Undergoing Rotator Cuff Repair Research Articles

Knowledge, attitudes, and practices toward postoperative rehabilitation among females with rotator cuff injury: a cross-sectional study

ObjectiveRotator cuff injuries are common shoulder disorders, particularly affecting middle-aged and older women, and postoperative rehabilitation plays a vital role in restoring function and preventing recurrence. To investigate the knowledge, attitudes, and practices (KAP) related to postoperative rehabilitation among female patients who had undergone rotator cuff repair surgery.DesignA cross-sectional study.MethodsThis cross-sectional study was conducted between January and July 2024 at two orthopedic centers in Chengdu, China, using convenience sampling. Demographic data and KAP scores were collected using a validated self-administered questionnaire (Cronbach's α = 0.851). The primary outcome measures were knowledge, attitude, and practice scores, assessed using a validated KAP questionnaire. Data were analyzed using descriptive statistics, group comparisons via t-tests or ANOVA, Spearman correlation analysis, and structural equation modeling (SEM) to examine the relationships between knowledge, attitudes, and practices.ResultsA total of 499 female participants who met the inclusion criteria were enrolled with a response rate of 99.60%. Among the participants (mean age: 59.8 ± 7.2 years), the mean scores for knowledge, attitude, and practice were 14.59 ± 4.24, 35.17 ± 5.70, and 27.91 ± 4.71, respectively. Knowledge demonstrated positive correlations with practice (rs = 0.106, p = 0.018), while attitude showed strong correlation with practice (rs = 0.572, p < 0.001). SEM analysis showed that practice was directly influenced by knowledge (β = 0.084, 95% CI: 0.013–0.155, p = 0.021), attitude (β = 0.514, 95% CI: 0.441–0.587, p < 0.001), surgery (β = -0.170, 95% CI: -0.301 to -0.039, p = 0.011), training (β = -0.125, 95% CI: -0.207 to -0.044, p = 0.002), and therapy (β = -0.129, 95% CI: -0.212 to -0.046, p = 0.002). Additionally, income (β = 0.035, p = 0.010) had indirect effect on attitude. Knowledge (β = 0.067, p = 0.005), exercise (β = 0.097, p < 0.001), and therapy (β = -0.113, p < 0.001) had indirect effects on practice.ConclusionFemales with rotator cuff injuries demonstrated adequate knowledge and positive attitudes but exhibited suboptimal practices towards postoperative rehabilitation. These findings suggest the need for targeted interventions to bridge the gap between knowledge and practice, with particular focus on enhancing positive attitudes, which were the strongest predictors of rehabilitation adherence. Healthcare providers should consider implementing comprehensive educational programs that address both knowledge transfer and behavioral change strategies to improve patient outcomes.

Evaluation and Management of Rotator Cuff Tears Following Shoulder Dislocation.

This review aims to summarize the epidemiology, associated pathology, and treatment options for rotator cuff tears following shoulder dislocations and to provide a treatment algorithm for these complex injuries. Rotator cuff tears after shoulder dislocations most often occur in patients older than 40 and may be more prevalent in women. Up to 50% of these patients may have concomitant Bankart lesions. Patients treated nonoperatively generally have worse functional outcomes and higher pain scores than those who undergo rotator cuff repair. However, further studies are needed to elucidate when the rotator cuff can be repaired in isolation versus in combination with capsulolabral stabilization. Reverse total shoulder arthroplasty is a viable treatment option for elderly patients with irreparable cuff tears after dislocation or post-instability arthropathy. Patients who sustain a shoulder dislocation should be evaluated for a rotator cuff tear, particularly if older than 40. Those with post-instability full-thickness rotator cuff tears benefit from surgical treatment. Further research is needed to clarify when additional stabilization procedures should be performed alongside rotator cuff repair.

Loosening the Lid on Shoulder Osteoarthritis: How the Transcriptome and Metabolic Syndrome Correlate with End-Stage Disease.

