Study: Addition of PRP to rotator cuff repair improves structural outcomes of rotator cuff tears

http://www.healio.com/orthopedics/sports-medicine/news/online/%7B2806f22e-3968-4df5-8fd3-580ca10c7677%7D/study-addition-of-prp-to-rotator-cuff-repair-improves-structural-outcomes-of-rotator-cuff-tears

Study: Addition of PRP to rotator cuff repair improves structural outcomes of rotator cuff tears

Jo C. Am J Sports Med. 2013. doi:10.1177/036346513497925.

• October 9, 2013

Patients with large to massive rotator cuff tears who had arthroscopic repair with the addition of platelet-rich plasma had improved structural outcomes compared with patients who underwent arthroscopic repair without platelet-rich plasma, according to results of this study.

"The application of platelet-rich plasma (PRP) for large to massive rotator cuff repairs significantly improved structural outcomes, as evidenced by a decreased retear rate and increased cross-sectional area of the supraspinatus compared with retears without platelet-rich plasma augmentation," the researchers wrote in the study.

Researchers randomized 48 patients into a group who underwent arthroscopic repair of rotator cuff tears and received PRP or a group of patients who underwent arthroscopic repair with no PRP. All patients were between the ages of 45 years and 85 years and had large to massive rotator cuff tears. Patients in the PRP group received three PRP gels applied between the torn end of the rotator cuff and the greater tuberosity. All patients returned to sport at 6 months to 9 months after treatment.

The change in postoperative cross-sectional area of the supraspinatus at 1-year follow-up was –15.54 mm² in the PRP group and –85.62 mm² for patients in the conventional treatment group. Patients who did not receive PRP had a retear rate of 55.6% compared with a 20% retear rate for patients in the PRP group. There were no significant preoperative and postoperative differences in shoulder function scores, pain, range of motion or strength between groups.

Disclosure: The research was supported by the Basic Science Research Program and the Bio & Medical Technology Development Program of the National Research Foundation funded by the Korean government.

http://ajs.sagepub.com/content/41/10/2240.abstract

Platelet-Rich Plasma for Arthroscopic Repair of Large to Massive Rotator Cuff Tears

A Randomized, Single-Blind, Parallel-Group Trial

1. Chris Hyunchul Jo, MD*,†, 
2. Ji Sun Shin, BS†, 
3. Young Gil Lee, MD†,
4. Won Hyoung Shin, MD†, 
5. Hyang Kim, PhD†, 
6. Seung Yeon Lee, MS†,
7. Kang Sup Yoon, MD† and 
8. Sue Shin, MD‡

+Author Affiliations

1. ^†Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
2. ^‡Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
3. Investigation performed at the SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea

1. ↵* Chris Hyunchul Jo, MD, Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, 156-707 Seoul, Korea (e-mail: chrisjo@snu.ac.kr).

Abstract

Background: Platelet-rich plasma (PRP) is expected to have a biological augmentation potential in the healing of various diseases and injuries, including rotator cuff tears. However, few evaluations have been performed specifically for large to massive tears.

Purpose: To assess the efficacy of PRP augmentation in patients undergoing arthroscopic repair for large to massive rotator cuff tears.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 48 patients scheduled for arthroscopic repair of large to massive rotator cuff tears were randomly assigned to receive either PRP-augmented (PRP group) or conventional treatment (conventional group). In the PRP group, 3 PRP gels (3 × 3 mL) were applied to each patient between the torn end and the greater tuberosity. The primary outcome measure was the retear rate assessed by magnetic resonance imaging (MRI) or computed tomographic arthrography (CTA) at a minimum of 9 months after surgery. Secondary outcome measures included pain, range of motion, muscle strength, overall satisfaction, functional scores, and the change in cross-sectional area (CSA) of the supraspinatus.

Results: The retear rate of the PRP group (20.0%) was significantly lower than that of the conventional group (55.6%) (P = .023). Clinical outcomes showed no statistical difference between the 2 groups (all P > .05) except for the overall function (P = .043). The change in 1-year postoperative and immediately postoperative CSA was significantly different between the 2 groups: –15.54 ± 94.34 mm² in the PRP group versus −85.62 ± 103.57 mm² in the conventional group (P = .047).

Conclusion: The application of PRP for large to massive rotator cuff repairs significantly improved structural outcomes, as evidenced by a decreased retear rate and increased CSA of the supraspinatus compared with repairs without PRP augmentation. While there was no significant difference in clinical outcomes except the overall shoulder function after 1-year follow-up, better structural outcomes in the PRP group might suggest improved clinical outcomes at longer term follow-up.

