Rotator Cuff Repair In Patients Research Articles

Pain neuroscience education following arthroscopic rotator cuff repair for patients with rotator cuff tears: a double blind randomized controlled clinical trial.

This trial examines the efficacy of the Pain Neuroscience Education (PNE) on clinical outcomes in patients with arthroscopic rotator cuff repair (ARCR). A total of 36 participants undergoing ARCR were assigned to either the experimental group (n = 18) or control group (n = 18) in this randomized study. A 6-week-long conventional physiotherapy program was administered for both groups. In addition, a PNE protocol was administered for the experimental group for a whole period of 6 weeks (one session/week, 15-60 min per session). The primary outcomes were to compare pre- and post-treatment scores of the experimental versus control groups on the pain and disability. Our secondary outcomes included the comparisons of scores on the catastrophizing, anxiety, depression, kinesiophobia, and quality of life. The participants were assessed both at baseline and post-treatment. The improvement in pain catastrophizing, anxiety, depression and kinesiophobia was greater in the experimental group (p < 0.05). The improvement was similar in both groups in terms of the rest of outcome measures. This study showed that the PNE improved only psychological aspects of the chronic pain in ARCR. Therefore, adding PNE to the conventional program might be useful to improve pain catastrophizing, anxiety, depression and kinesiophobia in patients with ARCR.

Outcomes of Superior Capsular Reconstruction Using the Long Head of the Biceps Tendon in Large to Massive Rotator Cuff Tears: A Meta-Analysis and Systematic Review.

(1) Background: Addressing large to massive rotator cuff tears (LMRCTs) poses complex challenges. This systematic review investigated outcomes of superior capsular reconstruction (SCR) with the long head of the biceps tendon (LHBT) compared to conventional rotator cuff repair (RCR) for LMRCTs. (2) Methods: A systematic search across the MEDLINE/PubMed, EMBASE, Cochrane Library, and Scopus databases until 1 October 2023 identified studies that directly compared SCR with LHBT with conventional RCR in patients with LMRCTs and included a minimum of a 12-month follow-up period. The assessed outcome measures encompassed retear rates, functional outcomes, range of motion (ROM), and acromiohumeral interval (AHI). Risk of bias assessment was conducted via the Robins-I tool. (3) Results: In six studies with 456 cases (210 SCR using LHBT and 246 using RCR), SCR with LHBT significantly reduced retear rates (OR = 0.21; 95% CI, 0.12-0.36; p < 0.01; I2 = 0%). Furthermore, SCR with LHBT showed significant improvement in range of forward flexion (SMD 0.32, 95% CI: 0.09-0.55, p < 0.01, I2 = 39%) and AHI (SMD 0.61, 95% CI: 0.31-0.92, p < 0.01, I2 = 0%) postoperatively. (4) Conclusion: SCR with LHBT is a safe and effective treatment for LMRCTs, reducing retear rates, maintaining greater postoperative AHI, and improving ROM compared to conventional RCR. Additional high-quality interventional studies are needed to confirm these results.

Early Postoperative Stiffness After Arthroscopic Rotator Cuff Repair Correlates With Improved Tendon Healing

PurposeThis study assessed if early postoperative stiffness predicts long-term stiffness and its relationship with repair integrity in arthroscopic rotator cuff repair (ARCR) patients. MethodsSingle-center retrospective study. 427 patients undergoing primary ARCR by a board-certified orthopaedic surgeon over four years were considered. Patients with at least one year of follow-up were categorized into stiff and non-stiff groups based on their range of motion (ROM) at three months postoperatively. Stiffness was defined as passive forward flexion <120°, external rotation <30°, or internal rotation below L3. We evaluated clinical outcomes using demographics, ROM, Constant Shoulder (CS) score, University of California, Los Angeles (UCLA) score, and visual analog scale (VAS) for pain preoperatively and at 3, 6, and 12 months postoperatively. Stiffness, retear rates, and tendon integrity were assessed via MRI at 12 months. ResultsOf 155 patients meeting the inclusion criteria, 68 (43.9%) were stiff, and 87 (56.1%) were non-stiff. The stiff group had significantly lower preoperative CS and UCLA scores (P=.013/.014) and higher VAS score (P=.034). At 3 months, this group showed lower ROM and functional scores (P<.001), persisting at 6 and 12 months (except internal rotation) (P<.001). Their 12-month VAS score was higher (P=.024). Postoperative stiffness occurred in 10.3% of the stiff group and 2.3% of the non-stiff group (P=.035). The 12-month retear rate was 5.9% in the stiff group and 17.2% in the non-stiff group (P=.032). Minimal clinically important difference (MCID) analysis indicated ROM changes but limited functional score changes in the two groups. ConclusionThis study showed that early postoperative shoulder stiffness correlates with lower preoperative functional scores and higher pain levels. Shoulder stiffness at three months post-ARCR predicts 12-month shoulder stiffness but indicates better tendon integrity. While early stiffness is linked to lower functional scores and more pain, its long-term clinical impact seems limited.

