Undergoing Rotator Cuff Repair Research Articles

Poster 164: Impact of Patient Resilience on Rotator Cuff Repair Post-Operative Outcomes

Objectives: Patient resilience, defined by an ability to bounce back or recover from stress, was previously reported to correlate with outcomes after total shoulder arthroplasty. However, it is unclear whether this relationship exists for other orthopaedic procedures. This study sought to evaluate the relationship between pre-operative patient resilience and post-operative surgical outcomes in patients undergoing rotator cuff repair (RCR). Methods: Patients who underwent RCR in 2020 were identified from a single multicenter institution using CPT codes. Patients undergoing primary RCR who completed the Brief Resilience Scale (BRS) pre- operatively through our standard patient reported outcome data analysis were considered for inclusion. Patients with less than 2-year follow-up, irreparable rotator cuff tears, or significant concomitant surgery (ex: labral repair, capsular release for adhesive capsulitis) were excluded. A chart review was conducted to collect demographic variables including pre-operative sports participation, mental health conditions, rotator cuff tear size, and concomitant procedures. Two-year follow-up was collected, including the American Shoulder and Elbow Surgeons (ASES) survey, the Single Assessment Numeric Evaluation (SANE) survey, the BRS, and complications. Outcomes were compared between patients with low resilience (LR), normal resilience (NR), and high resilience (HR) as previously defined. Results: Overall, 156 patients were eligible for inclusion, and 100 patients (52 male, 48 female) with an average age of 60±9 years completed the follow-up survey and were included in this study. Patients in the LR group had significantly higher rates of anxiety and depression than patients in the NR and HR groups. Resilience scores were not constant over time, with 39% of patients switching resilience groups at 6-month follow-up and 38% of patients switching resilience groups at 2-year follow-up. Pre-operative ASES scores were significantly different between the groups, with the LR group having the lowest scores (35.0±19.1) and HR patients having the highest scores (53.6±20.1) (Table 1). There were no significant differences in post-operative outcomes between groups, including reoperation rate, ASES score, change in ASES score, and SANE score. Patients with higher pre-operative resilience without a history of anxiety and/or depression had improved SANE scores relative to patients with lower pre-operative resilience (p=0.019) (Table 2). Multivariate analysis found that resilience at 2-year follow-up was significantly related to ASES score improvement (estimate=6.41, p=0.031) (Table 3). Conclusions: Pre-operative patient resilience correlated with pre-operative ASES score, and resilience at 2-year follow-up correlated with ASES score improvement. When excluding patients with anxiety/depression, patients with low resilience were found to have worse post-operative SANE scores. Additionally, patient resilience was not static; over half of the patients with low pre-operative resilience were found to have normal or high post-operative resilience. [Table: see text][Table: see text][Table: see text]

Poster 173: Comparison of Sensitivity of Diagnosis of Subscapularis Tear on 1.5 Tesla versus 3.0 Tesla Magnetic Resonance Imaging

Objectives: Diagnosis of subscapularis tears via Magnetic Resonance Imaging (MRI) has been reported to have variable accuracy, with prior studies indicating sensitivity of MRI ranging from 30.0-83.0%. In the current literature, studies utilizing 3.0T MRI scans have generally shown higher sensitivity compared to studies utilizing 1.5T MRI scans; however, there has not been direct comparison of differences in accuracy of 1.5 vs. 3.0T for diagnosis of subscapularis tear. The aim of this study is to investigate this difference. We hypothesize that 3.0T MRI scans will show higher sensitivity for the detection of subscapularis tears compared to 1.5T MRI scans. Methods: A single institution data set was queried to identify patients undergoing rotator cuff repair between January 2015 and January 2020. Patients were separated based on 1.5T and 3.0T MRI strength and these cohorts were analyzed based on intraoperative findings of subscapularis tears and interpretation of these MRI reports. Likewise, demographic information of the cohorts was analyzed including BMI, age, and sex. Univariate analysis, multivariate analysis, and Pearson’s χ2 test, Mann- Whitney U test were used when appropriate. Results: In a total 756 of patients, 151 were identified as having rotator cuff surgery with preoperative MRI that met our inclusion criteria. A total of 50 (33.1%) of patients were identified as having intraoperative findings of subscapularis tears that were not appreciable on MRI. A statistically significant difference was found when comparing the sensitivity of 3.0T MRI for identifying subscapularis tears when compared to 1.5T MRI. 3.0T MRI had a sensitivity of 72.9% compared to 56.4% respectively[TTW1] [GIM2] ( P < 0.05). Both groups had a PPV of 100% given no false positive results. 3.0T MRI had a NPV of 92.5% while 1.5T had a NPV of 92.2%. Conclusions: When a subscapularis tear is clinically suspected, surgeons should be critical over the choice of 1.5T vs 3.0T MRI imaging and understand their sensitivity to guide recommendations for intervention, preoperative planning, and overall patient satisfaction. [Table: see text][Table: see text]

