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Zhong K, Ting RS, Rosenthal R, Lam P, Calvert Murrell GA. Determinants of Patient-Rated Benefit 6 Months Post Arthroscopic Rotator Cuff Repair: An Analysis of 2010 Patients. J Am Acad Orthop Surg 2025; 33:e161-e171. [PMID: 39383115 DOI: 10.5435/jaaos-d-24-00646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Indexed: 10/11/2024] Open
Abstract
INTRODUCTION From the surgeon's perspective, a successful rotator cuff is one that remains intact. However, it is undetermined which factors contribute to an improved shoulder from the patient's perspective. The aim of this study was to determine the variables that predicted greater patient-rated benefit from presurgery to 6 months postarthroscopic rotator cuff repair. METHODS Multiple linear regression analysis was conducted on prospectively collected data of 2010 consecutive patients who underwent arthroscopic rotator cuff repair by a single surgeon to determine the predictors of greater patient-rated benefit. Patient-rated shoulder ranking was graded on a five-point Likert scale in response to "How is your shoulder overall?" preoperatively and at 6 months postoperatively. The patient-rated benefit was the difference in rankings between these time points. RESULTS Six months following rotator cuff repair, a self-reported benefit was observed in 84% of patients. Patients who rated their shoulder as poor preoperatively reported the greatest benefit (t = 22, P < 0.001). Other preoperative determinants of greater patient-rated benefit were lower patient-rated shoulder stiffness (t = 5, P < 0.001), an injury that was not related to work (t = 4, P < 0.001), stronger internal rotation strength (t = 4, P < 0.002), a more strenuous line of work preinjury (t = 3, P = 0.007), female sex (t = 2, P = 0.019), having a larger tear area (t = 2, P = 0.020), and weaker abduction strength (t = 2, P = 0.046). CONCLUSIONS Patients who were most likely to perceive a benefit from rotator cuff repair at 6 months postoperation were those who preoperatively rated their shoulder poorly, had a less stiff shoulder, an injury that was not related to work, stronger internal rotation, more strenuous line of work preinjury, were female, had larger tear area, and weaker abduction strength.
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Affiliation(s)
- Kaitlin Zhong
- From the Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, Australia
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Kim JH, Jung SH, Park DH, Kwon YU, Lee HY. Factors associated with patient satisfaction after arthroscopic rotator cuff repair: do they differ by age? Clin Shoulder Elb 2024; 27:345-352. [PMID: 39138940 PMCID: PMC11393441 DOI: 10.5397/cise.2024.00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/26/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Several studies have investigated factors affecting patient satisfaction after arthroscopic rotator cuff repair (ARCR); however, it is unknown if these factors vary according to age. Therefore, this study aimed to evaluate the factors associated with satisfaction of ARCR in individuals 70 years and older versus younger patients. METHODS Among 319 consecutive patients who underwent ARCR, 173 were included. Patients were divided into an old age group (≥70 years) and a young age group (<70 years), and the two age groups were further divided into satisfied and unsatisfied subgroups. Patient satisfaction was evaluated at the final follow-up visit using a binary question (yes or no). Clinical outcomes were assessed preoperatively and at the final follow-up. RESULTS Satisfaction rates in the older and younger age groups were 75.41% and 79.47%, respectively. Mean changes in Constant and American Shoulder and Elbow Surgeons scores were significantly different between the satisfied and unsatisfied subgroups (P=0.031 and P=0.012, respectively) in the young patients. In the old patients, there was a significant difference in the mean change in depression subscale of the Hospital Anxiety and Depression Scale (P=0.031) and anxiety subscale of the Hospital Anxiety and Depression Scale (P=0.044) scores between the satisfied and unsatisfied subgroups. CONCLUSIONS Factors affecting patient satisfaction after ARCR differed according to age. Psychological improvement was more important to elderly patients, whereas restoration of function was more important to younger patients. Pain relief was important for both age groups. Level of evidence: III.
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Affiliation(s)
- Jung-Han Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Soo-Hwan Jung
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Dae-Hyun Park
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Yong-Uk Kwon
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hyo-Young Lee
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
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Dyer L, Swanenburg J, Schwameder H, Bouaicha S. Defining the glenohumeral range of motion required for overhead shoulder mobility: an observational study. Arch Physiother 2024; 14:47-55. [PMID: 39280075 PMCID: PMC11393552 DOI: 10.33393/aop.2024.3015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/18/2024] [Indexed: 09/18/2024] Open
Abstract
Background Recovery of overhead mobility after shoulder surgery is time-consuming and important for patient satisfaction. Overhead stretching and mobilization of the scapulothoracic and glenohumeral (GH) joints are common treatment interventions. The isolated GH range of motion (ROM) of flexion, abduction, and external rotation required to move above 120° of global shoulder flexion in the clinical setting remains unclear. This study clarified the GH ROM needed for overhead mobility. Methods The timely development of shoulder ROM in patients after shoulder surgery was analyzed. Passive global shoulder flexion, GH flexion, abduction, and external rotation ROM were measured using goniometry and visually at 2-week intervals starting 6-week postsurgery until the end of treatment. Receiver operating characteristic curves were used to identify the GH ROM cutoff values allowing overhead mobility. Results A total of 21 patients (mean age 49 years; 76% men) after rotator cuff repair (71%), Latarjet shoulder stabilization (19%), and arthroscopic biceps tenotomy (10%) were included. The ROM cutoff value that accurately allowed overhead mobility was 83° for GH flexion and abduction with the area under the curve (AUC) ranging from 0.90 to 0.93 (p < 0.001). The cutoff value for GH external rotation was 53% of the amount of movement on the opposite side (AUC 0.87, p < 0.001). Conclusions Global shoulder flexion above 120° needs almost full GH flexion and abduction to be executable. External rotation ROM seems less important as long as it reaches over 53% of the opposite side.
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Affiliation(s)
- Linda Dyer
- Department of Physiotherapy, Balgrist University Hospital, University of Zurich, Zurich - Switzerland
| | - Jaap Swanenburg
- Department of Chiropractic Medicine, Balgrist University Hospital, Zurich - Switzerland
| | - Hermann Schwameder
- Department of Sport and Exercise Science, Paris Lodron University of Salzburg, Salzburg - Austria
| | - Samy Bouaicha
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich - Switzerland
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Gregory JM, Ybarra C, Liao Z, Kumaravel M, Patel S, Warth RJ. Clinical outcomes of rotator cuff repair with subacromial bursa reimplantation: a retrospective cohort study. JSES Int 2023; 7:763-767. [PMID: 37719828 PMCID: PMC10499868 DOI: 10.1016/j.jseint.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background The subacromial bursa has been found to be a rich, local, source of mesenchymal stem cells but is removed for visualization during rotator cuff repair. Reimplantation of this tissue may improve rotator cuff healing. The purpose of this study is to evaluate clinical outcomes of rotator cuff repair with and without subacromial bursa reimplantation. Methods Patients aged 37-77 with a full-thickness or near full-thickness supraspinatus tears underwent arthroscopic transosseous-equivalent double row rotator cuff repair. In patients prior to July 2019, the subacromial bursa was resected for visualization, and discarded. In patients after July 2019, the subacromial bursa was collected using a filtration device connected to an arthroscopic shaver and reapplied to the bursal surface of the tendon at the completion of the rotator cuff repair. Rotator cuff integrity was evaluated via magnetic resonance imaging on bursa patients at 6 months postoperatively. Minimum 18-month clinical outcomes (Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, patient satisfaction) were compared between bursa and nonbursa cohorts. Results A total of 136 patients were included in the study (control n = 110, bursa n = 26). Preoperative demographics and tear characteristics were not different between groups. Average follow-up was significantly longer in the control group (control: 3.2 ± 0.7 years; bursa: 1.8 ± 0.3 years; P < .001). The control group showed a significantly higher Single Assessment Numeric Evaluation score (control: 87.9 ± 15.8, bursa: 83.6 ± 15.1, P = .037) that did not meet minimum clinically important difference. The American Shoulder and Elbow Surgeons and patient satisfaction scores were similar between the groups. Symptomatic retears were not significantly different between groups (control: 9.1%, bursa 7.7%, P = .86). Seven patients in the control group underwent reoperation (6.4%), compared to 0 patients in the bursa group (0%, P = .2). Six-month postoperative magnetic resonance images obtained on bursa patients demonstrated 85% rotator cuff continuity (n = 17/20) as defined via Sugaya classification. Conclusion Augmentation of rotator cuff repair with bursal tissue does not appear to have negative effects, and given the accessibility and ease of harvest of this tissue, further research should be performed to evaluate its potential for improved tendon healing or clinical outcomes.
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Affiliation(s)
- James M. Gregory
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Cristian Ybarra
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Zean Liao
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Manickam Kumaravel
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Saagar Patel
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
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Fallahpour N, Jamalipour Soufi G, Jamalipour Soufi K, Hekmatnia A. Evaluation of the acromion variants in MRI and their association with rotator cuff injuries in non-traumatic patients. J Orthop 2023; 42:17-23. [PMID: 37449026 PMCID: PMC10336402 DOI: 10.1016/j.jor.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Understanding demographic and MRI parameters with determinant role in rotator cuff tearing (RCT) is required to predict outcomes and select more appropriate treatment in patients with non-traumatic shoulder pain. This study aimed to survey the association of rotator cuff tears with these factors. Methods We performed this cross-sectional study on patients referred to Kashani Hospital with non-traumatic shoulder pain suspected of rotator cuff injuries from April 2020 to February 2021. We obtained their demographic data and MRI from electronic hospital records. After that, two radiologists reviewed MRI and recorded data. We employed the SPSS 23 software to organize the obtained results and statistical evaluations. Results 371 subjects, with the age of 48.61 ± 14.89 years, were included in our study, and 50% of them were male. The flat and down-sloping acromion and partial tearing of the supra and infraspinatus tendons were more frequent than the others. Gender could not consider as a determinant factor for the severity of tendon injuries, acromion types and variants. The relation of age to acromion morphology and the tendinopathy severity was significant. Remarkably, down-sloping acromion was higher at all the acromion shapes; however, it makes no difference in the level of supra and infraspinatus involvement. Moreover, we found that partial tearing was higher in all acromion types, except concave. This distribution was significant only for supraspinatus tears. Conclusion The clinical decision is the most important step in patients with RCT and MRI prognostic factors, which are helpful to improve the management of the cases. RCT in older patients and down-slope acromion was more severe than the others. According to the previous studies, acromion morphology (as an important determinant factor) in RCT could be influenced by age, as well.
