Outcomes Of Rotator Cuff Repair Research Articles

Effects of Quality of Integrity on Clinical and Structural Outcomes of Rotator Cuff Repair: A Retrospective Cohort Study of 504 Cases

Background: The clinical implications of structural integrity have been a subject of long debate. The oversimplified binary categorization of structural integrity into either healing or retear, along with faulty preoperative baselines for comparison, may contribute to the controversy. Purpose: To determine how the quality of structural integrity in a repaired cuff tendon affects both clinical and structural outcomes by dividing the patients into groups based on integrity and using the immediate postoperative baseline (time zero). Study design: Cohort study; Level of evidence, 3. Methods: A total of 504 patients with a full-thickness rotator cuff tear who underwent arthroscopic rotator cuff repair and were followed up for at least a year with magnetic resonance imaging (MRI) were included. The quality of structural integrity was graded using the Sugaya classification. To evaluate clinical outcomes, pain, range of motion, strength, functional scores, and overall satisfaction and function were used for within- and between-group analyses at the last follow-up. For the assessment of structural outcomes, the Goutallier classification for fatty infiltration (FI) and the tangent sign, occupation ratio, and normalized cross-sectional area for muscle atrophy (MA) were used. The baselines for these structural measurements were both the preoperative and the time-zero MRI scans. Results: The mean clinical follow-up period was 31.8 ± 27.5 months, and the MRI follow-up period was 10.9 ± 5.3 months. There were 178 (35.3%), 228 (45.2%), 58 (11.5%), 14 (2.8%), and 26 (5.2%) shoulders with Sugaya grades 1, 2, 3, 4, and 5, respectively. Regardless of structural integrity, all clinical outcomes at a mean follow-up of 31.8 months after repair significantly improved compared with those before repair. Only in shoulders with Sugaya grade 1 did the FI of the supraspinatus muscle improve significantly from baseline. FI of the infraspinatus muscle did not change significantly in those with grades 1 and 2 but worsened in those with grades 3 and 5. MA measured using the occupation ratio improved significantly in shoulders with Sugaya grades 1 and 2 but declined in those with grade 5. Conclusion: This study established a correlation between improved structural integrity of the repaired cuff tendon and enhanced structural outcomes in rotator cuff muscles. Furthermore, the findings revealed that both FI and MA could be reversed in patients exhibiting high-quality structural integrity. However, these structural improvements were not mirrored in the clinical outcomes.

Anxiety, Depression, and Quality of Sleep Vary in Their Correlation to Postoperative Outcomes of Rotator Cuff Repair: A Prospective Study.

Background/Objectives: Recent studies imply that psychological factors and sleep quality play a role in the outcomes of surgical procedures, including in orthopedic surgery. The aim of the present study is to evaluate possible correlations between preoperative depression, anxiety, and quality of sleep and functional 6-month postoperative scores in patients having undergone rotator cuff repair (RCR). Methods: All patients included in the study performed the Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) questionnaires preoperatively and 36-item Short-Form Health Survey (SF-36), Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), and PSQI questionnaires at the six-month postoperative follow-up. A total of 47 patients were included in the analysis. Results: Statistically significant differences between preoperative anxious and not-anxious groups were found in the postoperative SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores and PSQI score. The correlation of the preoperative depression score to postoperative outcome measures revealed a strong positive correlation between the preoperative HADS-D score and the 6-month PCS, MCS, and OSS scores. The correlation of preoperative sleep quality to postoperative outcome measures revealed a strong positive correlation between the preoperative PSQI score and 6-month MCS score. Conclusions: Anxious patients had worse postoperative RCR outcomes. Depression may be influenced by factors related to RC pathology; however, there were no statistically significant correlations. Sleep quality generally improves postoperatively, and no significant association was found between bad preoperative sleepers and worse outcomes.

Association of Preoperative Patient Resilience With Postoperative Patient-Reported Outcomes and Sleep Quality Following Arthroscopic Rotator Cuff Repair: A Systematic Review.

Recent studies have shown that low preoperative resilience may lead to inferior outcomes following arthroscopic rotator cuff repair. Therefore, the purpose of this systematic review is to evaluate whether preoperative patient resilience is associated with outcome measures, including patient-reported outcome measurements (PROMs) and sleep quality, following arthroscopic rotator cuff repair. To perform the review, a literature search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the PubMed and Embase databases to gather studies related to the influence of preoperative resilience on postoperative outcomes of rotator cuff repair. Methodological quality and risk of bias were assessed using the Methodological Index for Non-randomized Studies (MINORS). Seven studies with 584 patients were included. Of 36 total reported postoperative outcomes, including PROMs and sleep quality, 14 had a significant positive correlation with higher preoperative resilience. One study reported that higher resilience was significantly correlated with worse sleep quality at a two-week follow-up but not at further follow-ups of up to 24 weeks. Significant differences in outcomes between patients with varying levels of resilience were assessed in five studies, all of which found that patients with higher resilience had significantly better outcomes or no significant differences in outcomes between patients with varying levels of preoperative resilience. In no study was it reported that patients with low resilience had better outcomes. Overall, approximately half of all reported postoperative outcome data was found to be significantly associated with preoperative resilience. Therefore, clinicians should preemptively identify those with low resilience and administer psychological interventions to limit inferior outcomes following arthroscopic rotator cuff repair.