Poster 172: Subpectoral open versus Arthroscopic Biceps Tenodesis with concomitant Arthroscopic Rotator Cuff Repair does not impact ability to achieve Minimal Clinically Important Difference with use of Patient Reported Outcome Measurement System

Objectives: Disagreement exists within the current literature as to whether performing an arthroscopic vs. open subpectoral bicep tenodesis with concomitant arthroscopic rotator cuff repair (ARCR) leads to significantly different outcomes. Therefore, the objective of this study is to use a matched cohort of patients who undergo arthroscopic versus subpectoral biceps repair with concomitant ARCR and assess if there is a significant difference in (Patient-Reported Outcomes Measurement Information System) PROMIS outcomes and the ability to achieve a minimal clinically important difference (MCID). Methods: Data from the electronic medical record, including operative reports, were retrospectively collected for patients who underwent ARCR performed by one of six fellowship-trained board-certified orthopedic surgeons at a single institution. Current Procedural Terminology (CPT) for open or arthroscopic biceps tenodesis with concomitant arthroscopic rotator cuff repair was used to identify patients who underwent this procedure concomitant with ARCR between 01/01/2016 to 12/31/2019.Preoperative PROMIS physical function (PF), pain interference (PI), and depression (Dep) scores were obtained at the closest date prior to arthroscopic rotator cuff repair, and postoperative scores were collected at every clinical visit thereafter. The final PROMIS score used for data analysis was determined by the patients’ PROMIS scores between 90 and 180 days. A delta PROMIS value was determined by taking the difference between the final PROMIS score and the preoperative score. Unadjusted bivariate analysis was performed to assess the differences in PROMIS outcomes between the two cohorts. The MCID was determined as one-half of the standard deviation of a given PROMIS value, which is consistent with the current orthopedic literature. Results: A total of 297 patients were identified underwent rotator cuff repair with concomitant biceps tenodesis. A total of 151 subjects underwent arthroscopic biceps tenodesis with concomitant ARCR, while 147 underwent open subpectoral bicep tenodesis. The average time to follow up was 132.2 days for the arthroscopic cohort and 136.3 days for the subpectoral open group.Bivariate analysis demonstrated no significant difference between the two cohorts for insurance, race, ethnicity, last PROMIS input day, mechanism of injury, ASA class, or Charleston Comorbidity Index (CCI). There was a significant difference for patients who required contaminant subscapularis repair (p < 0.001) and revision surgery (p < 0.001).Unadjusted t-test analysis showed that patients in the arthroscopic biceps tenodesis cohort had significantly higher postoperative PROMIS PF and lower PROMIS PI and Dep scores. (P = 0.001, P = 0.001, and P = 0.007, respectively) when compared to their preoperative PROMIS values. The subpectoral open biceps tenodesis cohort did not show a significant difference in the postoperative PROMIS Dep score when compared to its preoperative score (P = 0.18), but it did show a significant improvement for postoperative PROMIS PF and PI (P = 0.001 and P = 0.04, respectively). No significant difference was determined between the arthroscopic bicep and subpectoral bicep tenodesis cohorts for delta PROMIS PF, PI, and Dep (P = 0.50, P = 0.51, and P = 0.10, respectively). A chi-square analysis found no significant difference between the achievement of MCID for PROMIS PF, PI, and Dep (P = 0.64, P = 0.72, and P = 0.95, respectively). Finally, no significant difference was determined between the time it took to achieve a minimal clinically important difference for PROMIS PF, PI, or Dep for patients who underwent arthroscopic rotator cuff repair with concomitant arthroscopic biceps tenodesis when compared to subpectoral open biceps tenodesis. Conclusions: The objective of this study was to assess differences in PROMIS outcomes for patients who undergo ARCR with concomitant arthroscopic or open subpectoral bicep tenodesis. The main findings of our study highlighted that patients with arthroscopic biceps tenodesis showed significant improvement at six months for PROMIS PF, PI, and Dep, whereas those who underwent an open subpectoral approach showed significant improvement in PF and PI but not Dep. Our findings suggest there may be a slight benefit for patients who undergo arthroscopic tenodesis when compared a subpectoral open approach. However, no significant differences were found between the two cohorts for PROMIS or the time to reach MCID. Therefore, suggesting the modality of bicep tenodesis with concomitant ARCR does not impact patient outcomes at 6-month follow-up. [Table: see text][Table: see text][Table: see text]

Minimal Clinically Important Difference (MCID), Substantial Clinical Benefit (SCB), and Patient Acceptable Symptom State (PASS) of the Shoulder Disability Questionnaire (SDQ) in Patients Undergoing Rotator Cuff Repair.