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Affiliation(s)
| | | | | | - Ali Hekmatnia
- Radiology Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Ardebol J, Hwang S, Pak T, Menendez ME, Gobezie R, Denard PJ. Female Sex and Higher Infraspinatus Fatty Infiltration Are Linked to Dissatisfaction at a Minimum Follow-Up of 4 Years after Arthroscopic Repair of Massive Rotator Cuff Tears. Arthrosc Sports Med Rehabil 2023; 5:e731-e737. [PMID: 37388869 PMCID: PMC10300589 DOI: 10.1016/j.asmr.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/30/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To evaluate patient satisfaction at a minimum of 4 years after arthroscopic rotator cuff repair (ARCR) of massive rotator cuff tears (MRCT), to identify preoperative and intraoperative characteristics associated with satisfaction, and to compare clinical outcomes between satisfied and dissatisfied patients. Methods A retrospective review on prospectively collected data was conducted on ARCRs of MRCTs performed at 2 institutions between January 2015 and December 2018. Patients with a minimum 4-year follow-up, preoperative and postoperative data, and primary ARCR of MRCTs were included for analysis. Patient satisfaction was analyzed according to patient demographics, patient-reported outcome measures (American Shoulder and Elbow Surgeons score [ASES], visual analog scale [VAS] for pain, Veteran Rands 12-item health survey [VR-12], and Subjective Shoulder Value [SSV]), range of motion (forward flexion [FF], external rotation [ER], and internal rotation [IR]), tear characteristics (fatty infiltration, tendon involvement, and tear size), and clinical significant measures (minimal clinical important difference [MCID], substantial clinical benefit [SCB], and patient-acceptable symptomatic state [PASS]) for ASES and SSV. Rotator cuff healing was also assessed with ultrasound in 38 patients at final follow-up. Results A total of 100 patients met the study's criteria. Overall, 89% of patients were satisfied with ARCR of a MRCT. Female sex (P = .007) and increased preoperative infraspinatus fatty infiltration (P = .005) were negatively associated with satisfaction. Those in the dissatisfied cohort had significantly lower postoperative ASES (80.7 vs 55.7; P = .002), VR-12 (49 vs 37.1; P = .002), and SSV scores (88.1 vs 56; P = .003), higher VAS pain (1.1 vs 4.1; P = .002) and lower postoperative range of motion in FF (147° vs 117°; P = .04), ER (46° vs 26°; P = .003), and IR (L2 vs L4; P = .04). Rotator cuff healing did not have an influence on patient satisfaction (P = .306). Satisfied patients were more likely to return to work than dissatisfied patients (97% vs 55%; P < .001). Conclusions Nearly 90% of patients who undergo ARCR for MRCTs are satisfied at a minimum 4-year follow-up. Negative preoperative factors include female sex and increased preoperative infraspinatus fatty infiltration, but no association was observed with rotator cuff healing. Furthermore, dissatisfied patients were less likely to report a clinically important functional improvement. Level of Evidence Level IV, prognostic case series.
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Affiliation(s)
| | - Simon Hwang
- Oregon Shoulder Institute, Medford, Oregon, U.S.A
| | - Theresa Pak
- Oregon Shoulder Institute, Medford, Oregon, U.S.A
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Barret H, Langlais T, Laumonerie P, Faruch M, Mansat P, Bonnevialle N. Which preoperative factors influence the patient's short-term subjective assessment after rotator cuff repair? Orthop Traumatol Surg Res 2023; 109:103490. [PMID: 36442808 DOI: 10.1016/j.otsr.2022.103490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To highlight the preoperative risk factors that influence postoperative patient satisfaction following Rotator Cuff Repair (RCR) and to determine whether this satisfaction was correlated with tendon healing. HYPOTHESIS Preoperative factors influence patient satisfaction, assessed by SSV (Subjective Shoulder Value) postoperatively, with a correlation with tendon healing. METHODS With a mean age of 60.6 years (40-72), 102 patients with arthroscopic RCR were included retrospectively. The preoperative SSV score was less than or equal to 50%. There was clinical and radiological follow-up with an ultrasound evaluation of tendon healing 6 months postoperatively. We divided the patients into 2 groups using a postoperative SSV of 85% as the cut-off; 55 patients in the first group (SSV>85%); and 47 patients in the second group (SSV<85%). RESULTS In multivariate analysis, Preoperative risk factors for poor postoperative SSV after RCR were: tobacco use [-8.41 (-13.64; -3.17) p=0.002], fatty infiltration [-3.65 (-6.24 -1.06) p=0.006] and workers compensation [-19.15 (-24.04; -14.27) p<0.001]. When patients were not in workers compensation, the lower their SSV score before surgery, the higher their postoperative SSV score. For patients in workers compensation, the higher the SSV preoperatively, the less elevated was SSV postoperatively. The Sugaya ultrasound classification did not influence the SSV score (p=0.15) CONCLUSIONS: Smoking, fatty infiltration and patients in workers compensation are factors of poorer subjective results evaluated by the SSV score. Tendon healing did not influence the SSV score and patient satisfaction. LEVEL OF EVIDENCE IV, cohort study.
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Go TW, Park JE, Oh S, Cho M, Jo CH. Effect of Quality of Repair on Clinical and Structural Outcomes of Rotator Cuff Repair. Am J Sports Med 2022; 50:3915-3923. [PMID: 36341899 DOI: 10.1177/03635465221130759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anatomic repair of a torn rotator cuff tendon on the greater tuberosity (GT) is an important surgical goal in rotator cuff repair. However, few studies have investigated whether the efforts made to maximize coverage of the GT are associated with the clinical and structural outcomes after rotator cuff repair surgery. PURPOSE To investigate whether the quality of repair at the time of surgery is associated with clinical and structural outcomes after surgery and to identify factors influencing the quality of repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were retrospectively collected from 141 patients who underwent arthroscopic rotator cuff repair between 2008 and 2016. All repairs were classified according to the amount of postoperative GT coverage: A, complete coverage of the GT (n = 96); B, incomplete coverage, comprising more than half of GT (n = 27); C, incomplete coverage, comprising less than half of the GT (n = 16); and D, exposure of the glenohumeral joint (n = 2). All patients underwent magnetic resonance imaging 1 year after surgery. Clinical outcomes and structural integrity based on Sugaya classification were assessed 2 years and 1 year after surgery, respectively. Preoperative factors associated with the postoperative GT coverage (measured at the close of surgery) were identified using a multivariable proportional odds cumulative logit model. RESULTS The forward flexion strength in group A (10.3 ± 4.6 lb) was significantly greater than that in group C (6.5 ± 3.7 lb) (P = .003) 2 years after surgery. The postoperative Constant score in group A (76.6 ± 11.5) was greater than that in group C (66.7 ± 15.6) (P = .018). The number of cases that showed retearing of the repaired tendon was as follows: group A (5/96; 5.2%), group B (7/27; 25.9%), and group C (10/16; 62.5%). There was no significant difference in the changes of pain visual analog scale scores among groups 2 years after surgery (all P > .05). Also, there was no significant difference in the changes of range of motion in all directions among groups 2 years after surgery (all P > .05). Patients with preoperative GT coverage B included in the postoperative GT coverage groups through surgery were as follows: group A (23/45; 51.1%), group B (17/45; 37.8%), and group C (5/45; 11.1%). Preoperative GT coverage was the only independent factor that was associated with GT coverage in multivariable analysis. CONCLUSION Quality of repair, measured as the extent of postoperative GT coverage at the time of surgery, was associated with clinical and structural outcomes after rotator cuff repair surgery.
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Affiliation(s)
- Tae Won Go
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Eun Park
- Daegu Hansol Hospital, Daegu, Republic of Korea
| | - Sohee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Minjoon Cho
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chris Hyunchul Jo
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Sharabianlou Korth MJ, Lu LY, Finlay AK, Kamal RN, Goodman SB, Maloney WJ, Amanatullah DF, Huddleston JI. A Physician Assistant Is Associated With Higher Patient Satisfaction With Outpatient Orthopedic Surgery. Orthopedics 2022; 45:e252-e256. [PMID: 35576483 DOI: 10.3928/01477447-20220511-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Patient satisfaction is increasingly used to assess the quality of care and determine physician reimbursement. Patient characteristics influence patient satisfaction, but the effect of physician practice parameters on satisfaction has not been studied in detail. Outpatient satisfaction scores from 11,059 patients who rated 24 orthopedic surgeons from a single institution were studied. Practice-related parameters were collected in a provider-reported survey. Univariate logistic regressions were used to test the associations between each provider characteristic and the likelihood of receiving a 5-star rating on a selection of 16 Press Ganey patient satisfaction questions. The presence of a physician assistant in the clinic positively affected the 5-star rating for all but 1 of the patient satisfaction questions examined, including overall satisfaction (odds ratio [OR], 1.38; 95% CI, 1.03-1.85; P=.031); the likelihood of being recommended to others (OR, 1.57; 95% CI, 1.16-2.14; P=.004); and friendliness/courtesy (OR, 1.58; 95% CI, 1.17-2.13; P=.003). However, having a fellow or nurse practitioner in the clinic, treating children, productivity (measured as total relative value units), taking trauma call, and provider distance from home were not associated with higher scores for any of the Press Ganey patient satisfaction questions. Having a physician assistant in the clinic is an actionable, practice-specific characteristic that positively affects patient satisfaction on many levels and may ultimately improve the perception of care. [Orthopedics. 2022;45(5):e252-e256.].
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Lacheta L, Horan MP, Nolte PC, Goldenberg BT, Dekker TJ, Millett PJ. SLAP Repair Versus Subpectoral Biceps Tenodesis for Isolated SLAP Type 2 Lesions in Overhead Athletes Younger Than 35 Years: Comparison of Minimum 2-Year Outcomes. Orthop J Sports Med 2022; 10:23259671221105239. [PMID: 35757237 PMCID: PMC9218463 DOI: 10.1177/23259671221105239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: It remains unclear if young overhead athletes with isolated superior labrum anterior-posterior (SLAP) type 2 lesions benefit more from SLAP repair or subpectoral biceps tenodesis. Purpose: To evaluate clinical outcomes and return to sport in overhead athletes with symptomatic SLAP type 2 lesions who underwent either biceps tenodesis or SLAP repair. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed in patients who underwent subpectoral biceps tenodesis (n = 14) or SLAP repair (n = 24) for the treatment of isolated type 2 SLAP lesions. All patients were aged <35 years at time of surgery, participated in overhead sports, and were at least 2 years out from surgery. Clinical outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) score; Single Assessment Numerical Evaluation (SANE) score; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score; and the 12-Item Short Form (SF-12) physical component score. Return to sport and patient satisfaction were documented. Clinical failures requiring revision surgery and complications were reported. Results: Preoperative baseline scores in both the tenodesis and SLAP repair groups were similar. There were no significant differences between the groups on any postoperative outcome measure: For biceps tenodesis versus SLAP repair, the ASES score was 92.7 ± 10.4 versus 89.1 ± 16.7, the SANE score was 86.2 ± 13.7 versus 83.0 ± 24.1, the QuickDASH score was 10.0 ± 12.7 versus 9.0 ± 14.3, and SF-12 was 51.2 ± 7.5 versus 52.8 ± 7.7. No group difference in return-to-sports rate (85% vs 79%; P = .640) was noted. More patients in the tenodesis group (80%) reported modifying their sporting/recreational activity postoperatively because of weakness compared with patients in the SLAP repair group (15%; P = .022). One patient in each group progressed to surgery for persistent postoperative stiffness, and 1 patient in the tenodesis group had a postoperative complication related to the index surgery. Conclusion: Both subpectoral biceps tenodesis and SLAP repair provided excellent clinical results for the treatment of isolated SLAP type 2 lesions, with a high rate of return to overhead sports and a low failure rate, in a young and high-demanding patient cohort. More patients reported modifying their sporting/recreational activity because of weakness after subpectoral tenodesis.
