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Current Reviews in Musculoskeletal Medicine

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01-03-2018 | Rotator Cuff Repair (M Tao and M Teusink, section editors)

Expectations Following Rotator Cuff Surgery

Authors: Alejandro Novoa-Boldo, Lawrence V. Gulotta

Published in: Current Reviews in Musculoskeletal Medicine | Issue 1/2018

Abstract

Purpose of Review

To outline the radiographic and clinical outcomes after a rotator cuff surgery in order to set the expectations with the patient before the surgery to obtain a better outcome, taking into account the factors that can affect the outcome and the technique used for the repair.

Recent Findings

The majority of surgeons use arthroscopic repair.

The double-row repair has better biomechanical strength, footprint coverage, and radiographic healing rates.

The principal factors that can affect the outcome of the surgery are the tendon quality, tear size and retraction, fatty infiltration, chronicity of the tear, and concomitant pathologies.

Summary

Arthroscopic rotator cuff repair can decrease pain and increase function allowing patients to improve their quality of life; 90% of patients are happy 6 months after the surgery and maintain stability during 5 years. Greater preoperative expectations would show better outcomes and patient satisfaction after the surgery.

•• Lin EC, Mall NA, Dhawan A, Sherman SL, McGill KC, Provencher MT, et al. Arthroscopic primary rotator cuff repairs in patients aged younger than 45 years. Arthroscopy. 2013;29(5):811–7 https://doi.org/10.1016/j.arthro.2013.01.015 This study showed excellent postoperative pain scores and patient-reported functional outcome with a 3-year follow-up. CrossRefPubMed

• Garcia GH, Liu JN, Wong A, Cordasco F, Dines DM, Dines JS, et al. Hyperlipidemia increases the risk of retear after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2017; This study showed that hyperlipidemia is a significant risk factor for retears after arthroscopic rotator cuff repair so we included it as a factor that affects the outcome after the repair

• Kitagaki JJ, Gomes G, Teruo F, Archetti N, Pozzetti J, Sugawara MJ. Functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair. World J Orthop. 2017;8(8):631–7. https://doi.org/10.5312/wjo.v8.i8.631. This study showed good results in a 43-month follow-up after rotator cuff surgery and reported good outcomes no matter if it is a traumatic or a non-traumatic injury.

•• Henn RF III, Kang L, Tashjian RZ, Green A. Patients’ preoperative expectations predict the outcome of rotator cuff repair. J Bone Joint Surg Am. 2007;89(9):1913–9. https://doi.org/10.2106/JBJS.F.00358. This study supports our conclusion that if the patients have greater expectations before the rotator cuff surgery it is associated with better function and better pain relief after the rotator cuff repair surgery.CrossRefPubMed

• Khair MM, Lehman J, Tsouris N, Gulotta LV. A systematic review of preoperative fatty infiltration and rotator cuff outcomes. HSSJ. 2016;12(2):170–6. https://doi.org/10.1007/s11420-015-9465-5. We used this study to support that the quality of the tendon is an important factor that can affect the outcomes after a rotator cuff repair surgery.

• Acevedo DC, Paxton ES, Williams GR, and Abboud JA. A survey of expert opinion regarding rotator cuff repair. J Bone Joint Surg Am. 2014;96:e123(1–7) https://doi.org/10.2106/JBJS.M.00399. This study helped us support that most of the surgeons nowadays use arthroscopy for rotator cuff repair surgery.

•• Gulotta LV, Nho SJ, Dodson CC, Adler RS, Altchek DW, MacGillivray JD. Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part I. Functional outcomes and radiographic healing rates. J Shoulder Elbow Surg. 2011;20(6):934–40. https://doi.org/10.1016/j.jse.2011.03.028 We used this study to support that 90% of the patients are happy after 6 months of arthroscopic rotator cuff repair and the repairs remain stable at an intermediate follow-up of 5 years.CrossRefPubMed

• Aleem AW, Brophy RH. Outcomes of rotator cuff surgery: what does the evidence tell us? Clin Sports Med. 2012, 31:665–74. https://doi.org/10.1016/j.csm.2012.07.004. This article reviewed the evidence regarding outcomes of surgical techniques in rotator cuff surgery including open surgery, mini open, and arthroscopic surgery showing that all of them have good to excellent outcomes in terms of functional improvement and pain relief

•• Frederik O, Heerspink L, Dorrestijn O, van Raay J, Diercks RL. Specific patient-related prognostic factors for rotator cuff repair: a systematic review. J Shoulder Elbow Surg. 2014;23(7):1073–80. https://doi.org/10.1016/j.jse.2014.01.001. This study shows the factors that could influence the outcomes after rotator cuff surgery, highlighting older age groups with WCB status, multiple tendon involvement, greater tear size, or additional AC or biceps disease.

