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1.
Rev. bras. ortop ; 57(1): 136-143, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365747

ABSTRACT

Abstract Objective To evaluate the functional outcome of patients who underwent partial arthroscopic repair of massive rotator cuff tears. Methods Retrospective case series evaluating patients with massive rotator cuff tears who underwent partial arthroscopic repair. The primary outcome was the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) at 24 months. The secondary outcomes were the Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA), and the following subdomains: satisfaction, active forward flexion and strength of forward flexion subdomains. Results We evaluated 33 patients. The ASES scale evolved from 39.7 ± 19.6 to 77.6 ± 17.4 (p< 0.001). The UCLA scale evolved from 13.3 ± 5.5 to 27.9 ± 5.6 (p< 0.001). The satisfaction rate was 97%. The number of patients with active forward flexion > 150° increased from 12 (36.4%) to 25 (75.8%) (p= 0.002). The number of patients with normal or good strength of forward flexion increased from 9 (27.3%) to 22 (66.7%) (p = 0.015). Conclusion Partial repair of irreparable rotator cuff tears leads to significant improvement according to the ASES and UCLA scales.


Resumo Objetivo Avaliar o resultado funcional de pacientes submetidos ao reparo parcial por via artroscópica de roturas extensas do manguito rotador. Métodos Série de casos retrospectiva, avaliando pacientes com roturas extensas do manguito rotador submetidos ao reparo parcial por via artroscópica. O desfecho primário foi a escala American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES, na sigla em inglês) aos 24 meses. Foram desfechos secundários a escala Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA, na sigla em inglês), e seus subdomínios satisfação, flexão anterior ativa e força de flexão anterior ativa. Resultados Avaliamos 33 pacientes. A escala da ASES evoluiu de 39,7 ± 19,6 para 77,6 ± 17,4 (p< 0,001). A escala da UCLA evoluiu de 13,3 ± 5,5 para 27,9 ± 5,6 (p< 0,001). A taxa de satisfação foi de 97%. O número de pacientes com flexão anterior ativa > 150° passou de 12 (36,4%) para 25 (75,8%) (p= 0,002). O número de pacientes com força de flexão anterior ativa normal ou boa passou de 9 (27,3%) para 22 (66,7%) (p= 0,015). Conclusão O reparo parcial nas roturas irreparáveis do manguito rotador leva a melhora significativa de acordo com as escalas da ASES e UCLA.


Subject(s)
Humans , Male , Female , Arthroscopy , Evaluation of Results of Therapeutic Interventions , Rotator Cuff/surgery , Shoulder Injuries
2.
Rev. bras. ortop ; 56(4): 485-489, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1341181

ABSTRACT

Abstract Objective To evaluate the methodological quality of systematic reviews for the surgical and nonsurgical treatment of individuals with rotator cuff syndrome; to compare, through the Assessing the methodological quality of systematic reviews (AMSTAR) instrument, the quality of studies found in the Cochrane Library, PubMed (Publisher Medline), EMBASE andQinsightdatabases. Methods This is a descriptive and comparative cross-sectional study, in which two independent authors analyzed, through the AMSTAR instrument, the methodological quality of Cochrane and non-Cochrane systematic reviews on the treatment of individuals diagnosed with rotator cuff syndrome. Results A total of 76 systematic reviews were evaluated by the AMSTAR instrument. The overall mean score was 6.1 (±2.1) and the mean per database was 9.1 (±0.9) for the Cochrane reviews and 5.7 (±1.8) for the non-Cochrane reviews. The lowest-scoring item of AMSTAR was 11, related to the display of the conflict of interests of the publication. In a comparative analysis of the final variable score, there was a statistical difference between the Cochrane and non-Cochrane studies. Conclusion According to the present study, systematic reviews using the Cochrane methodology have a better methodological quality compared to non-Cochrane studies on the treatment of rotator cuff dysfunctions.