Metabolic syndrome (MetS) associated with Osteoarthritis (OA) is an increasingly recognised entity. Whilst the degenerative pattern in cuff-tear arthropathy (CTA) has been well documented, the biological processes behind primary shoulder OA and CTA remain less understood. This study investigates transcriptomic differences in these conditions, alongside the impact of MetS in patients undergoing total shoulder replacement. In a multi-centre study, 20 OA patients undergoing total shoulder replacement were included based on specific treatment indications for OA and cuff-tear arthropathy as well as 25 patients undergoing rotator cuff repair (RCR) as a comparator group. Tissues from subchondral bone, capsule (OA and RCR), and synovium were biopsied, and RNA sequencing was performed using Illumina platforms. Differential gene expression was conducted using DESeq2, adjusting for demographic factors, followed by pathway enrichment using the mitch package. Gene expressions in CTA and primary OA was differentially affected. CTA showed mitochondrial dysfunction, GATD3A downregulation, and increased cartilage degradation, while primary OA was marked by upregulated inflammatory and catabolic pathways. The effect of MetS on these pathologies was further shown. MetS further disrupted WNT/β-catenin signalling in CTA, and in OA. Genes such as ACAN, PANX3, CLU, and VAT1L were upregulated, highlighting potential biomarkers for early OA detection. This transcriptomic analysis reveals key differences between end-stage CTA and primary glenohumeral OA. CTA shows heightened metabolic/protein synthesis activity with less immune-driven inflammation. Under MetS, mitochondrial dysfunction (including GATD3A downregulation) and altered Wnt/β-catenin signalling intensify cartilage and bone damage. In contrast, primary OA features strong complement activation, inflammatory gene expression, and collagen remodelling. MetS worsens both conditions via oxidative stress, advanced glycation end products, and ECM disruption-particularly, increased CS/DS degradation. These distinctions support targeted treatments, from antioxidants and Wnt modulators to aggrecanase inhibitors or clusterin augmentation. Addressing specific molecular disruptions, especially those amplified by MetS, may preserve shoulder function, delay surgical intervention, and improve long-term patient outcomes.

Human dermal allograft augmentation in primary and revision arthroscopic rotator cuff repair: a retrospective controlled study including patient outcomes and ultrasound evaluation of tendon healing.

Rotator cuff (RC) tears are common in older adults, often leading to muscle atrophy. Standard arthroscopic repair has high re-tear rates, prompting the use of biological patches for augmentation. This study assessed differences in range of motion, strength, and tendon healing using ultrasound in primary and revision RC repairs using acellular dermal allograft augmentation. Forty-eight patients undergoing arthroscopic RC repair with dermal allograft augmentation were assessed, with 42 completing a median follow-up of 32.4 months. Twenty patients had primary repairs and 22 had revision procedures. A control group of 26 patients, matched for age, sex, BMI, and RC injury type, underwent RC repair without patch augmentation. Active range of motion, Constant-Murley socre (CS), Simple Shoulder Test (SST), Subjective Shoulder value (SSV) and isometric strength were measured. Tendon healing was assessed via dynamic US. Both primary and revision groups showed significant improvements in clinical scores and shoulder mobility. However, the primary group had significantly higher postoperative CS, SST and SSV scores. Strength tests indicated lower values in the revision group compared to primary and control groups. Ultrasound outcomes showed reduced tendon thickness in 23 patients, with similar repair integrity across groups. Five cases of RC re-tears were noted, with higher but not significantly different re-tear rates in the revision group. Dermal allograft augmentation in RC repair leads to significant clinical improvement in both primary and revision cases, but strength recovery is less pronounced in revision repairs. Long-term follow-up is necessary to validate these findings and assess the durability of tendon healing. Level III, Retrospective cohort design, Treatment study.

Effects of mobilization with movement on muscle strength and EMG activity of shoulder external rotator in individual with rotator cuff repair: A randomized controlled trial

