RESUMEN
This study aimed to evaluate the differences between mini-open (MO) and arthroscopic (ART) repair procedures for rotator cuff tendon tears in terms of clinical and radiological outcomes. This retrospective study included 59 patients, and data were collected prospectively. Patients with full-thickness rotator cuff tears were randomized to undergo MO or ART repair at 2 centers by 2 surgeons between January 2012 and December 2017. Data were collected 3 weeks before surgery and 6 and 12 months after surgery. Physical function was assessed using the American Shoulder and Elbow Surgeons index, VAS, and Constant scoring system. Radiological outcomes were assessed using the Sugaya classification, adapted for ultrasound. Changes between baseline and follow-up were compared between the 2 groups. Fifty-nine patients who underwent ART or MO rotator cuff repair were included in this study. The 2 groups had similar demographic characteristics and preoperative baseline parameters. Both the MO and ART groups showed statistically significant improvement in outcome parameters (P ≤ .0001); however, cuff repair integrity was significantly better in the ART group (Pâ =â .023). All other improvements in the patient-derived parameters were equivalent. None of the patients in either group required revision surgery. According to the results of our retrospective study, MO and ART rotator cuff repair are effective and viable options for surgeons to repair rotator cuff tears. There were no differences in objective and subjective outcomes between the full ART and MO techniques for rotator cuff tears. Surgeons should choose a technique with which they are more familiar.
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Artroscopía , Lesiones del Manguito de los Rotadores , Humanos , Lesiones del Manguito de los Rotadores/cirugía , Artroscopía/métodos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Anciano , Manguito de los Rotadores/cirugíaRESUMEN
BACKGROUND: Graft failure is a common complication after superior capsule reconstruction (SCR). The graft in SCR is fixed on the greater tuberosity and superior glenoid, and graft failure has been reported on both sides. PURPOSE: To evaluate the clinical manifestations of patients with graft failure after SCR and identify the clinical and radiological differences between medial and lateral graft failure. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients who underwent SCR with a dermal allograft for symptomatic irreparable rotator cuff tears between March 2018 and September 2021 were retrospectively reviewed. All patients had minimum 2-year follow-up and underwent magnetic resonance imaging at 6 months postoperatively. Patients with graft failure were divided into 2 groups: those with lateral graft failure on the greater tuberosity side (group I) and those with medial graft failure on the glenoid side (group II). Patients with intact grafts were included in group III as a control group. Intergroup differences in clinical and radiological characteristics were analyzed, and multiple regression analysis was performed. RESULTS: Among the 93 patients included, there were 18 patients in group I, 15 in group II, and 60 in group III. Overall, 11 patients (61.1%) in group I and 9 patients (60.0%) in group II had a partial graft rupture at one anchor. The postoperative graft volume was significantly lower in group I than in groups II and III (2514.0 ± 564.3 mm3, 3183.5 ± 547.1 mm3, and 3198.0 ± 584.8 mm3, respectively; P = .002 for group I vs II; P < .001 for group I vs III). The acromiohumeral distance (AHD) was significantly increased at 6 months postoperatively compared with before surgery in group I (6.6 ± 1.6 mm vs 4.3 ± 1.9 mm, respectively; P < .001) and group II (7.4 ± 1.3 mm vs 5.7 ± 1.7 mm, respectively; P = .002). However, group I exhibited a significantly greater decrease in the AHD over time than group II (P < .001) and a significantly lower AHD at the final follow-up than the other groups (P < .001). The postoperative American Shoulder and Elbow Surgeons score was significantly lower in group I than in the other groups (P < .001). On multiple regression analysis, fatty infiltration of the infraspinatus muscle, Hamada grade, and graft width were independent factors for lateral graft failure. CONCLUSION: Patients with lateral graft failure had inferior clinical outcomes and lower postoperative graft volumes than those with medial graft failure after SCR using a dermal allograft. The AHD of patients with lateral graft failure improved postoperatively; however, it deteriorated over time.
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Lesiones del Manguito de los Rotadores , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Lesiones del Manguito de los Rotadores/cirugía , Anciano , Imagen por Resonancia Magnética , Trasplante de Piel/métodos , Adulto , Procedimientos de Cirugía Plástica/métodos , Cápsula Articular/cirugíaRESUMEN
INTRODUCTION: Socioeconomic status (SES) affects access to care for traumatic rotator cuff (RTC) tears. Delayed time to treatment (TTT) of traumatic RTC tears results in worse functional outcomes. We investigated disparities in TTT and hypothesized that individuals from areas of low SES would have longer time to surgical repair. METHODS: Patients who underwent repair of a traumatic RTC tear were retrospectively reviewed. Median household income and Social Deprivation Index were used as a proxy for SES. The primary outcome was TTT. Patients were further stratified by preoperative forward flexion and number of tendons torn. RESULTS: A total of 221 patients met inclusion criteria. No significant difference in TTT was observed between income classes (P = 0.222) or Social Deprivation Index quartiles (P = 0.785). Further stratification by preoperative forward flexion and number of tendons torn also yielded no significant difference in TTT. DISCUSSION: Contrary to delays in orthopaedic care documented in literature, our study yielded no difference in TTT between varying levels of SES, even when stratified by the severity of injury. Thus, we reject our original hypothesis. Based on our findings, mechanisms in place at our institution may have mitigated some of these health disparities within our community.