The Shoulder Disability Questionnaire (SDQ) is a Patient-Reported Outcome Measure (PROM) applied to evaluate shoulder surgery outcomes. The purpose of this study is to identify the accurate Minimal Clinically Important Difference (MCID), Substantial Clinical Benefit (SCB) and Patient Acceptable Symptom State (PASS) values for the SDQ score. A total of 35 patients (21 women and 16 men, mean age 76.6 ± 3.2 years) were followed up at 6 months postoperatively. To assess the patient's health satisfaction and symptoms, anchor questions were used. The MCID and SCB values of the SDQ score for patients who underwent arthroscopic rotator cuff repair from inception to final follow-up were 40.8 and 55.6, respectively. A change of 40.8 in the SDQ score at 6 months after surgery shows that patients achieved a minimum clinically important improvement in their state of health, and a 55.6 change in the SDQ score reflects a substantial clinically important improvement. The PASS cut-off of the SDQ score at 6 months postoperatively ranged from 22.5 to 25.8. If an SDQ score of 22.5 or more is attained after surgery, the health condition can be recognized as acceptable by the majority of patients. These cut-offs will help with understanding specific patient results and allow clinicians to personally assess patient improvement after rotator cuff repair.

American Shoulder and Elbow Surgeons score: what does it tell us about patients selecting operative treatment of a rotator cuff injury?

As shared decision-making rises in importance and minimum clinically important differences become benchmarks for treatment success or failure based on the increased usage of patient-reported outcomes, it is important to understand the breadth of starting points for patients as that should affect the interpretation of individual postoperative score changes. This is a retrospective data review of prospectively collected American Shoulder and Elbow Surgeons (ASES) score of patients electing to undergo rotator cuff repair with 1-year follow-up. A residual improvement: possible to achieve ratio (RIPAR) was calculated to demonstrate what percent of maximal possible improvement was gained at 1 year. A minimal clinically important difference (MCID) of 12 was used. Three hundred thirty-five patients with an age range of 32-79 years form the population. Baseline ASES score ranged from 0 to 97.5, with a mean of 47.8. At 1 year, the mean was 84.7 (range, 30-100). There was no statistical difference by age, but men reported more overall preoperative dysfunction than women (50.3 vs. 44.1, P<.001). The RIPAR was on average 67%. Seventy-eight percent of the population demonstrated RIPAR scores >50% which showed improvement of over half of their preoperative deficit. Eighty-nine percent of patients achieved a positive MCID and 3% achieved a negative MCID. The ASES scores showed a broad range of baseline scores for patients choosing to undergo rotator cuff repair highlighting the need for individual patient rather than population review of patient-reported outcome measures. As shared decision-making is taking on a larger role in clinical care, it is important to counsel patients accurately. Evaluating the ASES score by MCID and maximal possible improvement provides different population perspectives with the concept of RIPAR allowing for personalization of decision-making on the individual patient level.

Abnormal Laboratory Values for Metabolic and Hormonal Syndromes Are Prevalent Among Patients Undergoing Rotator Cuff Repair

To determine the prevalence of systemic laboratory abnormalities among patients undergoing rotator cuff repair (RCR). Patients who underwent RCR at the authors' institution for 1 year between October 2021 to September 2022 were retrospectively identified. Preoperative laboratory values, including serum sex hormones, vitamin D, hemoglobin A1C, and a lipid panel, were obtained as part of our routine practice during the study period. Demographics and tear characteristics were compared in patients with laboratory data and those without. For included patients with laboratory data, mean laboratory values and percentage of patients with abnormal laboratory values were recorded. During a 1-year period of time, 135 RCRs were performed, of which preoperative labs were obtained on 105. Of these, 67% were sex hormone deficient, 36% were vitamin D deficient, 45% had an abnormal hemoglobin A1C, and 64% had an abnormal lipid panel. In total 4% had "normal" labs. In this retrospective study, sex hormone deficiency is highly prevalent among patients undergoing RCR. Nearly all patients undergoing RCR have systemic laboratory abnormalities involving either sex hormone deficiency, vitamin D deficiency, dyslipidemia, and/or prediabetes. Level IV, prognostic case series.

Assessment of Safety, Efficacy, and Functional Outcomes After Rotator Cuff Repair Using Ceptre® Titanium Screw Anchor: A Retrospective Study.

