate the efficacy and safety of these interventions and to guide clinical practice.

Peculiarities of Acromioplasty in Patients with Chronic Massive Rotator Cuff Ruptures

Background. According to the literature, from 14% to 28% of patients with rotator cuff tendon ruptures have unsatisfactory results of treatment and require a reverse shoulder joint arthroplasty in the future.&#x0D; Objective: to compare the results of open rotator cuff repair of chronic massive rotator cuff tears in groups with standard subacromial decompression and subacromial decompression with resection of the lateral part of the acromion.&#x0D; Materials and Methods. The study included 58 patients who underwent an open rotator cuff repair of chronic massive rotator cuff tears (supraspinatus and infraspinatus tendons) and who underwent a rehabilitation program and follow-up up to 12 months after surgery. The age of the patients ranged from 30 to 60 years. All patients were divided into 2 groups: group 1 – classic subacromial decompression, group 2 – classic subacromial decompression complemented by resection of 5 mm of the lateral end of the acromion. Shoulder joint function was assessed using the Constant Shoulder Score and VAS scales before surgery, 6 and 12 months after surgery.&#x0D; Results. Six months after surgery, the mean functional result on the Constant Shoulder Score scale in group 1 was slightly worse (24.5 ± 16.2 points) than in group 2 (18.5 ± 6.1 points); p = 0.131. Twelve months after surgery, the mean functional score on the Constant Shoulder Score was 21.1 ± 5.6 points in group 1 and 10.1 ± 6.1 points in group 2 (p = 0.031). Six months after surgery, the average score on the VAS scale was worse in group 1 than in group 2 and ranged from 3.5 ± 1.2 points. Twelve months after surgery, the mean score on the VAS scale was also worse in group 1 than in group 2 (p = 0.05). Conclusions. Resection of the lateral part of the acromion during the open rotator cuff repair of chronic massive rotator cuff tendons tears allows to obtain better average functional results of treatment both 6 months and 12 months after the surgery. Resection of the lateral end of the acromion changes the vector of the total force of the rotator cuff and deltoid muscles during shoulder elevation. This reduces the probability of the subacromial conflict syndrome development and thus reduces the load on the area of the rotator cuff tendon suture.

Midterm outcomes of autologous bridging of rotator cuff tears with an autologous tendon patch (TEAR patch)

Large and massive rotator cuff tears and tears after failed surgical repair are a challenging clinical problem with different treatment options. The purpose of the study was to evaluate the mid-term outcomes following rotator cuff repair (RCR) with autologous hamstring tendon graft bridging (TEAR patch) with the hypothesis, that outcomes would be reasonable and complication rates low. This is a retrospective case series study of patients who underwent open RCR using a TEAR patch from June, 2015 to March, 2019. evidence of cuff tear arthropathy, advanced fatty infiltration, moderate to severe arthropathy and workers compensation board or litigation involved. Clinical outcome measures: Constant score (CS), Disabilities of Arm, Shoulder and Hand score (DASH), Simple Shoulder Test (SST), Subjective Shoulder Value (SSV), range of motion (ROM) and manual muscle test (MMT) for forward elevation, abduction, external and internal rotation, patient satisfaction, willingness to do the operation again. Radiographic outcome measures: MRI, ultrasound and radiographs: Graft integrity and acromiohumeral distance (AHD). 44 patients were followed (89%) for ≥ 2 years (45 shoulders, mean age 60.3 years (48-76), mean follow-up 4.3 years (2-6)). All clinical outcome measures (CS, DASH, SST, SSV, ROM, and MMT) demonstrated significant improvement except active external and internal rotation. At 2 years follow-up, the mean patient satisfaction was high (12.2 out of 15 points) and 33 of 38 patients (73.3%) would do the operation again. A perfect graft integration was observed in n=30 (66.7%) a small gap in n=7 (15.6%), a retear in n=3 (7%) and a complete failure of the tendon patch in n=5 (11%) patients. Graft integrity was strongly correlated with the postoperative AHD (r=0.599 , p=0.001 ) and the gain in AHD (r=0.599 , p=0.001) but not with ROM or PROM's or patient satisfaction. Four patients required revision surgeries (three due to deep infection and one for poor function and pain). Mid-term clinical and radiographic outcomes following RCR with graft bridging using a TEAR patch were reasonable. The procedure resulted in improved shoulder function and a high level of patient satisfaction. The revision rate is acceptable in view of the specific patient group and treatment alternatives. The described technique of the TEAR patch can be a valuable alternative to existing methods and a novel autograft source for rotator cuff surgeries that need bridging of a tendon defect.