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Lesiones del Manguito de los Rotadores , Clase Social , Tiempo de Tratamiento , Humanos , Lesiones del Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/terapia , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Anciano , Disparidades en Atención de SaludRESUMEN
The aim of this study was to investigate the effect of zoledronic acid (ZA) on postoperative healing and functional rehabilitation in osteoporotic patients with rotator cuff (RC) injury. 96 Patients were divided into three groups according to bone mineral density and ZA use (Group A: normal BMD; Group B: osteoporosis and intravenous ZA use; Group C: osteoporosis, without ZA use). Radiologic, functional and Serological outcomes were evaluated 6 months after surgery. The functional scores in all groups exhibited significant improvement 6 months after surgery. Inter-group comparison showed that Constant Shoulder joint function Score (CSS) of group A not significantly differing from that of group B, the other indicators were significantly better than those of group B and C. There were no significant differences in shoulder forward flexion, abductive Range of Motion between group B and C. Other indicators of group B were significantly improved compared to group C. The retear rate in group C (30.3%, 10/33) was higher than group A (6.1%, 2/33) and group B (13.3%, 4/30). In conclusion, the application of ZA can significantly reduce the rate of RC retear in elderly patients with osteoporosis after surgery, which is significant for postoperative shoulder joint functional rehabilitation.
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Osteoporosis , Lesiones del Manguito de los Rotadores , Ácido Zoledrónico , Humanos , Ácido Zoledrónico/administración & dosificación , Ácido Zoledrónico/uso terapéutico , Femenino , Anciano , Masculino , Osteoporosis/tratamiento farmacológico , Estudios Retrospectivos , Lesiones del Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/tratamiento farmacológico , Rango del Movimiento Articular/efectos de los fármacos , Resultado del Tratamiento , Persona de Mediana Edad , Conservadores de la Densidad Ósea/administración & dosificación , Conservadores de la Densidad Ósea/uso terapéutico , Anciano de 80 o más Años , Manguito de los Rotadores/cirugía , Densidad Ósea/efectos de los fármacos , Administración IntravenosaRESUMEN
Failure rate after chronic rotator cuff repair is considerably high. Moreover, diabetes mellitus is known as a compromising factor of rotator cuff tear. The effect of Polydeoxyribonucleotide (PDRN) and polynucleotide (PN) on tendon healing and fatty infiltration is unclear as tissue regeneration activator in diabetic state. Therefore, a diabetic rat model with chronic rotator cuff tear was made for mechanical, histologic and blood tests. In the animal study using a diabetic rat cuff repair model, the administration of PDRN and PN increased the load to failure of repaired cuffs and improved tendon healing and decreased fatty infiltration. Also, the plasma levels of vascular endothelial growth factor and fibroblast growth factor were elevated in PDRN and PN administrated groups. We concluded that PDRN and PN appear to boost tendon recovery and reduce the presence of fatty infiltration following cuff repair in diabetic state. Also, PN showed a later onset and a longer duration than PDRN associated with the mean plasma growth factors.