Background Rotator cuff tears (RCTs) are the most common cause of shoulder disability. RCT is characterized by progressive wear and tear of the tendon tissue over time. The incidence of cuff tears ranges from 5% to 39%. With increasing advancements in the surgical sector, an upward trend has been observed in repair surgeries where torn tendons are repaired arthroscopically by inserting surgical implants. With this background, this study aimed to assess the safety, efficacy, and functional outcomes after RCT repair using Ceptre® titanium screw anchor implants. Methodology This retrospective, observational, single-center, clinical study was conducted at Epic Hospital in Gujarat, India. Patients who underwent rotator cuff repair surgery between January 2019 and July 2022 were recruited and followed up in December 2022. Baseline characteristics and surgical and post-surgical details were collected from patient medical reports and post-surgery progress data were documented through telephonic follow-up. The functional outcomes and efficacy of the implant were assessed using the American Shoulder and Elbow Surgeons (ASES) form, Shoulder Pain and Disability Index (SPADI) score, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) score. Results The mean age of the recruited patients was 59.74 ± 8.91 years. Among the recruited patients, 64% were females and 36% were males. About 85% of patients had a right shoulder injury and 15% of patients (n = 6/39) had a left shoulder injury. Further, 64% (n = 25/39) of patients had supraspinatus tears, whereas 36%(n = 14) of patients had both supraspinatus and infraspinatus tears. The mean ASES, SPADI, SST, and SANE scores were observed to be 81.43 ± 14.20, 29.41 ± 12.6, 75.41 ± 12.96, and 94.67 ± 7.50, respectively. No adverse events, re-injuries, or re-surgeries were reported by any of the patients during the study period. Conclusions Our findings suggest that arthroscopic rotator cuff repair using Ceptre Knotted Ultra-High-Molecular-Weight Polyethylene Suture Titanium Screw Anchor resulted in favorable functional outcomes. Thus, it could be a considerable implant for a successful surgery.

Resilience correlates with patient-reported outcome measures at a minimum of 2 years after arthroscopic rotator cuff repair.

We aimed to evaluate the correlation between preoperative and postoperative resilience scores and postoperative outcomes at minimum 2-year follow-up after arthroscopic rotator cuff repair. We prospectively enrolled 98 patients who underwent rotator cuff repair. We assessed resilience using the Brief Resilience Scale. Postoperatively, we obtained patient-reported outcomes measures including American Society of Shoulder and Elbow Surgeons scores, Single Assessment Numeric Evaluation, and Patient-Reported Outcome Measurement Information System Global Health-10 at minimum 2-year follow-up. We used Spearman correlation coefficients (r) to assess the relationship between variables. Ninety-one of 98 patients (93%) provided follow-up at an average of 32 months. Preoperative Brief Resilience Scale did not show a statistically significant correlation with American Society of Shoulder and Elbow Surgeons (r = 0.156; p = 0.142). However, preoperative Brief Resilience Scale showed statistically significant correlations with Patient-Reported Outcome Measurement Information System Global Health-10 (r = 0.290; p = 0.005) and Single Assessment Numeric Evaluation (r = 0.259; p = 0.014). Postoperative Brief Resilience Scale showed statistically significant correlations with American Society of Shoulder and Elbow Surgeons (r = 0.291; p = 0.005), Single Assessment Numeric Evaluation (r = 0.384; p < 0.001) and Patient-Reported Outcome Measurement Information System Global Health-10 (r = 0.515; p < 0.001). Resilience may be a valuable predictor of patients at risk of having suboptimal outcomes after rotator cuff repair and a target to improve surgical outcomes through non-surgical means.

Golf participation after rotator cuff repair: functional outcomes, rate of return and factors associated with return to play.

Golf is a popular sport involving overhead activity and engagement of the rotator cuff (RC). This study aimed to determine to what level golfers were able to return to golf following RC repair, the barriers to them returning to golf and factors associated with their failure to return to golf. Patients preoperatively identifying as golfers undergoing RC repair at the study centre from 2012 to 2020 were retrospectively followed up with to assess their golf-playing status, performance and frequency of play and functional and quality of life (QoL) outcomes. Forty-seven golfers (40 men [85.1%] and 7 women [14.9%]) with a mean age of 56.8 years met the inclusion criteria, and 80.1% were followed up with at a mean of 27.1 months postoperatively. Twenty-nine patients (76.3%) had returned to golf with a mean handicap change of +1.0 (P=0.291). Golf frequency decreased from a mean of 1.8 rounds per week preinjury to 1.5 rounds per week postoperatively (P=0.052). The EuroQol 5-dimension 5-level (EQ-5D-5L) index and visual analog scale (EQ-VAS) score were significantly greater in those returning to golf (P=0.024 and P=0.002), although functional outcome measures were not significantly different. The primary barriers to return were ipsilateral shoulder dysfunction (78%) and loss of the habit of play (22%). Golfers were likely (76%) to return to golf following RC repair, including mostly to their premorbid performance level with little residual symptomatology. Return to golf was associated with a greater QoL. Persistent subjective shoulder dysfunction (78%) was the most common barrier to returning to golf. Level of evidence: Level IV.

