Rotator Cuff Research Articles

The impact of acromial morphology on the localization and size of calcific tendonitis in the rotator cuff

The impact of acromial morphology on the localization and size of calcific tendonitis in the rotator cuff

Outcomes of repaired and intact rotator cable in large posterosuperior rotator cuff ruptures

Outcomes of repaired and intact rotator cable in large posterosuperior rotator cuff ruptures

Acute tear versus chronic-degenerated rotator cuff pathologies are associated with divergent tendon metabolite profiles

ABSTRACT Purpose/Aim Metabolic disorders are risk factors for rotator cuff injuries, which suggests that the rotator cuff is sensitive to local metabolic fluctuations. However, the link between the metabolic microenvironment and pathologic features of acute tear versus chronic degeneration is currently unknown. The overarching goal of this study was to evaluate alterations in tendon metabolite profiles following acute tear or chronic degeneration of the rotator cuff. We hypothesized that injury types (acute tear vs. chronic degeneration) would result in distinct metabolite profiles relative to clinically unaffected tendon controls. Materials and Methods We utilized untargeted metabolomics to identify pathways that were altered at the time of rotator cuff repair (RCR; acute tear) or reverse total shoulder arthroplasty (rTSA; chronic degeneration) relative to total shoulder arthroplasty controls (TSA; tendon clinically unaffected). Results Acute tears to the rotator cuff were associated with an overall decrease in tendon metabolites. This global decrease was primarily associated with glycolic acid and decreased tricarboxylic acid (TCA) cycle activity. Conversely, chronic tendon specimens from patients undergoing rTSA showed an overall increase in metabolites. Most notably, chronic injury was associated with increased levels of multiple amino acids including alanine, aspartate, lysine, and proline. Conclusions Overall, this study demonstrates that distinct metabolite profiles are associated with injury types, and that therapeutic strategies should address both cellular and matrix components regardless of injury induction. The specific pathways identified paired with validated, established, treatment methods may serve as novel therapeutic targets for patients who suffer from rotator cuff injuries.

Sling Results in Better Sleep Quality and Less Anxiety Early After Arthroscopic Rotator Cuff Repair: A Randomized Single-Blinded Trial.

Sleep disturbance is commonly reported by patients wearing an abduction brace after arthroscopic rotator cuff repair (ARCR). Although a sling has been proven noninferior to an abduction brace for function and repair integrity, there is no evidence-based medical support for the advantage of the sling in improving sleep quality compared with a brace. This study aimed to compare the effects of a sling and an abduction brace on sleep quality and clinical outcomes after ARCR. It was hypothesized that immobilization in a sling would result in better sleep quality while not deteriorating clinical outcomes and bone-tendon healing compared with an abduction brace. Randomized controlled trial; Level of evidence, 1. A total of 142 consecutive patients with rotator cuff tears were randomly assigned to 2 groups: (1) the brace group, receiving abduction brace immobilization for 6 weeks, and (2) the sling group, receiving sling immobilization after ARCR for 6 weeks. The primary outcome was the Pittsburgh Sleep Quality Index at 6 weeks postoperatively. Secondary outcomes-American Shoulder and Elbow Surgeons score, Self-rating Anxiety Scale, pain, satisfaction, and tendon healing (using ultrasonography)-were evaluated until 1 year postoperatively. Complete outcome measurements were obtained for 131 patients. The Pittsburgh Sleep Quality Index at 6 weeks was 11.1 ± 2.7 for the brace group and 9.2 ± 2.3 for the sling group (P < .001), indicating a statistically significant advantage for the sling group. The sling group also reported significantly lower Self-rating Anxiety Scale, lower pain level, and higher satisfaction scores at 6 weeks. No significant difference was observed in outcome measures between groups at 1 year. The tendon healing rates (91% vs 88%, respectively) were comparable between the brace and sling groups within the first 1 year (risk ratio, 1.03 [95% CI, 0.92-1.16]; P = .59). The use of a sling resulted in better sleep quality, less anxiety, and higher satisfaction compared with an abduction brace in the first 6 weeks after ARCR; nevertheless, functional outcomes and repair integrity were similar at 1 year postoperatively between the 2 groups. These findings indicate that a sling is appropriate for the postoperative care of ARCR. However, caution should be used when interpreting these results because the clinical relevance of sling-related benefits warrants further investigation. ChiCTR2200059967 (Chinese Clinical Trial Registry).