Background Exercises that improve infraspinatus (ISP) muscle activation and limit excessive anterior translation of the humeral head are important for shoulder strength training in patients who have undergone rotator cuff (RC) repair. Posterior glenohumeral (GH) glide mobilization during external rotation (ER) strengthening exercise can limit the anterior translation of the humeral head. Objective To compare the ER strength and muscle activity of shoulder external rotator between ER strengthening performed at 0° and 90° shoulder abduction with and without posterior GH mobilization, at a single time point. Methods The study included patients who had undergone RC repair. Forty patients who underwent rotator cuff repair were randomized into two groups: with mobilization group (n = 20) and without mobilization group (n = 20). The with mobilization group applied posterior GH mobilization during ER strengthening at 0° and 90° shoulder abduction, whereas the without mobilization group performed ER strengthening at the same angles without posterior GH mobilization. Surface electromyography was used to record muscle activity in the infraspinatus, middle deltoid, and posterior deltoid. Fixed-base isometric dynamometry was used for shoulder ER strength. Group and shoulder abduction angle differences were analyzed using 2-way repeated-measures analysis of variance. Results Significant group-by-angle were observed for ER muscle strength and ISP/PD ratio. Post hoc testing revealed that ER muscle strength and ISP muscle activity were significantly higher in the group with mobilization than the group without mobilization at both 0° (p &lt; .001) and 90° (p &lt; .001) shoulder abduction angle. The ISP/PD ratio was significantly greater in the group with mobilization than in the group without mobilization group at 90 ° shoulder abduction angle (p &lt; .001). Conclusion Our results suggest that posterior GH mobilization could be a useful strategy for immediate strength of shoulder ER rotation in patients who underwent an arthroscopic repair.

Cost comparison of orthopedic sports medicine procedures in an ambulatory surgical centre and a hospital outpatient department.

Ambulatory surgery centres are becoming an attractive alternative to hospital-based outpatient departments; however, limited data exist on their cost efficacy in a publicly funded health care model. In this study, we aimed to compare costs for ambulatory sports medicine procedures performed at an ambulatory surgery centre and a hospital outpatient department. We retrospectively identified patients who underwent rotator cuff repair, anterior cruciate ligament reconstruction (ACLR), or hip arthroscopy between January 2020 and August 2022. We collected demographic characteristics, procedural costs, and procedural data. We used 2-sample t tests to compare care-related costs between groups treated in an ambulatory surgery centre and hospital outpatient department. After controlling for age and concomitant procedures, we included a total of 132 patients for analysis. Patients who underwent hip arthroscopy or rotator cuff repair in an ambulatory surgery centre had significantly shorter duration of total operating room time, and procedural duration was equivocal (p > 0.1) between sites. Procedure time for ACLR was significantly shorter in the group treated in an ambulatory surgery centre than in the group treated in a hospital outpatient department (p = 0.01). The total case costs for the ambulatory surgery centre were significantly lower for hip arthroscopy ($3543, standard deviation (SD) $365 v. $6209, SD $681; p < 0.05), rotator cuff repair ($4259, SD $934 v. $5786, SD $934; p < 0.05), and ACLR ($3136, SD $459 v. $4821, SD $1511; p < 0.05), despite a lack of differences in associated disposable implant costs for ACLR and rotator cuff repair (p > 0.1). Material costs were significantly lower in the group receiving hip arthroscopy at an ambulatory surgery centre than in the group receiving the same procedure at a hospital outpatient department (p < 0.05). There were no differences in immediate 6-week postoperative care-associated costs between groups (p > 0.4). Ambulatory sports medicine procedures performed at an ambulatory surgery centre were associated with significantly reduced operating room time and total cost compared with matched cases performed via a hospital outpatient department. Ambulatory surgery centres provide an opportunity to improve cost efficacy and reduce wait-lists for surgical care.

Acceptability of Biologic Treatments to Patients Undergoing Rotator Cuff Repair

Acceptability of Biologic Treatments to Patients Undergoing Rotator Cuff Repair

Does dynamically tensioning suture alter outcomes after rotator cuff repair?

Does dynamically tensioning suture alter outcomes after rotator cuff repair?

Does the Timing of the Initiation of Physical Therapy Post-Rotator Cuff Repair Impact Shoulder Function?