10.

Lähteenmäki HE, Hiltunen A, Virolainen P, Nelimarkka O. Repair of full-thickness rotator cuff tears is recommended regardless of tear size and age: a retrospective study of 218 patients. J Shoulder Elb Surg. 2007;16(5):586–90 https://doi.org/10.1016/j.jse.2007.04.001.CrossRef

11.

Choi S, Kim MK, Kim GM, Young-Ho HIK, Kang H. Factors associated with clinical and structural outcomes after arthroscopic rotator cuff repair with a suture bridge technique in medium, large, and massive tears. J Shoulder Elb Surg. 2014;23(11):1675–81 https://doi.org/10.1016/j.jse.2014.02.021.CrossRef

12.

Aleem AW, Syed UA, Wascher J, Zoga AC, Close K, Abboud JA, et al. Functional outcomes after bilateral arthroscopic rotator cuff repair. J Shoulder Elb Surg. 2016;25(10):1668–73. https://doi.org/10.1016/j.jse.2016.01.027.

13.

Brian J. Cole, MD, L. Pearce McCarty III, Richard W. Kang, Winslow Alford, Paul B. Lewis, and Jennifer K. Hayden Arthroscopic rotator cuff repair: prospective functional outcome and repair integrity at minimum 2-year follow-up. J Shoulder Elb Surg 2007;16:579–585 https://doi.org/10.1016/j.jse.2006.12.011, 5

14.

•• Gulotta LV, Nho SJ, Dodson CC, Adler RS, Altchek DW, JD MG. Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part II—prognostic factors for clinical and radiographic outcomes. J Shoulder Elbow Surg. 2011;20(6):941–6. https://doi.org/10.1016/j.jse.2011.03.028. This study showed that the predictors of a radiographic defect are similar to the predictors of clinical outcomes and that there is no association with radiographic healing and functional results after a rotator cuff repair surgery.CrossRefPubMed

15.

• Millett PJ, Warth RJ, Dornan GJ, Lee JT, Spiegl UJ. Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials. J Shoulder Elbow Surg. 2014;23(4):586–97. https://doi.org/10.1016/j.jse.2013.10.006. This study shows that the double row rotator cuff repair is better because it have a lower re tear rate than the single-row rotator cuff repair.CrossRefPubMed

16.

Chuang MJ, Jancosko J, Nottage WM. Clinical outcomes of single-row arthroscopic revision rotator cuff repair. Orthepedics. 2014;37(8):692–8. https://doi.org/10.3928/01477447-20140728-54.

17.

Russell RD, Knight JR, Mulligan E, Khazzam MS. Structural integrity after rotator cuff repair does not correlate with patient function and pain. J Bone Joint Surg Am. 2014;96(4):265–71 https://doi.org/10.2106/JBJS.M.00265.CrossRefPubMed

18.

Ji X, Bi C, Wang F, Wang Q. Arthroscopic versus mini-open rotator cuff repair: an up-to-date meta-analysis of randomized controlled trials. Arthroscopy. 2015;31(1):118–24. https://doi.org/10.1016/j.arthro.2014.08.017.CrossRefPubMed

19.

Baker CL, Liu SH. Comparison of open and arthroscopically assisted rotator cuff repairs. Am J Sports Med. 1995;23(1):99–104. https://doi.org/10.1177/036354659502300117.CrossRefPubMed

20.

Kim SH, Ha KI, Park JH, Kang JS, Oh SK, Oh I. Arthroscopic versus mini-open salvage repair of the rotator cuff tear: outcome analysis at 2 to 6 years’ follow-up. Arthroscopy. 2003;19(7):746–54. https://doi.org/10.1016/S0749-8063(03)00395-5.CrossRefPubMed

21.

Burkhart SS, Lo IK. Arthroscopic rotator cuff repair. J Am Acad Orthop Surg. 2006;14(6):333–46. https://doi.org/10.5435/00124635-200606000-00003.CrossRefPubMed

22.