Comparison of post-operative outcomes in arthroscopic repair of traumatic and atraumatic rotator cuff tears

Background Traumatic or atraumatic etiologies are associated with different pathophysiology, and thus, may lead to different post-operative outcomes after arthroscopic rotator cuff repair (RCR). Methods Institutional records were used to identify patients who underwent arthroscopic RCR in 2019-2020. Retrospective review of medical records was performed to determine mechanism of injury, pre- and post-operative range of motion and strength measures. Results Among 100 RCR patients, 53 sustained a traumatic RC injury. Patients with traumatic rotator cuff tears (TR) presented to the clinic after onset of pain sooner than patients with atraumatic tears (aTR) (TR: 166±193 vs aTR: 595±679 days; P&lt;0.001). Pre-operative measurements were worse among traumatic patients than atraumatic patients: forward elevation (TR: 130º±48º vs aTR: 152º±25º; P=0.036), external rotation (TR: 49º±17º vs aTR: 55º±16º; P=0.076), internal rotation (TR: L4 vs aTR: L3; P=0.033), forward elevation strength (TR: 4/5 vs aTR: 5/5; P=0.035), external rotation strength (TR: 5/5 vs aTR: 5/5; P=0.065), and internal rotation strength (TR: 5/5 vs aTR: 5/5; P=0.150). However, there was no significant difference in post-operative measurements between cohorts: forward elevation (TR: 158º±19º vs aTR: 153º±28º; P=0.433), external rotation (TR: 53º±16º vs aTR: 50º±15º, P=0.332), internal rotation (TR: L2 vs aTR: L2; P=0.703), forward elevation strength (TR: 5/5 vs aTR: 5/5; P=0.926), external rotation strength (TR: 5/5 vs aTR: 5/5; P=0.920), and internal rotation strength (TR: 5/5 vs aTR: 5/5; P=0.519). Conclusion Traumatic RCR patients had significantly worse functional measurements during pre-operative exam than atraumatic RCR patients, but there was no significant difference in post-operative outcomes.

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.

Shoulder pain management strategies and early functional outcome after arthroscopic rotator cuff tear repair. A randomized controlled study

BackgroundThe management of acute postoperative pain after rotator cuff surgery can be challenging. To our knowledge, there are no data available in the literature correlating satisfactory pain control with improvement in terms of function. The purposes of the present study were to evaluate: 1) pain pattern after arthroscopic rotator cuff repair in patients operated with two different techniques (transosseous vs transosseous equivalent); 2) safety/efficacy of three different pharmacological pain control strategies; 3) possible relationship between a correct shoulder pain management protocol in the early post-operative period and patients’ functional improvement. Methods114 patients underwent rotator cuff tear repair, either with a Transosseus or a Transosseus equivalent technique. 62 (54%) were male and 52 (46%) were female. The average age was 59 ± 9 years. They were randomly assigned into three different pain management protocols: Paracetamol as needed (max 3 tablets/day) for 1 week (Protocol A), Paracetamol + Codein 1 tablet three times per day for 7 days (Protocol B), or Paracetamol + Ibuprofen 1 tablet two times per day for 7 days (Protocol C). Immediate passive mobilization of the operated shoulder was allowed. VAS and Passive Flexion values were recorded at 7 (T1), 15 (T2) and 30 (T3) days post-surgery. DASH values were recorded at 90 days post-surgery. All patients were asked to register any kind of signs/symptoms that may appear during drug assumption according to each pain management protocols. ResultsAll the pain management protocols administered were well tolerated by all the study population, and no adverse signs/symptoms were highlighted during drug assumption.Pain pattern: in both surgical techniques, patients within Protocol A were associated with worst results in terms of mean VAS at each time point examined when compared to Protocol B and C (p < 0,05). In patients within Protocol A, no statistically significant differences were found at each point time examined comparing the two surgical techniques, with the exception of T2, where the TO was associated with an higher VAS value than TOE (p < 0.05). No differences were highlighted in Protocol B and C when comparing the values between two surgical techniques.ROM: in both surgical techniques, patients within Protocol A were associated with worst results in terms of mean PROM at each time point examined when compared to Protocol B and C (p < 0,05). In the TO group, patients within Protocol B had better PROM values at T1 (p < 0,05) and T2 (p < 0,05) compared to Protocol C, but no differences were highlighted at T3. In the TOE group, no statistically significant differences were found between patients within Protocol B and C at each time point examined.DASH: In the TO group, no statistically significant differences were found regarding the DASH values comparing Protocol B vs Protocol C, but they were highlighted comparing the values between Protocol A and Protocol B (p < 0,05), and between Protocol A and Protocol C (p < 0,05). Similar results were recorded in the TOE group. ConclusionPost-operative pain is influenced by the surgical technique used being transosseous more painful in the first 15 days after surgery. Oral anti-inflammatory drugs are a feasible strategy to appropriately control post-operative pain. An association between Paracetamol and either Codein or Ibuprofen can lead to better outcomes in terms of VAS reduction and early recovery of passive ROM.