Poster 174: Arthroscopic rotator cuff repair with bioinductive patch achieves equivalent patient- reported outcomes at 1 year

Objectives: To compare patient reported outcomes, range of motion (ROM), and complications of patients undergoing arthroscopic rotator cuff repair (RCR) augmented with a bioinductive patch compared to standard repair. Methods: A retrospective review of patients undergoing primary arthroscopic rotator cuff repair with and without bioinductive bovine collagen patch augmentation for supraspinatus/infraspinatus tears from 2016 to 2021 at a single institution was performed. Patients were excluded based on the following criteria: age &lt;18 years, open or mini-open rotator cuff repair, prior surgery of the affected shoulder (except diagnostic arthroscopy), rheumatological disease, active infection, or cancer. Patients who underwent RCR augmented with a collagen patch were matched 1:1 to those undergoing standard rotator cuff repair based on tear thickness and size. The electronic medical record was used to obtain patient demographics, range of motion (ROM), and assess for complications. MRI or ultrasound was used to confirm tear and classify size using the DeOrio and Cofield classification of small (&lt;1cm), medium (1-3cm), large (3-5cm), and massive (&gt;5cm). In addition, Patient Reported Outcome Information System (PROMIS) scores were recorded at preoperative, 6 weeks, 3 months, 6 months, and 1 year postoperative time points. Results: Fifty-four patients underwent RCR with patch augmentation and were matched to 54 controls. No significant differences were found between groups in terms of age (56.7 ± 9.0 patch vs. 59.3 ± 8.5 years control, p=0.12), sex, smoking, diabetes, degenerative vs. traumatic tears (50% vs. 50.9%, p=1.0), partial vs. full thickness (38.9% vs. 25.5%, p=0.2), as well as tear size (p=0.8). ROM in forward flexion (FF) and abduction (ABD) were significantly increased at 1 year compared to controls (FF 162 +/- 22 vs. 148 +/- 26 degrees, p&lt;0.01; ABD 137 +/- 37 vs. 117 +/- 40, p=0.047). No differences were seen for PROMIS- UE, but PROMIS-PI scores were significantly lower in the patch group at 6 months (55.2 +/- 8.0 vs. 61.9 +/- 2.0, p&lt;0.01) and 1 year (56.0 +/- 7.5 vs. 62.1 +/- 3.6, p&lt;.01). The patch group had 7 retears compared to 0 controls (13.0% vs 0%, 2/7 for subscapularis tears not augmented) and 1 biceps tenodesis rupture, with 5 requiring revision surgery. Conclusions: Bioinductive patch augmentation for RCR demonstrated increased ROM, but equivalent physical function after 1 year. [Table: see text][Table: see text]

A Study on Outcomes of Mini Open Procedures on Rotator Cuff Injuries

Background: Many treatment options exist for the management of rotator cuff tears, varying from non-operative-benign neglect to complex arthroscopic partial repair using an interval slide technique. Although satisfactory results may be obtained with many of these options, it should be remembered that few prospective, randomized trials exist comparing these treatments. Thus, controversy remains as to the absolute indications for each, and individual patient factors may significantly affect the final treatment decision. Methods: Hospital-based observational study. Informed consent was taken from the patients. A total of 30 patients who got admitted to the Department of Orthopaedics, Government General Hospital, Kakinada from November 2018 to September 2020 were included in the study. Results: Twenty five cases showed excellent results four cases showed good results and one showed poor result using University of California LosAngeles shoulder scale. Twenty nine cases showed excellent results and one case showed good result with Constant Murley Score. Conclusion: In the era of arthroscopic rotator cuff surgery the mini open technique with open acromio plasty and rotator cuff repair adds to rural surgeon as an elective procedure and can produce clinically competing results that of other contemporary techniques.

Use of electrocautery devices for suture passage through the greater tuberosity: a biomechanical study.