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Diabetes Mellitus Experimental , Polidesoxirribonucleótidos , Polinucleótidos , Lesiones del Manguito de los Rotadores , Cicatrización de Heridas , Animales , Polidesoxirribonucleótidos/farmacología , Polidesoxirribonucleótidos/uso terapéutico , Diabetes Mellitus Experimental/tratamiento farmacológico , Ratas , Cicatrización de Heridas/efectos de los fármacos , Lesiones del Manguito de los Rotadores/tratamiento farmacológico , Lesiones del Manguito de los Rotadores/patología , Lesiones del Manguito de los Rotadores/metabolismo , Masculino , Polinucleótidos/farmacología , Manguito de los Rotadores/patología , Manguito de los Rotadores/efectos de los fármacos , Modelos Animales de Enfermedad , Factor A de Crecimiento Endotelial Vascular/metabolismo , Factor A de Crecimiento Endotelial Vascular/sangre , Ratas Sprague-Dawley , Tejido Adiposo/efectos de los fármacos , Tejido Adiposo/metabolismo , Tejido Adiposo/patologíaRESUMEN
INTRODUCTION: In reverse shoulder arthroplasty (RSA) new designs enable greater amounts of lateralization to prevent instability and scapular notching and increase range of motion, however, excessive lateralization leads to stress upon the acromion that can result in scapular spine fatigue fractures. Aim of this study was to gender- and size-specifically assess the influence of glenosphere size and different humeral designs on lateralization, distalization, and bony impingement-free range of motion (ROM) in patients undergoing RSA. METHODS: Computed tomography scans from 30 osteoarthritic patients (f:15, m:15) and 20 cuff tear arthropathy patients (f:10, m:10) were used to virtually simulate RSA implantation. The efficacy of an inlay Grammont-type system vs. an onlay lateralizing system combined with different glenosphere sizes (36 mm vs. 42 mm) in achieving ROM, lateralization, and distalization was evaluated. Moreover, gender and patient's constitution were correlated to humeral size by radiologically measuring the best-fit circle of the humeral head. RESULTS: A different amount of relative lateralization was achieved in both genders using large glenospheres and onlay designs. Latter yielded a higher ROM in all planes for men and women with a 42 mm glenosphere; with the 36 mm glenosphere, an increased ROM was observed only in men. The 155° inlay design led to joint medialization only in men, whereas all designs led to lateralization in women. When adjusting the absolute amount of lateralization to humerus' size (or patient's height), regardless of implant type, women received greater relative lateralization using 36 mm glenosphere (inlay: 1%; onlay 12%) than men with 42 mm glenosphere (inlay: -3%; onlay: 8%). CONCLUSION: The relative lateralization achieved using onlay design is much higher in women than men. Small glenospheres yield greater relative lateralization in women compared to large glenospheres in men. Humeral lateralization using onlay designs should be used cautiously in women, as they lead to great relative lateralization increasing stress onto the acromion. LEVEL OF EVIDENCE: Basic Science Study, Computer Modeling.
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Artroplastía de Reemplazo de Hombro , Diseño de Prótesis , Rango del Movimiento Articular , Articulación del Hombro , Prótesis de Hombro , Humanos , Femenino , Masculino , Artroplastía de Reemplazo de Hombro/métodos , Artroplastía de Reemplazo de Hombro/instrumentación , Anciano , Persona de Mediana Edad , Articulación del Hombro/cirugía , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/fisiopatología , Factores Sexuales , Osteoartritis/cirugía , Osteoartritis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano de 80 o más Años , Lesiones del Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/diagnóstico por imagenRESUMEN
BACKGROUND: The aim of this study is to investigate the potential relationship between shoulder anatomical parameters and the shape of rotator cuff tears (L-shaped, U-shaped, and crescent-shaped). MATERIALS AND METHODS: The study included 160 (n:160) patients. Patients were divided into four groups: crescent type, u type and L type tears and control group. There were 40 cases in each group. The operated patients were divided into three groups based on the shape of the tears in arthroscopic images. Measurements of Critical Shoulder Angle (CSA), Greater Tuberosity Angle (GTA), Acromion Index (AI), Lateral Acromion Angle (LAA), and Humerus Footprint width (coronal width and sagittal width) were taken in each group and compared. RESULTS: Patients were divided into four different groups: Crescent type group (n:40), L type group (n:40), U type group (n:40) and control group (n:40). Upon assessing the coronal and sagittal width measurements, The mean coranal width measurement of the L-type tear group was 12.62 ± 0.29 mm, which was significantly higher than all other groups (p < 0.05). The mean sagittal width of the L-type tear group was 34.95 ± 0.29 mm, which was significantly higher than all other groups (p < 0.05). When the groups were evaluated based on GTA, CSA, and AI data, the mean GTA measurement of the L-type tear group was 73.03 ± 0.95 degrees, which was significantly higher than all other groups (p < 0.05). The mean CSA measurement of the L-type tear group was 34.77 ± 0.66 degrees, which was significantly higher than all other groups (p < 0.05). The mean AI measurement of the L-type tear group was 0.77 ± 0.02, which was significantly higher than all other groups (p < 0.05). When the groups were evaluated based on LAA data, the mean LAA measurement of the L-type tear group was 76.98 ± 1.04 degrees, which was significantly lower than all other groups (p < 0.05). CONCLUSION: In our study, especially in L-shaped tears, measurements of GTA, CSA, AI, LAA, coronal and sagittal width were found to be different compared to the control group. These results suggest that shoulder anatomy affects the mechanisms of rotator cuff tear formation and that these parameters play a more significant role in L-shaped tears.
