Rotator Cuff Research Articles

A dual phase biologic augmentation of rotator cuff healing in a preclinical rat model using IL-17F and low-dose lithium

BackgroundRotator cuff tendon tears are a common cause of shoulder dysfunction in adults. Yet, impaired healing continues to result in higher failures rates after surgical repair resulting in patient dysfunction and prolonged recovery. This has spurred increased investigation of biologic augmentation to improve tendon healing. This study examines the outcome of peritendinous IL-17F administration and oral low-dose lithium carbonate on rotator cuff healing following acute surgical repair in a rat model. MethodsTreatment group included an open supraspinatus peel and repair followed by a local injection of IL-17F at the bone-tendon interface and a 7-day course of oral lithium carbonate. Control rats received no additional intervention prior to surgical closure. Evaluation of healing was then preformed using MRI imaging, biomechanical testing, and histological analysis at the bone-tendon interface. ResultsEighteen rats (9 control, 9 experimental) underwent complete testing. Combined treatment of peri-tendinous IL-17F and oral low-dose lithium carbonate after rotator cuff repair improved rotator cuff healing in all outcomes when compared to controls. MRI imaging in the treatment group showed complete healing of all supraspinatus tendons across the anatomic footprint after repair. We also found significant increases in biomechanical stiffness compared to controls (p <0.01). At the histological level, treatment groups also had decreased osteoclasts (p<0.001), and increased histologic organization of fibroblasts compared to controls. These findings are consistent with an increase in biomechanical stiffness. ConclusionWe demonstrated that the combined treatment of IL-17F and oral low-dose lithium improved rotator cuff tendon healing quality following acute surgical repair in a rat model.

Diagnostic Accuracy and Interobserver Reliability of Rotator Cuff Tear Detection with Ultrasonography are Improved with Attentional Deep Learning.

Improve the accuracy of one-stage object detection by modifying the YOLOv7 with Convolutional Block Attention Module (CBAM), known as YOLOv7-CBAM, which can automatically identify torn or intact rotator cuff tendon to assist physicians in diagnosing rotator cuff lesions through ultrasound. Between 2020 and 2021, patients who experienced shoulder pain for over 3 months and had both ultrasound and MRI examinations were categorized into torn and intact group. To ensure balanced training, we included the same number of patients on both groups. Transfer learning was conducted using a pre-trained model of Yolov7 and an improved model with CBAM. The mean average precision (mAP), sensitivity and F1-score were calculated to evaluate the models. Gradient-weighted Class Activation Mapping (Grad-CAM) method was employed to visualize important regions using a heatmap. Simulation dataset was recruited to evaluate the diagnostic performance of clinical physicians using our AI-assisted model. A total of 280 patients were included in this study, with 80% of 840 ultrasound images randomly allocated for model training. The accuracy for test set was 0.96 for Yolov7 and 0.98 for Yolov7-CBAM, the precision and sensitivity were 0.94 and 0.98 for Yolov7, 0.98 and 0.98 for Yolov7-CBAM. F1-score and mAP@0.5 were higher for Yolov7-CBAM (0.980 and 0.993) than Yolov7 (0.961 and 0.965). Furthermore, the Grad-CAM method elucidated that the deep learning model primarily emphasized hypoechoic anechoic defect within the tendon. Following adopting an AI-assisted model (YOLOv7-CBAM model), diagnostic accuracy improved from 80.86% to 88.86% (p=0.01) and interobserver reliability improved from 0.49 to 0.71 among physicians. The YOLOv7-CBAM model demonstrate high accuracy in detecting torn or intact rotator cuff tendon from ultrasound images. Integrating this model into the diagnostic process can assist physicians in improving diagnostic accuracy and interobserver reliability across different physicians. The attentional deep learning model aids physicians in improving the accuracy and consistency of ultrasound diagnosis of torn or intact rotator cuff tendons.

Radiofrequency Ablation of Terminal Sensory Articular Nerves Before Arthroscopic Rotator Cuff Repair Surgery Improved Early Postoperative Functional Outcomes: A Pilot Study With 3 Months Follow-up.