Resumo Objetivo Avaliar a qualidade metodológica das revisões sistemáticas para tratamento cirúrgico e não cirúrgico de indivíduos com síndrome do manguito rotador; comparar, através do instrumento Assessingthemethodologicalqualityofsystematic reviews(AMSTAR, na sigla em inglês), a qualidade dos estudos encontrados nas bases de dados Cochrane Library, PubMed (Publisher Medline), EMBASE e Qinsight. Métodos Trata-se de um estudo transversal descritivo e comparativo, em que dois autores independentes analisaram, por meio do instrumento AMSTAR, a qualidade metodológica das revisões sistemáticas Cochrane e nãoCochrane sobre tratamento de indivíduos com diagnóstico de síndrome do manguito rotador. Resultados 76 revisões sistemáticas foram avaliadas pelo instrumento AMSTAR. O escore médio geral foi de 6,1(±2,1) e a média por base de dados foi 9,1(±0,9) para as revisões Cochrane e 5,7(±1,8) para as não Cochrane. O item de menor pontuação do AMSTAR foi 11, relacionada à exibição dos conflitos de interesse da publicação. Em uma análise comparativa do escore da variável final, houve uma diferença estatística entre os estudos Cochrane e nãoCochrane. Conclusão De acordo com o presenteestudo, revisões sistemáticas utilizando a metodologia Cochrane têm uma melhor qualidade metodológica em comparação com estudos nãoCochrane sobre o tratamento de disfunções do manguito rotador.


Subject(s)
Rotator Cuff/surgery , Methodology , Systematic Review
3.
Article in Chinese | WPRIM | ID: wpr-888303

ABSTRACT

OBJECTIVE@#To observe and compare the clinical outcomes between arthroscopic modified Mason-Allen repair and suture-bridge repair for medium-size rotator cuff tears.@*METHODS@#From January 2017 to January 2018, 22 patients with medium-size rotator cuff tears underwent arthroscopic modified Mason-Allen repair. There were 9 males and 13 females with an average age of (57.14±10.26) years. From February 2018 to January 2019, 20 patients with medium-size rotator cuff tears underwent arthroscopic suture-bridge repair. There were 6 males and 14 females with an average age of (57.75±7.57) years. The preoperative and postoperative clinical function was assessed by American Shoulder and Elbow Surgeons (ASES) and Constant score system. The healing status of repaired rotator cuff was assessed using MRI.@*RESULTS@#All patients were followed up, and the duration ranged from 24 to 33 months, with a mean of (26.38±2.29) months. In modified Mason-Allen group, AS###ES score and Constant score increased from (45.22±7.58) and (58.72±9.26) preoperatively to (96.89±3.49) and (93.18± 3.20) postoperatively. In suture-bridge group, ASES score and Constant score increased from(47.33±7.50) and (60.05±11.76) scores to (97.58±3.43) and (93.85±3.15). There were no significant differences in ASES score and Constant score between the two groups before and after operation. There were no significant differences in rotator cuff healing between the two groups.@*CONCLUSION@#Both arthroscopic modified Mason-Allen and suture-bridge repair for treatment of medium-size rotator cuff tears could obtain good clinical outcomes, and there were no significant differences in clinical outcomes between the two techniques.


Subject(s)
Aged , Arthroscopy , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Rotator Cuff/surgery , Rotator Cuff Injuries/surgery , Suture Techniques , Sutures , Treatment Outcome
4.
Article in Chinese | WPRIM | ID: wpr-879390

ABSTRACT

Shoulder arthroscopic as a conventional method usually is applied to repair rotator cuff tears. In clinical, plenty single-row, double-row and transosseous tunnels suture technique are performed, but the ideal suture technique for rotator cuff repair is not found. Compared with single-row, double-row has better strength in biomechanics property. As the two best suture technique among the single-row, massive cuff stitch and modified Mason-Allen suture have the strongest biomechanics property. Clinical trials indicate that double-row could improve healing rates, but there are no significant difference in clinical outcome functional scores. Transosseous tunnel techniques possess a better bio-mechanic property, which could improve regional micro-environment and induce tendon-bone healing. Transosseous tunnel techniques are better for small to media size rotator cuff tears and osteoporosis patient. The author suggest that optimal rotator cuff repair technique should performed according to skill of performer and individual of patient by analysing bio-mechanic properties, clinical outcome, operative complexity and patient situation. The technique should follow simple opertaion, rapid, less trauma, stable fixation and utility to perform.