Clinical and Structural Outcomes of Arthroscopic Rotator Cuff Repair in Patients Over 75 Years Are Comparable to Those in Younger Patients: A Propensity Score-Matched Comparative Study

PurposeTo compare clinical and structural outcomes of arthroscopic rotator cuff repair (ARCR) in patients over 75 years and those under 75 years and to analyze the factors associated with retear and clinical outcomes after ARCR. MethodsThis retrospective study reviewed patients who underwent ARCR between 2011 and 2021 with at least 2-years of follow-up. Using propensity score matching for sex, tear size, subscapularis involvement, and follow-up time, this study included 54 patients older than 75 years (group A) and 54 patients younger than 75 years (group B). Cuff integrity was evaluated using magnetic resonance imaging (MRI). Structural and clinical outcomes were compared between the two groups. ResultsThe mean improvements in external rotation (P = .030) and the ASES score (P = .043) were significantly higher in group A. Visual analog scales for pain and function, American Shoulder and Elbow Surgeons (ASES) score, and Constant score were significantly improved in both groups (all P = .001). On routine postoperative MRI at 6 months, the retear rate was 20.4% (11/54) in group A and 18.5% (10/54) in group B with no statistical difference between the two groups (P = .808). Factor analysis in group A showed that follow-up duration (P = .019), tear size in mediolateral dimension (P = .037), occupation ratio (P = .036), and incomplete repair (P = .034) were associated with retear, and mild glenohumeral arthritis (P = .003) and subscapularis involvement (P = .018) were associated with inferior Constant score. ConclusionClinical and structural outcomes after ARCR in patients aged 75 years or older are comparable to those in patients younger than 75 years. Level of evidenceIII, Retrospective case-control study

Single-stage capsular release and rotator cuff repair for patients with rotator cuff tear

Objectives: Shoulder stiffness is often an associated symptom in patients with rotator cuff (RC) tear. With an ongoing debate on the timing and staging of procedures, there seems to be no clear consensus about managing these patients. In this study, we aimed to ascertain if performing a single-stage rotator cuff repair (RCR) along with concomitant capsular release (CR) has any advantage over performing RCR alone and whether it has any impact on the functional outcome of the patients. Materials and Methods: Retrospective study was conducted with 23 patients who received arthroscopic RCR under a single surgeon from 2017 to 2022. From 2017 to 2019, patients underwent only RCR without any CR; from 2020 to 2022, concomitant CR was done along with all RCR. A total of 12 patients were identified under the CR group and 11 patients under the no-CR group. Range of motion (ROM) and functional outcomes were recorded and assessed pre- and post-operatively for 2 years. Results: There was no significant variation in gender distribution, age, and cuff tear size between the two groups. Postoperatively, there was a substantial variation between the two groups in the recovery period (6 months post-operative) of ROM. Postoperatively, patients in both groups reported lesser pain and improved ROM compared to pre-operation. However, there was no substantial variation in functional outcome scores and ROM between both groups at the final follow-up. Conclusion: Combined single-stage RCR along with CR significantly reduces the recovery period compared to those who underwent repair without CR.

Validated Wearable Device Shows Acute Postoperative Changes in Sleep Patterns Consistent With Patient-Reported Outcomes and Progressive Decreases in Device Compliance After Shoulder Surgery

To assess the utility of a validated wearable device (VWD) in examining preoperative and postoperative sleep patterns and how these data compare to patient-reported outcomes (PROs) after rotator cuff repair (RCR) or total shoulder arthroplasty (TSA). Male and female adult patients undergoing either RCR or TSA were followed up from 34 days preoperatively to 6 weeks postoperatively. Sleep metrics were collected using a VWD in an unsupervised setting. PROs were assessed using the following validated outcome measures: Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function questionnaire; American Shoulder and Elbow Surgeons self-evaluation questionnaire; visual analog scale assessing pain; and Disabilities of the Arm, Shoulder and Hand questionnaire. Data were analyzed preoperatively and at 2-week intervals postoperatively with χ2 analysis to evaluate device compliance. Sleep metrics and PROs were evaluated at each interval relative to preoperative values within each surgery type with an analysis of variance repeated on time point. The relation between sleep metrics and PROs was assessed with correlation analysis. A total of 57 patients were included, 37 in the RCR group and 20 in the TSA group. The rate of device compliance in the RCR group decreased from 84% at surgery to 46% by 6 weeks postoperatively (P < .001). Similarly, the rate of device compliance in the TSA group decreased from 81% to 52% (P < .001). Deep sleep decreased in RCR patients at 2 to 4 weeks (decrease by 10.99 ± 3.96 minutes, P= .021) and 4 to 6 weeks postoperatively (decrease by 13.37 ± 4.08 minutes, P= .008). TSA patients showed decreased deep sleep at 0 to 2 weeks postoperatively (decrease by 12.91 ± 5.62 minutes, P= .045) and increased rapid eye movement sleep at 2 to 4 weeks postoperatively (increase by 26.91 ± 10.70 minutes, P= .031). Rapid eye movement sleep in the RCR group and total sleep in the TSA group were positively correlated with more favorable PROs (P < .05). VWDs allow for monitoring components of sleep that offer insight into potential targets for improving postoperative fatigue, pain, and overall recovery after shoulder surgery. However, population demographic factors and ease of device use are barriers to optimized patient compliance during data collection. Level IV, diagnostic case series.