Effect of post-operative NSAID use on rotator cuff repair outcomes

BackgroundThe impact of non-steroidal anti-inflammatory drugs (NSAIDs) on rotator cuff repair is an ongoing area of study within orthopedics, with conflicting results in current literature. Despite concerns over the deleterious effects of NSAIDs on rotator cuff healing, they are becoming an integral part of a multimodal post-operative pain control regiment. The purpose of this study was to compare post-operative patient-reported outcomes (PROs), complications rates, and retear rates of arthroscopic rotator cuff repairs in patients using ibuprofen post-operatively to those who abstained from NSAIDs for six weeks after surgery. It was hypothesized that a short course of ibuprofen post-operatively would not lead to inferior PRO scores, increased retear rates, nor increased complication rates after arthroscopic rotator cuff repair. MethodsPatients of the primary surgeon who underwent arthroscopic rotator cuff repair between 2012 and 2022 were evaluated by retrospective chart review. In May 2017 the primary surgeon changed his protocol from avoiding NSAIDs for six weeks after surgery to routinely prescribing two weeks of Ibuprofen 800 mg TID post-operatively. Patients who avoided NSAIDs for six weeks were compared to patients who were prescribed NSAIDs post-operatively. Patient demographic data, pre-operative MRI results, pre-operative and post-operative PROs were collected from the EMR. Additionally, post-operative complications and repair failures requiring reoperation within one year were evaluated. Results125 patients met inclusion criteria for this study with 36 patients in the NSAID group and 89 in the no NSAID group. When comparing improvement in PROs, the NSAID group reached MCID at one year in 83.8 % of patients and the no NSAID group reached MCID at one year in 73.9 % of patients. There was no significant difference between the groups in reaching MCID improvement at one year (p = 0.471). Five post-operative complications were reported in the no NSAID group and two in the NSAID group (5.7 % vs 5.4 %, respectively, p = 0.827). Finally, there was no significant difference in the percentage of post-operative rotator cuff repair failures requiring revision in the first year between the groups (2.3 % vs 2.7 %, p = 1.000). ConclusionThere was no difference in percent of patients improving their PRO by the MCID between the groups that used ibuprofen and the group that did not. There was also no difference in post-operative complication rates and rates of symptomatic retear requiring reoperation between the groups. This supports that a short course of NSAIDs post-operatively, specifically ibuprofen, after rotator cuff repair does not increase reoperation rates nor lead to a clinically significant decrease in PROs at one year.

The impact of social deprivation on rotator cuff repair outcomes

BackgroundRotator cuff tears are a common orthopedic injury and the role of social determinants of health (SDoH) in surgical outcomes remains underexplored. The goal of this study was to investigate the correlation between social deprivation, measured by the Area Deprivation Index (ADI), and outcomes following arthroscopic rotator cuff repair. MethodsWe conducted a retrospective chart review on patients undergoing primary arthroscopic rotator cuff repair at a level one academic center between 2006 and 2019. Patient demographics (age, gender, race), comorbidities, ADI scores, range of motion, visual analog pain scores, and patient-reported outcomes (SST, ASES, and QuickDASH) were collected. Patients were stratified into terciles based on their relative level of deprivation. Statistical analysis was performed using ANOVA, t-tests, chi-square tests, and univariate/multivariate logistic regression. Results322 patients were included in this study. The most deprived group had a higher prevalence of diabetes compared to the least and intermediately deprived group (p<0.001). Massive tear occurrence was greater in the least deprived group (p=0.003) compared to the most deprived group. There was no difference in objective outcomes between groups. Patient-reported outcomes (SST, ASES, and QuickDASH) were worse in the most deprived group compared to the least and intermediate deprived groups. ConclusionSocial deprivation significantly affects patient-reported outcomes in rotator cuff repair surgery. While clinician-reported outcomes were consistent, patients' perceptions varied based on social determinants. Integrating SDoH considerations in orthopedic care is a promising next step in securing equitable approaches. However, more research is needed to validate and expand these findings.