Chronic shoulder pain caused by a rotator cuff tear is commonly treated with arthroscopic rotator cuff repair surgery (ARCR). However, ARCR may be associated with moderate-to-severe postoperative pain, and poorly controlled pain can result in delayed functional recovery and the development of frozen shoulder. Terminal sensory articular nerve radiofrequency ablation (RFA) has been shown to be clinically effective in patients with severe refractory shoulder pain from multiple etiologies. We aimed to investigate whether preoperative RFA would improve the postoperative pain and functional outcomes after ARCR. In this prospective pilot study, participants were randomized to receive fluoroscopic-guided terminal sensory articular nerve cooled RFA (CRFA) (supraspinatus nerve, axillary nerve, lateral pectoral nerve) 1-5 days prior to elective ARCR as an intervention group compared to ARCR without prior RFA as a control group. Constant score (CS), American Shoulder and Elbow Surgeon score (ASES), and Pain numerical rating score (NRS) were assessed at 1, 2, 3, 4, 5, and 6 weeks and 3 months following ARCR. Twenty-one participants were enrolled in this study, including 11 in the control group and 10 in the cooled RFA group. The cooled RFA group showed statistically significantly better CS and ASES both at 6 weeks and 3 months. The two groups showed no differences in pain outcomes at all time points. No intervention-related complications were noted. Cooled RFA of the terminal sensory articular branches of the supraspinatus, axillary, and lateral pectoral nerves performed 1-5 days prior to elective ARCR as part of a multimodal postoperative pain management regimen can improve functional outcomes as early as 6 weeks. III.

Lower trapezius tendon transfer for massive irreparable rotator cuff tears improves outcomes in patients with high grade fatty infiltration of teres minor

BackgroundThis study compares postoperative outcomes of lower trapezius tendon transfers (LTTT) in massive irreparable rotator cuff (RC) tears based on the degree of teres minor (TM) fatty infiltration. MethodsIn this prospective longitudinal observational study, patients with massive RC tears undergoing arthroscopic-assisted LTTT by two surgeons were screened. TM fatty infiltration on preoperative MRI was graded using the Goutallier classification. Two groups were created: Group A included Grades 0 and 1 (no or little fatty infiltration), and Group B included Grades 2 to 4 (moderate to severe fatty infiltration). Participants completed the SANE score preoperatively, and 12- and/or 24-months postoperative along with a clinical assessment. Independent t-tests compared groups, and paired t-tests compared pre- versus postoperative results. Significance was defined as p < 0.05. ResultsThere were 47 patients in Group A and 19 in Group B. No group differences were found in preoperative SANE score, forward elevation or active external rotation (ER). Both groups showed significant postoperative improvements in SANE score with no differences between groups. An ER lag sign was observed in 18/47 patients (38.3 %) in Group A and 11/19 patients (57.9%) in Group B (p=0.177). Preoperative ER strength was significantly different in Group A (2.9 kg) versus Group B (0.7 kg; p=0.001), but postoperative ER strength was similar (p=0.931). ConclusionLTTT is a suitable salvage procedure regardless of the degree of TM fatty infiltration and should be considered as an alterative procedure to latissimus dorsi tendon transfer in patients with high grade TM fatty infiltration.

Outcomes and Complications of Failed Anatomic Shoulder Arthroplasty Revised with Reverse Arthroplasty: A Systematic Review.

Reverse shoulder arthroplasty (RSA) is an increasingly utilized option to address complications following anatomic total shoulder arthroplasty (TSA). This systematic review aims to identify the patient outcomes, complication rates, and re-revision rates following revision to a reverse shoulder replacement from a failed anatomic total shoulder arthroplasty. MEDLINE, EMBASE, and CENTRAL were searched from inception until November 21, 2023 to identify studies reporting outcomes and/or complications for patients with a failed TSA revised to an RSA. Primary outcomes included the intra- and postoperative complication rate and secondary surgery rate. Secondary outcomes included the mean post-revision improvement in the ASES score, pain, Constant score, SST score, and range of motion. From 1,347 records, 26 studies (730 patients) assessing RSA following a failed TSA were included. The most common indications for revision were rotator cuff tear (32%), loosening (12%), and instability (12%). Postoperatively, clinically important improvements were found for the ASES score, VAS pain, Constant score, flexion, and abduction. Following revision to RSA, complications occurred in 22% of patients, with implant failure being the most prevalent (25%). Secondary surgery after RSA occurred in 12% of patients. The revision of a failed TSA to an RSA resulted in clinically significant benefits. The most common indication for TSA revision was due to rotator cuff pathology, followed by instability and loosening. Despite the high potential for improved patient outcomes post-revision, the procedure is accompanied by a higher complication rate relative to primary RSA, with implant failure and fractures being the most common.