"Surviving the dip" after subacromial balloon spacer implantation for massive rotator cuff tear treatment: a retrospective case series.

Subacromial balloon spacer implantation (SBSI) attempts to decrease glenohumeral joint (GHJ) pain and improve function in patients with an irreparable rotator cuff tear (RCT) and minimal osteoarthritis. Between 12 and 26 weeks post-SBSI, gradual implant resorption may create a "balloon dip" that decreases GHJ function and increases pain. This retrospective cohort study attempted to delineate shoulder function, active mobility, strength, pain, and functional task impairment during the "balloon dip" period. Sixty-five consecutive patients (55.9 ± 7years of age, 42 men) with an irreparable RCT treated by the same fellowship-trained shoulder surgeon participated in this study. Outcome measurements pre-SBSI, during Phase I (early pain control ≤ 3weeks post-SBSI), Phase II (early rehabilitation > 3-11weeks post-SBSI), Phase III (advanced rehabilitation-early balloon resorption > 11-16weeks post-SBSI), Phase IV (early strength training > 16-24weeks post-SBSI), and Phase V (advanced strength training > 24weeks post-SBSI) included the American Shoulder and Elbow Society (ASES) score for perceived bilateral shoulder function, visual analog scale (VAS) surgical shoulder pain score, active mobility, and shoulder manual muscle strength testing (p ≤ 0.05). The mean final follow-up time was 40weeks (range = 24.1-89.7weeks). The surgical shoulder had higher ASES scores at Phase V than pre-SBSI. Surgical shoulder pain was less during Phase V than pre-SBSI. The surgical shoulder had greater flexion during Phase V than at Phase II or pre-SBSI, and greater external rotation (adducted) during Phases V-III than pre-SBSI. Peak shoulder internal rotation to level 12 (thoracic spinous process #10) occurred during Phase V. Peak shoulder flexor, external rotator, and internal rotator strength occurred during Phase V. During Phase I, most subjects were unable to sleep on their surgical shoulder, wash their back/do up their bra, reach a high shelf, or lift 10-lbs overhead. Tasks that were impaired during the "balloon dip" (between Phase III and V) were lifting 10-lbs overhead, reaching a high shelf, and doing normal work. By the end of Phase V, however, most subjects could perform each task with minimal or no difficulty. Surgical shoulder function improved and pain decreased, however, specific perceived functional task impairments remained. During the "balloon dip" phase, the perceived ability to lift 10 lbs above shoulder level, to reach a high shelf, and to do usual work activities were the most impaired tasks.

Satisfactory Clinical Outcomes After Latissimus Dorsi Tendon Transfer for Irreparable Posterosuperior Massive Rotator Cuff Tears: A 10- to 20-Year Follow-up.