Ultrasound and patient-reported outcomes of rotator cuff repair with new acellular human allograft at 6 months and 1 year post surgery

PurposeDetermine the effect of a novel acellular cannulated dermal allograft, on tendon-to-bone healing, retear rates, and clinical outcomes over a 12-month period. MethodsThis was a single surgeon prospective non-randomized case series. Patients with medium sized full-thickness superior and posterosuperior rotator cuff tears, as confirmed by magnetic resonance imaging (MRI), were consented. Patients were excluded if they had fatty atrophy indicative of Goutallier grade III or IV. The allograft is a cannulated rectangular prism that has a 5-year shelf life, does not require prehydration, and does not need to be trimmed to size. Outcome metrics included ultrasound (US) assessment at 1 year as well as 6 month patient reported outcomes scores. Results31 patients consented and enrolled in this consecutive cohort series. 9 patients were excluded and statistical analysis was performed on the remaining 22 patients. There were 9 females and 13 males. The average age was 59.27 ± 7.48 years old. The average supraspinatus short axis measurement in males was 0.56 ± 0.12 cm and 0.52 ± 0.09 cm in females (p=0.44). The average supraspinatus long axis measurement in males was 0.61 ± 0.18 cm and 0.55 ± 0.14 cm in females (p=0.46). The average infraspinatus short axis measurement in males was 0.48 ± 0.10 cm and 0.50 ± 0.13 in females (p=0.74). The average infraspinatus long axis measurement in males was 0.44 ± 0.12 cm and 0.43 ± 0.08 cm in females (p=0.84). Of the 19 patients who completed baseline and 6 month PRO’s, 17 achieved the MCID for ASES and PROMIS UE 7a. Retear occurred in 2 cases. The remaining 20 cases have all demonstrated healing or fully healed repairs at their most recent clinic visits with no additional cases of retears. ConclusionThis study is the first to report the results of a novel acellular dermal allograft for Rotator Cuff Repair Augmentation. Satisfactory patient-reported outcome measures and robust tendon healing at 1 year as measured by ultrasound demonstrate the utility of a cannulated human acellular dermal allograft as a viable biologic augmentation device for Rotator Cuff repair.

Impact of obesity on outcomes of rotator cuff repair: A systematic review and meta-analysis.

To synthesize the existing evidence on the association between obesity and rotator cuff repair outcomes such as pain, shoulder function, range of motion, and complications. We searched PubMed, EMBASE, and Scopus databases for relevant observational studies (cohort and case-control) and randomized controlled trials (RCTs). The target population in the included studies comprised adults who had undergone rotator cuff repair procedures. The outcomes of interest were functional outcomes (such as range of motion), pain scores, patient-reported outcome measures, and complication rates (such as re-repair and readmission rates). We applied random-effects models and calculated pooled effect sizes reported as standardized mean differences (SMDs) or relative risks (RRs) with 95% confidence intervals. We analysed data from 11 studies. In most, the follow-up periods ranged from 12 to 60 months. Obese individuals experienced greater pain (SMD 0.30; 95% CI, 0.10, 0.50) and lower shoulder function (SMD -0.33; 95% CI, -0.54, -0.12) than other individuals in the long-term post-operative follow-up. Obese individuals also had higher risks of complications (RR 1.48; 95% CI, 1.11, 1.98) and readmission (RR 1.35; 95% CI, 1.27, 1.43), but a similar likelihood of re-repair (RR, 1.27; 95% CI, 0.82, 1.95) than non-obese/normal BMI individuals. While the forward flexion and external rotation functions were comparable, obese individuals displayed less internal rotation function than other individuals (SMD -0.59; 95% CI, -0.87, -0.30). Obesity was associated with unfavourable outcomes after rotator cuff surgery, including increased pain, reduced shoulder function, high risks of complications, and readmission. These findings emphasize the importance of addressing obesity-related factors to improve post-operative outcomes.

Distal Clavicular Resection Worsens Outcomes in Rotator Cuff Repair: A National Database Study.

Distal clavicular resection (DCR) is a procedure used to alleviate acromioclavicular joint (ACJ) pain, often done alongside rotator cuff repair (RCR). This investigation explored the relationships between DCR and RCR, outcomes of DCR during RCR, and complication rates of DCR. This retrospective study used electronic medical record data from the TriNetX database. Cohorts were subdivided based on the timeline of DCR in comparison to RCR, as well as comparing RCR with DCR against RCR without DCR. In total 46 534 patients underwent RCR with 14.8% (6898) of these patients also undergoing DCR. And 72.8% (5021) had DCR during RCR, and 10.7% (740) had DCR after RCR. Less than 5% (<10) of patients with preexisting ACJ pain required DCR 3 years postoperatively, and 0.002% (78) patients without ACJ pain developed ACJ pain within 3 years. Less that 20 patients underwent DCR within 3 years of being diagnosed with ACJ pain. Patients who had RCR with DCR were more likely to have chronic pain postoperatively (P < .0001). Patients undergoing RCR do not require subsequent DCR. Performing DCR does not offer significant benefit when compared to performing isolated RCR without DCR in patients with preexisting ACJ pain, but increases risk for ACJ instability and chronic pain.