Biological strategies in rotator cuff repair: a clinical application and molecular background.

Conventional repair of rotator cuff tears bears a variable but significant risk of incomplete healing. Biological therapies that accompany surgical rotator cuff repair include platelet-rich plasma, stem cells of different origins, and biological scaffolds. Biological therapies facilitate the regeneration of the correct microarchitecture of the tendon attachment to the bone and reduce failures after surgical rotator cuff repair.

Arthroscopic Superior Capsular Reconstruction with Acellular Human Dermal Allograft for Irreparable Rotator Cuff Tears: Outcomes, Complications, and Reoperations at 2-Year Minimum Follow-up

BackgroundManagement of posterosuperior irreparable rotator cuff tears (IRCTs) remains challenging without clear consensus amongst shoulder surgeons. Arthroscopic superior capsular reconstruction (SCR) with dermal allograft has been proposed as a promising treatment option. However, current investigations are limited to short term studies and recent data has suggested variable clinical outcomes. Therefore, the purpose of this investigation was to report intermediate-term clinical outcomes in patients who underwent arthroscopic SCR with a dermal allograft for IRCTs. MethodsOver a four-year period (2016 to 2020), all patients who underwent an arthroscopic dermal allograft SCR with a minimum two-year follow-up period were identified. SCR with dermal allograft was performed for patients with an IRCT utilizing a 3mm acellular dermal allograft. Collected clinical outcomes included range of motion (ROM), strength, Numeric Rating Scale (NRS) for pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE) score, complications, and reoperations. ResultsThe final cohort included 41 dermal allograft SCR performed in 40 patients (one bilateral) with a majority male cohort (n = 29; 72%), a mean age of 67 ± 7 years, BMI of 28.4 ± 5.0, and follow-up of 5.3 ± 1.4 years. Clinically, there was a significant improvement in pre- and post-operative NRS pain scores from 5.0 to 1.8 (P < .001), but no differences in pre- and post-operative forward flexion (P = .268), abduction (P = .822), external rotation (P = .323), or internal rotation (P = .995). The final post-operative ASES and SANE scores were 66 ± 28 and 59 ± 30, respectively. There were 8 (19.5%) complications, which consisted primarily of symptomatic graft failure in 6 (14.6%) shoulders and progression of rotator cuff arthropathy in 2 (4.9%) shoulders. Reoperations occurred in 6 (14.3%) shoulders: 4 (9.8%) were conversion to rTSA and 2 (4.9%) were arthroscopic revision dermal allograft SCR with partial repair and reattachment of the torn graft. ConclusionAt a cohort mean of five years after arthroscopic superior capsular reconstruction with dermal allograft for irreparable rotator cuff tears, patients experienced sustained pain relief but no significant improvement in shoulder function. Additionally, 20% sustained a postoperative complication with a 14% reoperation rate. These findings should be considered when counseling patients about the challenges of managing IRCTs and the possible outcomes of utilizing dermal allograft SCR as a surgical modality.

What Happens To Patients Long Term When We Don’t Repair Their Cuff Tears? Ten-year Rotator Cuff Quality of Life Index (RC-QOL) Outcomes Following Non-Operative Treatment of Patients with Full Thickness Rotator Cuff Tears.

What Happens To Patients Long Term When We Don’t Repair Their Cuff Tears? Ten-year Rotator Cuff Quality of Life Index (RC-QOL) Outcomes Following Non-Operative Treatment of Patients with Full Thickness Rotator Cuff Tears.

Growth Hormone-Releasing Peptide 2 May Be Associated With Decreased M1 Macrophage Production and Increased Histologic and Biomechanical Tendon-Bone Healing Properties in a Rat Rotator Cuff Tear Model.