Subject(s)
Arthroscopy , Humans , Rotator Cuff/surgery , Rotator Cuff Injuries/surgery , Suture Anchors , Suture Techniques , Sutures
5.
Artrosc. (B. Aires) ; 28(1): 56-61, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1252447

ABSTRACT

Introducción: El objetivo de este trabajo es evaluar el porcentaje de cicatrización y los resultados funcionales de una cohorte de pacientes sometidos a reparación artroscópica del tendón del supraespinoso mediante una técnica de doble fila transósea equivalente. Materiales y métodos: durante el período de enero de 2015 a diciembre de 2017, se realizó una reparación artroscópica del supraespinoso a cuarenta y ocho pacientes utilizando una técnica transósea equivalente, todas por el mismo cirujano; al cuarto mes de evolución, se evaluó la tasa de cicatrización del tendón mediante ecografía. Los resultados funcionales se analizaron mediante la escala de Constant-Murley (CS), valoración subjetiva del hombro (SSV) y la escala visual análoga (EVA) para objetivar el dolor. Para el análisis estadístico se utilizó t test para muestras pareadas. Población sometida a compensación laboral.Resultados: el seguimiento ecográfico objetivó una tasa de re-ruptura del 6%. El promedio de incremento en la escala de Constant-Murley fue de 55 puntos, del SSV de 55%, de flexión anterior 32° y de rotación externa de 13°. La escala visual análoga tuvo un descenso de 6 puntos. Todos estos cambios fueron estadísticamente significativos (p < 0.05). Conclusión: la reparación del tendón del supraespinoso, mediante una técnica transósea equivalente mejora los resultados clínicos y funcionales de los pacientes, objetivados con los índices de Constant-Murley y SSV. En nuestra serie obtuvimos una tasa de cicatrización en el 94% de los pacientes. Tipo de estudio: Serie de casos. Nivel de Evidencia: IV


Introduction: the objective of this work was to evaluate the healing rate and functional results in a retrospective cohort of patients undergoing arthroscopic repair of the supraspinatus tendon, using a double row transosseous equivalent technique. Materials and methods: during the period from January 2015 to December 2017, an arthroscopic repair of the supraspinatus was performed on forty-eight patients, using a transosseous technique, by the same surgeon. We evaluated the healing rate by an ultrasound exam at the fourth month of evolution. Functional results were evaluated using the Constant-Murley scale (CS), subjective shoulder assessment (SSV) and the visual analog scale (VAS) to objectify the pain. For the statistical analysis, t-tests were used for paired samples. This cohort of patients is subject to workers compensation. Results: the ultrasound follow-up showed a 6% re-rupture rate. The average increase in the Constant scale was 55 points, the SSV had a mean increase of 55% and the VAS score decrease 6 points. All these changes were statistically significant (p < 0.05).Conclusions: the supraspinatus tendon repair, using an equivalent transosseous technique, improves the clinical and functional results of patients, objectified with the Constant-Murley and SSV scores. In our series we obtained a healing rate on 94% of the patients. Type study: Case Series. Level of Evidence: IV


Subject(s)
Adult , Middle Aged , Arthroscopy/methods , Shoulder Joint/surgery , Treatment Outcome , Rotator Cuff/surgery , Rotator Cuff Injuries , Workers' Compensation
6.
Säo Paulo med. j ; 138(4): 310-316, July-Aug. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1139710

ABSTRACT

ABSTRACT BACKGROUND: The accuracy of magnetic resonance imaging (MRI) for making the diagnosis of subscapularis tears presents wide variation in the literature and there are few prospective studies. OBJECTIVE: To compare the findings from MRI and arthroscopy for diagnosing subscapularis tears. DESIGN AND SETTING: Diagnostic test study performed in a tertiary care hospital. METHODS: We included patients who underwent arthroscopic rotator cuff repair and who had firstly undergone high magnetic field MRI without contrast. The images were independently evaluated by a shoulder surgeon and two musculoskeletal radiologists. Sensitivity, specificity, positive and negative predictive values, accuracy and inter and intra-observer agreement were calculated. RESULTS: MRIs on 200 shoulders were evaluated. The incidence of subscapularis tears was 69.5% (41.5% partial and 28.0% full-thickness). The inter and intra-observer agreement was moderate for detection of subscapularis tears. The shoulder surgeon presented sensitivity of 51.1% to 59.0% and specificity of 91.7% to 94.4%. The radiologists showed sensitivity of 83.5% to 87.1% and specificity of 41% to 45.9%. Accuracy ranged from 60.5% to 73.0%. CONCLUSION: The 1.5-T MRIs without contrast showed mean sensitivity of 70.2% and mean specificity of 61.9% for detection of subscapularis tears. Sensitivity was higher for the musculoskeletal radiologists, while specificity was higher for the shoulder surgeon. The mean accuracy was 67.6%, i.e. lower than that of rotator cuff tears overall.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Tendon Injuries/diagnostic imaging , Magnetic Resonance Imaging/methods , Rotator Cuff/diagnostic imaging , Rotator Cuff Injuries/diagnostic imaging , Arthroscopy , Observer Variation , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Rotator Cuff/surgery , Diagnostic Tests, Routine , Rotator Cuff Injuries/surgery
7.
Acta ortop. mex ; 34(2): 139-145, mar.-abr. 2020. graf
Article in Spanish | LILACS | ID: biblio-1345103