One-year patient-reported outcomes following primary arthroscopic rotator cuff repair vary little by surgeon

This study's purpose was to investigate the extent to which differences among operating surgeons may influence 1-year patient-reported outcome measures (PROMs) in patients undergoing rotator cuff repair (RCR) surgery, after controlling for general and disease-specific patient factors. We hypothesized that surgeon would be additionally associated with 1-year PROMs, specifically the baseline to 1-year improvement in Penn Shoulder Score (PSS). We used mixed multivariable statistical modeling to assess the influence of surgeon (and alternatively surgical case volume) on 1-year PSS improvement in patients undergoing RCR at a single health system in 2018, controlling for eight patient- and six disease-specific preoperative factors as possible confounders. Contributions of predictors to explaining variation in 1-year PSS improvement were measured and compared using Akaike's Information Criterion. 518 cases performed by 28 surgeons met inclusion criteria, with median (quartiles) baseline PSS of 41.9 (31.9, 53.9) and 1-year PSS improvement of 42 (29.1, 55.3) points. Contrary to expectation, surgeon and surgical case volume were neither statistically significantly nor clinically meaningfully associated with 1-year PSS improvement. Baseline PSS and mental health status (VR-12 MCS) were the dominant and only statistically significant predictors of 1-year PSS improvement, with lower baseline PSS and higher VR-12 MCS predicting larger 1-year PSS improvement. Patients generally reported excellent 1-year outcomes following primary RCR. This study did not find evidence that the individual surgeon or surgeon case volume influences 1-year PROMs, independently of case-mix factors, following primary RCR in a large employed hospital system.

Pain associated psychological distress is more strongly associated with shoulder pain and function than tear severity in patients undergoing rotator cuff repair

Psychological distress has been associated with declining shoulder function in patients with rotator cuff tears (RCTs). Thus, we aimed to 1) evaluate the absence or presence of differences in shoulder pain, function, or pain-associated psychological distress in patients with increasing RCT severity and 2) assess whether psychological distress is associated with shoulder pain and function while adjusting for RCT severity. Consecutive patients who underwent rotator cuff repair and completed the optimal screening for prediction of referral and outcome (OSPRO) survey from 2019 to 2021 were included. OSPRO is composed of 3 domains that estimate pain associated psychological distress (negative mood, negative coping, and positive coping). Demographics, tear characteristics, and three patient reported outcomes (PRO), including the visual analog scale (VAS), Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) were collected. Patients were analyzed with analysis of variance and chi-square tests and stratified based on severity of RCTs into three groups: partial-thickness, small-to-medium full-thickness, and large-to-massive full-thickness tear. Linear regression analysis was used to evaluate the association between OSPRO scores and PROs, adjusting for severity of RCT. Eighty-four patients were included: 33 (39%) had partial-thickness, 17 (20%) had small-to-medium full-thickness, and 34 (41%) had large-to-massive tears. Regarding PROs and psychological distress, there were no significant differences amongst the three cohorts. In contrast, multiple significant associations between psychological distress and PROs were found. Within the negative coping domain, fear avoidance dimensions demonstrated the strongest correlation to PROs: fear-avoidance behavior for physical activity (ASES Beta-0.592, P<.001; VAS 0.357, P<.001) and work (ASES Beta-0.442, P<.001; VAS 0.274, P=.015). Several other dimensions within the negative coping, negative mood, and positive coping domains also demonstrated significant associations to PROs. These findings suggest that in patients undergoing arthroscopic rotator cuff repair, preoperative psychological distress can more strongly influence patient perception of shoulder pain and diminished shoulder function than RCT severity.