To explore the potential of growth hormone-releasing peptide 2 (GHRP-2) for tendon-bone healing in a rat rotator cuff tear (RCT) model. The impact of GHRP-2 on M1 macrophage polarization invitro was determined using real-time polymerase chain reaction, Western blot, and immunofluorescence staining. GHRP-2 was then applied in a rat RCT model, and the healing of the tendon-bone interface was systemically evaluated by histologic staining, radiologic assessments, gait analysis, and biomechanical tests. M1 macrophage polarization at the tendon-bone interface was assessed by immunofluorescence staining. GHRP-2 was found to reduce the expression of Cd86, Nos2, and tnfa (all P < .01), suggesting inhibited M1 macrophage polarization invitro. The invivo experiments showed that the proportion of M1 macrophages was reduced both 2 and 4 weeks after surgery (P < .01), and the number of M1 was reduced 4 weeks after surgery (P < .01) at the tendon-bone interface. The invivo experiments also showed that histologic scores and bone mineral density were increased by GHRP-2 at 8 weeks postsurgery (P < .01), suggesting improved healing of the tendon-bone interface. Furthermore, the GHRP-2 group showed a better biomechanical property at both 4 and 8 weeks postsurgery, including maximal failure load, stiffness, and tension (all P < .01), and better gait parameters at 8 weeks postsurgery, including mean area of the left front foot and mean intensity of the right front foot (all P < .05). GHRP-2 may be associated with decreased M1 macrophage production and increased histologic and biomechanical tendon-bone healing properties in a rat RCT model. The present study might be a transitional study to show the efficacy of GHRP-2 in enhancing bone-tendon healing and reduce retear rate after rotator cuff repair.

The Effect of Reverse Shoulder Arthroplasty Design and Surgical Indications on Deltoid and Rotator Cuff Muscle Length

BackgroundAdvancements in surgical planning, technique, and prosthesis design have improved adaptation to patient anatomy in reverse total shoulder arthroplasty (rTSA). Postoperative changes in deltoid and rotator cuff muscle length are important and may vary based on preoperative indications and prosthesis selection. The purpose of this study is to demonstrate the changes in deltoid and rotator cuff muscle length for planned rTSA using the spectrum of prosthesis configurations in both GHOA and RCA. MethodsTen shoulder arthroplasty surgeons used preoperative planning software to plan rTSA cases for 20 subjects (10 GHOA, 10 RCA) following surgical guidelines. Each surgeon planned each case using three prosthesis configurations: (1) 8-mm lateralized glenosphere and 135° neck-shaft angle (135+8), (2) 4-mm lateralized glenosphere and 145° neck-shaft angle (145+4), and (3) 0-mm lateralized glenosphere and 155° neck-shaft angle (155+0). Pre- and postoperative deltoid and rotator cuff muscle lengths and percentage-change were calculated and compared between prosthesis configurations within each indication. Different muscle lines of action were included representing the deltoid, subscapularis, infraspinatus, and teres minor. ResultsPreoperatively, the RCA cohort had significantly shorter muscle lines of action in the posterior, lateral, and anterior deltoid (P<0.001), a longer inferior subscapularis (P=0.022), and a longer teres minor (P=0.001) than the GHOA cohort. ANOVA and post-hoc analysis showed that post-planning lengths of each deltoid action line were greater in the 155+0 configuration compared to the 135+8 configuration in the RCA cohort (P<0.001, P=0.003, P=0.032, respectively), and post-planning lengths of the anterior and middle deltoid action lines were also greater for the same comparison in the GHOA cohort (P=0.004 and P=0.017, respectively). There were no significant differences in post-planning deltoid lengths between the 135+8 and 145+4 configurations in either diagnosis cohort (P>0.05). All post-planning rotator cuff muscle lengths (subscapularis, infraspinatus, and teres minor) differed significantly (P<0.001) between all prosthesis configurations in both diagnosis cohorts, with the 135+8 configuration resulting in the longest lengths and the 155+0 configuration resulting in the shortest lengths. ConclusionAutomated preoperative planning software calculates the lengths of muscle action lines, which vary between GHOA and RCA diagnoses. Varying rTSA implant geometries result in predictable differences in deltoid lengthening and rotator cuff shortening. Shoulder prostheses with a more lateralized center of rotation show greater rotator cuff muscle length and similar deltoid muscle length when compared to medialized designs with similar deltoid lengthening. Surgeons can use this software to understand the impact of implant geometry on muscle length.