ABSTRACT

Resumen: Introducción: La lesión masiva e irreparable del manguito rotador es un problema clínico que genera la pérdida de la función biomecánica del hombro. Esta lesión amerita una intervención oportuna, de modo tal que, previo a la artrosis, ayude a preservar la función articular durante el mayor tiempo posible. La opción de reparación de la cápsula superior con autoinjerto de fascia lata en la ruptura masiva e irreparable del manguito rotador es una técnica propuesta por Mihata, la cual ha demostrado obtener constantes mejorías de la función a corto y mediano plazo. Reporte de caso: Se trata de una mujer de 51 años con lesión irreparable del supraespinoso e infraespinoso y fallo en el tratamiento conservador. Clínicamente, se presentó con dolor de hombro intolerable y disfunción subjetiva; sin datos de artropatía moderada a severa, defectos óseos, rigidez o disfunción del deltoides, del dorsal ancho y del pectoral mayor. Se realizó reconstrucción de la cápsula superior con autoinjerto de fascia lata en Agosto de 2018 y seguimiento en las primeras 12 semanas. El resultado de este procedimiento mostró mejoría de las escalas SST de 58.33 y QD de 20.45 puntos con respecto a la valoración prequirúrgica (SST de 33.3 y QD de 27.7 puntos) y una movilización activa completa en abducción, flexión, extensión y rotación interna; el único arco de movilidad que no presentó mejoría fue la rotación externa del hombro, la cual se mantuvo en las mismas condiciones previas al procedimiento quirúrgico.


Abstract: Introduction: Massive and irreparable rotator cuff injury is a clinical problem that results in loss of shoulder function and merits timely intervention that helps preserve it as long as possible before arthropathy. The option of repair of the superior capsule with autograft of Fascia Lata in the massive and irreparable rupture of the rotator cuff, is a technique proposed by Mihata, which has demonstrated an improvement of function in the short and medium term. Case report: Female of 51 years old with irreparable tear of supraspinatus and infraspinatus, failure in conservative treatment, clinically with intolerable shoulder pain, subjective dysfunction without signs of moderate to severe arthropathy, no bone defects, stiffness or dysfunction of Deltoid, Latissimus Dorsi and Pectoralis Major. Superior capsule reconstruction was performed with autograft of fascia Lata in August 2018, with follow-up for the first 12 weeks. The result of this procedure showed improvement of the SST 58.33 and QD 20.45 scales compared to pre-surgical evaluation (SST 33.3 and QD 27.7). Full active mobilization in abduction, flexion, extension and internal rotation. The external rotation of the shoulder has no functional improvement.


Subject(s)
Humans , Female , Shoulder Joint , Rotator Cuff Injuries/surgery , Rupture/surgery , Range of Motion, Articular , Rotator Cuff/surgery , Middle Aged
8.
Acta ortop. mex ; 34(2): 87-90, mar.-abr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1345093

ABSTRACT

Abstract: Introduction: The rotator cuff tears are a very frequent condition. The rotator cuff repair is a procedure often perform by the orthopedic surgeon. There are multiple techniques and suture configurations for this type of repairs. The double row configuration is one of the most used and consider very effective for mid-size and large size rotator cuff tears. The parachute configuration for this repair is a novel technique that may be useful for mid-size and large size tears, for this repair two medial double row anchors are used and one knotless lateral anchor. Our porpoise was to compare biomechanical performance and footprint coverage of a conventional suture-bridge double-row rotator cuff repair configuration versus a double-row-parachute. Methods: This paper shows the biomechanical behavior on a cadaver model of the parachute configuration, and also compares this conformation with a double row in a suture-bridge fashion. Our hipothesis was that the Parachute configuration's biomechanical performance is equivalent to the suture-bridging double-row technique. Results: The parachute configuration advantages show the advantage of using less anchors, which will decrease the surgical time and also the risks of using multiple hardware in the humeral head.