Duquin TR, Buyea, and Bisson LJ. Which method of rotator cuff repair leads to the highest rate of structural healing? Am J Sports Med 2010;38:635–641 https://doi.org/10.1177/0363546509359679, 4

23.

Kim SJ, Choi YR, Jung M, Lee W, Chun YM. Arthroscopic repair of anterosuperior massive rotator cuff tears. Am J Sports Med. 2017;45(8):1762–8. https://doi.org/10.1177/0363546517694028 . https://doi.org/10.1177/0363546517694028.CrossRefPubMed

24.

Potter HG, Jawetz ST, Foo LF. Imaging of the rotator cuff following repair: human and animal models. J Shoulder Elb Surg. 2007;16(5):134S–9S https://doi.org/10.1016/j.jse.2007.02.114.CrossRef

25.

Gartsman GM, Drake G, Edwards TB, Elkousy HA, Hammerman SM, O’Connor DP, et al. Ultrasound evaluation of arthroscopic full-thickness supraspinatus rotator cuff repair: single-row versus double-row suture bridge (transosseous equivalent) fixation. Results of a prospective, randomized study. J Shoulder Elb Surg. 2013;22(11):1480–7 https://doi.org/10.1016/j.jse.2013.06.020.CrossRef

26.

Nho SJ, Brown BS, Lyman S, Adler RS, Altchek DW, MacGillivray JD. Prospective analysis of arthroscopic rotator cuff repair: prognostic factors affecting clinical and ultrasound outcome. J Shoulder Elb Surg. 2009;18(1):13–20 https://doi.org/10.1016/j.jse.2008.05.045.CrossRef

27.

•• Harryman DT, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA. Repairs of the rotator cuff correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991;73(73):982–9. This study talks about how patients with a healed rotator after a rotator cuff repair had better clinical outcomes when compared to patients with failures. https://doi.org/10.2106/00004623-199173070-00004.CrossRefPubMed

28.

Flurin PH, Hardy P, Abadie P, Boileau P, Collin P, Deranlot J, et al. Arthroscopic repair of the rotator cuff: prospective study of tendon healing after 70 years of age in 145 patients. Orthopaedics Traumatology Surg Research. 2013;99S(8):S379–84 https://doi.org/10.1016/j.otsr.2013.10.007.CrossRef

29.

Lee E, Bishop JY, Braman JP, Langford J, Gelber J, Flatow EL. Outcomes after arthroscopic rotator cuff repairs. J Shoulder Elb Surg. 2007;16(1):1–5 https://doi.org/10.1016/j.jse.2006.04.007.CrossRef

30.

Dines JS, Grande DA, Dines DM. Tissue engineering and rotator cuff tendon healing. J Shoulder Elb Surg. 2007;16(5):204S–7S https://doi.org/10.1016/j.jse.2007.03.004.CrossRef

31.

Cho NS, Lee BJ, Rhee YG. Arthroscopic rotator cuff repair using a suture bridge technique is the repair integrity actually maintained? Am J Sports Med. 2011;39(10):2108–16 https://doi.org/10.1177/0363546510397171.CrossRefPubMed

32.

Tashjian RZ, Hollins AM, Kim HM, Teefey SA, Middleton WD, Steger-May K, et al. Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med. 2010;38(12):2435–42 https://doi.org/10.1177/0363546510382835.CrossRefPubMed

33.

JH O, Yoon JP, Kim JY, Kim SH. Effect of expectations and concerns in rotator cuff disorders and correlations with preoperative patient characteristics. J Shoulder Elb Surg. 2012;21(6):715–21 https://doi.org/10.1016/j.jse.2011.10.017.CrossRef

34.

Chung SW, Park JS, Kim SH, Shin SH, Oh JH. Quality of life after arthroscopic rotator cuff repair evaluation using SF-36 and an analysis of affecting clinical factors. Am J Sports Med. 2012;40(3):631–9 https://doi.org/10.1177/0363546511430309.CrossRefPubMed

Title: Expectations Following Rotator Cuff Surgery
Authors: Alejandro Novoa-Boldo
Lawrence V. Gulotta
Publication date: 01-03-2018
Publisher: Springer US
Published in: Current Reviews in Musculoskeletal Medicine / Issue 1/2018
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-018-9470-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Expectations Following Rotator Cuff Surgery

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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