Elevated HbA1c is not associated with reoperation following arthroscopic rotator cuff repair in patients with diabetes mellitus

Hyperglycemia is a known risk factor for tendon degeneration due to oxidative stresses from production of advanced glycosylation end products. In patients with Diabetes Mellitus (DM), analysis of glycated hemoglobin (HgA1c) provides a 3-month window into a patient's glucose control. No guidelines exist for ideal preoperative HgA1c and glucose control prior to arthroscopic rotator cuff repair. This study evaluated if a critical HgA1c level is associated with reoperation following arthroscopic rotator cuff repair. We retrospectively evaluated patients with DM who underwent primary arthroscopic rotator cuff repair from January 2014 to December 2018 at a single institution. Patients required a preoperative Hg1Ac within 3 months of surgery. Medical records were queried to evaluate for reoperation and identify the subsequent procedures performed. Univariate statistical analysis was performed to assess factors associated with reoperation (p< 0.05 considered significant). Threshold, area under the curve (AUC), analysis was performed to assess if a critical HgA1c value was associated with reoperation. 402 patients met inclusion criteria. Patients had an average age of 65.5 years (range 40-89) at time of surgery; 244 (60.6%) patients were male; and average BMI was 32.96 +/- 5.81. Mean HgA1c was 7.36 (Range 5.2 to 12). Thirty-three patients (8.2%) underwent subsequent reoperation. Six patients (1.5%) underwent capsular release and lysis of adhesions, 20 (5.0%) patients underwent a revision rotator cuff surgery, combination revision rotator cuff repair and lysis of adhesions, graft augmented revision repair, or superior capsular reconstruction, and 7 (1.7%) patients underwent revision to reverse shoulder arthroplasty (1.7%). There were no cases of reoperation for infection. On AUC analysis, no critical HgA1c value was identified to predispose to reoperation. Interestingly, elevated preoperative ASA (2.8 vs 2.28, p = 0.001) was associated with a higher reoperation rate. In patients with DM, preoperative HgA1c is not a predictive factor for surgical failure requiring reoperation. Stable glycemic control is important to a patient's overall health and may play a role in minimizing postoperative medical complications, but an elevated preoperative HgA1c should not be a strict surgical contraindication for arthroscopic rotator cuff repair. In patients with DM, an elevated ASA score is associated with an increased rate of subsequent reoperation; diabetic patients should be counselled accordingly.

Effect of Insurance Reimbursement Status on Pre- and Postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Scores After Arthroscopic Rotator Cuff Repair

Background: Previous studies reported inferior patient-reported outcomes (PROs) after arthroscopic rotator cuff repair for patients receiving workers’ compensation (WC) relative to patients with commercial insurance. The extent to which alternative insurance reimbursement, including Medicaid and Medicare, influences outcomes after arthroscopic rotator cuff repair remains understudied. Hypothesis: Compared with patients with commercial insurance reimbursement, patients with WC or government-issued reimbursement would report lower pre- and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) scores, report higher pre- and postoperative PROMIS Depression (D) and Pain Interference (PI) scores, and experience smaller levels of improvement in all PROMIS domains with surgical intervention. Study Design: Cohort study; Level of evidence, 3. Methods: Demographic and surgical data were extracted from the medical record, and PROMIS domains were prospectively collected. Patients were divided into cohorts based on insurance reimbursement status. Differences between insurance-based cohorts for baseline variables, pre- and postoperative PROMIS scores, and change from baseline to final follow-up (delta) for PROMIS scores were evaluated using Kruskal-Wallis or chi-square tests. Mixed-effects linear regression models were performed to assess the influence of insurance while controlling for other variables. Survival analysis was performed to determine time to achieve minimal clinically important difference (MCID) for each PROMIS domain per cohort. Results: 1252 patients underwent arthroscopic rotator cuff repair, met inclusion criteria, and completed PROMIS questionnaires. Statistically significant differences were noted in demographic variables including age (P < .001), sex (P < .001), ethnicity (P < .001), and body mass index (P < .001) between insurance-based cohorts. Unadjusted analysis revealed significantly higher PF scores and lower PI and D scores for the group with commercial insurance relative to those with Medicare, Medicaid, and WC at 6- and 12-month follow-up (P < .01 all comparisons), except for the Medicare versus commercial subcohort analysis for PI at 6 months (P = .28). These differences persisted for the Medicare, Medicaid, and WC groups (P < .03 all comparisons) after adjustment for confounding variables in linear regression. Conclusions: The baseline characteristics of patients undergoing arthroscopic rotator cuff repair differed based on insurance reimbursement. Patients with commercial insurance reported improved physical function, decreased pain interference, and improved mood (less depression) relative to patients with government-issued and WC insurance, with maximum improvement 6 to 12 months postoperatively. There were few significant differences between insurance groups in change of PROMIS scores from preoperative to postoperative intervals, indicating that differences in the baseline demographic and surgical characteristics of these groups accounted for differences in response to surgery.