The use of electrocautery to facilitate passage of a suture needle through bone without the aid of a drill or burr is a novel technique that has potential utility in orthopedic procedures, but there is a scarcity of research to support its utility. The specific aims of this cadaveric biomechanical study were to evaluate (1) the axial force reduction during suture passage using electrocautery when applied to rotator cuff repair, (2) the temperature change caused while using electrocautery, and (3) the failure loads and failure modes of this technique. Five matched pairs of fresh frozen humeri were used, classified into 2 groups: with electrocautery on needle (study group) and without electrocautery on needle (control group). Four individual osseous tunnels were made on the greater tuberosity around the insertion of the supraspinatus tendon. Each specimen was sequentially tested in 2 parts: a needle penetration test (part I) to measure the peak axial force and temperature change and a single load-to-failure test (part II) to measure the maximum load to failure as well as the mechanism of failure. A No. 2 FiberWire suture with a straight needle was used. In part I, the mean peak axial force was lower in the study group compared with the control group for all osseous tunnels but was not statistically significant for individual tunnels. However, there was a significant decrease in peak axial force in the study group of 36% compared with the control group overall (P=.033). There was no significant change in temperature of the tunnel site with the use of electrocautery (mean: 0.2±0.3°C, P=.435). In part II, 100% of the samples from each study group experienced bone tunnel failure. Forty percent of the trials in the study group found lower ultimate failure loads compared with the control group (reduction range: 7%-38%). There was no statistically significant difference in the ultimate failure load between either the loop tested or between the 2 study groups (loop 1: P=.352; loop 2: P=.270). Suture passage using electrocautery does significantly decrease the peak force needed to pass a needle directly through the greater tuberosity. This technique does not appear to burn the bone or weaken the bone tunnels. This technique may be useful during open rotator cuff repair or shoulder arthroplasty, although clinicians should be cautious when using this technique as its utility depends on bone quality and cortical thickness, and invivo results may differ.

Payor Type Is Associated with Increased Rates of Reoperation and Healthcare Utilization following Rotator Cuff Repair: A National Database Study.

Despite strong evidence supporting the efficacy of rotator cuff repair (RCR), previous literature has demonstrated that socioeconomic disparities exist among patients who undergo surgery. There is a paucity of literature examining whether payor type, including Medicare, Medicaid, and commercial insurance types, impacts early medical complications and rates of reoperation following RCR. Patients with Medicare, Medicaid, or commercial payor type insurance who underwent primary open or arthroscopic RCR between 2010 and 2019 were identified using a large national database. Ninety-day incidence of medical complications, emergency department (ED) visit, and hospital readmission, as well as one-year incidence of revision repair, revision to arthroplasty, and cost of care were evaluated. Propensity score matching was used to control for patient demographic factors and comorbidities as covariates. 113,257 Medicare, 23,074 Medicaid, and 414,447 commercially insured patients were included for analysis. Medicaid insurance was associated with an increased 90-day risk of various medical complications, ED visit (OR 2.87; p<0.001) and one-year revision RCR (OR 1.60; p<0.001) compared to Medicare insurance. Medicaid insurance was also associated with an increased risk of various medical complications, ED visit (OR 2.98; p<0.001), hospital readmission (OR 1.56; p=0.002), as well as one-year risk of revision RCR (OR 1.60; p<0.001) and conversion to arthroplasty (OR 1.4358; p<0.001) compared to commercially insured patients. Medicaid insurance was associated with a decreased risk of conversion to arthroplasty compared to Medicare patients (OR 0.6887; p<0.001). Medicaid insurance was associated with higher one year cost of care compared to patients with both Medicare (p<0.001) and commercial insurance (p<0.001). Medicaid insurance is associated with increased rates of medical complications, healthcare utilization, and reoperation following rotator cuff surgery, despite controlling for covariates. Medicaid insurance is also associated with a higher one-year cost of care. Understanding the complex relationship between sociodemographic factors, such as insurance status, medical comorbidities, and outcomes, is necessary to ensure optimal healthcare access for all patients and to allow for appropriate risk stratification.

Surgical treatment of shoulder pain: a focused study on rotator cuff injury

Background: Shoulder pain is a common problem nowadays. With the increase in sports activities and an ageing population, the number of patients with shoulder pain is also increasing. The cause of shoulder pain is very complicated. Most shoulder pain is caused by rotator cuff disease, adhesive capsulitis, joint instability, calcific tendinitis, biceps problem, degenerative osteoarthritis, or rheumatoid arthritis. This article aims to identify and describe various surgical treatment methods and prognosis associated with rotator cuff disease.Current Concepts: The initial treatment for rotator cuff disease is conservative with rehabilitative exercise therapy. Patients who do not respond to conservative treatment require appropriate surgical treatment. The surgical treatment methods differ depending on the lesions. The surgical treatment can be classified as: open rotator cuff repair, arthroscopic rotator cuff repair, and reverse total shoulder arthroplasty. If patients do not receive the appropriate surgical treatment, there will be irreversible changes in the patient’s shoulder joint. Besides, the prognosis of the disease would also not be good for any other treatment.Discussion and Conclusion: For the best prognosis of patients, it is important to choose an appropriate treatment method after an accurate diagnosis as per the patient’s conditions.