Resumen: Introducción: La lesión del manguito rotador es una patología común cuya reparación es un procedimiento realizado por los cirujanos ortopedistas. Existen muchas técnicas de reparación, así como múltiples configuraciones de anclas y suturas para realizar estos procedimientos. La técnica de doble fila es una de las más usadas para rupturas de tamaño mediano y grande con buenos resultados. La configuración en «paracaídas¼ para la reparación del manguito rotador puede llegar a ser útil para éstas, en este tipo de configuración se utilizan dos anclas mediales y un ancla sin nudos lateral. Nuestro objetivo fue la comparación de la eficiencia biomecánica y cobertura de la huella de una configuración convencional de doble fila «suture bridge¼ frente a una configuración en «paracaídas¼. Métodos: Este trabajo revisó el comportamiento biomecánico, en piezas cadavéricas, de la configuración de paracaídas y se comparó con la configuración de doble fila tipo «suture-bridge¼. Nuestra hipótesis era que el rendimiento biomecánico de la configuración de Parachute es equivalente a la técnica de doble fila «suture bridge¼. Resultados: Las posibles ventajas de la configuración de paracaídas son el uso de menos anclas, disminuyendo el tiempo quirúrgico y los riesgos de tener múltiples implantes en la cabeza humeral.


Subject(s)
Humans , Rotator Cuff Injuries/surgery , Sutures , Biomechanical Phenomena , Suture Techniques , Rotator Cuff/surgery
9.
Acta ortop. mex ; 34(1): 38-42, ene.-feb. 2020. tab
Article in Spanish | LILACS | ID: biblio-1345083

ABSTRACT

Resumen: Antecedentes: El aumento de la esperanza de vida de la población incrementa el número de pacientes con patología sintomática del manguito rotador. Nuestro objetivo fue determinar los resultados clínicos de una cohorte de pacientes mayores de 60 años con rotura del manguito rotador intervenidos mediante cirugía artroscópica de hombro (CAH). La hipótesis de trabajo fue que la CAH permitiría resultados clínicos satisfactorios. Material y métodos: De nuestra base de datos prospectiva de CAH seleccionamos los pacientes con: edad mayor de 60 años, rotura de manguito rotador, seguimiento mínimo de dos años. La valoración clínica se determinó según el test de Constant y el cuestionario Quick-DASH de calidad de vida. Resultados: 42 pacientes con una edad media de 66.7 años (rango de 60 a 83). La rotura del supraespinoso se reparó con sutura en doble fila en 25 pacientes (59.5%) y en fila única en 17 pacientes (40.5%). Lesiones asociadas: lesión de la porción larga del bíceps en 31 pacientes (48.4%), del subescapular en 24 pacientes (37.5%) y lesión tipo SLAP en tres pacientes (7.1%). El seguimiento medio fue de 32.4 meses. La puntuación media en la escala de Constant pasó de 48.3 puntos en el preoperatorio a 87.2 puntos al final del seguimiento. El cuestionario DASH síntomas/discapacidad disminuyó de 52.5 de media a 11.0 al final del seguimiento. Discusión: El tratamiento artroscópico de las roturas de manguito rotador en mayores de 60 años permite obtener resultados satisfactorios en los cuestionarios de valoración funcional y calidad de vida a mediano plazo.


Abstract: Introduction: Increasing life expectancies in population increase the number of patients with rotator cuff tears. The purpose of this study was to evaluate clinical outcomes after arthroscopy rotator cuff repair in patients over 60 years old. We hypothesized that shoulder arthroscopy would allow significant improvements in clinical outcomes without serious complications. Material and methods: We screened from our shoulder arthroscopy database patients older than 60 years old, with rotator cuff tear, and minimun 2-year follow-up. The patients were evaluated using Constant scores for clinical outcomes and Quick-DASH score for quality of life. Results: In total, 42 patients were enrolled in the study with a mean age of 66.7 years old (range 60 to 83). A double-row repair was indicated in 25 patients (59.5%), and single-row repair in 17 patients (40.5%). As associated injuries we found proximal biceps pathology in 31 patients (48.4%), subscapularis tears in 24 patients (37.5%), and SLAP tears in 3 patients (7.1%). Mean follow-up was 32.4 months. Constant scores improved from 48.3 preoperatively to 87.2 at final follow-up. Quick-DASH decreased from 52.5 preoperatively to 11.0 at final follow-up. Discussion: Arthroscopy cuff repair in patients older than 60 years old provides satisfactory clinical outcomes without morbidity at medium follow-up.