Mental health disorders and pain modulation in orthopedic shoulder patients

Various studies have examined the relationship between preoperative mental health diagnoses (MHDs) and postoperative outcomes in orthopedic shoulder patients. However, few investigations delve into the relationship between a preoperative MHD and postoperative opioid pain control regimens in patients who have undergone rotator cuff repair (RCR), total shoulder arthroplasty (TSA), and reverse TSA (rTSA). We hypothesize that orthopedic shoulder patients with a preoperative MHD will be prescribed more opioids (ie, request more refills) postoperatively than those without a MHD. An institutional review board-approved retrospective chart review was performed on 438 patients, 18 years or older, who underwent RCR, TSA, or rTSA. Patients were divided into two groups: those diagnosed with depression, anxiety, bipolar disorder, and/or schizophrenia (n=193), and those with no previous MHD (n=245). Statistical outcomes were analyzed with the independent t-test, Mann-Whitney U test, one-way Analysis of Variance, and Kruskal-Wallis test. Univariate analysis demonstrated significant differences between the MHD group and non-MHD group in average 90-day postoperative opioid scripts (2.10 vs. 1.55, respectively, P<.001) and median 90-day postoperative morphine milligram equivalents (MMEs) prescribed (225 MME vs. 185.25 MME, respectively, P<.001). Among patients who were opioid naive 90 days preoperatively, significant differences were found in MMEs prescribed between the MHD and non-MHD group (225 MME vs. 150 MME, respectively, P<.001). Further analysis of opioid naive patients with specifically depression compared to patients with an alternate or no MHD diagnosis yielded significant differences in scripts (1.78 vs. 1.33, respectively, P=.031) and MMEs prescribed (225 MME vs. 150 MME, respectively, P<.001). This study found that RCR, TSA, or rTSA patients with a preoperative MHD were prescribed significantly more postoperative MMEs and more opioid scripts (ie, requested more refills) than those without MHD. This is despite preoperative education on postoperative pain expectations and limiting opioid use. Our findings support our hypothesis and emphasize the clinical importance of recognizing mental health disease while navigating postoperative pain control expectations. Given the rising prevalence of mental health disorders nationwide, considering the effect of these comorbidities on postoperative pain in RCR, TSA, and rTSA patients will be essential to enhance preoperative and postoperative counseling and management by orthopedic surgeons. We further recommend a multidisciplinary approach to help manage pain in these patients.

Rotator cuff repair in patients 50 years of age or younger: A comparative study of functional outcomes in relation to older patients

BackgroundFew studies have evaluated the clinical results of surgical treatment of rotator cuff tears in young patients and most of the publications are only case series and with a small number of evaluated individuals. The aim of this study is to compare the clinical outcomes of patients undergoing arthroscopic rotator cuff repair according to age at the time of the procedure. HypothesisPatients with 50 years of age or younger undergoing surgical treatment of rotator cuff tear have similar clinical outcomes to older patients. Materials and methodsRetrospective cohort study comparing results obtained after surgical treatment of rotator cuff tears between patients aged 50 years or younger and the older patients by the ASES and UCLA functional scales. Patients undergoing arthroscopy full-thickness rotator cuff repair were included. ResultsWe evaluated 390 shoulders (377 patients), 94 aged 50 years or younger (median=46.5 years) and 296 aged over 50 years (median=60 years). Both groups significantly improved with the procedure after 24 months of follow-up, according to the ASES and UCLA scales (p<0.001). The groups did not differ in the scores obtained in the preoperative assessments and at 24 months of follow-up. The score obtained on the ASES scale at 24 months of follow-up had a median of 87.2 (IQR=38) among patients aged 50 years or younger and 90 points (IQR=26.4) among older patients (p=0.253). The scores obtained by the UCLA scale were 31 points (IQR=9) and 33 points (IQR =7) respectively (p=0.156). DiscussionOur results showed that, after 24 months, the functional results of arthroscopic full-thickness rotator cuff repair did not differ between patients younger than 50 years and older patients. These results are similar to those found by other authors. Both groups of patients achieved significant improvement after the surgical procedure, achieving approximately 90 points on the ASES scale and 32 points on the UCLA scale. Level of evidenceIII Retrospective cohort study.

Paper 50: Biceps Autograft Patch Augmentation for Rotator Cuff Repair: The Effect of Point of Care Compression on Tenocyte Viability.