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Lesiones del Manguito de los Rotadores , Manguito de los Rotadores , Humanos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/patología , Femenino , Masculino , Persona de Mediana Edad , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/anatomía & histología , Manguito de los Rotadores/patología , Anciano , Adulto , Artroscopía , Articulación del Hombro/anatomía & histología , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/patología , Estudios RetrospectivosRESUMEN
OBJECTIVE: The purpose of this study was to evaluate the clinical and functional outcomes in patients who underwent surgical treatment for rotator cuff tears using open and arthroscopic techniques, and to evaluate the direct costs involved. METHODS: Retrospective cohort study with analysis of the data of patients who were referred to two private hospitals in Sao Paulo, Brazil for surgical repair of the rotator cuff from January 2018 to September 2019. Clinical outcomes were assessed using functional scores (SPADI and QuickDASH) and a quality of life questionnaire (EuroQoL). Procedure costs were calculated relative to each hospital's costliest procedure. RESULTS: Data from 362 patients were analyzed. The mean patient age was 57 years (SD= 10.46), with a slight male predominance (53.9%). Arthroscopic procedures were more common than open procedures (95.6% versus 4.4%). Significant clinical improvement was reported in 84.8% of the patients. The factors associated with increased surgery costs were arthroscopic technique (increase of 29.2%), age (increase of 0.6% per year), and length of stay (increase of 18.9% per day of hospitalization). CONCLUSION: Rotator cuff repair surgery is a highly effective procedure, associated with favorable clinical outcomes and improvement in life quality, and low rates of complications. Arthroscopic surgery tends to be costlier than open surgery.
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Artroscopía , Calidad de Vida , Lesiones del Manguito de los Rotadores , Humanos , Masculino , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Lesiones del Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/economía , Artroscopía/economía , Resultado del Tratamiento , Anciano , Brasil , Adulto , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Manguito de los Rotadores/cirugía , Costos y Análisis de CostoRESUMEN
BACKGROUND Reverse shoulder arthroplasty (RSA) is an accepted treatment that provides reproducible results in the treatment of rotator cuff deficiency and proximal humerus fractures. This single-center study aimed to evaluate the outcomes from reverse shoulder arthroplasty for rotator cuff insufficiency and proximal humerus fractures in 22 patients from a single center. MATERIAL AND METHODS Twenty-two patients were included in the study. The median age of the patients was 66 years (Range: 58-95). Proximal humerus fractures were diagnosed using X-ray and CT, while rotator cuff tears were diagnosed using MRI. For the assessment of joint function, the Constant-Murley score, the American Shoulder and Elbow Surgeons (ASES), and the Disabilities of Arm, Shoulder, and Hand (DASH) scores were used as patient-reported outcome measures. Kaplan-Meier analysis was conducted to evaluate implant survival. RESULTS The mean follow-up duration was 4.05±1.2 years. Significant improvements were observed: ASES Score: Increased from 35.8±2.8 to 81.3±5.4 (p<0.001). VAS Pain Score: Decreased from 7.3±1 to 2.9±0.9 (p<0.001). DASH Score: Improved from 66.3±4.3 to 32.5±3.6 (p<0.001). Constant-Murley Score: Increased from 48.3±3.5 to 74.6±7.7 (p<0.001). Kaplan-Meier analysis estimated implant survival at 6.7 years (95% CI, 6.3-7.2). CONCLUSIONS When performed with appropriate indications, RSA yields positive results, as seen in the literature and our study. Interscalene block anesthesia, advancements in implant technology, and adherence to surgical procedures can reduce RSA complications and ensure its safe application.
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Artroplastía de Reemplazo de Hombro , Lesiones del Manguito de los Rotadores , Manguito de los Rotadores , Fracturas del Hombro , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Artroplastía de Reemplazo de Hombro/métodos , Artroplastía de Reemplazo de Hombro/efectos adversos , Fracturas del Hombro/cirugía , Manguito de los Rotadores/cirugía , Anciano de 80 o más Años , Lesiones del Manguito de los Rotadores/cirugía , Resultado del Tratamiento , Rango del Movimiento Articular , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatologíaRESUMEN
After rotator cuff injuries, uncontrolled inflammation hinders tendon-bone junction regeneration and induces scar formation in situ. Therefore, precisely controlling inflammation could be a solution to accelerate tendon-bone junction regeneration. In this study, we synthesized a peptide-metal ion complex hydrogel with thermosensitive capability that can be used as a hydrogel chemical regulator. By the coordination complex between Mg2+ and BMP-12, the free and coordinated Mg2+ can be programmability released from the hydrogel. The fast release of free Mg2+ can prevent inflammation at the early stage of injuries, according to the results of RT-qPCR and immunofluorescence staining. Then, the coordinated Mg2+ was slowly released from the hydrogel and provided an anti-inflammatory environment for tendon-bone junction regeneration in the long term. Finally, the hydrogel demonstrated enhanced therapeutic effects in a rat rotator cuff tear model. Overall, the Mg2+/BMP-12 peptide-metal ion complex-based hydrogel effectively addresses the regenerative requirements of the tendon-bone junction across various stages by graded modulating inflammation.