Excellent Correlation of the Patient-Reported Outcomes Measurement Information System Upper Extremity Score With Legacy Outcome Scores Preoperatively and at 1 Year After Arthroscopic Rotator Cuff Repair

To assess the preoperative and postoperative performance of the Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE, version 2.0) outcome score in comparison to the American Shoulder and Elbow Surgeons (ASES) and Western Ontario Rotator Cuff Index (WORC) instruments in patients undergoing rotator cuff repair. This prospective longitudinal study included 91 patients undergoing rotator cuff repair. Patients completed the PROMIS-UE, ASES, and WORC instruments preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, and 12 months. The Pearson correlation coefficient (r) between these tools was calculated at each time point. Correlations were graded as excellent (>0.7), excellent-good (0.61-0.7), good (0.4-0.6), or poor (<0.4). Responsiveness to change was assessed using the effect size and the standardized response mean. Floor and ceiling effects for each instrument were also assessed. The PROMIS-UE instrument showed good to excellent correlation with the legacy instruments at all time points. There were variations in the measured effect sizes of the various instruments, with the PROMIS-UE instrument showing responsiveness to change at 3 and 12 months but the ASES and WORC instruments showing responsiveness at 6 weeks, 3 months, and 12 months. Both PROMIS-UE and ASES scores displayed ceiling effects at 12 months. The PROMIS-UE instrument shows excellent correlation with the ASES instrument and a rotator cuff-specific outcome instrument-the WORC instrument-preoperatively and at 1 year after arthroscopic rotator cuff repair. Variations in the measured effect sizes at different postoperative time points and high ceiling effects of the PROMIS-UE instrument at the 1-year time point may limit its utility in the early postoperative phase and at long-term follow-up after rotator cuff repair. The performance of the PROMIS-UE outcome measure after arthroscopic rotator cuff repair was investigated.

Developing a machine learning algorithm to predict probability of retear and functional outcomes in patients undergoing rotator cuff repair surgery: protocol for a retrospective, multicentre study

IntroductionThe effectiveness of rotator cuff tear repair surgery is influenced by multiple patient-related, pathology-centred and technical factors, which is thought to contribute to the reported retear rates between 17% and...

Can Patients Accurately Recall their Preoperative Pain and Functional Scores Following Rotator Cuff Repair and Total Shoulder Arthroplasty?

Accurate analysis of preoperative shoulder pain and function is important for understanding treatment efficacy and producing high-quality research. Oftentimes, preoperative patient-reported outcomes (PROs) are missing. Therefore the accuracy of recalled preoperative PROs may be important. We investigate the ability of patients who underwent rotator cuff repair (RCR) or shoulder arthroplasty (TSA) to recall their preoperative PROs. We identified 145 patients who underwent either RCR or TSA and had preoperative PROs. All patients completed the ASES, SANE, SST, and VAS surveys within 3 months prior to surgery. Patients were contacted between one and four years after surgery and asked to recall their baseline pain and shoulder function prior to surgery. The mean difference was calculated by determining the difference between the mean recalled score and the mean actual score. Intraobserver reliability analysis was performed, comparing recall and actual score for each using the 2-way mixed-effects intraclass correlation coefficient (ICC) model. The ICC values > 0.75 were considered excellent, values between 0.4 and 0.75 were considered moderate, and values of < 0.4 demonstrated a weak agreement. For patients who underwent RCR, the mean differences between actual and recalled ASES, SANE, SST and VAS pain were 6.3 (P=0.004), 2.0 (P=0.155), -0.04 (P=0.625) and - 1.0 (P<0.001), respectively. In patients who underwent TSA, the mean differences between actual and recalled ASES, SANE, SST and VAS pain were 4.5 (P =0.038), -3.9 (P=0.262), -1.2 (P=0.001) and -1.5 (P<0.001), respectively. ASES, SST, and VAS show moderate reliability, and SANE reliability was weak in both RCR and TSA populations. Patients had a tendency to recall higher pain scores than actual preoperative pain scores. In patients who underwent RCR or TSA, there was too much variability between individual patient's ability to accurately recall preoperative pain and function to reliably use recall data for research purposes.

All-inside technique versus in situ transtendon repair for Ellman Ⅲ partial articular supraspinatus tendon avulsion.

The current surgical techniques for repairing Ellman Ⅲ partial articular supraspinatus tendon avulsion (PASTA) is mainly tear completion followed by repair and in situ transtendon repair, and both techniques have been proven to have good clinical effects. In situ transtendon repair is more widely used because of its high performance in preserving the integrity of the bursal side supraspinatus tendon. However, there is still some scope for improvement. Our purpose was to compare the clinical outcomes of the all-inside repair technique and in situ transtendon repair for Ellman III PASTA. A retrospective comparative study was conducted on 56 patients who suffered from Ellman Ⅲ PASTA and underwent rotator cuff repair; 28 patients were treated with the all-inside technique (group A), and 28 patients were treated with the transtendinous technique (group B). All patients were followed up for at least 2 years. The visual analog scale (VAS), Constant, and American Shoulder and Elbow Surgeons (ASES) scores were used to evaluate the patient's shoulder joint function before surgery, 1 month and 3 months after surgery, and at the last time of follow-up. Group A showed superiority in pain and functional improvement 1 month after the operation: the VAS score, 2.8±0.3 in group A vs. 4.7±0.4 in group B (P=.042); Constant score, 73±5 in group A vs. 60±6 in group B (P=.038); and ASES score, 75±5 in group A vs. 58±7 in group B (P=.043), whereas there was no statistical difference in group B. However, 3 months after surgery and at the last follow-up, the VAS, Constant, and ASES scores in both groups were significantly improved (P<.01), and there was no significant statistical difference between the groups (P > .05). Magnetic resonance imaging showed that the repaired rotator cuff tendon-bone healed well; at the last follow-up, all patients were in good function, the pain was completely relieved, and no revision was performed in both groups. Arthroscopic repair of Ellman Ⅲ PASTA provided satisfactory functional improvements and pain relief regardless of the all-inside and in situ transtendon repair techniques. However, the all-inside repair technique is more beneficial due to its dual function in preserving the intact bursa and avoidance of uneven tension of the articular side, which is advantageous to early postoperative rehabilitation.