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Affiliation(s)
- Lucca Lacheta
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | | | - Philip C Nolte
- BG Klinik Ludwigshafen, Department of Trauma and Orthopedic Surgery, Ludwigshafen, Germany
| | | | - Travis J Dekker
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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Fancher AJ, Mok AC, Vopat ML, Templeton K, Kimbrel BK, Tarakemeh A, Mulcahey MK, Mullen S, Schroeppel JP, Vopat BG. Comparing Sex-Specific Outcomes After Rotator Cuff Repair: A Meta-analysis. Orthop J Sports Med 2022; 10:23259671221086259. [PMID: 35620113 PMCID: PMC9128058 DOI: 10.1177/23259671221086259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background Rotator cuff repair (RCR) is a well-studied procedure. However, the impact of patient sex on outcomes after RCR has not been well studied. Purpose To conduct a systematic review and meta-analysis of sex-based differences in outcomes after RCR and to record what proportion of studies examined this as a primary or secondary purpose. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was performed using multiple databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were written in English, performed on humans, consisted of patients who underwent RCR, evaluated at least 1 of the selected outcomes based on patient sex, and had statistical analysis available for their sex-based claim. Excluded were case reports, review studies, systematic reviews, cadaveric studies, and studies that did not report at least 1 sex-specific outcome or included certain other injuries associated with a rotator cuff injury. Results Of 9998 studies screened and 1283 full-text studies reviewed, 11 (0.11%) studies with 2860 patients (1549 male and 1329 female) were included for quantitative analysis. None of these 11 studies examined the impact of patient sex on outcomes after RCR as a primary outcome. Postoperative Constant-Murley scores were analyzed for 7 studies. Male patients had a postoperative Constant-Murley score of 76.77 ± 15.94, while female patients had a postoperative Constant-Murley score of 69.88 ± 17.02. The random-effects model showed that male patients had significantly higher scores than female patients, with a mean difference of 7.33 (95% CI, 5.21-9.46; P < .0001). Analysis of retear rates in 5 studies indicated that there was no difference in the retear rate between sexes (odds ratio, 0.91 [95% CI, 0.49-1.67]). Conclusion Female patients had lower postoperative Constant-Murley scores compared with male patients, but there was no difference in the retear rate. However, these results were based on an analysis of only 11 studies. The paucity of studies examining the impact of sex suggests that more research is needed on the impact of patient sex on outcomes after RCR.
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Affiliation(s)
- Andrew J. Fancher
- University of Kansas School of Medicine–Wichita, Wichita, Kansas, USA
| | - Anthony C. Mok
- University of Kansas School of Medicine–Kansas City, Kansas City, Kansas, USA
| | - Matthew L. Vopat
- University of Kansas School of Medicine–Wichita, Wichita, Kansas, USA
| | - Kim Templeton
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brandon K. Kimbrel
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Armin Tarakemeh
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mary K. Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Scott Mullen
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - John P. Schroeppel
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Bryan G. Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Ventimiglia DJ, Chrencik M, Schneider MB, Zhang T, Munn M, Kolakowski L, Gilotra MN, Hasan SA, Henn RF. Preoperative Factors Associated with Patient Satisfaction Two Years After Elective Shoulder Surgery. JSES Int 2022; 6:649-654. [PMID: 35813145 PMCID: PMC9264137 DOI: 10.1016/j.jseint.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Purpose Patient satisfaction has become an increasingly important component of quality measures for both hospital reimbursement and quality assessment. Additionally, patient satisfaction influences patient behavior and patient follow-up. The purpose of this study was to identify preoperative factors associated with patient satisfaction 2 years after shoulder surgery. Methods Electronic surveys were used to collect patient information including demographic, surgical, and social history, as well as outcome data. Satisfaction was measured 2 years after surgery using the Surgical Satisfaction Questionnaire. Results Multivariable linear regression identified preoperative Patient-Reported Outcomes Measurement Information System Pain Interference, annual income, and American Society of Anesthesiologists score as independent predictors of lower patient satisfaction, while total shoulder arthroplasty was an independent predictor of greater patient satisfaction. The model accounted for 15% of the variance in satisfaction scores (R2 = 0.15). Conclusion Patient satisfaction 2 years after shoulder surgery is associated with preoperative patient-reported outcome scores. Lower patient satisfaction is independently predicted by greater preoperative PROMIS PI, income less than $70,000, and ASA score >1, while higher patient satisfaction is predicted by total shoulder arthroplasty.
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Cigolotti A, Biz C, Lerjefors E, de Iudicibus G, Belluzzi E, Ruggieri P. Medium- to long-term clinical and functional outcomes of isolated and combined subscapularis tears repaired arthroscopically. Arch Med Sci 2021; 17:1351-1364. [PMID: 34522265 PMCID: PMC8425253 DOI: 10.5114/aoms.2020.97714] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/24/2019] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION The purpose of this study was twofold. First, the efficacy of arthroscopic repair in patients with full thickness, isolated subscapularis tendon tears (I-STTs) or combined subscapularis tendon tears (C-STTs) involving the rotator cuff tendons was evaluated. Second, the outcomes between these two groups were compared. The influence of age and gender on the cohort clinical outcomes was also analysed. Our hypothesis was that satisfactory functional results could be obtained arthroscopically in both groups without any influence of age or gender. MATERIAL AND METHODS Seventy-nine patients were enrolled: 15 with I-STTs and 64 with C-STTs. The clinical outcomes were assessed using Constant and Disabilities of the Arm, Shoulder and Hand (DASH) scores, Numeric Rating Scale (NRS) for pain and Visual Analogue Scale (VAS) for satisfaction. The subscapularis strength was assessed using a comparative dynamometric bear-hug test. Group outcomes were compared, including statistical analysis. RESULTS For each group, there were no differences regarding the subscapularis strength of the operated and non-operated shoulders. A comparison of the post- with the pre-operative outcomes showed an increase in the Constant score and a decrease in the NRS. Comparing the two groups, we found no difference in strength of the operated and non-operated shoulders, but a significant difference in relation to pre-operative Constant score and pre-operative NRS. Age was negatively correlated with both pre-operative and post-operative Constant scores. No association was found between gender and the outcomes, although the DASH score was higher in women. CONCLUSIONS Arthroscopic repair of STTs provided functional restoration, pain relief and patient satisfaction in both groups. Age and gender did not affect the clinical outcomes achieved by arthroscopic STT repair.
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Affiliation(s)
- Augusto Cigolotti
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
| | - Carlo Biz
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
| | - Erik Lerjefors
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
- Orthopaedic Clinic, NU Hospital Group, NÄL Hospital Trollhättan and Uddevalla Hospital, Trollhättan, Sweden
| | - Gianfranco de Iudicibus
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
| | - Elisa Belluzzi
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy
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Is single stage capsular release and rotator cuff repair suitable for rotator tears with concomitant stiffness? J Orthop 2020; 21:496-499. [PMID: 32999537 DOI: 10.1016/j.jor.2020.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/31/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction It is common for patients with a rotator cuff tear to present with shoulder stiffness. There is no consensus on the acceptable level of stiffness at time of rotator cuff repair.We aim to determine if patients with stiffness undergoing rotator cuff repair and concomitant capsular release have different outcome than those with no stiffness undergoing rotator cuff repair alone. We hypothesize that patients with stiffness will not have poorer outcome than patients with no stiffness. Method We conducted a retrospective study of prospectively collected data for 47 patients who underwent arthroscopic rotator cuff repair under a single surgeon from 2010 to 2015. 25 patients were considered stiff (Stiff group) and 22 patients were considered to have no pre-operative stiffness (Non-stiff group).Range of motion and functional outcomes were collected preoperatively and post-operatively at two-years. Results There were no significant differences in gender distribution, age and cuff tear size between both groups. Pre-operatively, patients in the Stiff group had significantly poorer active range of motion (Forward flexion - Stiff 74.8° vs Non-stiff 100.2°, P = 0.001) and poorer function (Constant score - Stiff 23.5 vs Non-stiff 43.2, P < 0.001). Post-operatively, both groups of patients had increased range of motion, strength and reported lesser pain compared to pre-operation. There were no significant differences in post-operative outcomes between both groups. Conclusion Single-stage surgery combining capsular release and rotator cuff repair is effective for patients with stiffness as they are able to achieve similar results to those without shoulder stiffness.
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Swarup I, Henn CM, Gulotta LV, Henn RF. Patient expectations and satisfaction in orthopaedic surgery: A review of the literature. J Clin Orthop Trauma 2019; 10:755-760. [PMID: 31316250 PMCID: PMC6611830 DOI: 10.1016/j.jcot.2018.08.008] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 08/02/2018] [Indexed: 11/20/2022] Open
Abstract
Patient expectations have been shown to be an independent predictor of outcomes in clinical medicine. In the orthopaedic literature, the majority of studies have focused on the relationship between pre-operative expectations and post-operative outcomes in patients undergoing total hip arthroplasty, total knee arthroplasty, shoulder surgery, and spine surgery. Various methodologies have been used to assess patient expectations in orthopaedic surgery, including direct questioning, short questionnaires, and validated surveys. Multiple patient factors have been associated with greater expectations prior to elective orthopaedic surgery, and greater pre-operative expectations have been shown to be associated with better subjective and objective outcomes after total hip and knee arthroplasty, shoulder surgery, and spine surgery. While there are very few validated measures of patient satisfaction after orthopaedic surgery, increased post-operative patient satisfaction is consistently associated with meeting pre-operative patient expectations. Given the relationship between pre-operative patient expectations and post-operative outcomes and patient satisfaction, understanding and defining expectations prior to elective orthopaedic surgery may optimize outcomes. In this review, we aim to summarize the current literature on patient expectations in orthopaedic surgery.
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Affiliation(s)
- Ishaan Swarup
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70 Street, New York, NY 10021, USA
- Corresponding author.
| | - Curtis M. Henn
- Department of Orthopaedic Surgery, Medstar Georgetown Orthopaedic Institute, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Lawrence V. Gulotta
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70 Street, New York, NY 10021, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD 21207, USA
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Rincón‐Hurtado ÁM, Rocha‐Buelvas A, López‐Cardona A, Martínez JW. Calidad de vida relacionada con la salud de pacientes con lesiones de manguito rotador, Eje Cafetero, Colombia, 2013. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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17
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Rincón-Hurtado ÁM, Rocha-Buelvas A, López-Cardona A, Martínez JW. Health-related quality of life of patients with rotator cuff injuries, Cofee Triangle, Colombia, 2013. Rev Bras Ortop 2018; 53:364-372. [PMID: 29892590 PMCID: PMC5993925 DOI: 10.1016/j.rboe.2018.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/02/2017] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the quality of life related to health and its related factors in patients diagnosed with rotator cuff lesions in the Municipality of Pereira, Colombia, 2013. Methods Cross-sectional study. Simple random sampling of 239 patients over 18 years of age attended at five health care institutions in the urban area of Pereira. Socio-demographic, biological, clinical and self-perception aspects of the disability were collected regarding the quality of life related to health. Use of measures of frequency, Chi-square and logistic regression for analysis. Results 72% (173) reported poor quality of life related to health in the physical health status component and 60% (144) in the mental health status component. Factors associated with poor quality of life related to health according to physical health status were: schooling, having caregiver, and shoulder disability in manual activities, daily activities and pain and physical limitation. While the factors associated with poor quality of life related to health in mental health status components were: schooling, having caregiver and shoulder disability due to pain and physical limitation. The greater the perception of shoulder disability, the worse the perception of health status. Conclusion The introduction of psychometric measures for the evaluation of the health status of patients with shoulder injuries contributes to a treatment adjusted to individual requirements and daily activities of the patient.