Shoulder &amp; Elbow

The December 2024 Shoulder &amp; Elbow Roundup360 looks at: Predicting recurrence of instability after a primary traumatic anterior shoulder dislocation; Predictors of surgery and long-term outcomes in nonoperative management of full-thickness rotator cuff tears; Reverse shoulder arthroplasty viable despite acquired acromial compromise, but higher infection risk noted; LP-PRP reduces retear rates in rotator cuff repair but shows no functional outcome advantage; Long-term clinical outcomes of arthroscopic supraspinatus tendon repair using the single anchor tension band technique – minimum five-year follow-up; Arthroscopic stabilization for anterior shoulder dislocation shows low recurrence rates regardless of prior dislocations; ORIF outperforms arthroplasty for complex radial head fractures: mid-term outcomes; Routine use of surgical helmet systems may not reduce infection risk in shoulder arthroplasty.

Muscle fat infiltration: a narrative review of the magnetic resonance (MR)-based evaluation methods and their clinical applications.

Muscle fat infiltration (MFI) can be seen in several pathologies of various origin including neuromuscular, endocrinological, or musculoskeletal etiologies. Its evaluation is possible through medical imaging, especially MRI, using qualitative or quantitative methods. This paper is an overview of the techniques used to evaluate MFI in different pathologies. The literature search was performed on the PubMed database for articles published in English between 2010 and end of January 2023. The keywords used were: (Fat infiltration of the muscle) AND magnetic resonance imaging (MRI). In total, 159 articles were included. Qualitative methods of MFI evaluation represented 20% of the studies, with the Goutallier classification being the most used, especially in the setting of rotator cuff tears. Quantitative methods were used in most studies (80%), with the Dixon technique being the most adopted. The evaluation of MFI was used for the assessment of endocrinological, neuromuscular and musculoskeletal disorders. Spinal pathologies, including low back pain and spinal deformities, were the most represented (44% of the studies). This review shows the importance of automated MFI calculation using MRI to monitor the progression of diseases, assess the effect of treatments, or predict post-surgical complications such as in the setting of adult spinal deformity. This review also showed the importance of automation of MFI assessment, particularly using the Dixon technique, to make its use easier in clinical settings and open MFI assessment applications to other diseases.

Combined Superior Capsular Reconstruction Using Fascia Lata Autograft and Lower Trapezius Transfer Using Achilles Tendon Allograft is Associated with Improved Surgical Outcomes in Patients with Posterosuperior Irreparable Massive Rotator Cuff Tears.

To evaluate the minimum 12-month clinical and radiological outcomes of combined superior capsular reconstruction (SCR) and lower trapezius transfer (LTT) for posterosuperior irreparable massive rotator cuff tears (IMRCTs). Patients with posterosuperior IMRCTs and severe fatty infiltration (Goutallier grades 3 or more) in the infraspinatus who underwent SCR +LTT were retrospectively reviewed. A double-folded fascia lata autograft with one layer of polypropylene mesh inside was used for SCR and an Achilles tendon allograft was used to connect the tendon of lower trapezius to the greater tuberosity. A thorough preoperative assessment with clinical history, physical examination, and imaging studies is critical for identifying tear patterns that are (ir)reparable and to guide further treatment. The American Shoulder and Elbow Surgeon (ASES) score, visual analog scale (VAS), Constant score, Single Assessment Numeric Evaluation (SANE), and range of motion (ROM) were collected at a minimum 12-month follow-up postoperatively. Radiologic evaluation included the graft integrity and acromiohumeral distance (AHD) at the final follow-up. Postoperative magnetic resonance imaging was used to assess the graft integrity. Minimal clinically important difference were calculated as one-half of the standard deviation of the score changes between the preoperative baseline and the latest follow-up. Fifteen patients were included in this study, with a mean follow-up of 20.6 months (range, 12.2 - 31.2). Significant improvements in clinical and radiological outcomes were found after surgery. The VAS score decreased from 4.1 to 0.7 (P = 0.001). ASES, Constant, and SANE scores improved from 54.5 to 83.7 (P = 0.001), 61.1 to 76.7 (P = 0.001), and 48.7 to 74.0 (P = 0.001), respectively. External rotation (ER) improved from 26.0° to 45.7° (P = 0.009). Postoperative MRIs had a mean final follow-up of 14.2 months (range, 11.9-23.2). The AHD improved significantly from 4.9 mm to 8.1 mm after surgery (P = 0.003). Two patients (13.3%) developed both the fascia lata and Achilles tendon graft tears during follow-up. Minimal clinically important difference was obtained in 80.0%, 66.7%, 53.3%, and 46.7% of patients for ASES, VAS, Constant, and SANE scores, respectively. SCR + LTT contributes to significant pain relief and functional improvements with a graft healing rate of 86.7% at a minimum 12-month follow-up in patients with posterosuperior IMRCTs and high-grade fatty infiltration (FI) in the infraspinatus.