Rehabilitation typically restores shoulder function after a common rotator cuff repair; however, it is unclear when to initiate physical therapy (PT) post-surgery. To understand effective start times, this study analyzed PT start times and their effect on shoulder function. The most effective shoulder outcomes were hypothesized to occur when PT started 0-4 weeks post-surgery. Data from 1002 patients who underwent rotator cuff repair were analyzed retrospectively from 52 outpatient clinics in the years of 2016-2021. The primary data of timings between surgery and the start of PT (0-2 weeks [0-14 days], 2-4 weeks [15-28 days], 4-6 weeks [29-42 days], and 6-14 weeks [43-100 days]), change in functional shoulder scores, number of PT visits utilized, and functional scores changed per visit were analyzed. Regression analyses of the impact of age, sex, payor source, and tear size were completed. The change in functional scores and functional scores changed per visit are not affected by the initiation timing of PT post- rotator cuff surgery, when controlling for baseline functional scores. This result is revealed despite initial functional scores being significantly different. Functional scores change per visit may have been affected by payor source (R 2 = 0.004, p ≤ 0.010). PT start times may have been impacted by age (R 2 = 0.010, p = 0.007), payor source (R 2 = 0.016, p = 0.001), and tear size (R 2 = 0.007, p = 0.026). Payor source may have influenced the number of PT visits (R 2 = 0.060, p < 0.001). After rotator cuff surgery, patients should choose to complete rehabilitation to optimize shoulder function. However, the initiation timing of PT may not affect functional shoulder outcomes.

Interscalene nerve block with plain bupivacaine versus liposomal bupivacaine for arthroscopic rotator cuff repair: A randomized controlled trial.

Although single injections with anesthetics are commonly administered given their safety, their short-acting nature limits pain control. Liposomal bupivacaine represents a promising alternative to plain bupivacaine in interscalene nerve blocks. The goal of our study was to determine whether an interscalene block with liposomal bupivacaine provides superior analgesia and reduces opioid requirements compared to plain bupivacaine in patients undergoing arthroscopic rotator cuff repair (ARCR). A single-center, double-blinded, randomized controlled trial of patients undergoing ARCR was performed. Patients received a single-shot interscalene nerve block with plain bupivacaine or liposomal bupivacaine. Visual analog scale pain scores at rest and with activity, as well as morphine milligram equivalents, were recorded in postoperative recovery and on postoperative days 1, 2, 3, and 7. Comparisons between groups were made using descriptive statistics; the significance level was set at P < 0.05. A total of 41 patients were randomized into the liposomal bupivacaine (n = 18 patients) and plain bupivacaine (n = 23 patients) groups. The differences in visual analog scale and morphine milligram equivalents between the two groups were not significant, with or without movement, on all postoperative days assessed. There was no difference in the visual analog scale or morphine milligram equivalents after arthroscopic rotator cuff repair with interscalene blocks using liposomal bupivacaine versus plain bupivacaine. Given the increased cost associated with liposomal bupivacaine use and the variation in multimodal pain regimens worldwide, multicenter clinical trials are necessary to examine the clinical benefit and cost-effectiveness of liposomal bupivacaine in patients undergoing rotator cuff repair.

The effects of preoperative glenohumeral osteoarthritis on rotator cuff repair: A systematic review and meta-analysis.

This meta-analysis was carried out to evaluate the clinical effectiveness of rotator cuff repair surgery in treating rotator cuff tears in individuals with mild glenohumeral osteoarthritis (GHOA). A computer-based search was conducted across multiple databases including PubMed, Embase, Web of Science, and Cochrane Library using the keywords "Shoulder Joints", "Osteoarthrosis", and "rotator cuff". Only studies focusing on patients with GHOA who underwent rotator cuff repair were considered for inclusion. The pertinent data was extracted and assessed for heterogeneity. A total of 5 studies involving 924 patients were included in the meta-analysis. The treatment outcomes of patients with rotator cuff tears accompanied by mild GHOA and those with simple rotator cuff tears after rotator cuff repair were comparable in terms of retear(OR: 1.24; 95% CI 0.82-1.89; P = 0.31). The postoperative functional scores: the VAS score (MD: 0.14; 95% CI -0.19-0.47; P = 0.41)、ASES score (MD: -0.33; 95% CI -1.64-0.99)were similar between the two groups. Subgroup analysis of rotator cuff tears(small to moderate, MD: 0.85; 95%CI -0.65-2.39; p = 0.28; large to massive, MD: -1.94; 95% CI -8.45-4.58; P = 0.56), showed no difference in postoperative ASES scores between the two groups. Constant score (MD:-3.20; 95% CI -6.33-0.08; P = 0.04), external rotation (ER) in Range of motion (ROM) (MD: -4.42; 95% CI -6.72-2.13; P = 0.0002) and forward flexion (FF) in ROM(MD: -4.22; 95% CI -8.28-0.15; P = 0.04) were superior in patients with simple rotator cuff tears compared to those with rotator cuff tears accompanied by GHOA. Patients with rotator cuff tears and mild GHOA can achieve shoulder joint restoration after shoulder cuff repair surgery, and there is only a certain difference in postoperative Constant Score and ROM between these two groups. PROSPERO registration CRD42024565212.