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Affiliation(s)
| | | | | | - José William Martínez
- Departamento de Medicina Comunitaria, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira (UTP), Pereira, Colombia
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Piekaar RSM, Bouman ICE, van Kampen PM, van Eijk F, Huijsmans PE. Early promising outcome following arthroscopic implantation of the subacromial balloon spacer for treating massive rotator cuff tear. Musculoskelet Surg 2017; 102:247-255. [PMID: 29151232 DOI: 10.1007/s12306-017-0525-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/08/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Massive rotator cuff tear (RCT) can result in disability and severe pain. When conservative treatment fails, surgical treatment should be considered, as various surgical options can provide relatively satisfactory results. However, choosing an optimal treatment remains controversial. A relatively new treatment for irreparable RCT is the arthroscopic implantation of a biodegradable balloon spacer into the subacromial space. Here, we examined whether placement of this balloon spacer reduces pain and improves functional outcome in patients with an irreparable RCT. Patients were followed for 1 year following implantation. METHODS In this prospective single-arm study, a biodegradable balloon spacer was implanted into the subacromial space of patients with a massive RCT. Pain was evaluated using a numeric rating scale (NRS), and functional outcome was evaluated using the Oxford shoulder score (OSS) and the Constant-Murley shoulder score (CMS). Five follow-up visits were performed during the first postoperative year. RESULTS Forty-six shoulders in 44 patients with massive RCT were treated by surgical implantation of the subacromial balloon spacer. The mean reduction in NRS score was 3.5 points (95% CI 2.5-4.4), and 74% of patients achieved the minimal clinically important difference of 2 points by the 1-year follow-up visit. Functional outcome improved significantly based on OSS and CMS scores, and 80% of patients reported that they were satisfied with their outcome. No surgical or postoperative medical complications due to implantation of the balloon spacer were reported. CONCLUSIONS Our results suggest that arthroscopic implantation of a biodegradable balloon spacer in the subacromial space significantly reduces pain and improves activities of daily living in patients with massive RCT during 1 year of follow-up. The specific contribution of the balloon with respect to improved clinical outcome needs further study, ideally in a randomized controlled trial.
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Affiliation(s)
- R S M Piekaar
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands.
| | - I C E Bouman
- Department of Orthopaedic Surgery, Haga Hospital The Hague, Sportlaan 600, 2566 MJ, The Hague, The Netherlands
| | - P M van Kampen
- Department of Orthopaedic Surgery, Bergman Clinics, Laan van Oversteen 20, 2289 CX, Rijswijk, The Netherlands
| | - F van Eijk
- Department of Orthopaedic Surgery, Bergman Clinics, Laan van Oversteen 20, 2289 CX, Rijswijk, The Netherlands
| | - P E Huijsmans
- Department of Orthopaedic Surgery, Bergman Clinics, Laan van Oversteen 20, 2289 CX, Rijswijk, The Netherlands
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Determinants of patient satisfaction following reconstructive shoulder surgery. BMC Musculoskelet Disord 2017; 18:458. [PMID: 29141613 PMCID: PMC5688638 DOI: 10.1186/s12891-017-1812-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 11/06/2017] [Indexed: 01/27/2023] Open
Abstract
Background Obtaining patient satisfaction is a key goal of surgical treatment. It was the purpose of this study to identify pre-, peri- and postoperative factors determining patient satisfaction after shoulder surgery, quantify their relative importance and thereby allow the surgeon to focus on parameters, which will influence patient satisfaction. Methods We retrospectively reviewed 505 patients, who underwent either rotator cuff repair (n = 216) or total shoulder arthroplasty (n = 289). We examined 21 patient-specific and socio-demographic parameters as well as 31 values of the Constant-Score with regard to their impact on patient satisfaction. Results In the univariable analysis higher patient satisfaction was correlated with higher age, private health insurance, light physical work, retirement, primary surgery, non-smoking, absence of chronic alcohol abuse, absence of peri- or postoperative complications, operation performed by the medical director as well as various Constant Score sub-values (p < 0.05). In the multivariable analysis absence of peri- or postoperative complications (p = 0.008), little postoperative pain (p = 0.0001), a large range of postoperative active abduction (p = 0.05) and a high postoperative subjective shoulder value (p = 0.0001) were identified as independent prognostic factors for high satisfaction. Conclusion After reconstructive shoulder surgery particular attention should be paid to prevention of complications, excellent perioperative pain control and restoration of abduction during rehabilitation. This study is first step towards a preoperative prediction model of a subjectively successful surgery as well as a tool to exclude irrelevant parameters in clinical routine.
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Abstract
Background The primary purpose of this study was to explore the relationship between patient satisfaction and rotator cuff tendon reparability. Materials and methods This was a secondary analysis of prospectively collected data of consecutive patients who underwent arthroscopic repair of full-thickness rotator cuff tear and were followed up for 2 years. The satisfaction level was rated on a 6-point Likert scale. Patient-oriented disability measures included the American Shoulder and Elbow Surgeons score, the short version of the Western Ontario Rotator Cuff index, the Constant-Murley score, and the Quick Disabilities of the Arm, Shoulder, and Hand. Partial repair was defined as repair with >1 cm residual gap. Results There were 145 patients (65 women, 80 men; mean age, 62 years) who met the inclusion criteria. There were 12 massive, 31 large, and 102 small or moderate rotator cuff tears. Of 43 large or massive tears, 23 had a partial repair. There was a statistically significant relationship between satisfaction and tendon reparability (P = .01). Patients with work-related shoulder injury reported less satisfaction with surgery (P = .005). Age, gender, or tear size did not affect satisfaction with surgery. Satisfaction was a predictor of all postoperative outcome scores after being adjusted for preoperative scores (P = .001 to P < .0001). Conclusion In this study, patients with partial repair and those with an active compensable injury were less satisfied with surgery than their counterparts were. Older age, female sex, or a larger tear was not a negative predictor of patient satisfaction.
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Affiliation(s)
- Helen Razmjou
- Department of Rehabilitation, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Richard Holtby
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Hope P, Zhang X. Examining user satisfaction with single sign-on and computer application roaming within emergency departments. Health Informatics J 2015; 21:107-19. [PMID: 26021667 DOI: 10.1177/1460458213505572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In an age where mandatory computer usage within clinical care settings is a non-negotiable term of employment, the amount of applications a provider must access to document care is rapidly increasing. Each application contains an associated username and password. The increasing frequency with which clinicians have to log in and out of different applications is a source of frustration for many healthcare professionals. Healthcare executives see lost productivity. Single sign-on with added computer application roaming capabilities on shared workstations is a viable solution for both the clinician and the organization. The aim of this study is to assess the effect of implementation of single sign-on technology with application roaming on shared workstations. This study focuses on the perception of satisfaction with the implementation of single sign-on technologies within a midsized integrated delivery health network's five emergency departments. We contribute to theory with the following: (1) the development of a construct called facilitated technology interruptions, (2) validation of the construct facilitated technology interruptions, and (3) application of a quantitative method to test the relationship between facilitated technology interruptions and user satisfaction. We surveyed five emergency departments and proposed five hypotheses. We found the positive relationship between facilitated technology interruptions and user satisfaction; the positive relationships between effort expectancy and satisfaction, and effort expectancy and willingness to recommend; and the positive relationship between satisfaction and willingness to recommend. We did not confirm the positive relationship between facilitated technology interruptions and willingness to recommend. We conclude that single sign-on technology increases user satisfaction. Other organizations may use the findings from this study and perform pre-single sign-on versus post-single sign-on evaluations. In practice, single sign-on improved productivity and ensured compliance with the Health Insurance Portability and Accountability Act, minimization of errors, and disruption for critical work.
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Shon MS, Koh KH, Lim TK, Kim WJ, Kim KC, Yoo JC. Arthroscopic Partial Repair of Irreparable Rotator Cuff Tears: Preoperative Factors Associated With Outcome Deterioration Over 2 Years. Am J Sports Med 2015; 43:1965-75. [PMID: 26015444 DOI: 10.1177/0363546515585122] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic partial repair is a treatment option in irreparable large-to-massive rotator cuff tears without arthritic changes. However, there are indications that arthroscopic partial repair does not yield satisfactory outcomes. PURPOSE To report the clinical and radiographic results of arthroscopic partial repairs in patients with irreparable large-to-massive cuff tears. In addition, an analysis was performed regarding preoperative factors that may influence patient outcomes and patient-rated satisfaction over time. STUDY DESIGN Case series; Level of evidence, 4. METHODS From 2005 to 2011, a total of 31 patients who underwent arthroscopic partial repair for irreparable large-to-massive cuff tears were retrospectively evaluated. Partial repair was defined as posterior cuff tissue repair with or without subscapularis tendon repair to restore the transverse force couple of the cuff. Pain visual analog scale (PVAS), questionnaire results (American Shoulder and Elbow Surgeons [ASES] and Simple Shoulder Test [SST]), and radiographic changes (acromiohumeral distance and degenerative change) were assessed preoperatively, at first follow-up (roughly 1 year postoperatively), and at final follow-up (>2 years postoperatively). Patients rated their satisfaction level at each postoperative follow-up as well. Preoperative factors that might influence outcomes, such as patient demographics, tear size, and fatty infiltration, were investigated. RESULTS The preoperative, first follow-up, and final follow-up results for mean PVAS (5.13, 2.13, and 3.16, respectively) and questionnaires (ASES: 41.97, 76.37, and 73.78; SST: 3.61, 6.33, and 6.07, respectively) improved significantly (all P < .05). Radiographic evaluation showed no difference compared with preoperative status. Nevertheless, patient-rated satisfaction at final evaluation was inferior: 16 good responses ("very satisfied" and "satisfied") and 15 poor responses ("rather the same" and "dissatisfied"). Despite initial improvements in both groups (P < .05), patients with poor satisfaction demonstrated statistically significant deterioration in mean PVAS (from 2.07 to 4.67), questionnaire scores (ASES: from 74.56 to 59.80; SST: from 5.11 to 3.81), and acromiohumeral distance (from 7.19 to 5.06 mm) between the first and final follow-up (all P < .05). Patients with good satisfaction showed no significant difference or they improved (P > .05) from the first to the final follow-up. Among preoperative factors, fatty infiltration of the teres minor was identified as the only statistically significant factor affecting patient-rated satisfaction (P = .007). CONCLUSION This study showed that arthroscopic partial repair may produce initial improvement in selected outcomes at 2-year follow-up. However, about half of the patients in the study were not satisfied with their outcomes, which had deteriorated over time. Preoperative fatty infiltration of the teres minor was the only factor that correlated with worse final outcomes and poor satisfaction after arthroscopic partial repair.
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Affiliation(s)
- Min Soo Shon
- Department of Orthopedic Surgery, Center for Joint Surgery, National Medical Center, Seoul, South Korea
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, South Korea
| | - Tae Kang Lim
- Department of Orthopedic Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Won Ju Kim
- Department of Orthopedic Surgery, Center for Joint Surgery, National Medical Center, Seoul, South Korea
| | - Kyung Cheon Kim
- Department of Orthopedic Surgery, Chungnam National University Hospital, Daejeon, South Korea
| | - Jae Chul Yoo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Shrader MW, Jones J, Falk MN, White GR, Burk DR, Segal LS. Hip reconstruction is more painful than spine fusion in children with cerebral palsy. J Child Orthop 2015; 9:221-5. [PMID: 25944242 PMCID: PMC4486500 DOI: 10.1007/s11832-015-0656-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 04/20/2015] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Concerns about pain control in patients with cerebral palsy (CP) are especially anxiety provoking for parents, given the fact that spasticity, communication issues, and postoperative muscle spasms are significant problems that make pain control difficult in these patients. A better understanding of the magnitude and quality of the pain these patients experience after our surgical procedures would better prepare the patients and their families. The purpose of this study is to quantify the amount of postoperative pain in children with CP undergoing hip reconstruction and spinal fusion. Specifically, the study will compare pain scores and the amount of narcotics used between the two groups. MATERIALS AND METHODS This is a retrospective chart review of a consecutive series of children with CP (GMFCS levels IV and V) over a 5-year period undergoing hip reconstruction (femoral osteotomy, pelvic osteotomy, or both) and posterior spinal fusion (PSF) at a tertiary-care pediatric hospital. The primary end point was the total opioid used by the patient during the hospitalization, by converting all forms of narcotics to morphine equivalents. The secondary end point was the documentation of pain with standard pain scores at standard time points postoperatively. Adverse effects related to pain management were documented for both groups. Student's t-tests were utilized to statistically compare differences between the groups, with significance determined at p < 0.05. RESULTS Forty-two patients with CP who underwent hip reconstruction (mean age 8.8 years) were compared to 26 patients who underwent PSF (mean age 15.4 years). The total opioid used, normalized by body weight and by days length of stay (DLOS), in the hip group was 0.49 mg morphine/kg/DLOS, compared to 0.24 for the spine group (p = 0.014). The mean pain score for the hip group was 1.52, compared to 0.72 for the spine group (p = 0.013). There were no significant differences in the occurrence of adverse effects related to pain management between the two groups. CONCLUSION Patients with CP undergoing hip reconstruction surgery had significantly more pain, as exhibited by requiring more narcotics and having higher pain scores, than those patients undergoing PSF. The knowledge that hip reconstruction is more painful than PSF for patients with CP will better prepare families about what to expect in the postoperative period and will alert providers to supply better postoperative pain control in these patients. LEVEL OF EVIDENCE III (case control series).