Subject(s)
Aged , Aged, 80 and over , Rotator Cuff/surgery , Rotator Cuff Injuries/surgery , Arthroscopy , Quality of Life , Range of Motion, Articular , Treatment Outcome , Middle Aged
10.
Rio de Janeiro; s.n; 2020. 102 p.
Thesis in Portuguese | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1223231

ABSTRACT

Na cirurgia de bloqueio ósseo descrita por Latarjet, a desinserção cirúrgica do músculo subescapular resulta, frequentemente, em alterações na sua função e estrutura, podendo ter caráter definitivo. Dessa forma, a divulsão das fibras musculares do subescapular foi descrita como alternativa à desinserção. Com o objetivo de verificar o impacto desta abordagem preservativa, tanto na estrutura quanto na função do músculo subescapular, avaliou-se um grupo de pacientes submetidos à cirurgia de Latarjet nos quais a divulsão muscular foi realizada. Foram selecionados participantes com seguimento pós-operatório mínimo de um ano e que tivessem sido submetidos a exame de tomografia computadorizada do ombro acometido, como parte da rotina pré-operatória. Os participantes foram submetidos a exame físico, para avaliação da amplitude de movimento e função do subescapular. Além disso, através da análise das imagens de tomografia computadorizada, foram avaliados a espessura dos músculos subescapular e infra-espinal e o estágio de infiltração gordurosa do subescapular pósoperatórias. Para avaliação da força, foram realizadas análises bilaterais do torque muscular dos rotadores mediais e laterais, utilizando dinamômetro isocinético. Participaram do estudo 32 indivíduos de ambos os sexos, com média de idade de 33,9 ± 9,2 anos. Em relação ao exame físico, apesar da redução da amplitude de movimento no ombro acometido, em relação ao contralateral, não observamos, clinicamente, disfunção do subescapular. Nas imagens de tomografia computadorizada realizadas no pós-operatório, utilizando o lado contralateral como controle, verificou-se menor espessura média do subescapular (2,28 ± 0,46 cm e 2,10 ± 0,46 cm, respectivamente) e do infra-espinal (2,84 ± 0,33 cm e 2,76 ± 0,30 cm, respectivamente) no lado acometido. Houve também diferença significativa da força dos rotadores mediais e laterais entre os ombros, com menores valores tanto do pico de torque quanto do trabalho total no ombro acometido, com índice de simetria entre membros variando entre 76,3 e 89,4%. Houve correlações significativas, porém pequenas, no pós-operatório, entre a espessura muscular do subescapular e os valores de pico de torque e do trabalho total dos rotadores mediais do ombro acometido. Os resultados sugerem que abordagem com preservação da inserção umeral do subescapular, durante a realização do procedimento descrito por Latarjet, resulta em diminuição da espessura muscular do subescapular e do pico de torque e trabalho total de rotadores mediais. Estas alterações, no entanto, não se manifestaram no exame físico, com as manobras realizadas para a avaliação da função do subescapular se apresentando negativas