Interpositional Bioresorbable Scaffold-Anchor Appears Non-inferior to a Standard Anchor in the Treatment of Rotator Cuff Tears.

Failure after rotator cuff repair is typically due to a loss of integrity of the bone-tendon interface. The BioWick anchor (Zimmer-Biomet) is an interpositional scaffold-anchor that was developed to improve tendon-bone healing. The purpose of this study was to determine the clinical efficacy of this novel anchor compared with a standard anchor with respect to retear rates and patient outcomes. We enrolled 99 patients in a double-anonymized, prospective, randomized controlled trial who underwent rotator cuff repair. Fifty patients were randomized to the novel anchor group and 49 patients were randomized to the standard anchor group. The primary outcome was rotator cuff repair integrity assessed via ultrasound at 6 months postoperatively. Secondary outcomes included visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), strength, and active range of motion (AROM) assessed preoperatively and postoperatively at 3 and 6 months. There were no statistically significant differences in demographic data, mean rotator cuff tear size, tobacco use, workers' compensation status, or operative side between the groups. At 6-month follow-up, the retear rate was 22% (n=9) for the novel anchor group vs 23% (n=10) for the standard anchor group (P=.8864). Secondary outcomes, including VAS pain score, ASES score, SST, strength, and AROM measurements, did not differ significantly between the groups at 3- or 6-month follow-up. There were no complications identified in either group. This study did not demonstrate superior clinical improvements or decreased retear rates with the use of this novel anchor compared with a standard anchor. [Orthopedics. 2025;48(1):e33-e39.].

The Effect of Early Scapular Training on Shoulder Joint Function after Surgery for Rotator Cuff Injuries: A Retrospective Study.

This study aims to evaluate the impact of early scapular rehabilitation training in patients after rotator cuff injury. Furthermore, it sought to analyze the application of this approach in promoting surgical site healing and enhancing shoulder joint function recovery. This retrospective study obtained the clinical data from 74 patients who underwent rotator cuff repair between July 2022 and June 2024. Patients were divided into two experimental groups: the control group (n = 35), including those who underwent routine rehabilitation exercises after rotator cuff repair, and the exposed group (n = 39), who received scapular training exercises. The patients were followed up and examined at 8 weeks and 16 weeks after surgery. The range of motion (adduction and abduction), shoulder muscle strength (adduction and abduction), Visual Analogue Scale (VAS) scores, and the University of California-Los Angeles (UCLA) shoulder scales were compared between the two groups before rotator cuff repair. We observed that after 8 weeks of treatment-post-surgery, both the groups showed significant improvement in the range of motion (adduction and abduction) and the muscle strength (adduction and abduction) within the shoulder joint compared with those observed before treatment (p < 0.05). After 16 weeks of treatment, the range of motion (adduction and abduction) and shoulder muscle strength (adduction and abduction) further improved compared to those observed after 8 weeks of treatment (p < 0.05). After 8 weeks and 16 weeks of treatment, the University of California shoulder joint scores in both groups were significantly better compared to those before treatment (p < 0.05), and the VAS score significantly decreased (p < 0.05), with the effects after 16 weeks of treatment being better than those observed after 8 weeks (p < 0.05). Additionally, there was no difference in the overall incidence of complications between the two groups (p > 0.05). Early scapular training, following rotator cuff injury, is beneficial in functional recovery of shoulder joint function, which improves rehabilitation outcomes and ultimately promotes patient prognosis.