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Affiliation(s)
- M. Wade Shrader
- Division of Pediatric Orthopaedic Surgery, Phoenix Children’s Hospital, 1919 East Thomas Road, Phoenix, AZ 85016 USA
| | - John Jones
- Division of Pediatric Orthopaedic Surgery, Phoenix Children’s Hospital, 1919 East Thomas Road, Phoenix, AZ 85016 USA
| | - Mandy N. Falk
- Division of Pediatric Orthopaedic Surgery, Phoenix Children’s Hospital, 1919 East Thomas Road, Phoenix, AZ 85016 USA
| | - Greg R. White
- Division of Pediatric Orthopaedic Surgery, Phoenix Children’s Hospital, 1919 East Thomas Road, Phoenix, AZ 85016 USA
| | - David R. Burk
- Division of Pediatric Orthopaedic Surgery, Phoenix Children’s Hospital, 1919 East Thomas Road, Phoenix, AZ 85016 USA
| | - Lee S. Segal
- Division of Pediatric Orthopaedic Surgery, Phoenix Children’s Hospital, 1919 East Thomas Road, Phoenix, AZ 85016 USA
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Abstract
BACKGROUND The literature does not provide consistent information on the impact of patients' gender on recovery after rotator cuff repair. The purpose of this study was to determine whether gender affects pain and functional recovery in the early postoperative period after rotator cuff repair. METHODS Eighty patients (40 men and 40 women) were prospectively enrolled. Pain intensity and functional recovery were evaluated, using visual analog scale (VAS) pain score and range of motion on each of the first 5 postoperative days, at 2 and 6 weeks and at 3, 6, and 12 months after surgery. Perioperative medication-related adverse effects and postoperative complications were also assessed. RESULTS The mean VAS pain score was significantly higher for women than men at 2 weeks after surgery (p = 0.035). For all other periods, there was no significant difference between men and women in VAS pain scores, although women had higher scores than men. Mean forward flexion in women was significantly lower than men at 6 weeks after surgery (p = 0.033) and the mean degree of external rotation in women was significantly lower than men at 6 weeks (p = 0.007) and at 3 months (p = 0.017) after surgery. There was no significant difference in medication-related adverse effects or postoperative complications. CONCLUSIONS Women had more pain and slower recovery of shoulder motion than men during the first 3 months after rotator cuff repair. These findings can serve as guidelines for pain management and rehabilitation after surgery and can help explain postoperative recovery patterns to patients with scheduled rotator cuff repair.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center and Pain Research Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hee-Uk Ye
- Department of Orthopedic Surgery, Dongsan Medical Center and Pain Research Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jae-Won Jung
- Department of Orthopedic Surgery, Dongsan Medical Center and Pain Research Center, Keimyung University School of Medicine, Daegu, Korea
| | - Young-Kuk Lee
- Department of Orthopedic Surgery, Hanmi Hospital, Daegu, Korea
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Pécora JOR, Malavolta EA, Assunção JH, Gracitelli MEC, Martins JPS, Ferreira AA. Prognostic factors for clinical outcomes after rotator cuff repair. ACTA ORTOPEDICA BRASILEIRA 2015; 23:146-9. [PMID: 26207092 PMCID: PMC4503607 DOI: 10.1590/1413-78522015230300992] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 09/26/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To identify prognostic factors of postoperative functional outcomes. METHODS Retrospective case series evaluating patients undergoing rotator cuff repair, analyzed by the UCLA score (pre and 12-month postoperative) and Magnetic Resonance Imaging (preoperative). Patients' intrinsic variables related to the injury and intervention were evaluated. Multivariate linear regression analysis was performed to determine variables impact on postoperative functional assessment. RESULTS 131 patients were included. The mean UCLA score increased from 13.17 ± 3.77 to 28.73 ± 6.09 (p<0,001). We obtained 65.7% of good and excellent results. Age (r= 0.232, p= 0.004) and reparability of posterosuperior injuries (r= 0.151, p= 0.043) correlated with the functional assessment at 12 months. After multivariate linear regression analysis, only age was associated (p = 0.008). CONCLUSIONS The surgical treatment of rotator cuff tears lead to good and excellent results in 65.6% of patients. Age was an independent predictor factor with better clinical outcomes by UCLA score in older patients. Level of Evidence IV, Case Series.
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Affiliation(s)
- José Otávio Reggi Pécora
- Institute of Orthopedics and Traumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Angeli Malavolta
- Institute of Orthopedics and Traumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jorge Henrique Assunção
- Institute of Orthopedics and Traumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mauro Emílio Conforto Gracitelli
- Institute of Orthopedics and Traumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - João Paulo Sobreiro Martins
- Institute of Orthopedics and Traumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Arnaldo Amado Ferreira
- Institute of Orthopedics and Traumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Booker S, Alfahad N, Scott M, Gooding B, Wallace WA. Use of scoring systems for assessing and reporting the outcome results from shoulder surgery and arthroplasty. World J Orthop 2015; 6:244-251. [PMID: 25793164 PMCID: PMC4363806 DOI: 10.5312/wjo.v6.i2.244] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 08/08/2014] [Accepted: 12/19/2014] [Indexed: 02/06/2023] Open
Abstract
To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit. A total of 174 research articles that were published in the four journals used some form of shoulder scoring system. The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score (CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes. CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent. The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score.
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Saccomanni B. A new test for acromio-clavicolar pathology. J Clin Orthop Trauma 2013; 4:75-9. [PMID: 26403628 PMCID: PMC3880508 DOI: 10.1016/j.jcot.2013.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 03/01/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND A prospective study was established to assess the sensitivity and specificity of the new Saccomanni (SAC) test for isolated AC pathology, and compare with 4 commonly used clinical tests. MATERIALS AND METHODS The Saccomanni (Sac) test is essentially the cross-adduction test, with the addition of attempted elevation against resistance. In a positive test, this results in some pain and the inability of the patient to maintain the arm in the adducted and elevated position against resistance. Fifty-eight patients with isolated AC joint symptoms were assessed in random order with the Saccomanni test and 4 other tests. A corticosteroid and local anaesthetic injection was administered into the AC joint space. The Saccomanni test and 4 other tests were then repeated following the injection. After the injection, a symptom free clinical examination was used as a measure of true positive tests. STUDY DESIGN Case series. RESULTS The SAC test showed a sensitivity of 98% and specificity is 91.7%. All 4 other tests were less sensitive. CONCLUSION The SAC test is a highly sensitive test in patients presenting with isolated AC related symptoms. This study is an innovation for clinical tests in the world. The primary aim of this study was to assess the diagnostic sensitivity of my newly described SAC test. From the present study, it can be concluded that the easy-to use SAC is a highly sensitive test to evaluate AC joint pathology, when compared to other standard tests. CLINICAL RELEVANCE Level III, Diagnostic Study of Nonconsecutive Patients.
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Affiliation(s)
- Bernardino Saccomanni
- Medical Doctor, Orthopaedic and Trauma Surgery, Ambulatorio di Ortopedia, via della Conciliazione, 65, 74014 Laterza (TA), Italy
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Shoulder pain in primary care: diagnostic accuracy of clinical examination tests for non-traumatic acromioclavicular joint pain. BMC Musculoskelet Disord 2013; 14:156. [PMID: 23634871 PMCID: PMC3646690 DOI: 10.1186/1471-2474-14-156] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 04/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite numerous methodological flaws in previous study designs and the lack of validation in primary care populations, clinical tests for identifying acromioclavicular joint (ACJ) pain are widely utilised without concern for such issues. The aim of this study was to estimate the diagnostic accuracy of traditional ACJ tests and to compare their accuracy with other clinical examination features for identifying a predominant ACJ pain source in a primary care cohort. METHODS Consecutive patients with shoulder pain were recruited prospectively from primary health care clinics. Following a standardised clinical examination and diagnostic injection into the subacromial bursa, all participants received a fluoroscopically guided diagnostic block of 1% lidocaine hydrochloride (XylocaineTM) into the ACJ. Diagnostic accuracy statistics including sensitivity, specificity, predictive values, positive and negative likelihood ratios (LR+ and LR-) were calculated for traditional ACJ tests (Active Compression/O'Brien's test, cross-body adduction, localised ACJ tenderness and Hawkins-Kennedy test), and for individual and combinations of clinical examination variables that were associated with a positive anaesthetic response (PAR) (P≤0.05) defined as 80% or more reduction in post-injection pain intensity during provocative clinical tests. RESULTS Twenty two of 153 participants (14%) reported an 80% PAR. None of the traditional ACJ tests were associated with an 80% PAR (P<0.05) and combinations of traditional tests were not able to discriminate between a PAR and a negative anaesthetic response (AUC 0.507; 95% CI: 0.366, 0.647; P>0.05). Five clinical examination variables (repetitive mechanism of pain onset, no referred pain below the elbow, thickened or swollen ACJ, no symptom provocation during passive glenohumeral abduction and external rotation) were associated with an 80% PAR (P<0.05) and demonstrated an ability to accurately discriminate between an PAR and NAR (AUC 0.791; 95% CI 0.702, 0.880; P<0.001). Less than two positive clinical features resulted in 96% sensitivity (95% CI 0.78, 0.99) and a LR- 0.09 (95% CI 0.02, 0.41) and four positive clinical features resulted in 95% specificity (95% CI 0.90, 0.98) and a LR+ of 4.98 (95% CI 1.69, 13.84). CONCLUSIONS In this cohort of primary care patients with predominantly subacute or chronic ACJ pain of non-traumatic onset, traditional ACJ tests were of limited diagnostic value. Combinations of other history and physical examination findings were able to more accurately identify injection-confirmed ACJ pain in this cohort.
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Mulligan EP, Devanna RR, Huang M, Middleton EF, Khazzam M. Factors that impact rehabilitation strategies after rotator cuff repair. PHYSICIAN SPORTSMED 2012; 40:102-14. [PMID: 23306420 DOI: 10.3810/psm.2012.11.1993] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Multiple factors influence rehabilitation strategies after rotator cuff repair. These variables may also impact the overall success of the surgical intervention. Physicians and rehabilitation specialists should be aware of prognostic indicators that can provide therapeutic guidance and offer insights into eventual clinical outcomes. The success of surgical and rehabilitative interventions is often evaluated in terms of patient-reported outcome measures, return to activity, and pain. Although these factors are somewhat interdependent, each of them independently influences the final result. This article presents a comprehensive overview of the recent literature in this area to provide insight as to the short- and long-term outcomes that patients should expect based on their unique presentations. This article examines both intrinsic and extrinsic patient factors to help therapists develop customized rehabilitation programs that optimize surgical outcomes.