Latissimus dorsi tendon transfer (LDTT) leads to good clinical outcomes and recovery of function. A previous study have evaluated the outcomes of LDTT at a minimum 10-year follow-up and found durable improvements in shoulder function and pain relief but observed that shoulders with fatty infiltration of the teres minor muscle and insufficiency of the subscapularis muscle tended to have inferior results. To evaluate the outcomes of LDTT with a minimum follow-up of 10 years in a sizeable cohort for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs). Case series; Level of evidence, 4. Patients who underwent LDTT for irreparable mRCTs between 2004 and 2013, performed by the same senior surgeon, were included in this study. All intraoperative and postoperative complications, as well as whether patients required conversion to reverse shoulder arthroplasty (RSA), were noted. At a minimum follow-up of 10 years, an independent observer collected range of motion measurements and clinical scores, including those for the Constant score, the Subjective Shoulder Value, and a visual analog scale for pain; the subacromial space was also assessed. A total of 143 patients (147 shoulders) that underwent LDTT, with a minimum follow-up of 10 years, were included; of these, 24 patients (24 shoulders, 16%) were lost to follow-up, 1 patient (1 shoulder, 0.7%) died 9 years after the index procedure for reasons unrelated to shoulder surgery, and 18 patients (18 shoulders, 12%) required conversion to RSA, of which 6 underwent conversion at ≥6 years after LDTT. The remaining 101 patients (104 shoulders), including 3 patients who were scheduled to undergo RSA, were assessed at a mean time of 12.3 ± 2.2 years (range, 10-20 years) after index LDTT, comprised 52 men (53 shoulders) and 49 women (51 women) and had a mean age of 61.6 ± 8.0 years (range, 39-81 years) at the time of index surgery. Complications were noted in 14 shoulders, of which 4 required a reoperation. The Constant score improved by 34.2 ± 11.7 points, the adjusted Constant score by 43.5 ± 15.3 points, and the Subjective Shoulder Value score by 50.4 ± 16.4 points. The subacromial space decreased by 0.3 ± 2.0 mm. At a minimum follow-up of 10 years, LDTT for the treatment of irreparable posterosuperior mRCTs led to satisfactory clinical scores. Of the 147 shoulders that underwent LDTT, 18 (12%) required conversion to RSA.

A full thickness and partial rotator cuff tear with retraction of fibers and reconstruction with palmaris longus graft

A full thickness and partial rotator cuff tear with retraction of fibers and reconstruction with palmaris longus graft

Ultrasound-guided suprascapular nerve block with lidocaine vs. saline combined with physical exercises for the rehabilitation of supraspinatus tendinitis: a randomized double-blind controlled trial

IntroductionShoulder pain is the third leading cause of musculoskeletal complaints in primary care clinics. Its prevalence varies from 14% to 34%. Among all the structures that can cause shoulder pain, the most vulnerable to injury is the tendon of the supraspinatus muscle. The ideal management protocol is still unknown. To date, little is known in the literature about the use of ultrasound-guided suprascapular nerve block as a treatment for supraspinatus muscle tendinitis. Our objective was to assess the effects of the association of a single ultrasound-guided suprascapular nerve block combined with home-based rotator cuff exercises to reduce pain and improve shoulder functioning in patients with supraspinatus tendinitis.MethodsWe evaluated the effect of a single ultrasound-guided suprascapular nerve block on pain and functioning of people with supraspinatus tendinitis. Diagnosis was performed using the positive Jobe test. Due to large disparity between clinical and radiological findings, only clinical diagnostic criteria were used to select patients. This was a double-blind, randomized, controlled, clinical study in which patients in the intervention group (n = 42) received a single injection of 5 ml of 2% lidocaine, while in the control group (n = 41) patients underwent the same procedure receiving saline solution 0.9%. All patients received face to face instructions by an experienced physiotherapist and a leaflet explaining home-based exercises. Pain and functioning were assessed using the Shoulder Pain and Disability Index (SPADI) questionnaire before the procedure, one week and 12 weeks after the procedure.ResultsPatients in both groups improved significantly since the initial evaluation until the 12th week. Intervention group SPADI (pre, 1 week, 12 weeks): 75.80 ± 18.96, 56.25 ± 31.37, 46.31 ± 31.41 (p &amp;lt; 0.001); Control group SPADI: 75.49 ± 16.67, 50.51 ± 27.58, 49.37 ± 30.90 (p &amp;lt; 0.001). However, there were no significant differences between groups (p = 0.291).Discussion/conclusionWe concluded that both lidocaine and saline ultrasound-guided suprascapular nerve blocks reduce pain and improve shoulder functioning in patients with supraspinatus tendinitis. Unexpectedly, the same block performed with saline showed similar results and effects. Clinical Trial RegistrationClinicalTrials.gov, identifier [NCT02495818].