In vivo shoulder kinematic changes and rotator cuff healing after surgical repair of large-to-massive rotator cuff tears

BackgroundFew studies have investigated the correlation between shoulder kinematics and clinical outcomes in patients undergoing rotator cuff repair using dynamic analysis. This study assessed shoulder kinematics before and after surgical repair in patients with rotator cuff tears (RCTs) and determined the relationship among shoulder kinematics and between shoulder kinematics and clinical outcomes.MethodsTen patients with large-to-massive RCTs and 10 control participants were included. In vivo shoulder kinematics during scapular plane abduction were measured preoperatively and 1 year postoperatively using validated image-registration techniques and compared among the control, preoperative, and postoperative groups. Mixed models were used to compare the effects of the groups on shoulder kinematics, followed by Tukey’s honest significant difference test. Pearson’s correlation coefficient was used to identify the correlations among shoulder kinematics and between each kinematic and clinical outcome.ResultsThe scapula, tilted more anteriorly preoperatively, was not different from the control group postoperatively. Additionally, the change in scapular posterior tilt (PT) throughout dynamic abduction was 18.17° ± 3.59° in the postoperative group, greater than that in the control group (11.54° ± 2.29°; p = 0.0037). The postoperative change in PT significantly correlated with acromiohumeral distance (AHD) and rotator cuff integrity (Sugaya classification) (AHD: r = 0.71, p = 0.023; Sugaya classification: r = − 0.75, p = 0.013), but not preoperative change in PT. Functional score improved from preoperative to postoperative (p < 0.0001). Abduction angle and functional score significantly correlated with Sugaya classification (abduction angle: r = − 0.67, p = 0.034; functional score: r = − 0.70, p = 0.025) but not with shoulder kinematics. Mean superior translation of the humeral head and AHD throughout abduction changed from 1.77 ± 1.34 to 0.61 ± 1.37 and 1.44 ± 1.59 to 2.71 ± 2.27 mm, respectively, from preoperative to postoperative (both p < 0.0001).ConclusionsAfter the surgical repair of large-to-massive RCTs, glenohumeral stability normalized, and the more anteriorly tilted orientation of the scapula improved. Additionally, the preoperative increased scapular motion throughout dynamic abduction was further enhanced postoperatively. Interestingly, in postoperative patients, scapular motion toward PT during dynamic abduction correlated with minimum AHD and cuff healing.

Beyond the Surgery: The Impact of Coping Strategies on Persistent Pain After Rotator Cuff Repair.

Background: Rotator cuff repair is widely recognized as one of the most painful orthopedic surgeries, yet postoperative pain management in these patients is often underexplored. This study aimed to explore the relationship between pain outcomes and functional recovery six months after arthroscopic rotator cuff repair (ARCR), with a focus on the role of different pain coping mechanisms as mediators. Methods: This study included 83 patients that underwent rotator cuff repair. Pain levels were assessed using the Brief Pain Inventory (BPI-SF), while shoulder function was evaluated using the Oxford Shoulder Score (OSS). Coping strategies, including self-statements, ignoring pain, distraction, and praying, were examined in relation to pain severity and interference and were assessed with the Coping Strategies Questionnaire-Revised (CSQ-R). Simple and parallel mediation analyses were performed using the PROCESS macro to assess the mediating effects of coping mechanisms on the relationship between pain intensity, pain interference, and postoperative OSS. Results: Post-surgery, patients showed a significant improvement in OSS (from 29 ± 9 to 42 ± 6). At six months, 24% of patients reported chronic postsurgical pain (CPSP), defined as a pain severity score of 3 or higher. Correlation analyses revealed that OSS was negatively associated with pain catastrophizing (r = -0.35, p < 0.01) and praying (r = -0.28, p < 0.01). OSS was significantly negatively associated with pain severity (r = -0.54; p < 0.01) and pain interference (r = -0.51, p < 0.01). Mediation analysis demonstrated that coping self-statements significantly mediated the relationship between pain interference and shoulder function (a*b = 0.5266 (BootSE = 0.2691, 95% CI [0.1010, 1.1470]), emphasizing the important role of cognitive strategies in supporting recovery outcomes. Conclusion: Patients engaging in adaptive coping strategies, particularly coping self-statements, reported better functional outcomes. The findings underscore the importance of targeted interventions focusing on effective pain coping mechanisms to improve recovery post-ARCR.

Efficacy of Diagnostic In-Office Shoulder Ultrasound in the Surgical Treatment of Full-Thickness Rotator Cuff Tears.