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Affiliation(s)
- Edward P Mulligan
- Department of Physical Therapy, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Thaker H, Sharma AK. Engaging stem cells for customized tendon regeneration. Stem Cells Int 2012; 2012:309187. [PMID: 22685473 PMCID: PMC3363009 DOI: 10.1155/2012/309187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/13/2012] [Indexed: 12/21/2022] Open
Abstract
The need for a consistent therapeutic approach to tendon injury repair is long overdue. Patients with tendon microtears or full ruptures are eligible for a wide range of invasive and non invasive interventions, often subjectively decided by the physician. Surgery produces the best outcomes, and while studies have been conducted to optimize graft constructs and to track outcomes, the data from these studies have been inconclusive on the whole. What has been established is a clear understanding of healthy tendon architecture and the inherent process of healing. With this knowledge, tissue regeneration efforts have achieved immense progress in scaffold design, cell line selection, and, more recently, the appropriate use of cytokines and growth factors. This paper evaluates the plasticity of bone-marrow-derived stem cells and the elasticity of recently developed biomaterials towards tendon regeneration efforts. Mesenchymal stem cells (MSCs), hematopoietic progenitor cells, and poly(1,8-octanediol co-citrate) scaffolds (POC) are discussed in the context of established grafting strategies. With POC scaffolds to cradle the growth of MSCs and hematopoietic progenitor cells, developing a fibroelastic network guided by cytokines and growth factors may contribute towards consistent graft constructs, enhanced functionality, and better patient outcomes.
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Affiliation(s)
- Hatim Thaker
- Division of Pediatric Urology, Children's Memorial Hospital of Chicago, Chicago, IL, USA
| | - Arun K. Sharma
- Division of Pediatric Urology, Children's Memorial Hospital of Chicago, Chicago, IL, USA
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Institute for BioNanotechnology in Medicine (IBNAM), 303 East Superior Street, Northwestern University, IBNAM 11-113, Chicago, IL 60611, USA
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Alavi K, Cervera-Servin JA. Patient Satisfaction and Surgery: Can It Be Measured? SEMINARS IN COLON AND RECTAL SURGERY 2011. [DOI: 10.1053/j.scrs.2011.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nyman P, Palenius K, Panula H, Mälkiä, PhD, PT E. Patients' experiences of shoulder problems prior to and following intervention. Physiother Theory Pract 2011; 28:221-31. [DOI: 10.3109/09593985.2011.598220] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jo CH, Kim JE, Yoon KS, Lee JH, Kang SB, Lee JH, Han HS, Rhee SH, Shin S. Does platelet-rich plasma accelerate recovery after rotator cuff repair? A prospective cohort study. Am J Sports Med 2011; 39:2082-90. [PMID: 21737832 DOI: 10.1177/0363546511413454] [Citation(s) in RCA: 173] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP) has been recently used to enhance and accelerate the healing of musculoskeletal injuries and diseases, but evidence is still lacking, especially on its effects after rotator cuff repair. HYPOTHESIS Platelet-rich plasma accelerates recovery after arthroscopic rotator cuff repair in pain relief, functional outcome, overall satisfaction, and enhanced structural integrity of repaired tendon. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Forty-two patients with full-thickness rotator cuff tears were included. Patients were informed about the use of PRP before surgery and decided themselves whether to have PRP placed at the time of surgery. Nineteen patients underwent arthroscopic rotator cuff repair with PRP and 23 without. Platelet-rich plasma was prepared via plateletpheresis and applied in the form of a gel threaded to a suture and placed at the interface between tendon and bone. Outcomes were assessed preoperatively and at 3, 6, 12, and finally at a minimum of 16 months after surgery (at an average of 19.7 ± 1.9 months) with respect to pain, range of motion, strength, and overall satisfaction, and with respect to functional scores as determined using the following scoring systems: the American Shoulder and Elbow Surgeon (ASES) system, the Constant system, the University of California at Los Angeles (UCLA) system, the Disabilities of the Arm, Shoulder and Hand (DASH) system, the Simple Shoulder Test (SST) system, and the Shoulder Pain and Disability Index (SPADI) system. At a minimum of 9 months after surgery, repaired tendon structural integrities were assessed by magnetic resonance imaging. RESULTS Platelet-rich plasma gel application to arthroscopic rotator cuff repairs did not accelerate recovery with respect to pain, range of motion, strength, functional scores, or overall satisfaction as compared with conventional repair at any time point. Whereas magnetic resonance imaging demonstrated a retear rate of 26.7% in the PRP group and 41.2% in the conventional group, there was no statistical significance between the groups (P = .388). CONCLUSION The results suggest that PRP application during arthroscopic rotator cuff repair did not clearly demonstrate accelerated recovery clinically or anatomically except for an improvement in internal rotation. Nevertheless, as the study may have been underpowered to detect clinically important differences in the structural integrity, additional investigations, including the optimization of PRP preparation and a larger randomized study powered for healing rate, are necessary to further determine the effect of PRP.
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Affiliation(s)
- Chris Hyunchul Jo
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
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Macrodimitris S, Sherman EMS, Williams TS, Bigras C, Wiebe S. Measuring patient satisfaction following epilepsy surgery. Epilepsia 2011; 52:1409-17. [PMID: 21762442 DOI: 10.1111/j.1528-1167.2011.03160.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To systematically review primary research examining patient satisfaction with epilepsy surgery in order to obtain evidence-based estimates of this surgical outcome; to assess methods used to measure epilepsy surgery satisfaction, overall epilepsy surgery satisfaction ratings, and predictors of epilepsy surgery satisfaction. METHODS Systematic review of published studies in English up to June 2009, focusing on patient satisfaction with all types of epilepsy surgery in patients of all ages. We excluded studies that focused on satisfaction with epilepsy treatment in general, on quality of life without specific exploration of patient satisfaction with surgery, and on satisfaction with the process of health care delivery, rather than with surgery and its outcomes. KEY FINDINGS Eight studies met inclusion criteria. Satisfaction was assessed using one or more global questions. Four epilepsy surgery satisfaction question content patterns emerged: (1) satisfied or dissatisfied, (2) perceived success or failure, (3) overall positive or negative impact, and (4) willingness to repeat surgery or regretting surgery. Overall 71% were satisfied; 64% considered it a success; it had a positive effect for 78%; and 87% would repeat surgery. Seizure freedom was the most common predictor of epilepsy surgery satisfaction, whereas postoperative neurologic deficit predicted dissatisfaction. SIGNIFICANCE Patient satisfaction with interventions is an important aspect of patient-centered care, but it has received little attention in epilepsy surgery. Future research is required to develop and validate epilepsy surgery satisfaction tools. We provide preliminary guiding principles for measuring satisfaction after epilepsy surgery.
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Affiliation(s)
- Sophia Macrodimitris
- Department of Clinical Neurosciences, Alberta Health Services, Calgary, Alberta, Canada.
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Millett PJ, Horan MP, Maland KE, Hawkins RJ. Long-term survivorship and outcomes after surgical repair of full-thickness rotator cuff tears. J Shoulder Elbow Surg 2011; 20:591-7. [PMID: 21398148 DOI: 10.1016/j.jse.2010.11.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 11/04/2010] [Accepted: 11/17/2010] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Rotator cuff injuries are commonly diagnosed orthopaedic conditions. The purpose of this study was to determine survivorship of primary open cuff repairs, with survivorship defined as a shoulder not requiring additional surgery. MATERIALS AND METHODS Between 1993 and 2004, open cuff repairs were performed in 254 patients (263 shoulders). All had a complete tear of the supraspinatus. In addition, 86 patients had tears of the infraspinatus and 50 had subscapularis tears. Survivors did not require further surgery. Survivorship was analyzed by use of the Kaplan-Meier method, and the log-rank test was used to compare survivorship between variables. RESULTS After surgery, 233 of 263 patients (89%) were contacted for survivorship data. Overall, 11% of patients (26 of 233) in this cohort had another surgery, with a survivorship of 94% at 5 years and 83% at 10 years. Increased survivorship was associated with single-tendon repairs (P = .02). For survivors, the mean follow-up was 6.3 years (range, 1 to 16 years), and there was a statistically significant improvement in mean American Shoulder and Elbow Surgeons (ASES) score from 56 preoperatively to 88 postoperatively. Chronic tears and tears that involved the subscapularis had lower ASES scores, and satisfaction with surgical outcome was 8 on a 10-point scale. CONCLUSION Overall survivorship was 94% at 5 years after open rotator cuff surgery and 83% at 10 years. Among those patients who survived at 6.3 years, there was a mean 32-point increase in the ASES score and a rating for patient satisfaction with surgical outcomes of 8 of 10. As a consequence, most failures occurred in the first 2 years and if the cuff repairs survived the initial years, they were highly likely to survive over the 10-year period.
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Affiliation(s)
- Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; Steadman Clinic, Vail, CO, USA.
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Nové-Josserand L, Liotard JP, Godeneche A, Neyton L, Borel F, Rey B, Noel E, Walch G. Occupational outcome after surgery in patients with a rotator cuff tear due to a work-related injury or occupational disease. A series of 262 cases. Orthop Traumatol Surg Res 2011; 97:361-6. [PMID: 21511555 DOI: 10.1016/j.otsr.2011.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 12/19/2010] [Accepted: 01/18/2011] [Indexed: 02/02/2023]
Abstract
UNLABELLED The goals of this study were to establish the occupational outcome after surgery in patients with a rotator cuff tear from a work-related injury (WRI) or occupational disease (OD) and determine which factors and conditions affected return to work. HYPOTHESIS return to work was possible for this type of patient. This questionnaire-based study comprised 262 shoulders in 254 patients with a WRI/OD who had surgery performed on their shoulder between 2000 and 2005. The average age was 50.5 ± 6.4 years. The following variables were analysed: employment status (private sector, self-employed, government employee), type of work (non-manual, manual, heavy manual labour), nature of tendon injury and surgical technique (open, mini-open and arthroscopy). Return to work occurred in 59.5% of the cases. Factors that prevented return to work (40.4% of the cases) included retirement (14.1%), an unrelated medical condition (10.3%), and the outcome of the operated shoulder (16.0%). Age had an impact on return to work (P<5 × 10(-4)). The type of work and nature of tendon injury did not affect return to work, but did affect time away from work. Employment status and surgical technique had an effect on return to work, but not on time away from work. Age was a decisive factor for return to work. Retirement seemed to be the most common choice starting at 55 years of age. Arthroscopy seemed to have reduced the impact of the WRI on the results, particularly on the time away from work. A preoperative evaluation of the patient's probability of returning to work should be done based on occupational and injury features. There may be a longer delay in returning to work for certain profiles of work (manual labour) and tendon injury. Patient management can be improved by knowing the factors and conditions that influence return to work. LEVEL OF EVIDENCE Level IV - Retrospective study.
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Affiliation(s)
- L Nové-Josserand
- Shoulder Unit, Santy Orthopaedic Center, 24, avenue Paul-Santy, 69008 Lyon, France.