Risk factors for healing failure after arthroscopic rotator cuff repair in small to medium-sized tears: a retrospective cohort study

ObjectivesTo identify risk factors for tendon healing failure following arthroscopic rotator cuff repair (ARCR) in patients with small to medium-sized rotator cuff tears (RCTs).MethodsA retrospective study was conducted on 320 patients with RCTs who underwent arthroscopic repair between June 2018 and June 2021. All patients had at least 2 years of postoperative follow-up, with MRI scans at the final assessment. Based on MRI results, patients were categorized into the healing success group (Group A: types I–III) or the healing failure group (Group B: types IV–V). Variables associated with rotator cuff healing, including patient characteristics, baseline symptoms, imaging data, and surgery-related factors, were analyzed using univariate and multivariate logistic regression.ResultsHealing failure occurred in 54 of the 320 patients (16.9%). Functional status improved significantly across all patients (P &amp;lt; 0.05), irrespective of healing outcomes. Multifactorial analysis identified smoking (OR = 1.931, P = 0.028), diabetes (OR = 3.517, P = 0.038), lower bone mineral density (BMD) (OR = 1.551, P = 0.018), higher fatty infiltration (FI) (OR = 4.025, P = 0.009), and smaller acromiohumeral distance (AHD) (OR = 2.546, P = 0.006) as independent risk factors for healing failure.ConclusionsSmoking, diabetes, lower BMD, higher FI, and smaller AHD are independent risk factors for healing failure following ARCR.

Inflammation-Responsive Functional Core-Shell Micro-Hydrogels Promote Rotator Cuff Tendon-To-Bone Healing by Recruiting MSCs and Immuno-Modulating Macrophages in Rats.

Rotator cuff injuries often necessitate surgical intervention, but the outcomes are often unsatisfactory. The underlying reasons can be attributed to multiple factors, with the intricate inflammatory activities and insufficient presence of stem cells being particularly significant. In this study, an innovative inflammation-responsive core-shell micro-hydrogel is designed for independent release of SDF-1 and IL-4 within a single delivery system to promote tendon-to-bone healing by recruiting MSCs and modulating M2 macrophages polarization. First, a MMP-2 responsive hydrogel loaded with IL-4 (GelMA-MMP/IL-4) is synthesized by cross-linking gelatin methacrylate (GelMA) with MMP-2 substrate peptide. Then, the resulting core particles are coated with a shell of chitosan /SDF-1/hyaluronic acid (CS/HA/SDF-1) using the layer-by-layer electrostatic deposition method to form a core-shell micro-hydrogel composite. The core-shell micro-hydrogel shows sustained release of SDF-1 and MMP-2-responsive release of IL-4 associated in situ MSCs homing and smart inflammation regulation by promoting M2 macrophages polarization. Additionally, by injecting these micro-hydrogels into a rat rotator cuff tear and repair model, notable improvements of fibrocartilage layer are observed between tendon and bone. Notably, this study presents a new and potentially powerful environment-responsive drug delivery strategy that offers valuable insights for regulating the intricate micro-environment associated with tissue regeneration.

Prior Shoulder Arthroscopy is Associated with Inferior Clinical Outcomes Following Primary Reverse Shoulder Arthroplasty for Rotator Cuff Tear Arthropathy