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Hidrogeles , Inflamación , Péptidos , Ratas Sprague-Dawley , Tendones , Animales , Hidrogeles/química , Hidrogeles/farmacología , Ratas , Péptidos/química , Péptidos/farmacología , Inflamación/tratamiento farmacológico , Inflamación/patología , Tendones/efectos de los fármacos , Tendones/patología , Magnesio/química , Magnesio/farmacología , Regeneración/efectos de los fármacos , Lesiones del Manguito de los Rotadores/tratamiento farmacológico , Lesiones del Manguito de los Rotadores/patología , Huesos/efectos de los fármacos , Huesos/patología , Masculino , Regeneración Ósea/efectos de los fármacosRESUMEN
Rotator cuff injuries present a clinical challenge for repair due to current limitations in functional regeneration of the native tendon-to-bone enthesis. A biomaterial that can regionally instruct unique tissue-specific phenotypes offers potential to promote enthesis repair. We have recently demonstrated the mechanical benefits of a stratified triphasic biomaterial made up of tendon- and bone-mimetic collagen scaffold compartments connected via a continuous hydrogel, and we now explore the potential of a biologically favorable enthesis hydrogel for this application. Here we report in vitro behavior of human mesenchymal stem cells (hMSCs) within thiolated gelatin (Gel-SH) hydrogels in response to chondrogenic stimuli as well as paracrine signals derived from MSC-seeded bone and tendon scaffold compartments. Chondrogenic differentiation media promoted upregulation of cartilage and entheseal fibrocartilage matrix markers COL2, COLX, and ACAN as well as the enthesis-associated transcription factors SCX, SOX9, and RUNX2 in hMSCs within Gel-SH. Similar effects were observed in response to TGF-ß3 and BMP-4, enthesis-associated growth factors known to play a role in entheseal development and maintenance. Conditioned media generated by hMSCs seeded in tendon- and bone-mimetic collagen scaffolds influenced patterns of gene expression regarding enthesis-relevant growth factors, matrix markers, and tendon-to-bone transcription factors for hMSCs within the material. Together, these findings demonstrate that a Gel-SH hydrogel provides a permissive environment for enthesis tissue engineering and highlights the significance of cellular crosstalk between adjacent compartments within a spatially graded biomaterial.
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Diferenciación Celular , Fibrocartílago , Gelatina , Hidrogeles , Células Madre Mesenquimatosas , Comunicación Paracrina , Humanos , Gelatina/química , Hidrogeles/química , Hidrogeles/farmacología , Diferenciación Celular/efectos de los fármacos , Células Madre Mesenquimatosas/efectos de los fármacos , Células Madre Mesenquimatosas/metabolismo , Células Madre Mesenquimatosas/citología , Comunicación Paracrina/efectos de los fármacos , Fibrocartílago/química , Fibrocartílago/efectos de los fármacos , Fibrocartílago/metabolismo , Condrogénesis/efectos de los fármacos , Manguito de los Rotadores , Subunidad alfa 1 del Factor de Unión al Sitio Principal/metabolismo , Factor de Transcripción SOX9/metabolismo , Andamios del Tejido/química , Lesiones del Manguito de los Rotadores/terapia , Agrecanos/metabolismo , Factores de Transcripción con Motivo Hélice-Asa-Hélice BásicoRESUMEN
BACKGROUND: The recent addition of biceps tendon augmentation to partial arthroscopic rotator cuff repair (ARCR) for the treatment of large-to-massive rotator cuff tears is proposed to improve clinical outcomes and reduce re-tears. MATERIALS AND METHODS: The purpose of this systematic review and meta-analysis (5 studies) was to compare outcomes between partial ARCR with (142 patients) and without (149 patients) biceps augmentation. RESULTS: Partial ARCR with and without biceps augmentation were comparable in pain, function, and range of motion. However, biceps augmentation vs no augmentation at all during ARCR may lower re-tear rates for irreparable large-to-massive rotator cuff tears (42.9% vs 72.5%, P=.007). CONCLUSION: More research is needed to investigate this technique and guide surgical decision-making. [Orthopedics. 2024;47(5):e217-e224.].