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Razmjou H, Davis AM, Jaglal SB, Holtby R, Richards RR. Disability and satisfaction after rotator cuff decompression or repair: a sex and gender analysis. BMC Musculoskelet Disord 2011; 12:66. [PMID: 21457534 PMCID: PMC3083386 DOI: 10.1186/1471-2474-12-66] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 04/01/2011] [Indexed: 12/16/2022] Open
Abstract
Background Rotator-cuff pathology is the most common cause of pain and disability in the shoulder. Examining the combined effect of biological and societal factors on disability would potentially identify existing differences between men and women with rotator cuff pathology which would help to provide suggestions for better models of care. Purpose of this study was to determine the overall differences in disability between men and women and to examine the relationship between factors that represent sex (biological factors) and gender (non-biological factors) with disability and satisfaction with surgical outcome 6 months after rotator cuff surgery. Methods Patients with impingement syndrome and/or rotator cuff tear who underwent rotator cuff surgery completed the Western Ontario Rotator Cuff (WORC) index, the American Shoulder & Elbow Surgeons (ASES) assessment form, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measures prior to surgery and 6 months post-operatively. They also rated their satisfaction with surgery at their follow-up appointment. Results and Discussion One hundred and seventy patients entered into the study (85 men and 85 women). One hundred and sixty patients (94%) completed the 6-month assessment. Women reported more disability both prior to and after surgery. Disability at 6 months was associated with pain-limited range of motion, participation limitation, age and strength. Satisfaction with surgery was associated with level of reported disability, expectations for improved pain, pain-limited range of motion and strength. Conclusions The results of this study indicate that women with rotator cuff pathology suffer from higher levels of pre- and post-operative disability and sex and gender qualities contribute to these differences. Gender-sensitive approach will help to identify existing differences between men and women which will help to promote more effective and tailored care by health professionals.
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Affiliation(s)
- Helen Razmjou
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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Papalia R, Franceschi F, Del Buono A, Maffulli N, Denaro V. Results of surgical management of symptomatic shoulders with partial thickness tears of the rotator cuff. Br Med Bull 2011; 99:141-54. [PMID: 21186203 DOI: 10.1093/bmb/ldq040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The optimal management of partial thickness tears of the rotator cuff (PTRCT) is still controversial. SOURCE OF DATA A literature search, on PubMed, Cochrane and Google Scholar databases, identified 273 relevant abstracts of articles published in peer-reviewed journals. Twenty-three clinical studies reporting the outcomes of surgically treated patients affected by PTRCTs were selected. AREAS OF AGREEMENT The different repair approaches results in variable functional outcomes. The Coleman Methodology Score (CMS) used to asses the quality of the studies showed great heterogeneity in study design, the sample, pre- and post-operative diagnostic assessments and the score used to evaluate outcomes. The mean CMS value was 67.95 (ranging from 30 to 82). AREAS OF CONTROVERSY The heterogeneity of the treatment options and of the outcome assessment methods makes it difficult to compare the results of the different studies. GROWING POINTS There is a need to use standardized pre- and post-operative assessment methods and functional outcome scores. To improve the diagnosis and to choose the best treatment, it may be useful to measure the thickness of the rotator cuff to ascertain whether the size correlates with outcome. CONCLUSION There is a lack of scientifically based guidelines, probably a result of the relatively low levels of evidence of the studies. There is a need for adequately powered randomized clinical trials, using standard diagnostic assessment, common and validated scoring system comparing reported outcomes and duration of follow-up greater than 2 years.
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Affiliation(s)
- Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo, Rome, Italy
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van Riet RP, Bell SN. Clinical evaluation of acromioclavicular joint pathology: sensitivity of a new test. J Shoulder Elbow Surg 2011; 20:73-6. [PMID: 20850994 DOI: 10.1016/j.jse.2010.05.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Revised: 05/20/2010] [Accepted: 05/25/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND A prospective study was established to assess the sensitivity of the newly described Bell-van Riet (BvR) test for isolated AC pathology, and compare with 4 commonly used clinical tests. MATERIALS AND METHODS The BvR test is essentially the cross-adduction test, with the addition of attempted elevation against resistance. In a positive test, this results in some pain and the inability of the patient to maintain the arm in the adducted and elevated position against resistance. Fifty-eight patients with isolated AC joint symptoms were assessed in random order with the BvR test and 4 other tests. A corticosteroid and local anaesthetic injection was administered into the AC joint space. The BvR test and 4 other tests were then repeated following the injection. After the injection, a symptom free clinical examination was used as a measure of truly positive tests. RESULTS The BvR test showed a sensitivity of 98%. All 4 other tests were less sensitive. CONCLUSION The BvR test is a highly sensitive test in patients presenting with isolated AC related symptoms, and demonstrates AC joint pathology better than other accepted tests.
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Affiliation(s)
- Roger P van Riet
- Department of Orthopedic Surgery and Traumatology, Monica Hospital, Deurne (Antwerp), Belgium.
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Mulieri P, Dunning P, Klein S, Pupello D, Frankle M. Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. J Bone Joint Surg Am 2010; 92:2544-56. [PMID: 21048173 DOI: 10.2106/jbjs.i.00912] [Citation(s) in RCA: 349] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of the present study was to evaluate the indications for, and outcomes of, reverse shoulder arthroplasty in patients with massive rotator cuff tears but without glenohumeral arthritis. METHODS From December 1998 to December 2006, sixty-nine patients (seventy-two shoulders) were managed with reverse shoulder arthroplasty for the treatment of irreparable rotator cuff dysfunction without glenohumeral arthritis. The indications for reverse shoulder arthroplasty were persistent shoulder pain and dysfunction despite a minimum of six months of nonoperative treatment, the presence of at least a two-tendon tear, and Hamada stage-1, 2, or 3 changes in a patient for whom a non-arthroplasty option did not exist. Fifty-eight patients (sixty shoulders) had a minimum of two years of follow-up. Thirty-four shoulders had had no previous surgery (Group A), and twenty-six shoulders had had at least one previous surgical procedure (Group B). Postoperatively, patients were prospectively followed both clinically and radiographically. Survival analysis was performed, with the end points being removal or revision of the implant, radiographic loosening, and declining American Shoulder and Elbow Surgeons score. RESULTS Common characteristics of patients managed with reverse shoulder arthroplasty in this study were pain and (1) <90° of arm elevation at the shoulder without anterosuperior escape (n = 40; 66.6%); (2) <90° of elevation with anterosuperior escape (n = 16; 26.7%); or (3) irreparable rotator cuff tear and pain with >90° of elevation (n = 4; 6.7%). The average duration of follow-up was fifty-two months (range, twenty-four to 101 months). All measured outcomes improved postoperatively. For all patients, the average American Shoulder and Elbow Surgeons score improved from 33.3 to 75.4 (p < 0.0001), the average Simple Shoulder Test score improved from 1.6 to 6.5 (p < 0.0001), the average visual analog score for pain improved from 6.3 to 1.9 (p < 0.0001), the average visual analog score for function improved from 3.2 to 7.1 (p < 0.0001), the average forward flexion improved from 53° to 134° (p < 0.0001), the average abduction improved from 49° to 125° (p < 0.0001), the average internal rotation improved from S1 to L2 (p < 0.0001), and the average external rotation improved from 27° to 51° (p = 0.001). There were a total of twelve complications in eleven patients (prevalence, 20%). The survivorship at a mean of fifty-two months (range, twenty-four to 101 months) was 90.7% for all patients, 91.8% for Group A, and 87% for Group B. CONCLUSIONS When non-arthroplasty options either have failed or have a low likelihood of success, reverse shoulder arthroplasty provides reliable pain relief and return of shoulder function in patients with massive rotator cuff tears without arthritis at the time of short to intermediate-term follow-up.
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Affiliation(s)
- Philip Mulieri
- Florida Orthopaedic Institute, 13020 North Telecom Parkway, Tampa, FL 33637, USA
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Squitieri L, Reichert H, Kim HM, Chung KC. Application of the brief international classification of functioning, disability, and health core set as a conceptual model in distal radius fractures. J Hand Surg Am 2010; 35:1795-1805.e1. [PMID: 20934818 PMCID: PMC4413476 DOI: 10.1016/j.jhsa.2010.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 05/27/2010] [Accepted: 07/06/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE In 2009, the World Health Organization published a conceptual outcome framework for evaluating upper extremity injury and disease, known as the Brief International Classification of Functioning, Disability, and Health (ICF) Core Set for Hand Conditions. The purpose of this study was to apply the ICF conceptual model to outcomes for distal radius fractures (DRFs) and determine the contribution of each ICF domain to patient satisfaction. METHODS Patient-rated and objective functional outcome data were collected at 6 weeks, 3 months, and 6 months after surgery. We measured satisfaction using a subsection of the Michigan Hand Outcomes Questionnaire (MHQ) satisfaction score. Measured study variables were linked to their corresponding ICF domain (personal factors, environmental factors, activity and participation, and body function). We then used hierarchical regression to assess the contribution of each ICF domain to variation in overall patient satisfaction at each time point. RESULTS We enrolled 53 patients with unilateral DRFs treated with the volar locking plating system. Regression analysis indicated that measured study variables explain 93% (6 weeks), 98% (3 months), and 97% (6 months) of variation in patient satisfaction. For all 3 study assessment dates, activity and participation variables (MHQ-Activities of Daily Living, MHQ-Work, and Jebsen-Taylor Score) contributed the most to variation in patient satisfaction, whereas personal and environmental factors had a considerably smaller role in predicting changes in patient satisfaction. CONCLUSIONS The results demonstrated that it is possible to reliably model the relative contributions of each ICF domain to patient satisfaction over time, and the findings are consistent with previous research (ie, that most outcome variation is due to physical or functional factors). These results are strong enough to support continued use and further research using the ICF model for upper extremity outcomes.
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Affiliation(s)
| | - Heidi Reichert
- Center for Statistical Consultation and Research, University of Michigan
| | - H. Myra Kim
- Center for Statistical Consultation and Research, University of Michigan
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System
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Oh JH, Kim SH, Kim KH, Oh CH, Gong HS. Modified impingement test can predict the level of pain reduction after rotator cuff repair. Am J Sports Med 2010; 38:1383-8. [PMID: 20522833 DOI: 10.1177/0363546509359071] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most patients experience a significant reduction in pain after rotator cuff repair. However, there is currently no method to predict the level of pain reduction that each patient will experience. This report explores the usefulness of the modified impingement test for prognosis in cases of rotator cuff repair. HYPOTHESIS The amount of pain reduction after injection of lidocaine into the subacromial space preoperatively correlates with the level of pain reduction after rotator cuff repair. STUDY DESIGN Cohort study (prognosis); Level of evidence, 2. METHODS Preoperatively, a visual analog scale for pain was measured in 153 patients (59 males and 94 females) with a rotator cuff tear before and after injection of lidocaine into the subacromial space. Subsequently, rotator cuff repair was performed. At least 1 year after surgery, the visual analog scale for pain and satisfaction, Constant score, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, and University of California, Los Angeles shoulder rating scale were evaluated. Correlation analyses were performed between the change in visual analog scale after the modified impingement test and after surgery. RESULTS The amount of pain reduction after the modified impingement test was significantly related to improvement of pain postoperatively (P < .001), as measured using the visual analog scale for pain. The change in ASES score was also related to the amount of pain reduction after the modified impingement test (P = .001); however, the other tests showed no statistical significance (P > .05). Univariate regression analysis revealed that a 0.621-unit reduction in postoperative pain on the visual analog scale could be expected for each 1 unit (on a scale of 10) reduction in pain after lidocaine injection preoperatively. CONCLUSION The amount of pain reduction after the modified impingement test preoperatively correlated with the improvement of pain after rotator cuff repair. This simple preoperative test could help patients understand the subjective level of pain reduction that they may experience after rotator cuff repair.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744. Korea
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Yum JK, Lee HS, Park SB. Tendon Transfer for Irreparable Massive Rotator Cuff Tear. Clin Shoulder Elb 2010. [DOI: 10.5397/cise.2010.13.1.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cho CH, Song KS, Kim SK. Antegrade Interlocking Intramedullary Nailing in Humeral Shaft Fractures. Clin Shoulder Elb 2010. [DOI: 10.5397/cise.2010.13.1.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Latissimus dorsi transfer for treatment of irreparable rotator cuff tears. INTERNATIONAL ORTHOPAEDICS 2010; 34:1239-44. [PMID: 20155494 DOI: 10.1007/s00264-010-0970-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 01/18/2010] [Accepted: 01/19/2010] [Indexed: 10/19/2022]
Abstract
Massive rotator cuff tendon ruptures are not uncommon in older patients. We propose the transfer of the latissimus dorsi muscle for treatment of irreparable ruptures associated with functional impairment and chronic pain. Five women and 11 men were so treated and reviewed with an average follow-up of 26 months. The mean age was 60 years. Four patients also had subscapularis deficiency. Results were assessed with the Constant score and the Oxford shoulder score. Humeral head position was analysed. Statistical analysis was performed by the Wilcoxon non-parametrical test. The Constant score increased by 24.2% (p = 0.001) with all parameters showing improvement. Nine patients showed improved humeral head positioning in internal rotation. Three of four patients with a deficient subscapularis had unfavourable results. Latissimus dorsi transfer for the treatment of irreparable massive rotator cuff tears leads to a substantial clinical improvement. An intact subscapularis tendon is mandatory.