In bone block surgery described by Latarjet, surgical disinsertion of the subscapularis muscle often results in alterations in its function and structure, which may be definitive. Thus, the split of subscapularis muscle fibers was described as an alternative to disinsertion. In order to verify the impact of this preservative approach, both on the structure and function of the subscapularis muscle, we evaluated a group of patients who underwent Latarjet surgery in which muscle split approach was performed. Participants with a minimum postoperative follow-up of one year who had undergone computed tomography of the affected shoulder, as part of the preoperative routine, were selected. Participants underwent physical examination to assess range of motion and subscapularis function. In addition, through the analysis of computed tomography images, we evaluated thickness of the subscapularis and infraspinatus muscles and the stage of postoperative subscapularis fatty infiltration. For strength evaluation, bilateral muscle torque analyzes of the medial and lateral rotators were performed using an isokinetic dynamometer. The study included 32 individuals of both genders, with a mean age of 33.9 ± 9.2 years. Regarding the physical examination, despite the reduction of the range of motion in the affected shoulder, in relation to the contralateral one, we did not clinically observe subscapularis dysfunction. Postoperative computed tomography images, using the contralateral side as a control, revealed reduced thickness of both subscapularis (2.28 ± 0.46 cm and 2.10 ± 0.46 cm, respectively) and infraspinatus (2.84 ± 0.33 cm and 2.76 ± 0.30 cm, respectively) muscles on the affected side. There was also a significant difference in the strength of the medial and lateral rotators between the shoulders, with lower values of both peak torque and total work on the affected shoulder, with a symmetry index between 76.3 and 89.4%. There were significant but small correlations between postoperative subscapularis muscle thickness and peak torque values and total work of the medial rotators of the affected shoulder. The results suggest that the approach with preservation of the subscapularis humeral insertion, during the procedure described by Latarjet, results in decreased subscapularis muscle thickness as well as in reduced peak torque and total work of medial rotators. These changes, however, did not manifest on physical examination, with the maneuvers performed to evaluate the subscapularis function being negative


Subject(s)
Humans , Diagnostic Imaging/methods , Rotator Cuff/surgery
11.
Article in Chinese | WPRIM | ID: wpr-880768

ABSTRACT

OBJECTIVE@#To observe the therapeutic effect of electro-acupuncture on tendon healing and functional recovery of rotator cuff injury in rats and explore the therapeutic mechanism of electro-acupuncture.@*METHODS@#Ninety SD rats were randomly divided into electro-acupuncture group, model group and blank control group, and models of rotator cuff injury were established in the former two groups.The rats in electro-acupuncture group was treated with electro-acupuncture after the operation, and those in the other two groups received no treatment.The right forefoot thermal withdrawal latency (TWL), the contents of IL-1β, IL-6 and TNF-α in the synovial fluid and the maximum tension load of supraspinatus tendon were measured at 2, 4 and 8 weeks after the operation.@*RESULTS@#TWL in the model group was significantly lower than that in the blank control group and electro-acupuncture group at 2, 4 and 8 weeks after the operation (@*CONCLUSIONS@#Electro-acupuncture treatment not only effectively reduces the expression of inflammatory factors to relieve pain, but also promotes the repair of damaged tissue to improve the biomechanical properties of rotator cuff in the rat models.


Subject(s)
Acupuncture Therapy , Animals , Biomechanical Phenomena , Disease Models, Animal , Rats , Rats, Sprague-Dawley , Rotator Cuff/surgery , Rotator Cuff Injuries/surgery , Wound Healing
12.
Article in Chinese | WPRIM | ID: wpr-879360

ABSTRACT

OBJECTIVE@#To investigate the method and clinical effects of arthroscopic rotator cuff repair with footprint ending shift for massive rotator cuff tear.@*METHODS@#From March 2015 to April 2019, 27 patients with massive rotator cuff tear underwent arthroscopic repair, including 12 males and 15 females, ranging in age from 37 to 74 years old, with an average age of (56.1±8.9) years. According to the tension of rotator cuff, 5 patients were treated with double row suture bridge technique, and 22 patients were treated with single row technique, among which 7 patients underwent partial rotator cuff repair. Before and after operation, University of California Los Angeles(UCLA) score, American Shoulder and Elbow Surgeons (ASES) score and visual analogue scale (VAS) were used to evaluate shoulder joint function.@*RESULTS@#All the patients were followed up, and the duration ranged from 8 to 40 months, with an average of (18.0±5.9) months. The UCLA score increased from preoperative 8.67±0.78 to final follow-up 30.89±1.07(@*CONCLUSION@#Arthroscopic rotator cuff repair with footprint ending shift for massive rotator cuff tear has satisfactory results, and single-row can be chosen to completely or partial repair rotator cuff tear for most patients.


Subject(s)
Adult , Aged , Arthroscopy , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Range of Motion, Articular , Rotator Cuff/surgery , Rotator Cuff Injuries/surgery , Treatment Outcome
13.
Article in Chinese | WPRIM | ID: wpr-879337

ABSTRACT

The rate of rotator cuff injury repair and retear is high in elderly patients due to the combination of different degrees of osteoporosis. To solve this problem, many surgeons try to reduce retear rate of rotator cuff injuries in these patients by increasing the initial fixation strength of anchors and changing local bone conditions. The rapid advances of tissue engineering have made it possible to use growth factors as an aid. However, repair of rotator cuff injury with osteoporosis is still a great challenge for clinical workers. How to better increase anchor fixation strength, improve micro-environment of tendon and bone healing, reduce the rotator cuff retear rate have become the research focus in recent years. The paper reviewed literatures on the relationshipbetween osteoporosis and rotator cuff injury, effect of osteoporosis in rotator cuff tendon healing, methods of reducing osteoporosis on rotator cuff tendon healing, in order to guide clinical treatment, improve operative effect and postoperative satisfaction.