Degenerative tendon matrix induces tenogenic differentiation of mesenchymal stem cells

PurposeMesenchymal stem cells (MSCs) react dynamically with the surrounding microenvironment to promote tissue-specific differentiation and hence increase targeted regenerative capacity. Extracellular matrix (ECM) would be the first microenvironment to interact with MSCs injected into the tissue lesion. However, degenerative tissues would have different characteristics of ECM in comparison with healthy tissues. Therefore, the influence of degenerative ECM on tissue-specific differentiation of MSCs and the formation of matrix composition need to be considered for the sophisticated therapeutic application of stem cells for tissue regeneration.MethodsHuman degenerative tendon tissues were obtained from patients undergoing rotator cuff repair and finely minced into 2 ~ 3 mm fragments. Different amounts of tendon matrix (0.005 g, 0.01 g, 0.025 g, 0.05 g, 0.1 g, 0.25 g, 0.5 g, 1 g, and 2 g) were co-cultured with bone marrow MSCs (BM MSCs) for 7 days. Six tendon-related markers, scleraxis, tenomodulin, collagen type I and III, decorin, and tenascin-C, osteogenic marker, alkaline phosphatase (ALP), and chondrogenic marker, aggrecan (ACAN), were analyzed by qRT-PCR. Cell viability and senescence-associated beta-galactosidase assays were performed. The connective tissue growth factor was used as a positive control.ResultsThe expressions of six tendon-related markers were significantly upregulated until the amount of tendon matrix exceeded 0.5 g, the point where the mRNA expressions of all six genes analyzed started to decrease. The tendon matrix exerted an inhibitory effect on ACAN expression but had a negligible effect on ALP expression. Cell viability did not change significantly over the culture period. The amount of tendon matrix exceeding 0.01 g significantly increased the SA-βgal activity of BM MSCs.ConclusionThis study successfully demonstrated tendon ECM-stimulated tenogenesis of BM MSCs through an indirect co-culture system without the use of exogenous growth factors and the alteration of cellular viability. In contrast to the initial hypothesis, the tenogenesis of BM MSCs induced with the degenerative tendon matrix accompanied cellular senescence.

Shoulder &amp; Elbow

The December 2022 Shoulder &amp; Elbow Roundup360 looks at: Biceps tenotomy versus soft-tissue tenodesis in females aged 60 years and older with rotator cuff tears; Resistance training combined with corticosteroid injections or tendon needling in patients with lateral elbow tendinopathy; Two-year functional outcomes of completely displaced midshaft clavicle fractures in adolescents; Patients who undergo rotator cuff repair can safely return to driving at two weeks postoperatively; Are two plates better than one? A systematic review of dual plating for acute midshaft clavicle fractures; Treatment of acute distal biceps tendon ruptures; Rotator cuff tendinopathy: disability associated with depression rather than pathology severity; Coonrad-Morrey total elbow arthroplasty implications in young patients with post-traumatic sequelae.

Can the Single Assessment Numeric Evaluation be used as a stand-alone subjective outcome instrument in patients undergoing rotator cuff repair?