Meta-analysis of obesity on the outcome of rotator cuff repair

To systematically evaluate obesity on the outcome of rotator cuff repair. Literatures on the relationship between obesity and outcomes after rotator cuff repair were searched from PubMed, Embase, Cochrane Library, Web of Science, China biology medicine(CBM), CNKI, Wanfang and VIP databases from building database to August 1, 2022, and were screened independently by two authors according to inclusion and exclusion criteria. Endnote X9 and Excel 2019 were used for literature extraction, management and data entry, and Newcastle-Ottawa Scale (NOS) was used to evaluate quality of the included literatures. STATA 16.0 and RevMan 5.4 softwares were used to evaluate postoperative retear rate, reoperation rate, complication rate, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS), operative time and external rotation angle of shoulder joint pain were analyzed. Totally 13 literatures were included, including 6 retrospective studies, 5 case-control studies, 1 prospective cohort study, and 1 abstract of a study for which the full text was not available, with 85 503 patients (31 973 in obese group and 53 530 in non-obese group). Meta-analysis showed there were statistical differences between two groups in retear rate [OR=2.58, 95%CI(1.23, 5.41), P=0.01], reoperation rate[OR=1.31, 95%CI(1.21, 1.42), P<0.00], complication rate [OR=1.57, 95%CI(1.31, 1.87), P=0.00], ASES score[MD=-3.59, 95%CI(-5.45, -1.74), P=0.00], and VAS[MD=0.24, 95%CI(0.00, 0.49), P=0.05]. While there were no differences between two groups in operative time[MD=6.03, 95%CI(-7.63, 19.69), P=0.39], external rotation angle of shoulder joint[MD=-1.79, 95%CI(-5.30, 1.71), P=0.32]. Obesity is associated with higher rates of retear, resurgery, complications, poorer shoulder function and pain after rotator cuff repair.

Arthroscopic rotator cuff repair in patients over 65 years of age: successful functional outcomes and a high tendon integrity rate can be obtained after surgery

BackgroundAlthough interest in studies evaluating the outcomes of rotator cuff repair is steadily increasing, the results and tendon integrity after arthroscopic rotator cuff repair in elderly patients have only been minimally investigated. The aim of this study was to evaluate clinical outcomes and repair integrity in patients over 65 years of age who underwent arthroscopic repair of full-thickness rotator cuff tears. MethodsA retrospective study was conducted with the following inclusion criteria (1) elective shoulder arthroscopy for rotator cuff repair for full-thickness postero-superior tears; (2) age over 65 years at surgery; and (3) participation in 24 months follow-up. Preoperatively, the range of motion (ROM) and the Constant-Murley Score (CMS) and at follow-up, the ROM, the SF-12, the American Shoulder and Elbow Surgeons (ASES), and the CMS were evaluated; an ultrasonographic assessment of tendon integrity was performed according to the adapted Sugaya classification. ResultsThe final sample consisted of 110 patients with an average age of 69.2±3.5 years. The mean duration of nonoperative management before surgery was 2.6 ± 0.8 months. The mean period of preoperative physical therapy was 0.6 ± 0.9 months. ROM and CMS showed statistically significant improvement (all p<0.001) after a mean follow-up time of 54.5±22.3 months. The ultrasonographic assessment showed tendon integrity (types I and II) in 75% of cases; 21% were type III repair, and rotator cuff retear (types IV and V) was recorded in 4% of cases. All scores directly correlated with the integrity of the tendon. In the multivariate analysis, higher postoperative CMS was associated with male sex (p<0.001, β=-6.085) and lower age (p=0.004, β=-0.533). Higher postoperative ASES were associated with lower age (p=0.020, β=-0.414). Higher postoperative SF-12 PCS and MCS were associated with lower age (p=0.013, β=-0.550 and p<0.001, β=-0.520, respectively) and shorter preoperative physical therapy period (p=0.013, β =-2.075 and p=0.006, β =-1.093, respectively). ConclusionsA significant ROM and CMS recovery and a rotator cuff integrity rate of 75% can be expected in patients over 65 years of age who undergo arthroscopic repair for full-thickness rotator cuff tears. Better functional, physical and mental health outcomes correlate with rotator cuff integrity and are predicted by male sex and a shorter period of preoperative physical therapy.

Influence of Pain Sensitivity on Surgical Outcomes of Arthroscopic Rotator Cuff Repair: A Prospective Cohort Study