Keywords:

• platelet-rich plasma
 
• large to massive rotator cuff tear
• rotator cuff repair
 
• biological augmentation
 
• retear
 
• integrity

Footnotes

• One or more of the authors has declared the following potential conflict of interest or source of funding: This research was supported by the Basic Science Research Program (No. 2011-0022184) and the Bio & Medical Technology Development Program (No. 2011-0019773) of the National Research Foundation (NRF) funded by the Korean Government (MEST).

Shoulder Arthritis and Rotator Cuff Tears: causes of shoulder pain: The not infrequent complications after reverse tot...

Shoulder Arthritis and Rotator Cuff Tears: causes of shoulder pain: The not infrequent complications after reverse tot...: Reverse total shoulder arthroplasty in patients of varying body mass index This article analyzes the association of one element (BMI) of the...

Sunday, October 6, 2013

The not infrequent complications after reverse total shoulders - influence of body mass index

Reverse total shoulder arthroplasty in patients of varying body mass index

This article analyzes the association of one element (BMI) of the characteristics of the patient and the rate of complications within a minimum of 90 days after a primary reverse total shoulder. They classified the patients into 3 groups: normal BMI (BMI <25 kg/m2) (30 patients), overweight or mildly obese (BMI 25-35 kg/m2) (65 patients), and moderately or severely obese (BMI >35 kg/m2) (24 patients).

Complications occurred in 30 patients (25%), major in 11 (9%), minor in 19 (16%), surgical in 21 (18%), and medical in 14 (12%). The most common surgical complications were acute blood loss anemia requiring transfusion (8.4%) and dislocation (4.2%). The most common medical complications were atelectasis (2.5%) and acute renal insufficiency (2.5%).

Patients with a BMI exceeding 35 kg/m2 had a significantly higher overall complication rate (P < .05) and intraoperative blood loss (P = .05) than the other groups. Patients with BMI of less than 25 kg/m2 had a greater overall complication rate than those with a BMI of 25 to 35 kg/m2 (P < .05).

While the increased complication rate in patients that are moderately to severely obese makes some intuitive sense, it is difficult to understand an increased complication rate in those of normal BMI. 

It is important to keep in mind that this analysis took a continuous variable, BMI, and converted it into a  categorial variable (normal, overweight and obese). The result is obvious: a patient with a BMI of 24.9 is "normal", while a patient with a BMI of 25 is "overweight"; a patient with a BMI of 35 is "overweight" while a patient with a BMI of 35.1 is "obese". It would have been more interesting to plot the rate of complications (a continuous variable) against the BMI (a continuous variable). This may have helped shed some light on the apparent anomaly of increased complications in the "normal" group.

The authors collected a lot of data on their patients, including age, gender, diagnosis, prior shoulder surgery, comorbidity score, operating time, blood loss as well as BMI. Perhaps a better way to have done the analysis would have been to conduct a univariate analysis of each of these for their association with the complication rate and then a multivariate analysis to see which were independent.

Perhaps the most important result from this study is that 25% of the patients having primary reverse total shoulders had complications within a minimum of 90 days (we could not find the average followup days for this patients listed in the article).  This is a real caveat to surgeons and patients alike.

Three-dimensional assessment of the dimensions of the osteoarthritic glenoid

http://www.bjj.boneandjoint.org.uk/content/95-B/10/1377.abstract

Three-dimensional assessment of the dimensions of the osteoarthritic glenoid

1. G. Walch, MD, Orthopaedic Surgeon1 ; 
2. M. Mesiha, MD, Orthopaedic Surgeon2; 
3. P. Boileau, MD, Orthopaedic Surgeon, Professor3 ;
4. T. B. Edwards, MD, Orthopaedic Surgeon4; 
5. C. Lévigne, MD, Orthopaedic Surgeon5; 
6. G. Moineau, MD, Orthopaedic Surgeon6; and 
7. A. Young, MSpMed, PhD, FRACS, Orthopaedic Surgeon7 

+Author Affiliations

1. 1Centre Orthopédique Santy- Hopital Privé Jean MERMOZ, Department of Orthopaedic Surgery, 24 Avenue Paul Santy, Lyon 69008, France.
2. 2Massachusetts General Hospital, 55 Fruit Street, Yawkey 3G Boston, Massachusetts 02114, USA.
3. 3L’Archet 2 Hospital, Department of Orthopaedic Surgery and Sports Traumatology, 151 rte de St A. de Ginestière, 06200 Nice, France.
4. 4Fondren Orthopedic Group LLP, 7401 South Main, Houston, Texas 77030, USA.
5. 5Clinique du Parc, 155 Boulevard Stalingrad, 69006 Lyon, France.
6. 6Centre Orthopédique Pasteur Lanroze, 18 rue Amiral Romain Desfossés, 29200 Brest, France.
7. 7Sydney Shoulder Specialists, Level 2, 156 Pacific Highway, St Leonards 2065, New South Wales, Australia.