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Artroscopía , Lesiones del Manguito de los Rotadores , Humanos , Lesiones del Manguito de los Rotadores/cirugía , Artroscopía/métodos , Resultado del Tratamiento , Manguito de los Rotadores/cirugíaRESUMEN
BACKGROUND: In patients with hyperlipidemia, the risk of retear increases after rotator cuff repair (RCR). In particular, it has been reported that preoperative low-density lipoprotein cholesterol (LDL-C) level affects cuff integrity. However, there are no studies assessing whether lipidemic control affects cuff healing. PURPOSE: To evaluate the effect of preoperative lipidemic control on cuff integrity after arthroscopic RCR across cardiovascular disease risk groups in patients with hyperlipidemia. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: The authors retrospectively reviewed the charts of patients with hyperlipidemia who underwent arthroscopic double-row suture bridge RCR between 2014 and 2019. The included patients had LDL-C tested within 1 month before surgery. Magnetic resonance imaging was conducted 6 months after surgery to evaluate the integrity of the repaired cuff tendon. Patients were divided into groups of low, moderate, high, and very high risk according to the 4th Korean Dyslipidemia Guidelines. On the basis of the target LDL-C set in each risk group, patients were categorized into 2 groups: group C (controlled hyperlipidemia, less than target LDL-C) and group U (uncontrolled hyperlipidemia, target LDL-C or greater). The correlation between serum lipid profile, lipidemic control, and post-RCR integrity was evaluated. RESULTS: A total of 148 patients were analyzed, 51 in group U and 97 in group C. The retear rate was significantly higher in group U than in group C (23/51 [45.1%] vs 18/97 [18.6%], respectively; P = .001). The proportion of group U was significantly higher in the retear group than in the healing group (56.1% vs 26.2%; P = .001). In addition, the proportions of patients with uncontrolled diabetes mellitus (DM) (19.5% vs 3.7%; P = .002) and mediolateral (2.6 ± 1.2 cm vs 1.7 ± 1.1 cm; P < .001) and anteroposterior (2.2 ± 1.1 cm vs 1.6 ± 0.8 cm; P = .003) tear sizes were significantly different between the retear and healing groups, respectively. No significant difference in serum lipid profile, including LDL-C level (119.6 ± 31.3 vs 116.7 ± 37.2; P = .650), was observed between the retear and healing groups. Multivariate regression analysis identified uncontrolled hyperlipidemia (OR, 4.005; P = .001), uncontrolled DM (OR, 5.096; P = .022), and mediolateral tear size (OR, 1.764; P = .002) as independent risk factors for retear. The 2.0-cm mediolateral size cutoff and the 3 independent risk factors had significant associations with retear. CONCLUSION: Poor preoperative lipidemic control was significantly associated with poor healing after RCR. In addition to large mediolateral tear size, uncontrolled hyperlipidemia and DM were significant risk factors for retear. Moreover, poor lipidemic control compared with the recommended target level before surgery was more correlated with an increased retear rate than a preoperative LDL-C level.
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LDL-Colesterol , Hiperlipidemias , Lesiones del Manguito de los Rotadores , Humanos , Lesiones del Manguito de los Rotadores/cirugía , Masculino , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Estudios de Casos y Controles , LDL-Colesterol/sangre , Anciano , Artroscopía , Imagen por Resonancia Magnética , Factores de RiesgoRESUMEN
BACKGROUND: Massive irreparable rotator cuff tears (MIRCTs) are among the most challenging shoulder conditions to treat surgically. Supraspinatus tendon reconstruction (STR) is a recently introduced technique for MIRCTs based on fascia lata-muscle interface healing, which completely differs from the classic bridging technique with fascia lata-tendon interface healing. However, histological and biomechanical comparisons of the fascia-muscle and fascia-tendon interfaces have not been performed. PURPOSE: To investigate the histological and biomechanical healing of the fascia-bone interface and fascia-muscle interface after chronic MIRCTs in a rat model using different surgical methods. STUDY DESIGN: Controlled laboratory study. METHODS: The authors established a chronic MIRCT model in the right shoulder of rats and then repaired it using the STR or bridging repair technique. Evaluations were performed at 2, 4, 8, and 12 weeks, including histological, imaging, biomechanical, and functional analyses. RESULTS: Both techniques resulted in good fascia-bone interface healing based on the histological results. The STR group had significantly more cartilage formation at 8 and 12 weeks and higher Modified Tendon Maturity Score after 12 weeks at the fascia-bone interface compared with the bridging repair group and formed the typical 4-layered structure. Collagen fibers in the fascia-muscle and fascia-tendon interfaces exhibited normal muscle-tendon interface characteristics at 12 weeks. However, the STR group had more improvement in fatty infiltration compared with the bridging repair group. The ultimate failure load and stiffness did not differ between the STR and bridging repair groups 4 weeks postoperatively in both the fascia-bone interface and supraspinatus muscle-fascia-bone integrity. Movement distance and grasp time were significantly longer in the STR group than in the bridging repair group at 12 weeks and attached the level in the normal control groups. CONCLUSION: These results suggest that the fascia-muscle interface from the STR technique is histologically and functionally better than the fascia-tendon interface. Moreover, this study provides a theoretical basis for the clinical use of the STR technique. CLINICAL RELEVANCE: The fascia-muscle interface and fascia-tendon interface were the key points of the STR and bridging techniques, respectively. The fascia-muscle interface is histologically and functionally superior to the bridging technique, and the STR technique might be a better choice for the treatment of MIRCTs.