Background: The Pain Sensitivity Questionnaire (PSQ) has been found to be a valid tool, and PSQ scores have been shown to be predictive of outcomes after surgery for lumbar stenosis. The effect of pain sensitivity on outcomes of rotator cuff repair (RCR) surgery has not been examined. Hypothesis: PSQ scores would be associated with surgical outcomes after arthroscopic RCR surgery. Study Design: Cohort study; Level of evidence, 2. Methods: Patients 18 to 80 years old scheduled for RCR were consecutively enrolled. Patients with glenohumeral arthritis grade ≥2 or RCR revision surgery were excluded. PSQ was completed preoperatively. The Disabilities of the Arm, Shoulder and Hand score and American Shoulder and Elbow Surgeons score were used as patient-reported outcome measurements (PROMs), and visual analog scale pain score was documented as well. Active shoulder external rotation (ER), internal rotation, and anterior forward elevation range of motion (ROM) were recorded. PROMs and ROM measurements were recorded preoperatively and at 3 months, 6 months, and 1 year after surgery. Rotator cuff tear size, type of repair, and concomitant procedures were documented. Patients were classified as having high or normal pain sensitivity based on PSQ scores. Results: Of 100 enrolled patients, 38 patients were classified as having high pain sensitivity. Patients with high pain sensitivity had worse American Shoulder and Elbow Surgeons and Disabilities of the Arm, Shoulder and Hand scores preoperatively, 6 months postoperatively, and 1 year postoperatively (P < .01). From the preoperative assessment to 3 months postoperatively, PROMs improved more in patients with high versus normal pain sensitivity. However, for patients with high pain sensitivity, PROMs plateaued after 3 months but continued to improve for patients with normal pain sensitivity (P < .01). Visual analog scale pain scores were higher at all time points for patients with high pain sensitivity (P < .05). Preoperatively, patients with high pain sensitivity had restricted active ROM compared with patients who had normal pain sensitivity for anterior forward elevation, ER, and internal rotation (P = .009, P = .012, and P = .006, respectively). By 1 year after surgery, ER ROM was still restricted in patients with high pain sensitivity. Conclusion: Pain sensitivity is an important factor influencing RCR outcomes. Patients with high pain sensitivity undergoing RCR showed less improvement in active ROM and worse PROMs after surgery compared with patients who had normal pain sensitivity. Preoperative PSQ may predict postoperative improvements.

Association of obesity with high retears, and complication rates, and low functional scores after rotator cuff repair: a systematic review and meta-analysis.

Obesity influences the outcomes of orthopedic surgeries such as total knee arthroplasty and spinal surgery. However, the effect of obesity on the outcomes of rotator cuff repair is unknown. This systematic review and meta-analysis aimed to examine the effect of obesity on rotator cuff repair outcomes. PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched to identify relevant studies published from their inception till July 2022. Two reviewers independently screened titles and abstracts using the specified criteria. Articles were included if they indicated the effect of obesity on rotator cuff repair and the related outcomes after surgery. Review Manager (RevMan) 5.4.1 software was used to perform statistical analysis. Thirteen articles involving 85497 patients were included. Obese patients had higher retear rates than nonobese patients (OR 2.58, 95% CI 1.23-5.41, P=0.01), lower American Shoulder and Elbow Surgeons (ASES) scores (MD: -3.59, 95% CI: -5.45-[-1.74]; P=0.0001), higher visual analog scale (VAS) for pain (MD: 0.73, 95% CI: 0.29-1.17; P=0.001), higher reoperation rates (OR 1.31, 95% CI 1.21-1.42, P<0.00001), and higher rates of complications (OR 1.57, 95% CI 1.31-1.87, P=0.000). Obesity did not affect the duration of surgery (MD: 6.03, 95% CI: -7.63-19.69; P=0.39) or external rotation (ER) of the shoulder (MD: -1.79, 95% CI: -5.30-1.72; P=0.32). Obesity is a significant risk factor for retear and reoperation after rotator cuff repair. Furthermore, obesity increases the risk of postoperative complications and leads to lower postoperative ASES scores and higher shoulder VAS for pain.

The effect of concurrent cervical spine degenerative disease on the outcome of rotator cuff repair: a national database study

Cervical spine degenerative disease (CSD) can cause shoulder pain, potentially confounding the management of patients with rotator cuff tears. This study aimed to investigate the relationships between CSD and rotator cuff repair (RCR). A national administrative database (PearlDiver) was used to study 4 patient cohorts: (1) RCR only (RCRo), (2) RCR with concurrent CSD (RCRC), (3) RCR after a cervical spine procedure (RCRA), and (4) RCR before a cervical spine procedure (RCRB). The outcomes of RCR were compared using multivariable logistic regression, controlling for age, sex, and Elixhauser Comorbidity Index, as well as preoperative opioid utilization in the analysis of opioid use. Between 2010 and 2021, a total of 889,977 patients underwent RCR. Of these patients, 784,230 (88%) underwent RCRo whereas 105,747 (12%) underwent RCRC, of whom 21,585 (2.4%) underwent cervical spine procedures (RCRA in 9670 [1.1%] and RCRB in 11,915 [1.3%]). At 2 years after RCR, compared with RCRo patients, RCRC patients had an increased risk of surgical-site infection (adjusted odds ratio [aOR]=1.25, P=.0004), deep vein thrombosis (aOR=1.17, P=.0002), respiratory complications (aOR=1.19, P=.0164), and ipsilateral shoulder reoperations (débridement [aOR=1.66, P<.0001], manipulation under anesthesia or arthroscopic lysis of adhesions [aOR=1.23, P<.0001], distal clavicle excision [aOR=1.78, P<.0001], subacromial decompression [aOR=1.72, P<.0001], biceps tenodesis [aOR=1.76, P<.0001], incision and drainage [aOR=1.34, P=.0020], synovectomy [aOR=1.48, P=.0136], conversion to shoulder arthroplasty [aOR=1.62, P<.0001], revision RCR [aOR=1.77, P<.0001], and subsequent contralateral RCR [aOR=1.71, P<.0001]). At 2 years, compared with RCRC patients who did not undergo cervical spine procedures, RCRC patients who underwent cervical spine procedures had an increased risk of incision and drainage (aOR=1.50, P=.0255), conversion to arthroplasty (aOR=1.40, P<.0001), and revision RCR (aOR=1.11, P=.0374), as well as a lower risk of contralateral RCR (aOR=0.89, P=.0469). The sequence of cervical spine procedures did not affect the risk of shoulder reoperations. At 1 year, the risk of opioid use after RCR was less for RCRA patients compared with RCRB patients (aOR=1.71 [95% confidence interval, 1.61-1.80; P<.0001] vs. aOR=2.01 [95% confidence interval, 1.92-2.12; P<.0001]). Concurrent CSD has significant detrimental effects on RCR outcomes. Patients with concurrent CSD undergoing cervical spine procedures have a greater risk of ipsilateral shoulder reoperations but a decreased risk of contralateral RCR. The risk of prolonged opioid use was lower if RCR followed a cervical spine procedure. Concurrent CSD must be considered and possibly treated to optimize the outcomes of RCR.