There is no consensus to which patient-determined shoulder outcome scores should be considered when analyzing patient outcomes. Use of multiple patient-determined outcomes may be redundant and cause increased responder burden. The Single Assessment Numeric (SANE) has not been widely accepted as a stand-alone shoulder-specific outcome measure. The hypothesis was that SANE will correlate with and be comparable in responsiveness to other subjective outcome measures that have been used in a stand-alone fashion in patients undergoing rotator cuff repair (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], Western Ontario Rotator Cuff Index [WORC], and the Simple Shoulder Test [SST]). In addition, the SANE will be more relevant to each patient compared to the ASES, further supporting its use as a stand-alone shoulder-specific outcomes measure. A retrospective review of a database of patients undergoing rotator cuff repair was reviewed where the SANE was recorded with the ASES, WORC, and/or SST. Correlations were determined using the Pearson coefficient. Subgroup analysis was performed to determine if correlations differed in (1) preoperative and (2) postoperative outcome determinations. Responsiveness was determined by calculating the standardized response mean (SRM) and the effect size (ES) of all scores. Relevance and precision of the SANE and ASES were examined using 150 consecutive patients to determine the number of questions in each score that were not answered. Correlation was excellent for the SANE and the ASES (n=1838, r=0.81, P<.0001), the WORC (n=1793, r=0.82, P<.0001), and the SST (n=1836, r=0.76, P<.0001). Correlation of preoperative scores was moderate and postoperative scores were excellent when comparing the SANE with all 3 scores. All scores were highly responsive, with the SRM of the SANE=2.1, ASES=2.2, WORC=2.4, and the SST=1.8. The ES of the SANE=2.4, ASES=2.7, WORC=3.0, and the SST=2.1. One hundred percent of the SANE scores were answered completely compared with 57% (P<.0001) of the ASES, with significant variability found in the answers to the "work" and "score" questions. In patients undergoing rotator cuff repair, the SANE highly correlated and has equivalent responsiveness with the WORC, ASES, and SST, which have been used as stand-alone shoulder-specific outcomes measures. The SANE may provide the same information as the WORC, ASES, and SST regarding outcome with significant reduction in responder burden. This study supports that the SANE can be used as a subjective, stand-alone instrument for patients undergoing rotator cuff repair.

Does suprascapular nerve release provide additional benefits for rotator cuff repair: a systematic review and meta-analysis

There is still a lack of consensus regarding whether suprascapular nerve decompression should be routinely performed with rotator cuff repair. Therefore, this meta-analysis aimed to evaluate whether additional suprascapular nerve release (SSNR) could improve shoulder functional outcomes and pain relief more than rotator cuff repair alone. We performed a literature review of electronic databases for noncomparative and comparative studies investigating the effect of SSNR in patients undergoing rotator cuff repair. The primary outcome was the change in shoulder function scores from the preoperative status, and the secondary outcome was the change in the visual analog scale (VAS) score of pain after surgery. A subgroup analysis was conducted based on the study design (noncomparative studies vs. comparative studies). Nine studies comprising 279 participants were included. Our analysis demonstrated that the group that underwent SSNR had a better shoulder functional score after surgery than at preoperative assessment (standardized mean difference [SMD], 1.333, 95% confidence interval [CI], 0.708-1.959). No significant differences were identified in shoulder function improvement between those with and without SSNR, with an SMD of 0.163 (95% CI, -0.091 to 0.418). Likewise, the group with SSNR showed a decreased VAS score after surgery compared to their preoperative status (SMD, 0.910; 95% CI, 0.560-1.260). However, there was no significant difference in VAS change between those with and without SSNR, with an SMD of 0.431 (95% CI, -0.095 to 0.956). The present meta-analysis revealed that SSNR might not be routinely needed in rotator cuff tendon repair as no additional benefits in functional improvement or pain relief were identified compared to rotator cuff tendon repair alone.

Race and Socioeconomic Status Are Associated With Inferior Patient-Reported Outcome Measures Following Rotator Cuff Repair

To investigate the impact social determinants of health (SDOH) have on National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive test scores and postoperative health care use in patients who undergo rotator cuff repair (RCR). All patients who underwent RCR surgery by 3 shoulder and/or sports medicine fellowship-trained orthopaedic surgeons between July 2017 and January 2020 were included. The electronic medical record (EMR) was used to identify SDOH for each patient. PROMIS computer adaptive test measures of Upper Extremity function, Pain Interference, and Depression were completed preoperatively and postoperatively (6 months and 1 year). Postoperative health care use (clinical visits, virtual encounters, imaging encounters, and physical therapy visits) were recorded as well. Univariate associations, multiple linear regressions, and Wilcoxon rank-sum tests were used to analyze mean differences between patient groups based on SDOH. Three hundred thirty-eight patients who underwent RCR were included. Patients who were Black, in lower median household income quartiles, had public insurance, and female reported lower PROMIS scores compared with their counterparts. Smokers and White patients attended fewer postoperative office visits whereas Black patients had more physical therapy and nonvisit encounters compared with their respective counterparts. Black race and lower socioeconomic status are associated with worse function and pain outcomes post-RCR compared with White race. Similarly, Black race and positive smoking status are associated with differential use of health care following RCR. Further attention may be required for these patients to address health care disparities. III, retrospective cohort study.