Background Various patient-related and condition-related factors can influence the clinical benefits of reverse shoulder arthroplasty (RSA). With the emergence of new potential joint-preserving arthroscopic interventions, understanding the impact of shoulder arthroscopy prior to RSA is increasingly relevant. Therefore, the purpose of this study was to understand the impact of previous ipsilateral shoulder arthroscopy on outcomes and shoulder function following RSA for rotator cuff tear arthropathy. Methods Patients who underwent RSA for rotator cuff tear arthropathy from June 2016 to September 2020 by a single surgeon were retrospectively reviewed from a prospectively collected clinical database. Patients were separated into two groups: 1) patients who underwent RSA following prior ipsilateral shoulder arthroscopy (RSAPA) and 2) patients who underwent RSA without previous shoulder surgery (RSA). Patient-reported outcomes (PROs), including SST, ASES, UCLA score, SAS score, and active shoulder range of motion were measured preoperatively and at a minimum 2 years postoperative. Results A total of 103 patients (n=38 RSAPA and n=65 control RSA) were analyzed. The mean duration of follow-up for patients with prior ipsilateral shoulder arthroscopy was significantly shorter compared to the control patients (RSAPA=33 months and RSA=50 months, p &lt; 0.0001). All PROs improved postoperatively (p &lt; 0.001). Improvements in PROs for RSAPA were diminished relative to RSA control group patients, including SST (RSAPA=5.4 vs RSA=7.6, p = 0.005), ASES (RSAPA=40.8 vs RSA=54.7, p = 0.021), and UCLA (RSAPA=16 vs RSA=20.7, p = 0.009) scores. Improvements in forward flexion (RSAPA=69° vs RSA=95°, p = 0.0003) and abduction (RSAPA= 67° vs RSA=83°, p = 0.003) were decreased in the RSAPA group compared to the control group (RSA). One patient (1.5%) with prior shoulder arthroscopy required revision due to recurrent instability, whereas no patients in the control group required revision surgery (p=0.25). Conclusion Patients with rotator cuff tear arthropathy who underwent RSA following prior shoulder arthroscopy demonstrated significant improvements in function and patient-reported outcomes, but these outcomes are diminished compared to those patients with no history of surgery.

Erratum: Regional variation in low-value musculoskeletal surgery: a nationwide study from the Finnish Care Register.

We would like to inform of an error in the reported incidences in our published article,Regional variation in low-value musculoskeletal surgery: a nationwide study from the Finnish Care Register. Specifically, the incidences for rotator cuff repair, partial meniscectomy, ankle arthroscopy, distal radius fracture fixation, and wrist arthroscopy surgeries were calculated using a too small population size. Accordingly, corrected calculations resulted in higher incidence values for these surgeries, impacting Table 3andFigure 3, which now show accurate incidence rates. We have also updatedFigure 6and the corresponding sections of the results accordingly. These corrections did not affect any other figures or tables, not the overall conclusions, and the text in the discussion section remains unchanged. The correct data further emphasizes the findings in our original article. We apologize for any confusion caused by these errors and appreciate the opportunity to correct the publication.

Knowledge, attitude and practice towards arthroscopic shoulder surgery in patients with rotator cuff tear: cross-sectional study

ObjectivesThis cross-sectional study aimed to explore the knowledge, attitude and practice (KAP) of patients with rotator cuff tears towards arthroscopic shoulder surgery (ASS), based on the hypothesis that the knowledge...

Factors affecting healing of rotator cuff repairs: microfracture of the greater tuberosity.

This study aimed to investigate the impact of microfractures generated within the footprint of the greater tuberosity (GT) on postoperative cuff healing following arthroscopic rotator cuff repair (ARCR). A retrospective analysis was conducted on patients who underwent ARCR for full-thickness rotator cuff tear (FTRCT) between April 2020 and October 2023 at our institution. A total of 73 patients was categorized into two groups based on the presence of microfractures: a microfracture group (group M, n=33) and a non-microfracture group (group N, n=40). Six months post-surgery, magnetic resonance imaging was performed to assess cuff healing and retear rates between the two groups. Furthermore, patients were stratified into retear and healing groups based on cuff integrity to analyze the factors influencing retear. Statistical analyses were performed to assess the associations between various demographic data (e.g., age) and radiologic parameters (tear size mediolateral [ML], anteroposterior [AP], and fatty infiltration [FI] of the rotator cuff muscle), including microfracture, with retear. There was no significant difference in retear rates between groups M and N (18.2% vs. 10.0%, P=0.332). Among demographic factors, age showed a significant difference between the retear and healing groups (67.4±8.5 vs. 61.6±6.1, P=0.044). ML tear size (3.1±1.7 vs. 2.0±1.1, P=0.015), AP tear size (2.4±1.2 vs. 1.6±1.0, P=0.332), FI of the supraspinatus (2.3±1.3 vs. 1.4±1.0, P=0.029), and FI of the infraspinatus (1.6±1.3 vs. 0.9±0.8, P=0.015) exhibited significant differences between the retear and healing groups. Multivariate logistic regression analysis identified age (odds ratio [OR], 1.153; 95% CI, 1.026-1.295; P=0.016) and tear size (OR, 1.988; 95% CI, 1.103-3.582; P=0.022) as independent risk factors for retear. ARCR with concurrent microfracture of the GT footprint did not significantly impact cuff healing in patients with FTRCT. However, older age and larger ML tear size were associated with an increased risk of retear. Level of evidence: III.