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Ratas Sprague-Dawley , Lesiones del Manguito de los Rotadores , Animales , Lesiones del Manguito de los Rotadores/cirugía , Fenómenos Biomecánicos , Ratas , Masculino , Manguito de los Rotadores/cirugía , Procedimientos de Cirugía Plástica/métodos , Modelos Animales de Enfermedad , Cicatrización de Heridas/fisiología , Fascia LataRESUMEN
AIM: Rotator cuff tears (RCTs) are a major cause of shoulder pain and disability, affecting millions worldwide. Understanding the risk factors and developing reliable predictive measures for RCTs is essential for early diagnosis, targeted prevention, and effective treatment of this patient population. This study seeks to enhance our understanding by analyzing the acromiohumeral distance (AHD) and Constant-Murley Score (CMS) in patients with and without RCTs, thereby aiding the development of a predictive model aimed at improving clinical outcomes and prevention strategies in rotator cuff pathology. METHODS: This retrospective analysis involved 201 patients with shoulder pain, categorized into RCT (n = 72) and no RCTs (N-RCTs, n = 129) groups based on Magnetic Resonance Imaging (MRI) findings. We compared demographics, AHD, CMS, and rotator cuff status between groups and utilized logistic regression for identifying RCT predictors, leading to the development of a multifactorial predictive model. RESULTS: The mean AHD was 6.60 ± 1.12 mm. The RCT group showed a marginally higher AHD than the N-RCT group (p = 0.669). CMS scores were significantly lower in the RCT group (p < 0.001). Dominant side involvement (Odds Ratio (OR) 2.244), type III acromion (OR 6.106), and lower CMS (OR 0.938) significantly correlated with RCTs. The predictive model demonstrated an area under the curve (AUC) of 0.701 for RCT diagnosis. CONCLUSIONS: Reduced CMS, dominance of the affected side, and type III acromion emerged as key risk factors for RCTs. Our predictive model, incorporating these factors, holds promise for RCT diagnosis, with future studies needed for further validation.
Asunto(s)
Lesiones del Manguito de los Rotadores , Humanos , Estudios Retrospectivos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Factores de Riesgo , Masculino , Femenino , Persona de Mediana Edad , Anciano , Imagen por Resonancia Magnética , Dolor de Hombro/etiología , Medición de Riesgo/métodos , Adulto , Acromion/diagnóstico por imagen , Acromion/lesionesRESUMEN
¼ Partial-thickness rotator cuff tears (PTRCTs) are a common pathology with a likely high asymptomatic incidence rate, particularly in the overhead athlete.¼ The anatomy, 5-layer histology, and relationship to Ellman's classification of PTRCTs have been well studied, with recent interest in radiographic predictors such as the critical shoulder angle and acromial index.¼ Depending on the definition of tear progression, rates of PTRCT progression range from 4% to 44% and appear related to symptomatology and work/activity level.¼ Nearly all PTRCTs should be managed conservatively initially, particularly in overhead athletes, with those that fail nonoperative management undergoing arthroscopic debridement ± acromioplasty if <50% thickness or arthroscopic conversion repair or in situ repair if >50% thickness.¼ Augmentation of PTRCTs is promising, with leukocyte-poor platelet-rich plasma having the most robust body of supportive data. Mesenchymal signaling cell biologics and the variety of scaffold onlay augments require more rigorous studies before regular usage.
Asunto(s)
Lesiones del Manguito de los Rotadores , Humanos , Lesiones del Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/terapia , Lesiones del Manguito de los Rotadores/fisiopatología , Artroscopía/métodosRESUMEN
Rotator cuff tears are common in middle-aged and elderly patients. Despite advances in the surgical repair of rotator cuff tears, the rates of recurrent tear remain high. This may be due to the complexity of the tendons of the rotator cuff, which contributes to an inherently hostile healing environment. During the past 20 years, there has been an increased interest in the use of biologics to complement the healing environment in the shoulder, in order to improve rotator cuff healing and reduce the rate of recurrent tears. The aim of this review is to provide a summary of the current evidence for the use of forms of biological augmentation when repairing rotator cuff tears.