Objectives: Augmentation of rotator cuff repair in patients at risk for retear has gained popularity. These techniques have generally consisted of allograft and xenograft patches. Recently, use of an autograft biceps from the normally discarded portion after biceps tenodesis was described as a potential patch for rotator cuff repair augmentation. As an autograft, it is free and readily available. The original description prepared the patch by placing it through a commercial skin graft preparation station. This technique results in a significant decrease in tenocyte viability, however, and results in a patch that is difficult to work with. Recently, an autograft compression plate has been employed to use as a point of care processor for adapting the discarded long head of the biceps after tenodesis into an autograft patch. The purpose of this study was to evaluate the feasibility of this point of care graft preparation method, and to specifically evaluate its effect on tenocyte viability in patients undergoing patch augmentation for rotator cuff repair. Methods: We reviewed the medical records of consecutive patients who underwent biceps tenodesis for either rotator cuff repair or anatomic shoulder arthroplasty. After tenodesis, and after 27 mm of the long head of the biceps was secured for compression into the patch, the remaining length of normally discarded tendon was longitudinally split, resulting in 2 equal lengths of remnant tendon from the same zone of the tendon. One sample was sent to pathology with no preparation, and the other was prepared as a biceps autograft patch using the autograft compression plate according to the manufacturer’s recommendations. Once prepared, this second biceps sample was sent to pathology along with the first. The request was to evaluate for tenocyte viability. Pathologists were not told which sample was compressed. Records were reviewed to determine if biceps tendon samples were viable at the time of harvest, and whether the compression process affected a change between the first and second specimen. Results: 20 consecutive patients were reviewed. All 20 biceps produced usable patches. The remnant biceps samples that were sent to pathology revealed the following: Sixteen of the 20 patients had biceps tenocyte viability that were read out as completely normal in both the compressed and non compressed samples. Of the 4 patients that did show some degree of tenocyte necrosis or death, 3 of the patients had identical findings between the compressed and non-compressed samples. Only 1/20 (5%) of the patients showed a difference between the compressed sample and the non-compressed sample, with the compressed sample demonstrating small areas of “patchy necrosis” while the non compressed sample showed normal tendon in that specimen. Conclusions: Compression of the long head of the biceps results in an autograft patch that is a promising option in rotator cuff augmentation. The method of compression plating to process the long head of the biceps remnant into an augmentation patch appears to have no significant effect on tenocyte viability, suggesting that the patch has live tenocytes at the time of point of care augmentation.

Patients With Depression and/or Anxiety Having Arthroscopic Rotator Cuff Repair Show Decreased Number of Prescriptions and Number of Psychotherapy Sessions in the Year After Surgery

To determine whether the utilization of psychological treatments changes after arthroscopic rotator cuff repair (RCR) for patients with preoperative depression and/or anxiety. The Truven Healthcare Marketscan database was used to identify patients who underwent arthroscopic RCR between January 2009 and December 2016. We included all patients with diagnosis codes associated with either depression or anxiety before RCR. Patients were excluded if they did not have complete insurance coverage for 1 year before or after surgery, or if they had arthroscopic RCR in the year before the index surgical procedure. We compared the proportion of patients with preoperative depression or anxiety who filled a prescription and had psychotherapy procedural codes in the year before and the year after arthroscopic RCR. A total of 170,406 patients who underwent RCR were identified, of which depression and/or anxiety was found in 46,737 patients (43.7% male). Of the 46,737 patients, 19.6% filled a prescription for a depression/anxiety medication at least once in the year before surgery. Of this subset of patients, 41.5% did not fill a prescription for depression or anxiety medication after surgery, whereas 32.6% continued medication use but demonstrated a median 30-day reduction in the number of days' worth of medication. Similarly, 13.1% of patients were attending psychotherapy sessions preoperatively, but 76.6% of those patients either stopped or reduced the amount of psychotherapy sessions in the year following RCR. The number of prescriptions and psychotherapy sessions decreased in the year after RCR for patients with preoperative diagnoses of depression and/or anxiety. Level IV, case series.

The Incidence of Carpal Tunnel Syndrome Diagnosis Increases after Arthroscopic Shoulder Surgery