Short-term radiographic and clinical outcomes of arthroscopic rotator cuff repair with and without augmentation with an interpositional nanofiber scaffold

Background The rate of retear after primary rotator cuff failure remains unacceptably high (up to 36% for small- to medium-sized tears). Augmentation of the repair with an interpositional scaffold has been reported to improve healing. Purpose To compare the short-term radiographic and clinical outcomes of arthroscopic rotator cuff repair with and without augmentation with an interpositional nanofiber scaffold. Methods We prospectively enrolled patients with full thickness rotator cuff tears into a multicenter study with institutional review board approval. All patients had a minimum of one year clinical and radiographic follow-up. A single fellowship trained shoulder surgeon performed all procedures. Patients were blinded and randomized at the time of surgery into either a treatment group consisting of double row rotator cuff repair augmented with an interpositional nanofiber scaffold or a control group in which a standard double-row repair without augmentation was performed. Range of motion, muscle dynamometer strength testing (Lafayette Instruments), and clinical outcomes according to visual analog scale pain, American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) scores were assessed preoperatively and at routine follow-up intervals. Magnetic resonance imaging (MRI) was obtained at a minimum of 4 months (range 4.5-14) on all patients and assessed according to the Sugaya classification with failure noted as grade 4 or higher. Patients without initial failure were then assessed at a minimum of one year (range 12-24 months) by ultrasound examination or MRI to assess for late failure of the repair and clinical outcomes. Results Thirty patients with a mean age of 64.6 years were statistically analyzed. Fourteen patients were treated with the nanofiber scaffold and 16 patients were non-augmented and made up the control. At an average of 6.8 months, all patients underwent MRI and early failure occurred in 7.1% of the nanofiber scaffold patients compared to 18.8% in the control group (p=.602). At an average time of 17 months postoperatively, all remaining patients with intact repairs underwent MRI (2) or ultrasound (28) and 9 more patients demonstrated Sugaya tear progression with five progressing to failure. All late failures and Sugaya tear progressions occurred in the control group. Cumulative treatment failure occurred significantly less often in patients who received the nanofiber scaffold (7.1%) compared to those who did not receive the bioresorbable scaffold (50%) (p=.017). Conclusion The present prospective study demonstrates a statistically significant difference in rotator cuff healing with use of an interpositional nanofiber scaffold. While future studies and larger series are warranted, the current data is promising in further advancing the outcomes of rotator cuff repairs.

Outcomes of Double-Row Rotator Cuff Repair Using a Novel All-Suture Soft Anchor Medial Row.

Few studies have examined the short-term clinical outcomes of rotator cuff repair (RCR) with all-suture anchors for medial row anchor fixation. To evaluate clinical outcomes of double-row suture bridge RCR using a novel all-suture medial row anchor. Case series; Level of evidence, 4. We enrolled 179 patients before double-row suture bridge RCR (mean age at surgery, 60.0 years; 63% male patients) at a single institution. All patients underwent RCR with all-suture anchor fixation for the medial row and solid anchor fixation for the lateral row. Preoperative (baseline) and follow-up (minimum follow-up time of 2 years; mean, 2.5 years) clinical outcomes were compared using the American Shoulder and Elbow Surgeons (ASES) score and a 10-point numeric pain rating scale (NPRS). We calculated the proportions of patients meeting previously published Patient Acceptable Symptom State (PASS) thresholds for the ASES (≥78.0) and NPRS (≤1.7). We further compared baseline and follow-up outcome scores and the proportions of patients meeting PASS thresholds using paired t tests and McNemar tests, respectively, and calculated effect size to quantify the magnitude of change from baseline to follow-up. Values significantly improved from baseline to follow-up for ASES (from 45.3 ± 19.8 to 87.3 ± 17.1) and NPRS (from 5.2 ± 2.5 to 1.4 ± 2.1). The proportion of patients meeting PASS thresholds also significantly improved for the ASES (from 6% to 77%) and the NPRS (from 7% to 72%). The magnitude of baseline to follow-up change for all measures was large (all effect sizes ≥1.5). Our study demonstrated excellent short-term clinical outcomes and substantial improvements for patients undergoing double-row suture bridge RCR with all-suture anchors for medial row fixation.