1. Correspondence should be sent to Dr G. Walch; e-mail:walch.gilles@wanadoo.fr

Abstract

Osteoarthritis results in changes in the dimensions of the glenoid. This study aimed to assess the size and radius of curvature of arthritic glenoids. A total of 145 CT scans were analysed, performed as part of routine pre-operative assessment before total shoulder replacement in 91 women and 54 men. Only patients with primary osteoarthritis and a concentric glenoid were included in the study. The CT scans underwent three-dimensional (3D) reconstruction and were analysed using dedicated computer software. The measurements consisted of maximum superoinferior height, anteroposterior width and a best-fit sphere radius of curvature of the glenoid.

The mean height was 40.2 mm (SD 4.9), the mean width was 29 mm (SD 4.3) and the mean radius of curvature was 35.4 mm (SD 7.8). The measurements were statistically different in men and women and had a Gaussian distribution with marked variation. All measurements were greater than the known values in normal subjects.

With current shoulder replacement systems using a unique backside radius of curvature for the glenoid component, there is a risk of undertaking excessive reaming to adapt the bone to the component resulting in sacrifice of subchondral bone or under-reaming and instability of the component due to a ’rocking horse‘ phenomenon.

Cite this article: Bone Joint J 2013;95-B:1377–82.

Footnotes

• The authors wish to thank P. Deransart, L. Ferrand, A. Amblard and J. Chaoui for their technical assistance.
  Tornier, Inc. (Bloomington, Minnesota, United States) funded this study through Imascap (Brest, France) for the development of the software and the measurements of the arthritic glenoids.
  The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article.
  This article was primary edited by P. Baird and first-proof edited by J. Scott.

• Received March 15, 2013.
• Accepted June 5, 2013.

• ©2013 The British Editorial Society of Bone & Joint Surgery

Reumails. Reumatología al día: Imagen: Rotura parcial del supraespinoso con bursi...

Reumails. Reumatología al día: Imagen: Rotura parcial del supraespinoso con bursi...: Presentamos el caso de una mujer de 45 años cuya actividad laboral le demanda realizar movimientos repetitivos con el hombro derecho ...
http://reumails.blogspot.mx/2013/10/imagen-rotura-parcial-del-supraespinoso.html
martes, 8 de octubre de 2013

Imagen: Rotura parcial del supraespinoso con bursitis subacromiodeltoidea tabicada

Presentamos el caso de una mujer de 45 años cuya actividad laboral le demanda realizar movimientos repetitivos con el hombro derecho en trayecto dependiente del supraespinoso: supraelevación por encima de los 60 grados y rotación externa mayor a los 45 grados.
La paciente consultaba por deformación en la cara anterior del hombro, limitación funcional en primeros grados de la retropulsión y rotación externa. El proceso se había instalado de forma súbita una semana antes aunque presentaba dolor a dicho nivel varias semanas atrás.

El motivo de presentar este caso, que no parece más que una tendinosis del tendón supraespinoso, es por las imágenes registradas en la ecografía.

En la foto 1 se demuestra la presencia de una distensión de contenido anecoico de la bursa subacromiodeltoidea compresible con la presión de la sonda y que abarca toda la extensión por encima del tendón supraespinoso. En esta imagen se aprecia un tabique de aspecto hiperecoico que parece compartimentalizar la bursa, que a esta altura correspondería a la subacromial. En la foto 2 se aprecia la misma bursa en su porción más lateral (correspondiente a la zona subdeltoidea). Aquí se puede observar un segundo tabique de las mismas características que el primero. El vídeo 1 muestra la imagen dinámica del subescapular y la bursa subacromiodeltoidea.

¿HOMBRO doloroso?

una publicación de Rehabilitación física y deportiva Playa del Carmen.