BIOMECHANICAL ASSESSMENT OF SCAPULAR PLANE ELEVATION EXERCISE WITH DIFFERENT MODES OF RESISTANCE IN SUBJECTS WITH AND WITHOUT IMPINGEMENT SYNDROME.

Background: Strengthening the rotator cuff and scapular stabilizers is usually prescribed for subjects with shoulder pain and is done either using dumbbells or TheraBand. The resistance offered by elastic Theraband increases with increase in change from initial length and therefore the resistance offered by TheraBand, and dumbbell differs across the range of motion. Objectives: The purpose of the study is to evaluate the scapular kinematics and activity of prime mover (Anterior Deltoid) while using two different modes of resistance (TheraBand v/s dumbbell) in subjects with and without impingement syndrome. Methods: Twenty-two asymptomatic subjects and 12 subjects with impingement syndrome were included. 3D motion sensors were attached over the humerus, scapulae and trunk to capture movements of the shoulders as the subject performed scapular elevation without load, with yellow Theraband or 2 Kg Dumbbell. Simultaneous electromyography (EMG) activity of anterior Deltoid was measured and analyzed as percentage of maximum voluntary contraction. Results: During arm elevation, scapular Upward rotation was significantly greater at 90° with TheraBand® as compared to unloaded. It was also greater at 120° as compared to unloaded and dumbbell conditions (p&lt;0.001) during elevation and lowering phase. Scapula upward rotation was significantly lesser at 30° with TheraBand® as compared to other conditions. Conclusion: This study found significant downward rotation and anterior tilt of scapula with TheraBand during lowering phase of exercise as compared to dumbbell and unloaded. The alterations of kinematics may help therapists make informed decisions while making exercise prescriptions.

Re-tear following rotator cuff repair: Do functional outcomes predict success?

The purpose of this study is to compare functional outcomes between patients who were found to have a retear on ultrasound versus those with an intact repair following arthroscopic rotator cuff repair. Retrospective cohort study comparing functional outcomes of 84 patients who underwent arthroscopic rotator cuff repair and were found to have a retear versus those who did not experience a retear. Functional outcomes included American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test, strength and active range of motion (AROM) assessed preoperatively and postoperatively at 3 and 6 months. Patients without a retear by 6 months demonstrated greater improvements in internal rotation at 3 months (2.3° of mean change, p = 0.0356), as well as greater improvements in external rotation range of motion (8.8° of mean change, p = 0.0210) between 3 and 6 months as compared to those patients who did experience a retear. Both groups showed decreased pain scores and increased ASES scores at all points postoperatively. Our study found statistically significant improvements in internal rotation at 3 months, and external rotation between 3 and 6 months in the non-retear group. No differences in functional outcomes existed between at final follow-up.

Effect of neuromuscular control on the shoulder function of patients with healed rotator cuff and those with retear after arthroscopic rotator cuff repair.