Insufficient evidence to confirm benefit of adjuvant distal clavicle resection during rotator cuff repair: a systematic review and meta-analysis.

The aim of this study is to determine whether adjuvant Distal Clavicle Resection (DCR) improves outcomes of Rotator Cuff Repair (RCR) in terms of ROM, clinical scores as well as reducing complications and/or reoperations. This systematic review conforms to the PRISMA guidelines. Studies were included if they compared outcomes of RCR with and without adjuvant DCR and reported on postoperative ROM, clinical scores, complications, and/or reoperations. Seven studies that comprised 1572 shoulders which underwent RCR at a follow-up ranged 8-54 months: 398 with adjuvant DCR and 1174 without DCR. No significant differences were found between patients that had DCR versus those that did not have DCR, in terms of postoperative clinical scores (ASES, Constant, pVAS), postoperative ROM (AFE, external and internal rotation), retear rate and reoperation rate. There were no significant differences in ROM, clinical scores, or rates of retears and reoperations between patients that underwent RCR with or without adjuvant DCR. There is insufficient evidence to support routine DCR during RCR; the incidence of new or residual acromioclavicular joint (ACJ) pain after RCR with adjuvant DCR is higher than following isolated RCR, which could in fact induce iatrogenic morbidity and therefore does not justify the additional surgery time and costs of routine adjuvant DCR.

Poster 177: Does Prior Ipsilateral Steroid Injection Affect Outcomes After Rotator Cuff Repair?

Objectives: Rotator cuff pathology is a common problem, affecting approximately 17 million individuals in the US. Among professional and competitive athletes, only 49.9% have returned to play at the same level as before their injury. Initial treatment often includes corticosteroid injections, but some patients continue to have pain resulting in surgical treatment. Although steroids are the mainstay of conservative treatment, recent studies have shown concerns for increased rates of postoperative infections and revision surgeries after RCR. This study aimed to determine the effect of prior ipsilateral steroid injection on outcomes following arthroscopic rotator cuff repair. Methods: A retrospective chart review was performed on 295 patients who underwent rotator cuff repair by a single fellowship-trained orthopedic surgeon from 2017-2019. Of the 225 patients that met inclusion criteria and underwent analysis, 42 patients were in the injection group (IG) and 183 in the control group (CG). Demographics, range of motion (ROM), patient-reported pain and satisfaction (0- 10), subjective shoulder value (SSV), complications and reoperations were compared between groups. Delta ROM and strength were defined as postoperative ROM minus preoperative ROM. Complications were defined as reoperations, retears, or subsequent infection. Statistical analysis included chi-square and student t-tests. Results: The cohort consisted of 57.4% males with an average age of 58.3, BMI of 29.5, and mean follow-up of 7.3 months. The mean time from injection to surgery was 5.6 months. There were no significant differences in demographics between the injection and control group. Preoperatively, the injection group had a significantly greater median supraspinatus strength (p=0.002), summed strength (p=0.003), forward elevation (p=0.003), abduction (p=0.005), and active external rotation (p&lt;0.001). This was specific to injections received within the 12 months before surgery. Postoperatively, there were no significant differences between the groups on measures of pain, shoulder function, shoulder strength, range of motion, or SSV. The frequency of complications was also comparable between the no injection and injection group, having similar rates of persistent pain, limited ROM or stiffness, numbness or tingling, weakness, cervicalgia, adhesions, retear, and upper extremity DVT, and postoperative infections. Conclusions: The results of our study indicate that ipsilateral shoulder injection within one year of arthroscopic rotator cuff repair improves preoperative functional outcomes, namely improvements in forward flexion, abduction, external rotation, and relative strength. Despite enhancements preoperatively, postoperative measures of strength, range of motion, and complications are comparable between groups, which persists when analyzing the timing and number of injections. These results support the use of subacromial corticosteroid injections as an effective conservative treatment prior to rotator cuff repair. However, there is still a lack of consensus on how close in proximity to surgery it is safe to receive an injection and what preoperative patient characteristics may be more likely to benefit from injection prior to surgery. Future studies are needed to assess the short-term impact of corticosteroid injections on outcomes of rotator cuff repair, particularly in athletes.