Wide-awake local anesthesia for open rotator cuff repair: A case report.

Introduction and importanceImproper treatment of rotator cuff tear might result in progression of tear and deterioration of patient function. The rotator cuff tear can be managed conservatively in most cases however surgical treatment is inevitable in persistent patients.Presentation of caseA 45-year-old woman presented to our clinic with shoulder pain and restricted range of motion following a fall from a height three months before the current presentation. Due to the lack of favorable response to conservative treatment and the fact that rotator cuff rupture was traumatic, she became a candidate for rotator cuff repair surgery. Due to financial issues and the patient's refusal of undergoing general anesthesia we considered the WALANT technique. Prior to surgery, we explained the whole procedure to the patient, referring to its pros and cons.Clinical discussionThe WALANT procedure is a relatively recent technique that has become widespread in orthopedic surgery in the past decade. The advantages of the WALANT technique are that it is simple, feasible, and safe and that the analgesic is adequate during the operation and for the first few hours afterward (5). Concerns with this method include patient discomfort and pain during surgery, which can be managed by educating the patient and minute-by-minute explanation during the procedure.ConclusionWe advocate open rotator cuff repair with the WALANT approach as an effective, cost-saving, safe, simple, and quick alternative to general and regional anesthesia for certain patients or with limited anesthetic resources.Level of evidenceV

Results of Arthroscopic Revision Rotator Cuff Repair for Failed Open or Arthroscopic Repair: A Prospective Multicenter Study on 100 Cases

Background: Retears after rotator cuff repair (RCR) have been associated with poor clinical results. Meaningful data regarding the role of arthroscopic revision RCR are sparse thus far. Purpose/Hypothesis: To investigate results after arthroscopic revision RCR. We hypothesized that (1) arthroscopic revision RCR would lead to improved outcomes, (2) the clinical results would be dependent on tendon integrity and (3) tear pattern, tendon involvement, and repair technique would influence clinical and structural results. Study Design: Case series; Level of evidence 4. Methods: During a 40-month period, 100 patients who underwent arthroscopic revision RCR were prospectively enrolled in this multicenter study. Outcomes were evaluated preoperatively, at 6 months (6M), and at 24 months (24M) using the Constant score (CS), the Oxford Shoulder Score (OSS), and the Subjective Shoulder Value (SSV). Tendon integrity at 2 years was analyzed using magnetic resonance imaging. A total of 13 patients (13%) were lost to follow-up, and 14 patients (14%) had a symptomatic retear before the 24M follow-up. Results: All clinical scores improved significantly during the study period (CS: preoperative, 44 ± 16; 6M, 58 ± 22; 24M, 69 ± 19 points; OSS: preoperative, 27 ± 8; 6M, 36 ± 11; 24M, 40 ± 9 points; SSV: preoperative, 43% ± 18%; 6M, 66% ± 24%; 24M, 75% ± 22%) (P < .01). At 2 years, a retear rate of 51.8% (43/83) and a surgical revision rate of 12.6% (11/87) were observed. Mean full-thickness tear size decreased from 5.00 ± 1.61 cm2 to 3.25 ± 1.92 cm2 (P = .041). Although the Sugaya score improved from 4.5 ± 0.9 to 3.7 ± 1.4 (P = .043), tendon integrity did not correlate with better outcome scores. Previous open RCR, involvement of the subscapularis, chondral lesions of Outerbridge grade ≥2, and medial cuff failure were correlated with poorer SSV scores at 2 years (P≤ .047). Patients with traumatic retears had better CS and OSS scores at 2 years (P≤ .039). Conclusion: Although arthroscopic revision RCR improved shoulder function, retears were frequent but usually smaller. Patients with retears, however, did not necessarily have poorer shoulder function. Patient satisfaction at 2 years was lower when primary open RCR was performed, when a subscapularis tear or osteoarthritis was present, and when the rotator cuff retear was located at the musculotendinous junction. Patients with traumatic retears showed better functional improvement after revision.