Exactitud diagnóstica de las pruebas clínicas para la inestabilidad traumática anterior de hombro

una publicación de Anatomía & Fisioterapia - Español.

http://www.physiospot.com/research/diagnostic-accuracy-of-clinical-examination-features-for-identifying-large-rotator-cuff-tears-in-primary-health-care/

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

OCTOBER 1, 2013 BY WILLIAM HARRISON 

Rotator cuff tears are frequently reported and disabling. The early diagnosis of medium and large size rotator cuff tears can improve the prognosis of the patient. The authors’ objective in this study was to identify clinical features with the strongest ability to accurately predict the presence of a medium, large or multitendon (MLM) rotator cuff tear in a primary care cohort. Participants were consecutively recruited from primary health care practices (n = 203). All participants underwent a standardized history and physical examination, followed by a standardized X-ray series and diagnostic ultrasound scan. Clinical features associated with the presence of a MLM rotator cuff tear were identified (P<0·200), a logistic multiple regression model was derived for identifying a MLM rotator cuff tear and thereafter diagnostic accuracy was calculated.

A MLM rotator cuff tear was identified in 24 participants (11·8%). Constant pain and a painful arc in abduction were the strongest predictors of a MLM tear (adjusted odds ratio 3·04 and 13·97 respectively). Combinations of ten history and physical examination variables demonstrated highest levels of sensitivity when five or fewer were positive [100%, 95% confidence interval (CI): 0·86‐1·00; negative likelihood ratio: 0·00, 95% CI: 0·00‐0·28], and highest specificity when eight or more were positive (0·91, 95% CI: 0·86‐0·95; positive likelihood ratio 4·66, 95% CI: 2·34‐8·74).

The authors’ were able accurately detect the presence of a MLM rotator cuff tear with combinations of patient history and physical examination findings. These findings may assist the primary care clinician in more efficient and accurate diagnosis of rotator cuff tears that may require further investigation or orthopedic consultation.

- See more at: http://www.physiospot.com/research/diagnostic-accuracy-of-clinical-examination-features-for-identifying-large-rotator-cuff-tears-in-primary-health-care/#sthash.NgSJWPhs.dpuf

Cadogan A., McNair P., Laslett M., Hing W., Taylor S., Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care, Journal of Manual & Manipulative Therapy, Volume 21, Number 3, 2013 , pp. 148-159(12) - See more at: http://www.physiospot.com/research/diagnostic-accuracy-of-clinical-examination-features-for-identifying-large-rotator-cuff-tears-in-primary-health-care/#sthash.NgSJWPhs.dpuf

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

Authors: Cadogan, Angela¹; McNair, Peter¹; Laslett, Mark²; Hing, Wayne¹; Taylor, Stephen³

Source: Journal of Manual & Manipulative Therapy, Volume 21, Number 3, 2013 , pp. 148-159(12)

Publisher: Maney Publishing

Keywords: Physical examination; Primary health care; Rotator cuff; Sensitivity; Specificity
Abstract:

Objectives:

Rotator cuff tears are a common and disabling complaint. The early diagnosis of medium and large size rotator cuff tears can enhance the prognosis of the patient. The aim of this study was to identify clinical features with the strongest ability to accurately predict the presence of a medium, large or multitendon (MLM) rotator cuff tear in a primary care cohort.

Methods:

Participants were consecutively recruited from primary health care practices (n = 203). All participants underwent a standardized history and physical examination, followed by a standardized X-ray series and diagnostic ultrasound scan. Clinical features associated with the presence of a MLM rotator cuff tear were identified (P<0·200), a logistic multiple regression model was derived for identifying a MLM rotator cuff tear and thereafter diagnostic accuracy was calculated.

Results:

A MLM rotator cuff tear was identified in 24 participants (11·8%). Constant pain and a painful arc in abduction were the strongest predictors of a MLM tear (adjusted odds ratio 3·04 and 13·97 respectively). Combinations of ten history and physical examination variables demonstrated highest levels of sensitivity when five or fewer were positive [100%, 95% confidence interval (CI): 0·86‐1·00; negative likelihood ratio: 0·00, 95% CI: 0·00‐0·28], and highest specificity when eight or more were positive (0·91, 95% CI: 0·86‐0·95; positive likelihood ratio 4·66, 95% CI: 2·34‐8·74).

Discussion:

Combinations of patient history and physical examination findings were able to accurately detect the presence of a MLM rotator cuff tear. These findings may aid the primary care clinician in more efficient and accurate identification of rotator cuff tears that may require further investigation or orthopedic consultation.

Document Type: Original Article

DOI: http://dx.doi.org/10.1179/2042618612Y.0000000020

Affiliations: 1: Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand 2: School of Rehabilitation and Occupation Studies, Faculty of Health and Environmental Science, AUT University, Auckland, New Zealand 3: School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Science, AUT University, Auckland, New Zealand

Publication date: 2013-08-01