Clinical and Radiographic Outcome of Open Reduction and Internal Fixation of 3- and 4-Part Proximal Humerus Fractures Augmented with Impaction Bone Grafting and A Magnesium-Based Bone Filler

BackgroundOpen reduction and internal fixation (ORIF) of proximal humerus fractures (PHF) is a challenging operation with high rates of loss of reduction, screw cut out, avascular necrosis, and subsequent unplanned reoperation. Augmentation of the repair with synthetic bone fillers and other alternatives has shown promise in decreasing adverse outcomes. Our aim is to report radiographic and clinical outcome of impaction grafting with cancellous allograft chips and injection of magnesium-based bone filler for ORIF augmentation of PHFs. MethodsAll patients that underwent ORIF for a 3- or 4-part PHF with the standardized protocol with a minimum of 6 months radiographic follow-up by a single surgeon (VE) were included. Radiographs were taken at standardized time points up to 6 months, followed by a final radiographic follow-up, to define radiographic healing or failure. Patient-reported outcome measures (PROMs) were collected at final follow-up. Patient characteristics, complications, reoperations and radiographic measures of reduction quality were also recorded. Results17 patients were identified with a mean 34.1 months of radiographic follow-up. Median Penn Shoulder Score was 89 (IQR 19), American Shoulder and Elbow Surgeons score was 92 (25), Veterans-Rand 12 (VR-12) Mental Component Score was 53.9 (11.9), VR-12 Physical Component Score was 51.6 (12.8), and Single Assessment Numerical Assessment was 85 (18.5).14 patients (82.3%) had routine radiographic healing. Two patients (11.8%) developed avascular necrosis (AVN) with screw cutout. Two patients (11.8%) had reoperation including one hardware removal and one conversion to reverse total shoulder arthroplasty for a subsequent rotator cuff tear. No signs of glenohumeral arthritis were present in 12/17 patients (70.6%), and no signs of cuff tear arthropathy were noted in 13/17 patients (76%). Seven out of nine (78%) patients who worked prior to injury returned to work at a mean of 14.7 weeks postoperatively. ConclusionAugmentation of 3- and 4-part proximal humeral fractures with a standardized protocol utilizing cancellous chips and a synthetic magnesium-based bone filler results in a high rate of maintenance of fracture reduction, radiographic healing, and satisfactory patient outcomes. Further comparative data is needed to evaluate the efficacy of this technique compared to alternative methods of augmentation.

Superior Capsular Reconstruction of the Shoulder with Long Head of Biceps Autograft vs. Achilles Tendon Allograft: A 2-Year Comparative Study.