To compare functional outcomes such as muscle strength, neuromuscular control and patient-reported outcomes (PROs) between patients with healed rotator cuffs and those with retears after arthroscopic rotator cuff repair (RCR). One hundred and nine patients who underwent arthroscopic RCR were included (85 in the healed group, 24 in the retear group). Shoulder muscle strength and neuromuscular control index (acceleration time [AT]) were evaluated using an isokinetic device. PROs were assessed using the pain visual analogue scale (VAS), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) and University of California at Los Angeles (UCLA) scores. Continuous variables were compared using independent t tests. Multiple linear regression analysis was used to identify the influence of the predictor variables on the dependent variable. The muscle strength and ATs for external rotators (ERs), internal rotators (IRs) and forward flexors as well as PROs including VAS, SST and ASES scores, were not significantly different between the two groups pre- and postoperatively (n.s.). Multiple linear regression analysis revealed that postoperative ATs for the IRs (p = 0.006) and ERs (p = 0.028) in the operated shoulders were closely associated with the postoperative UCLA score. Compared with the healed group after arthroscopic RCR, the retear group had no clinically relevant differences in muscle strength, ATs and PROs, including VAS, SST, ASES and UCLA scores. However, postoperative ATs for IRs and ERs in the operated shoulders were a significant predictor of postoperative UCLA scores. Therefore, clinicians and therapists need to be aware of the importance of neuromuscular control in patients who have undergone arthroscopic RCR and prioritize therapeutic exercises to restore neuromuscular control. Level III.

Correlation of Ultrasound and MRI in Rotator Cuff Injuries

Correlation of Ultrasound and MRI in Rotator Cuff Injuries

Is the Use of a Buprenorphine Transdermal Patch More Effective Than Oral Medications for Postoperative Analgesia After Arthroscopic Rotator Cuff Repair? A Randomized Clinical Trial.

Appropriate analgesic protocols for patients following arthroscopic rotator cuff repair remain controversial. Although transdermal buprenorphine patches might potentially provide better pain control and fewer side effects, it is worth noting that there is limited evidence for this given a lack of direct comparisons with oral pain regimens. Among patients undergoing arthroscopic rotator cuff repair, and compared with an analgesic approach using oral tramadol plus celecoxib: (1) Does perioperative use of buprenorphine patches provide better pain relief by a clinically important margin? (2) Does perioperative use of buprenorphine patches improve shoulder joint function recovery? (3) Does perioperative use of buprenorphine patches have a lower frequency of adverse reactions? This was a prospective, single-center, randomized controlled trial. We included patients who underwent arthroscopic rotator cuff repair for partial- or full-thickness rotator cuff tears < 3 cm in size in the anterior to posterior direction as estimated by preoperative MRI and excluded those who had obesity, were pregnant, had opioid dependence, had history of cardiac bypass surgery or ipsilateral rotator cuff repair, had allergies to trial medications, were taking anticoagulants or antidepressants, were being treated with other postsurgical pain management methods, or had severe liver or kidney dysfunction. Based on these criteria, 64% (72 of 112) of patients were eligible. The patients were randomly assigned into either the control group (oral tramadol and celecoxib) or the experimental group (buprenorphine patches). The control group received 100 mg of tramadol and 200 mg of celecoxib every 12 hours for 2 weeks after surgery. The experimental group received buprenorphine patches about 48 hours before surgery without any oral medication. A medication journal was given to the patients to self-report their compliance in taking the drugs. The dosage regimen adhered strictly to protocol. After enrollment, 11% (4 of 36) of patients in the control group and 17% (6 of 36) of patients in the experimental group could not be fully analyzed because of loss to follow-up or missing data. The surveillance period was 3 months, and there was no crossover between groups. The groups did not differ at baseline in terms of demographic parameters and relevant clinical characteristics, including age, gender, BMI, American Society of Anesthesiologists classification, tear size, concomitant procedures, and number of anchors. The outcomes were (1) numeric rating scale (NRS) for pain score at rest or with movement, which ranges from 0 to 10, where 0 indicates no pain, and 10 indicates the worst pain; (2) the American Shoulder and Elbow Surgeons (ASES) score for joint function, which ranges from 0 to 100, with higher scores indicating better shoulder joint function; and (3) the incidence of postoperative adverse reactions. We defined the minimum clinically important difference on the NRS as 2 of 10 points and on the ASES score as 15 of 100 points, based on anchor-based approaches reported in other studies. We found no clinically important between-group differences in NRS pain scores at any time point, either at rest or with movement. Likewise, we found no clinically important between-group differences in ASES scores at any time point. Postoperative dizziness or drowsiness (20% [6 of 30 patients] versus 44% [14 of 32 patients]; p = 0.04) and nausea (10% [3 of 30 patients] versus 34% [11 of 32 patients]; p = 0.02) during the hospital stay were slightly lower in the experimental group compared with the control group. In this randomized trial, we found no clinically important advantages in pain or function to the use of buprenorphine patches after arthroscopic rotator cuff repair, and insufficient evidence exists to confirm whether the minor differences in transient side effects could justify the use of a new and largely untested analgesic approach in this context. That being so, we recommend against the routine use of buprenorphine patches for this indication. In general, we found that pain levels were low after the procedure in both groups. Future studies, therefore, should focus on the efficacy of buprenorphine patches for more invasive or more painful procedures. Level I, therapeutic study.