Clinical outcomes of rotator cuff repair with subacromial bursa reimplantation: a retrospective cohort study

The subacromial bursa has been found to be a rich, local, source of mesenchymal stem cells but is removed for visualization during rotator cuff repair. Reimplantation of this tissue may improve rotator cuff healing. The purpose of this study is to evaluate clinical outcomes of rotator cuff repair with and without subacromial bursa reimplantation. Patients aged 37-77 with a full-thickness or near full-thickness supraspinatus tears underwent arthroscopic transosseous-equivalent double row rotator cuff repair. In patients prior to July 2019, the subacromial bursa was resected for visualization, and discarded. In patients after July 2019, the subacromial bursa was collected using a filtration device connected to an arthroscopic shaver and reapplied to the bursal surface of the tendon at the completion of the rotator cuff repair. Rotator cuff integrity was evaluated via magnetic resonance imaging on bursa patients at 6 months postoperatively. Minimum 18-month clinical outcomes (Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, patient satisfaction) were compared between bursa and nonbursa cohorts. A total of 136 patients were included in the study (control n=110, bursa n=26). Preoperative demographics and tear characteristics were not different between groups. Average follow-up was significantly longer in the control group (control: 3.2±0.7 years; bursa: 1.8±0.3 years; P<.001). The control group showed a significantly higher Single Assessment Numeric Evaluation score (control: 87.9±15.8, bursa: 83.6±15.1, P=.037) that did not meet minimum clinically important difference. The American Shoulder and Elbow Surgeons and patient satisfaction scores were similar between the groups. Symptomatic retears were not significantly different between groups (control: 9.1%, bursa 7.7%, P=.86). Seven patients in the control group underwent reoperation (6.4%), compared to 0 patients in the bursa group (0%, P=.2). Six-month postoperative magnetic resonance images obtained on bursa patients demonstrated 85% rotator cuff continuity (n=17/20) as defined via Sugaya classification. Augmentation of rotator cuff repair with bursal tissue does not appear to have negative effects, and given the accessibility and ease of harvest of this tissue, further research should be performed to evaluate its potential for improved tendon healing or clinical outcomes.

Increased operative time has a negative impact on clinical outcome in arthroscopic rotator cuff repair.

Few data are available about the impact of operative time on outcome of rotator cuff repair. The aim of this study was to evaluate the impact of operative time on clinical outcome and tendon healing after arthroscopic rotator cuff repair. Patients operated on for distal supraspinatus tear in our institution between 2012 and 2018 were included retrospectively. Operative time, from skin incision until skin closure, was extracted from medical files. For statistical analysis, operative time was treated as a quantitative variable. Endpoints were clinical outcome (Constant score, range of motion), tendon healing (on CT or MRI) and complications at 1year. The significance threshold was set at p = 0.05. A total of 219 Patients, with a mean age of 54.6years (range 40-70years), were included. Mean operative time 44.9min (range 14-140min). Significant correlations (p < 0.05) were found for Constant score and external rotation at 1year: increasing operative time by 1min led to a decrease in Constant score of 0.115 points, or 6.9 points for a 60-min increase (p = 0.0167) and a decrease in external rotation of 0.134°, or 8.04° for a 60-min increase (p = 0.0214). No significant correlations were found for anterior elevation at 1year (p = 0.2577), tendon healing at 1year (p = 0.295) or onset of complications during follow-up (p = 0.193). The minimal clinically important difference in Constant score in patients undergoing rotator cuff surgery is between 6 and 10 points. An increase of more than 60min in operative time significantly impacted clinical outcome of arthroscopic distal supraspinatus repair, but not tendon healing. Level III: Retrospective Cohort Design. Therapeutic Study.

The Effect of the Overweight Condition on Arthroscopic Rotator Cuff Repair Outcomes.

This study sought to investigate the influence of a preexisting overweight condition (body mass index [BMI], 25-29.9 kg/m2) on functional outcomes after arthroscopic rotator cuff repair surgery. A retrospective review was performed examining the outcomes of arthroscopic rotator cuff repair in a normal-weight (BMI, 18.5-24.9 kg/m2) and an overweight (BMI, 25-29.9 kg/m2) population. Functional outcomes were assessed to include the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation score, and the visual analog scale (VAS) pain score, as well as range of motion in forward flexion, external rotation, and internal rotation. A total of 52 normal-weight patients (mean BMI, 23.7±2.1 kg/m2) and 57 overweight patients (mean BMI, 28.4±1.4 kg/m2) were included. Both groups demonstrated statistically and clinically significant improvements in VAS score, Single Assessment Numeric Evaluation score, and ASES score at final follow-up (P<.0001), with no difference in range of motion (P>.05). Overall, when comparing outcomes between the groups, there were significantly better outcomes in the normal-weight group's VAS scores (mean, 0.56±0.96 vs 1.3±1.7; P=.0064), ASES scores (mean, 96.1±5.8 vs 92.4±9.7; P=.0187), and internal rotation (mean thoracic vertebrae, 9.2±3.0 vs 10.4±2.6; P=.0289). However, these differences did not reach clinical significance regarding the threshold of patients meeting standard minimal clinically important difference, substantial clinical benefit, and patient-acceptable symptomatic state for rotator cuff repairs. Over-weight patients have improved outcomes after arthroscopic rotator cuff repair surgery with noninferior clinical results when compared with normal-weight patients. More data regarding outcomes of overweight patients will help physicians make better-informed decisions when considering rotator cuff repair. [Orthopedics. 2023;46(4):242-249.].