To retrospectively evaluate the clinical-functional outcomes, healing rates, complications, and surgical time in patients treated with superior capsular reconstruction (SCR) using long head of the biceps autograft (LHB) and Achilles allograft (AA). This retrospective study included 24 patients with irreparable rotator cuff tears of the supraspinatus and infraspinatus, treated with SCR. Two treatment groups were formed: one with 12 cases using AA and another with 12 cases using LHB. All patients were followed for a minimum of 2 years. The SSV was 73.7 ± 25.3 vs. 86.0 ± 8.7 (p=0.26), the Constant score was 76.8 ± 20.1 vs. 83.7 ± 4.6 (p=0.12), and the VAS was 1.6 ± 2.3 vs. 1.7 ± 0.5 (p=0.9) for the LHB and AA groups, respectively. Tendon healing was 66.7% in AA and 100% in LHB (p=0.001). Complications were 50% in AA and 0% in LHB. The average surgical time was 127.7 ± 37.6 minutes for AA and 84.3 ± 14.3 minutes for LHB (p=0.01). SCR with LHB showed better results in terms of tendon healing, fewer complications, and reduced surgical time compared to the use of AA. IV.

Therapeutic Arthroscopy for Noninfectious Stiffness and Anterior Shoulder Pain After Reverse Shoulder Arthroplasty Leads to Clinical Improvement in Most Patients with a Low Complication Rate.

Reverse shoulder arthroplasty (RSA) exhibits favorable outcomes in managing rotator cuff arthropathy, primary glenohumeral arthritis, and complex proximal humeral fractures. Despite its success and reliability, certain patients experience persistent pain and stiffness. The clinical utility of therapeutic arthroscopy in RSA patients remains an area for investigation. The purpose of this study was to report clinical outcomes, including patient-reported outcomes (PROs), range of motion (ROM), and satisfaction, in patients who underwent therapeutic arthroscopy for noninfectious stiffness and subcoracoid impingement following RSA. The hypothesis was that patients would experience clinical improvement and satisfaction, with earlier intervention being superior to later intervention. Multicenter retrospective review on patients who underwent therapeutic arthroscopy for noninfectious stiffness and anterior shoulder pain following RSA with minimum 1-year follow-up. PROs and ROM were collected pre- and postoperatively. Subjective improvement in ROM and pain, complications, satisfaction, and return to activities were recorded. Data was stratified into two cohorts based on timing of RSA to arthroscopy (1 year or less was considered early intervention and > 1 year late intervention) and variables were analyzed for each cohort. A total of 19 patients met the study criteria (13 patients in early intervention cohort, 6 in late intervention cohort). The average time from the index surgery to arthroscopy was 7.7 ± 2.1 months in the early intervention cohort and 28.3 ± 10.3 months in the late intervention cohort (p=0.004). The overall cohort improved significantly regarding pain (VAS: Δ-1.1, p=0.003), ROM (FF: Δ21°, p=0.002; ER: Δ14°, p=0.010; IR: Δ1 spinal level, p=0.023) and PROs (ASES: Δ18.2, p=0.001; SSV: Δ16.3, p=0.009). The early intervention cohort demonstrated significant improvement in VAS (Δ-1.1, p=0.029), ASES (Δ16.2, p=0.013), SSV (Δ18.5, p=0.008), FF (Δ23º, p=0.016), and ER (Δ15°, p=0.028). The late intervention cohort had significant improvement in VAS (Δ-1.3, p=0.048) and FF (Δ17°, p=0.017). Seventy-four percent of patients in the overall cohort reported decreased pain, 79% improvement in ROM, 68% returned to activities, and 74% were satisfied. There were no complications. Therapeutic arthroscopy for noninfectious stiffness and anterior shoulder pain following RSA improves clinical outcomes in most patients with a low complication risk. Although postoperative outcomes were comparable between groups, functional improvement was more likely in patients who underwent intervention earlier.

The Continuous Fragility Index of Outcomes in Rotator Cuff Repair Augmentation Randomized Trials: A Systematic Review

The Continuous Fragility Index of Outcomes in Rotator Cuff Repair Augmentation Randomized Trials: A Systematic Review

Accelerating the healing of rotator cuff tear through comprehensive repair strategy based on bioactive Cu2O-Decorated MXene Nanosheet

Accelerating the healing of rotator cuff tear through comprehensive repair strategy based on bioactive Cu2O-Decorated MXene Nanosheet

Sling is Not-Inferior to Brace Immobilization Following Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