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Does the literature support double-row suture anchor fixation for arthroscopic rotator cuff repair? A systematic review comparing double-row and single-row suture anchor configuration. Arthroscopy 2009; 25:1319-28. [PMID: 19896055 DOI: 10.1016/j.arthro.2009.02.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 01/28/2009] [Accepted: 02/09/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the clinical outcome of single-row (SR) and double-row (DR) suture anchor fixation in arthroscopic rotator cuff repair with a systematic review of the published literature. METHODS We searched all published literature from January 1966 to December 2008 using Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials for the following key words: shoulder, rotator cuff, rotator cuff tear, rotator cuff repair, arthroscopic, arthroscopic-assisted, single row, double row, and transosseous equivalent. The inclusion criteria were cohort studies (Levels I to III) that compared SR and DR suture anchor configuration for the arthroscopic treatment of full-thickness rotator cuff tears. The exclusion criteria were studies that lacked a comparison group, and, therefore, case series were excluded from the analysis. RESULTS There were 5 studies that met the criteria and were included in the final analysis: 5 in the SR group and 5 in the DR group. Data were abstracted from the studies for patient demographics, rotator cuff tear characteristics, surgical procedure, rehabilitation, range of motion, clinical scoring systems, and imaging studies. CONCLUSIONS There are no clinical differences between the SR and DR suture anchor repair techniques for arthroscopic rotator cuff repairs. At present, the data in the published literature do not support the use of DR suture anchor fixation to improve clinical outcome, but there are some studies that report that DR suture anchor fixation may improve tendon healing. LEVEL OF EVIDENCE Level III, systematic review of Levels I to III studies.
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Harris IA, Dao ATT, Young JM, Solomon MJ, Jalaludin BB. Predictors of patient and surgeon satisfaction after orthopaedic trauma. Injury 2009; 40:377-84. [PMID: 19041968 DOI: 10.1016/j.injury.2008.08.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 08/19/2008] [Accepted: 08/27/2008] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patient satisfaction has only recently gained attention as an outcome measure in orthopaedics, where it has been reported for joint replacement surgery. Little has been published regarding predictors of patient satisfaction in orthopaedic trauma. This study aims to explore the predictors of patient satisfaction, and of surgeon satisfaction, after orthopaedic trauma. MATERIALS AND METHODS Adult patients admitted to hospital with fractures after motor vehicle trauma were surveyed on admission, and at six months. Demographic, injury, socio-economic and compensation-related factors were measured. The two outcomes were satisfaction with progress of the injury, and satisfaction with recovery. The treating surgeons were also surveyed at six months to determine surgeon satisfaction with progress, and recovery (using the same questions), and the presence or absence of fracture union and any complications. Multivariate analysis was used to determine significant predictors of satisfaction for both groups, and satisfaction rates were compared between surgeons and patients. RESULTS Of 306 patients recruited, 232 (75.8%) returned completed questionnaires, but only 141 (46.1%) surgeons responded. Patients rated their satisfaction with progress and recovery as 74.6% and 44.4%, respectively, whereas surgeon-rated satisfaction with progress and recovery was significantly higher, at 88.0% and 66.7%, respectively (p<0.0001). Significant predictors of patient dissatisfaction were: blaming others for the injury, being female, and using a lawyer. Patient-rated satisfaction was not significantly associated with objective injury or treatment factors. The only significant predictor of surgeon dissatisfaction was fracture non-union. CONCLUSIONS Orthopaedic surgeons overestimated the progress of the injury and the level of recovery compared to patients' own ratings. Surgeons' ratings were influenced by objective, treatment-related factors, whereas patients' ratings were not. Measures of outcome commonly used by orthopaedic surgeons, such as fracture union, do not predict patient satisfaction.
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Affiliation(s)
- Ian A Harris
- University of New South Wales, South West Sydney Clinical School, Orthopaedic Department, Liverpool Hospital, Liverpool, NSW, 2170, Australia.
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Skolasky RL, Albert TJ, Vaccaro AR, Riley LH. Patient satisfaction in the cervical spine research society outcomes study: relationship to improved clinical outcome. Spine J 2009; 9:232-9. [PMID: 18495548 DOI: 10.1016/j.spinee.2008.03.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 02/01/2008] [Accepted: 03/11/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND CONTEXT Satisfaction is a key indicator of how health care has met patient expectations. PURPOSE To examine relationship between clinical and functional outcome and patient satisfaction. STUDY DESIGN/SETTING Prospective analysis of outcomes. PATIENT SAMPLE A total of 428 patients undergoing cervical spine surgery consecutively enrolled at 23 nationwide sites. OUTCOME MEASURES Cervical Spine Outcomes Questionnaire (CSOQ). METHODS We used the CSOQ to evaluate 428 patients undergoing cervical spine surgery at 23 nationwide sites. Satisfaction was assessed at 3 months by self-report. Clinical improvement was defined at 3 months as decreased postoperative CSOQ domain scores. Principal components analysis (PCA) was used to demonstrate adherence of the CSOQ to domains of clinical and functional recovery and to identify items measuring patient satisfaction. Psychometric properties of items measuring patient satisfaction were examined. The association between patient satisfaction and 3 month clinical and functional outcome was tested. RESULTS On repeat administration in a subset of 50 patients, these four items demonstrated good test-retest reliability (Cronbach's alpha=0.784). PCA extracted factors adhering to the domain structure of the CSOQ. A unique factor was characterized by the following: recommend to friend (loading=0.658), compare favorably with others (loading=0.525) and with expectations (loading=0.701), and show overall satisfaction (loading=0.513). Structural equation models revealed influence of CSOQ domain scores and socioeconomic status on patient satisfaction. All reported comparisons were significant at p<.001. CONCLUSIONS Satisfaction is unobservable, but can be assessed through self-report. Clinical improvement, especially in neck pain, after surgery is associated with improved patient satisfaction.
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Affiliation(s)
- Richard L Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224-2780, USA
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Marx RG, Koulouvaris P, Chu SK, Levy BA. Indications for surgery in clinical outcome studies of rotator cuff repair. Clin Orthop Relat Res 2009; 467:450-6. [PMID: 18949526 PMCID: PMC2628527 DOI: 10.1007/s11999-008-0585-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 10/03/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Full-thickness tears of the rotator cuff are common, but there is no clear consensus regarding indications for rotator cuff surgery. Because some patients with full-thickness rotator cuff tears who are asymptomatic or symptomatic can be successfully treated nonoperatively, clinical outcome studies of rotator cuff repair should describe the subjects in detail to allow appropriate interpretation of the results. However, we hypothesized the indications for surgery are poorly described in outcome studies of rotator cuff surgery. We undertook a detailed literature review over 11 years of six major orthopaedic journals to assess whether the indications for surgery were described adequately in studies of rotator cuff repair. Eighty-six papers fit the criteria for the study and were reviewed. Limitations of activities of daily living (31%), failure of nonoperative treatment (52%), duration of nonoperative treatment (26%), and history of nocturnal pain (16%) were reported in a minority of papers overall. The patients' characteristics and indications for surgery were not described in a majority of clinical outcome studies of rotator cuff repair. It is important for these factors to be considered and reported because, without this information, the reasons for and results of rotator cuff repair are difficult to interpret. LEVEL OF EVIDENCE Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Robert G. Marx
- Foster Center for Clinical Outcome Research, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA
| | | | - Samuel K. Chu
- Foster Center for Clinical Outcome Research, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA
| | - Bruce A. Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA
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Balyk R, Luciak-Corea C, Otto D, Baysal D, Beaupre L. Do outcomes differ after rotator cuff repair for patients receiving workers' compensation? Clin Orthop Relat Res 2008; 466:3025-33. [PMID: 18784971 PMCID: PMC2628237 DOI: 10.1007/s11999-008-0475-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 08/08/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Comparisons of outcomes after rotator cuff repair between Worker's Compensation Board (WCB) recipients and nonrecipients generally do not consider patient, injury, and shoulder characteristics. We compared preoperative differences between WCB recipients and nonrecipients and determined the impact on their 6-month postoperative outcome. We evaluated a prospective cohort of 141 patients with full-thickness rotator cuff tears, 36 of whom (26%) were WCB recipients, preoperatively and 3 and 6 months after rotator cuff repair. Their mean age was 54.0 +/- 10.4 years (standard deviation) and 102 (72%) patients were male. Shoulder range of motion, Western Ontario Rotator Cuff (WORC) index, and American Shoulder and Elbow Surgeons' score were used to evaluate outcomes. We performed regression analyses to control for baseline differences in age, baseline scores, smoking status, symptom duration, injury type, and associated biceps disorder between WCB recipients and nonrecipients. WCB recipients were younger and more likely to smoke, have a traumatic injury, and undergo surgery within 6 months of injury. WCB recipients had lower recovery for all outcomes when these differences were not considered but when differences were accounted for, only 6-month WORC scores were lower in WCB recipients. Clinicians should consider preoperative characteristics before concluding WCB recipients experience less recovery after surgical repair. LEVEL OF EVIDENCE Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- R. Balyk
- Department of Surgery, Caritas Health Group, Edmonton, AB Canada ,Department of Surgery, University of Alberta, Edmonton, AB Canada
| | - C. Luciak-Corea
- Department of Rehabilitation Medicine, Caritas Health Group, Edmonton, AB Canada
| | - D. Otto
- Department of Surgery, Caritas Health Group, Edmonton, AB Canada ,Department of Surgery, University of Alberta, Edmonton, AB Canada
| | - D. Baysal
- Department of Surgery, University of Alberta, Edmonton, AB Canada
| | - L. Beaupre
- Department of Surgery, University of Alberta, Edmonton, AB Canada ,Department of Physical Therapy, University of Alberta, Edmonton, AB Canada ,1F1.52 WMC, 8440-112 ST, Edmonton, AB Canada T6G 2B7
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