Effects of Late-Passage Small Umbilical Cord-Derived Fast Proliferating Cells on Tenocytes from Degenerative Rotator Cuff Tears under an Interleukin 1β-Induced Tendinopathic Environment.

Tendinopathy is a chronic tendon disease. Mesenchymal stem cells (MSCs), known for their anti-inflammatory properties, may lose effectiveness with extensive culturing. Previous research introduced "small umbilical cord-derived fast proliferating cells" (smumf cells), isolated using a novel minimal cube explant method. These cells maintained their MSC characteristics through long-term culture. Thus, the purpose of the present study was to assess the anti-inflammatory effects of late-passage smumf cells at P10 on tenocytes derived from degenerative rotator cuff tears in a tendinopathic environment.Edit made in title. Kindly check and confirm.Yes, I checked the title. No problem.Kindly check and confirm affiliation 1, 2 and 3 are correctly processed.The corresponding author's affiliation has been changed to 1, 2, and 3. The mRNA expression with respect to aging of MSCs and secretion of growth factors (GFs) by smumf cells at P10 were measured. mRNA and protein synthesis in tenocytes with respect to the tenocyte phenotype, inflammatory cytokines, and matrix- degradation enzymes were measured. The inflammatory signal pathways involving nuclear factor kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) in tenocytes were also investigated. The proliferative response of degenerative tenocytes to co-culture with smumf cells over 7days in varying IL-1β induced tendinopathic environments was investigated.Author names: Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 3 Given name: [Sam Joongwon] Last name [Hwang], Author 6 Given name: [Chris Hyunchul] Last name [Jo]. Also, kindly confirm the details in the metadata are correct.There is no problem with the name and order. We would appreciate it if you remove "Yejin Park" from the list of authors because she left the laboratory before completing her papers and works. RESULTS: smumf cells at P10 showed no signs of aging compared to those at P3. smumf cells at P10, secreting 2,043pg/ml of hepatocyte growth factor (HGF), showed a 1.88-fold (p = .002) increase in HGF secretion in a tendinopathic environment. Degenerative tenocytes co-cultured with smumf cells showed significantly increased protein expression levels of collagen type I (Col I) and the Col I/III ratio by 1.46-fold (p < .001) and 1.66-fold (p < .001), respectively. The smumf cells at P10 reduced both mRNA and protein expression levels of matrix metalloproteinases-1, -2, -3, -8, -9, and -13 in tenocytes and attenuated NF-κB (phosphorylated IκBα/IκBα and phosphorylated p65/p65) and MAPK (phosphorylated p38/p38 and phosphorylated JNK/JNK) pathways activated by IL-1β. Removal of IL-1β from the co-culture accelerated the growth of tenocytes by 1.42-fold (p < .001). Removal of IL-1β accelerated tenocyte growth in co-cultures. Late-passage smumf cells exert anti-inflammatory effects on tenocytes derived from degenerative rotator cuff tears under a tendinopathic environment, primarily through the secretion of growth factors (GFs).