Early surgical management of full-thickness traumatic rotator cuff tears (RCTs) may optimize functional outcomes, prioritizing timely diagnoses. Ultrasound and magnetic resonance imaging (MRI) are highly sensitive and specific modalities for RCT diagnosis, yet MRI remains the gold standard diagnostic tool despite increased costs and potential delays in care. Ultrasound can provide same-day diagnosis, thus possibly expediting care. The use of diagnostic shoulder ultrasound alone in the orthopaedic surgeon's office could increase the efficiency of diagnosis and care of traumatic full-thickness RCTs compared with MRI. Cohort study; Level of evidence, 3. A retrospective chart review of patients with full-thickness traumatic RCT diagnosed via ultrasound or MRI who subsequently underwent rotator cuff repair with 1 of 2 ultrasound-trained surgeons between January 1, 2014, and December 31, 2019, was performed. Inclusion criteria included patients ≥18 years old, documentation of a first-time traumatic event, and the patient's desire to have immediate surgical management. Revision surgeries, long-term shoulder instability, and nontraumatic injuries were excluded. Basic demographic data were collected, and the number of preoperative office visits and the timing from initial evaluation to diagnosis and surgery were calculated for the ultrasound and the MRI cohorts. A power analysis of 0.8 with an alpha of .05 required 38 patients per group. Overall, 133 patients were diagnosed via MRI compared with 76 via ultrasound. Besides body mass index, there were no significant differences in demographic variables or insurance status. Compared with the MRI cohort, patients in the ultrasound cohort received their diagnosis almost 2 weeks faster (P < .0001), were scheduled for surgery almost 3 weeks faster (P < .0001), and underwent surgery 2 weeks faster after initial evaluation (P < .0001) while requiring nearly half as many clinical visits (P < .0001). Regression analysis confirmed that ultrasound significantly reduced time to imaging, scheduling, and surgery after initial evaluation while requiring fewer clinical visits (P < .05). The study findings indicated that ultrasound was a time-saving alternative diagnostic modality for traumatic RCT compared with MRI without compromising standard of care. These results were achieved independent of patient insurance status, disability index, or other demographic variables.

EFFECTIVENESS OF PECTORALIS AND LOWER TRAPEZIUS EXERCISE USING PNF IN TREATING ROTATOR CUFF REPAIR WITH ROUNDED SHOULDER POSTURE: A RANDOMIZED CONTROLLED STUDY

This study aimed to determine the effects of pectoralis stretching and lower trapezius strengthening exercises (PSLTSE) using proprioceptive neuromuscular facilitation (PNF) on posture, shoulder range of motion (ROM), pain, and muscle tone in patients undergoing rotator cuff repair (RCR) and rounded shoulder posture (RSP). Following baseline measurements, participants ([Formula: see text]) with RCR were randomized into two groups: an experimental group ([Formula: see text] [11 male and 12 female; age: 56.69 years]), engaged in PNF-PSLTSE, and a control group ([Formula: see text] [12 male and 11 female; age: 54.09 years]), receiving traditional physical therapy. Each group participated in the intervention five times per week for two weeks. The RSP values for postural changes, flexion and abduction ROM, visual analog scale (VAS), and Myoton PRO of both groups were recorded pre- and post-intervention. A paired t-test was performed to compare differences within the groups pre- and post-intervention. An independent t-test was performed to compare differences between the both groups. After the intervention, RSP, ROM, VAS, and muscle tone improved significantly in the experimental and control groups ([Formula: see text]). The experimental group showed more effective changes in the RSP, ROM, VAS, and muscle tone than the control group ([Formula: see text]). The results suggested that PSLTSE using PNF reduced posture-related shoulder pain, and muscle tone and enhanced ROM in RCR patients with RSP.

Analysis of Six Cases Attached to Postoperative Infection after Shoulder Arthroscopic Rotator Cuff Repair: A Case Report