Asunto(s)
Productos Biológicos , Lesiones del Manguito de los Rotadores , Cicatrización de Heridas , Humanos , Lesiones del Manguito de los Rotadores/cirugía , Productos Biológicos/uso terapéutico , Cicatrización de Heridas/efectos de los fármacos , Manguito de los Rotadores/cirugíaRESUMEN
Rotator cuff pathology is the main cause of shoulder pain and dysfunction in older adults. When a rotator cuff tear involves the subscapularis tendon, the symptoms are usually more severe and the prognosis after surgery must be guarded. Isolated subscapularis tears represent 18% of all rotator cuff tears and arthroscopic repair is a good alternative primary treatment. However, when the tendon is deemed irreparable, tendon transfers are the only option for younger or high-functioning patients. The aim of this review is to describe the indications, biomechanical principles, and outcomes which have been reported for tendon transfers, which are available for the treatment of irreparable subscapularis tears. The best tendon to be transferred remains controversial. Pectoralis major transfer was described more than 30 years ago to treat patients with failed surgery for instability of the shoulder. It has subsequently been used extensively to manage irreparable subscapularis tendon tears in many clinical settings. Although pectoralis major reproduces the position and orientation of the subscapularis in the coronal plane, its position in the axial plane - anterior to the rib cage - is clearly different and does not allow it to function as an ideal transfer. Consistent relief of pain and moderate recovery of strength and function have been reported following the use of this transfer. In an attempt to improve on these results, latissimus dorsi tendon transfer was proposed as an alternative and the technique has evolved from an open to an arthroscopic procedure. Satisfactory relief of pain and improvements in functional shoulder scores have recently been reported following its use. Both pectoralis minor and upper trapezius transfers have also been used in these patients, but the outcomes that have been reported do not support their widespread use.
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Lesiones del Manguito de los Rotadores , Transferencia Tendinosa , Humanos , Transferencia Tendinosa/métodos , Lesiones del Manguito de los Rotadores/cirugía , Resultado del Tratamiento , Artroscopía/métodos , Fenómenos BiomecánicosRESUMEN
Aims: Favourable short-term outcomes have been reported following latissimus dorsi tendon transfer for patients with an irreparable subscapularis (SSC) tendon tear. The aim of this study was to investigate the long-term outcomes of this transfer in these patients. Methods: This was a retrospective study involving 30 patients with an irreparable SSC tear and those with a SSC tear combined with a reparable supraspinatus tear, who underwent a latissimus dorsi tendon transfer. Clinical scores and active range of motion (aROM), SSC-specific physical examination and the rate of return to work were assessed. Radiological assessment included recording the acromiohumeral distance (AHD), the Hamada grade of cuff tear arthropathy and the integrity of the transferred tendon. Statistical analysis compared preoperative, short-term (two years), and final follow-up at a mean of 8.7 years (7 to 10). Results: There were significant improvements in clinical scores, in the range and strength of internal rotation and aROM compared with the preoperative values in the 26 patients (87%) who were available for long-term follow-up. These improvements were maintained between short- and long-term follow-ups. Although there was a decreased mean AHD of 7.3 mm (SD 1.5) and an increased mean Hamada grade of 1.7 (SD 0.5) at final follow-up, the rate of progression of cuff tear arthropathy remained low-grade. Comparison between the isolated SSC and combined SSC and reparable supraspinatus tear groups showed no significant differences. At final follow-up, one patient (3.8%) had undergone revision surgery to a reverse shoulder arthroplasty (RSA). No neurological complications were associated with the procedure. Conclusion: Latissimus dorsi transfer for an irreparable SSC tendon tear resulted in a significant clinical improvement, particularly in pain, range and strength of internal rotation and aROM, which were maintained over a mean of 8.7 years following surgery. Given that this was a long-term outcome study, there was a low-grade progression in the rate of cuff tear arthropathy. Thus, the long-term clinical efficacy of latissimus dorsi tendon transfer in patients with irreparable SSC was confirmed as a joint-preserving procedure for these patients, suggesting it as an effective alternative to RSA in young, active patients without degenerative changes of the glenohumeral joint.
Asunto(s)
Rango del Movimiento Articular , Lesiones del Manguito de los Rotadores , Músculos Superficiales de la Espalda , Transferencia Tendinosa , Humanos , Transferencia Tendinosa/métodos , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Lesiones del Manguito de los Rotadores/cirugía , Anciano , Resultado del Tratamiento , Músculos Superficiales de la Espalda/trasplante , Adulto , Estudios de Seguimiento , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Traumatismos de los Tendones/cirugía , Manguito de los Rotadores/cirugíaRESUMEN
CASE: A 58-year-old, very active man sustained bilateral isolated teres major (TM) tendon tears when his arms were forcefully elevated overhead while wakeboarding. Staged surgical repair was performed. A progressive rehabilitation protocol was followed, and he returned to high-level activities 7 months postoperatively. At 1-year follow-up, outcome measures for bilateral shoulders were DASH 0, SST 12, ASES 100, and EQ-5D 1.0. CONCLUSION: Despite literature supporting conservative treatment, this case demonstrates that operative treatment of acute, isolated TM tears can result in highly successful outcomes for motivated active patients.