Arthroscopic shoulder surgery has been identified as a potential risk factor for carpal tunnel syndrome (CTS). The purposes of this study were as follows: to (1) examine the percentage of patients who underwent arthroscopic shoulder procedures and later developed ipsilateral CTS within 1 year of the procedure, (2) determine the percentage of those patients with CTS who subsequently underwent an injection or release, and (3) examine comorbidities associated with developing CTS after surgery. Patients who underwent arthroscopic rotator cuff repair (RCR), labral repair, or biceps tenodesis were retrospectively identified in a national database. Within 1 year, we compared the rates of ipsilateral CTS diagnoses versus the contralateral side. The rates of comorbidities between those who did and did not develop CTS were also compared. Within 1 year, arthroscopic RCR patients (1.47% vs 1.00%; odds ratio [OR], 1.48; P < .001) and arthroscopic labral repair patients (0.76% vs 0.52%; OR, 1.47; P < .001) had a significantly higher rate of ipsilateral carpal tunnel diagnosis versus contralateral side diagnosis. Arthroscopic RCR patients were also significantly more likely to have ipsilateral carpal tunnel injection (0.16% vs 0.11%; OR, 1.45; P < .001) and release (0.46% vs 0.37%; OR, 1.24; P < .001). Patients who had an ipsilateral carpal tunnel diagnosis following arthroscopic RCR and labral repair were both significantly older (both P < .001), a higher percentage of women (both P<.001), and more likely to have had a preoperative nerve block (both P < .05). Both cohorts had significantly higher mean Elixhauser comorbidity Index (P < .001) and more comorbidities. This study demonstrated a significantly higher incidence of operative side CTS within 1 year following arthroscopic RCR and labral repairs. Arthroscopic RCR was also demonstrated to result in significantly higher rates of injections and carpal tunnel release. The cohort that developed ipsilateral CTS was older, had higher percentage of women, and had more comorbidities. Prognostic III.

Work Related Outcomes of Revision Rotator Cuff Repair for Patients Receiving Workers' Compensation.

Workers' compensation (WC) patients are susceptible to poorer outcomes following primary rotator cuff repair (RCR). Failure of structural healing can explain some poor results and outcomes of revision RCR in this population are unknown. Retrospective review of subjects receiving WC who underwent arthroscopic revision RCR with or without dermal allograft augmentation at a single institution between January 2010 and April 2021. Preoperative MRI scans were assessed for rotator cuff tear characteristics, Sugaya classification, and Goutallier grade. Postoperative imaging was not routinely obtained unless for continued symptoms or re-injury. Primary outcome measures included return-to-work status, reoperation, American Shoulder and Elbow Surgeons (ASES) and Single Alpha Numeric Evaluation (SANE) scores. Twenty-seven shoulders (25 patients) were included. The population was 84% male, mean age of 54, 67% manual laborers, 11% sedentary workers, and 22% with a mixed profession. Average follow-up was 35.4 months. Fifteen patients (56%) returned to work at full duty status. Six (22%) returned to work with permanent restrictions. Six (22%) were unable to return to work in any capacity. Thirty percent of all patients and 35% of manual laborers changed occupation following revision RCR. Mean time to return-to-work was 6.7 months. Overall, symptomatic rotator cuff retear was found in 13 patients (48%). Reoperation rate after revision RCR was 37% (10 cases). Among patients who did not undergo reoperation, mean ASES scores improved from 37.8 to 69.4 at final follow-up (p<0.001). Mean SANE scores only improved marginally from 51.6 to 57.0 (p=0.61). No statistically significant correlation was found between preoperative MRI findings and outcome measures. Workers' compensation patients demonstrated fair improvements in outcomes scores after revision RCR. While some patients are able to return to full duty, nearly half were either unable to return or returned with permanent restrictions. This data is helpful for surgeons when counseling patients about expectations and return to work after revision RCR in this challenging population.

Revision Rotator Cuff Repair With Versus Without an Arthroscopically Inserted Onlay Bioinductive Implant in Workers’ Compensation Patients

Background: The addition of onlay biological grafts to augment difficult rotator cuff repairs has shown encouraging results in a case series. Purpose/Hypothesis: The purpose of this study was to determine whether the addition of an onlay bioinductive implant would improve repair integrity, shear wave elastographic appearance of the repaired tendon and patch, and patient-rated and/or surgeon-measured shoulder function when used in workers' compensation patients undergoing revision arthroscopic rotator cuff repair. We hypothesized that the addition of the bioinductive implant would enhance repair integrity and clinical outcomes compared with standard repair. Study Design: Cohort study; Level of evidence, 3. Methods: A post hoc matched-cohort study was conducted on prospectively recruited workers’ compensation patients who received a bioinductive implant for revision rotator cuff repair (n = 19). The control group was selected from consecutive workers’ compensation revision rotator cuff repair patients before the introduction of bioinductive implants. Then, they were matched for age and tear size (n = 32). Kaplan-Meier curves were generated to compare the primary outcome of repair integrity between groups. The secondary outcomes were to evaluate the elastographic appearance of the tendon and patch in the bioinductive implant group and to compare patient-rated and surgeon-measured shoulder function between groups preoperatively and at 1 week, 6 weeks, 3 months, and 6 months postoperatively. Results: No major complications associated with the bioinductive implants were identified. Six months after the revision rotator cuff repair, the retear rate in the bioinductive implant group was 16% (3/19), compared with 19% (6/32) in the age- and tear size-matched control group ( P = .458). At the final follow-up, the retear rate in the bioinductive implant group was 47% (9/19) at a mean of 14 months compared with 38% (12/32) at a mean of 29 months in the control group ( P = .489). The shear wave elastographic stiffness of repaired tendons augmented with the bioinductive implant remained unchanged at 6 m/s from 1 week to 6 months postoperatively, which is lower than the stiffness of 10 m/s in healthy tendons. There were no significant differences in patient-rated or surgeon-measured outcomes between groups 6 months postoperatively. Conclusion: There were no differences in repair integrity or clinical outcomes between workers’ compensation patients who underwent revision arthroscopic rotator cuff repair with an onlay bioinductive implant compared to those who underwent standard revision rotator cuff repair.