Background: The purpose of this case report was to investigate the incidence of departmental infections following arthroscopic rotator cuff repair over a three-year period as well as to compare the clinical efficacy of treating postoperative infections following rotator cuff repair using incisional debridement sutures, arthroscopic shoulder debridement and lavage treatment, and arthroscopic debridement and lavage in combination with antibiotic-cement beading. Case presentation: A retrospective evaluation of 600 shoulder arthroscopic rotator cuff repairs performed in our hospital between 2021.1 and 2023.12 was conducted to screen the data of six Chinese women aged 51-71 years, who completed routine hematological and radiological examinations after admission, were treated with antibiotics, and the use of antibiotics was adjusted according to the results of wound secretion culture. Among them, 2 cases were treated with arthroscopic debridement and irrigation of the shoulder, 2 cases were treated with arthroscopic debridement and irrigation of the shoulder combined with antibiotic cemented nails, 1 case was treated with incision and debridement and suture, and 1 case was treated conservatively. Postoperative anti-infective treatment with antibiotics was continued, and the relevant indexes were rechecked. Preoperative and postoperative follow-up were performed using the visual analog scale (VAS) and the American Shoulder and Elbow Surgeons (ASES) score. Results: The infection rate of patients who underwent rotator cuff repair during the evaluation period was 1%. Culture of wound secretions from six infected patients showed culture results of Staphylococcus aureus, Serratia marcescens, Mycobacterium xylosoxidans colorless, and Mycobacterium tuberculosis, with no obvious abnormalities, and no cultures were performed. Two cases were treated with shoulder arthroscopic debridement and irrigation, two cases were treated with shoulder arthroscopic debridement and irrigation combined with antibiotic bone cement beading, one case was treated with incision and debridement and suturing, and one case was treated conservatively. At the final follow-up, the scores of two patients treated with arthroscopic debridement and irrigation of the shoulder improved, two patients treated with arthroscopic debridement and irrigation of the shoulder combined with antibiotic-cemented beading did not show significant improvement, one patient treated with incisional debridement and suturing improved significantly, and one patient treated conservatively improved significantly. Conclusion: The overall infection rate of arthroscopic rotator cuff repair of the shoulder over 3 years was 1% (6/600). The use of incisional debridement and suturing or shoulder arthroscopic debridement and irrigation has better clinical outcomes than shoulder arthroscopic debridement and irrigation combined with cement beading for the treatment of infection after arthroscopic rotator cuff repair.

What influences the decision to undergo rotator cuff repair surgery: A survey of clinician's perspectives.

Many factors may influence a patient's decision to undergo rotator cuff repair surgery. The aim of this survey was to understand from a clinician's perspective how different factors influence the likelihood of a patient undergoing a repair. An online survey presenting a range of clinical scenarios was distributed through professional networks to understand how each patient related factor influenced the likelihood of a patient undergoing a rotator cuff repair. One hundred three clinicians completed the survey. Clinicians indicated that patients were more likely to undergo a repair if they were younger, had a traumatic or larger tear, high pain levels (64.1%), high functional demands (93.2%), and arm weakness (86.4%). Surgery was less likely in older patients who had degenerative or smaller tears, diabetics (62.1%), smokers (78.9%) and those with high body mass index (57.3%). 74.8% of clinicians indicated a repair was more likely if the patient expected that surgery was required to improve symptoms. From a clinician's perspective, the decision to undergo surgery is complex, it is influenced by onset, age, tear size and other health related factors. Patient expectations of treatment also appear to influence the decision, and this is an area that needs further exploration.

Rotator Cuff Tear Size: Could It Be Influenced by the Presence of One or More Diseases Capable of Altering the Peripheral Microcirculation?

Background: To date, it is not well known which systemic pathologies most frequently afflict patients with rotator cuff tear (RCT) and whether the coexistence of two or more pathologies can affect the lesion size. Therefore, we analyzed our database relative to a large group of patients who recently underwent rotator cuff repair. Methods: A total of 527 patients with full-thickness RCT were enrolled. For each patient, we checked the presence of at least one of diabetes, venous system diseases, cardiovascular diseases, hypercholesterolemia, blood hypertension, thyroid diseases, and a smoking habit. Patients were subdivided according to risk factors into five groups, representing those who had zero, one, two, three, and four or more risk factors, respectively. Statistical analysis was performed. Results: In total, 37% of our patients had no risk factors; 28% had one risk factor (arterial hypertension, smoking habit, and hypercholesterolemia were the most frequent); 23% had two risk factors (the hypertension/hypercholesterolemia association was the most frequent); and 8% suffered from three pathologies (the diabetes/arterial hypertension/hypercholesterolemia association was the most frequent). Comparing the cuff tear severity in patients without and with at least one risk factor, we observed that tear size increased in those with at least one risk factor. Conclusions: A total of 63% of patients with rotator cuff tears were either smokers and/or had at least one pathology capable of altering the peripheral microcirculation. Hypertension and hypercholesterolemia were the most frequent. Tear severity significantly increased with the presence of at least one risk factor.