The aim of this study was to compare the safety and efficacy of immobilizing the upper limb with a brace versus a less-constrained sling in the rehabilitation after arthroscopic rotator cuff repair (ARCR), by documenting clinical and radiological results. ARCR was performed in 110 patients (54.9±8.3 years) randomized in group A, using a brace for 6 weeks after surgery (3 weeks day and night then 3 weeks only at night), and group B, using a simple sling for 2 weeks only. Patients were evaluated at baseline, 6 weeks, 3 and 6 months. Functional outcomes were: range of motion, strength, Disabilities of the Arm, Shoulder and Hand score (DASH), and Constant score (CMS). Pain was assessed with a Visual Analog Scale (VAS); and quality of life with the SF36 questionnaire. The primary outcome was the CMS at 6 months. At 6 months, a 3 Tesla MRI was performed to document the status of the rotator cuff repair. The Minimal Clinically Important Difference (MCID) was also analysed. Both groups A and B showed a worsening at 6 weeks and an improvement at 3 and 6 months of DASH and CMS, as well as a significant VAS decrease at every follow-up (p<0.005). SF36 showed a different trend: General health improved at 6 weeks, then decreased at 3 months, and increased again at 6 months. No difference was retrieved between the two groups at any follow-up in terms of pain, functional, and general health scores. The MCID for the primary outcome was 14.5 points and was reached in 56.5% and 61.2% of patients in the sling and brace group, respectively. The MRI evaluation identified 5 patients in each group with a supraspinatus tendon re-rupture, with no statistical difference in the re-rupture rate between the two groups. This randomized controlled trial demonstrated that ARCR post-operative sling immobilization was not inferior to immobilization with a brace, having no differences in terms of functional scores, pain levels, general health, and risk of tendon re-rupture. Level 1: High-quality randomized controlled trial (designed as a therapeutic study investigating the results of treatment) with statistically significant difference.

Evaluation of Pain Relief and Opioid Consumption With the Addition of an Erector Spinae Plane Catheter Block After an Interscalene Nerve Block in Arthroscopic Rotator Cuff Repair.

The effects of the erector spinae plane (ESP) block and interscalene nerve block (ISNB) on arthroscopic rotator cuff repair (RCR) have been investigated separately. To evaluate whether additional catheterization for the ESP block can decrease acute postoperative pain and opioid consumption above the ISNB and multimodal oral analgesics in patients after arthroscopic RCR. Cohort study; Level of evidence, 3. Included were patients who underwent primary arthroscopic RCR between January 1 and December 31, 2021, and received either ISNB (ISNB group) or additional ESP block catheterization (ESP block group) as part of their pain management. Patients who underwent concomitant shoulder procedures were excluded. Patient characteristics, surgical details, pre- and postoperative numerical pain rating scale (NPRS) scores, rescue analgesic use, and possible opioid-related side effects were recorded. The primary outcome was the NPRS score immediately after surgery; secondary outcomes included rescue opioid use and opioid-related side effects until patients were discharged the next day. The Mann-Whitney U test or the chi-square test was used for between-group comparisons. Multiple linear regression analysis was conducted to examine predictors for total opioid consumption. A total of 54 patients were included-21 in the ISNB group and 33 in the ESP block group. The ESP block group exhibited significantly lower postoperative NPRS scores (2 ± 0.3 vs 3 ± 1.6 for ISNB; P = .003), reduced opioid consumption during hospitalization (0.5 ± 1.3 vs 6.1 ± 8.3 morphine milligram equivalent [MME] for ISNB; P < .001), and fewer opioid-related side effects (0 vs 3 for ISNB; P = .022). Multiple linear regression analysis indicated that the analgesic protocol (β = 5.750; P < .001) and the number of anchors used (β = 1.609; P = .022) were independently correlated with higher opioid consumption. Subgroup analysis revealed that additional ESP block significantly reduced opioid consumption during repairs involving ≥2 tendons (7.6 ± 9 vs 0.5 ± 1.4 MME; P < .001). The study findings indicated that additional catheterization for the ESP block reduced postoperative pain, opioid consumption, and opioid-related side effects during the acute postoperative period of arthroscopic RCR when the ISNB and multimodal oral analgesics had already been administered. Future studies are needed to evaluate this treatment protocol.