Mid-Term Outcomes of Arthroscopic Rotator Cuff Repair in Patients with Rheumatoid Arthritis.

The effectiveness of arthroscopic rotator cuff repair (ARCR) on rheumatoid arthritis (RA) patients remains a controversial topic. This study investigates the mid-term outcomes of ARCR in RA patients and identifies the factors influencing clinical efficacy. This retrospective study enrolled RA patients with small or medium rotator cuff tears (RCTs) between February 2014 and February 2019. Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Constant-Murley scores were collected at each follow-up time. Ultimately, magnetic resonance imaging (MRI) and X-ray were employed to assess rotator cuff integrity and progression of shoulder bone destruction, respectively. Statistical methods used two-way repeated-measures ANOVA or generalized estimation equations. A total of 157 patients were identified and divided into ARCR (n = 75) and conservative treatment (n = 82) groups. ARCR group continued to be divided into small tear (n = 35) and medium tear (n = 40) groups. At the final, all scores were better in ARCR group than in the conservative treatment group (p < 0.05). A radiographic evaluation of the final follow-up demonstrated that the progression rate in ARCR group (18.67%) was significantly lower than that of the conservative treatment group (39.02%, p < 0.05). In the comparison of the small tear and medium tear groups, all scores increased significantly after surgery (p < 0.05), and the final follow-up scores were better than preoperative scores (p < 0.05) but worse than those of the 6-month postoperative follow-up (p < 0.05). Comparison between the two groups revealed that all scores of the small tear group were significantly better than those of the medium tear group at 6-month postoperative follow-up (p < 0.05). Although the scores of small tear group remained better than those of the medium group at the final postoperative follow-up, the difference was not statistically significant (p > 0.05). Radiographic assessment of the final follow-up demonstrated that the progression rate in the small tear group (8.57%) was significantly lower than that in the medium group (27.50%, p < 0.05), and the retear rate of small tear group (14.29%) was significantly lower than that of the medium tear group (35.00%, p < 0.05). ARCR could effectively improve the quality of life for RA patients with small or medium RCTs, at least in the medium term. Despite the progression of joint destruction in some patients, postoperative retear rates were comparable to those in the general population. ARCR is more likely to benefit RA patients than conservative treatment.

Disruptions in Standard Care in Patients After Arthroscopic Rotator Cuff Repair During the COVID-19 Pandemic

The coronavirus disease-2019 (COVID-19) pandemic led to disruptions in care for orthopaedic patients who underwent surgery just before the outbreak, rendering some unable to participate in standard postoperative care. Many of these patients underwent clinical follow-up and physical therapy via telehealth. To evaluate the methods of postoperative care in patients who underwent arthroscopic rotator cuff repair (RCR) and had follow-ups during the height of the pandemic versus those who received prior standard of care. We aimed to compare the 1-year outcomes between these cohorts. Cohort study; Level of evidence, 3. A retrospective chart review was used to identify patients who underwent primary RCR in February and March 2020 (COVID cohort) and the same period in 2019 (control cohort) at a single institution. Excluded were patients who underwent revision RCR, used workers' compensation, or were incarcerated or deceased. The included patients reported the postoperative care received, their satisfaction with care, physical therapy appointment type (in person, home based, telehealth, or self-guided), satisfaction with physical therapy, and minimum 1-year postoperative American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Penn Shoulder Score (PSS) outcomes. Overall, 428 patients were included for final analysis--199 in the COVID cohort and 229 controls. Follow-up data were collected for 160 patients in the COVID group (80.4%) and 169 control patients (73.8%). In the COVID group, 110 patients (68.8%) had ≥1 clinical visit conducted via telehealth, compared with zero in the control group. There were no differences between the COVID and control groups in the ASES (84.2 ± 16.5 vs 86.5 ± 17; P = .27 ), SANE (83.9 ± 15.4 vs 84.8 ± 17.5; P = .66), PSS (84.8 ± 15.3 vs 87.1 ± 15.1; P = .22), or patient satisfaction with the care received (81.7 ± 22.6 vs 86.3 ± 23.5; P = .09). Satisfaction with physical therapy was significantly higher in the control group (88.3 ± 18.9 vs 81.9 ± 22.5; P = .01). Despite disruptions in care, RCR patients had comparable 1-year outcomes during the pandemic versus before the pandemic. Telehealth clinical follow-up appointments did not adversely affect patient-reported outcome measures and may be appropriate for RCR patients beyond the pandemic.