Subject(s)
Aged , Arthroplasty , Humans , Osteoporosis , Rotator Cuff/surgery , Rotator Cuff Injuries/surgery , Tendons/surgery
14.
Clinics ; 75: e1817, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133459

ABSTRACT

Rotator cuff tears are common among the elderly, and studies on the outcomes after rotator cuff repair in the elderly are limited. We carried out this meta-analysis with systematic literature search, aiming to clarify the outcomes after rotator cuff repair in the elderly as assessed by the American Shoulder and Elbow Surgeons (ASES) shoulder score. We conducted a literature search through October 2019 in PubMed and EMBASE databases and performed meta-analysis to calculate the summary mean difference comparing the post- and pre-operation ASES scores under both fixed-effect and random-effect models. Among 4978 studies identified through literature search, four studies (two in the United States, one in France, and one in Republic of Korea) were eligible for the meta-analysis, including 282 patients who were aged over 70 years. These studies had low heterogeneity as measured by Cochran's Q test (p=0.88) and I2 statistic (0%). The ASES scores on average increased by 39.7 (95% confidence interval 28.3-51.1, p<0.001) after rotator cuff repair, in both fixed-effect and random-effect models. No substantial publication bias was indicated. Our findings suggest improved outcomes after rotator cuff repair in the elderly population as measured by the ASES score, and such improvements have been consistent in previous studies.


Subject(s)
Humans , Aged , Surgeons , Rotator Cuff Injuries/surgery , Arthroscopy , Shoulder , United States , Treatment Outcome , Rotator Cuff/surgery , Elbow
15.
Clinics ; 75: e2026, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133409

ABSTRACT

OBJECTIVES: We compared the analgesic efficacy of a continuous suprascapular nerve block (C-SSNB) and a single-shot interscalene brachial plexus block (S-ISNB) for postoperative pain management in patients undergoing arthroscopic rotator cuff repair. METHODS: A total of 118 patients undergoing arthroscopic rotator cuff repair were randomly allocated to the S-ISNB or C-SSNB groups. Postoperative pain was assessed using the visual analog scale (VAS) at 1, 2, 6, 12, and 24 h postoperatively. Supplemental analgesic use was recorded as total equianalgesic fentanyl consumption. RESULTS: The C-SSNB group showed significantly higher VAS scores at 0−1 h and 1−2 h after the surgery than the S-ISNB group (4.9±2.2 versus 2.3±2.2; p<0.0001 and 4.8±2.1 versus 2.4±2.3; p<0.0001, respectively). The C-SSNB group showed significantly lower VAS scores at 6−12 h after the surgery than the S-ISNB group (4.1±1.8 versus. 5.0±2.5; p=0.031). The C-SSNB group required significantly higher doses of total equianalgesic fentanyl in the post-anesthesia care unit than the S-ISNB group (53.66±44.95 versus 5.93±18.25; p<0.0001). Total equianalgesic fentanyl in the ward and total equianalgesic fentanyl throughout the hospital period were similar between the groups (145.99±152.60 versus 206.13±178.79; p=0.052 and 199.72±165.50 versus 212.15±180.09; p=0.697, respectively) CONCLUSION: C-SSNB was more effective than S-ISNB at 6−12 h after the surgery for postoperative analgesia after arthroscopic rotator cuff repair.


Subject(s)
Humans , Brachial Plexus Block , Rotator Cuff Injuries/surgery , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapy , Arthroscopy , Rotator Cuff/surgery , Anesthetics, Local
16.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(3): 265-272, jun. 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1020342

ABSTRACT

Introducción: La prevalencia del dolor de hombro oscila entre el 6,7% y el 66,7%; los trastornos del manguito rotador y especialmente la ruptura pueden alcanzar una prevalencia del 22,1%. Debido a los importantes avances y estudios en la reparación de esta lesión, la cirugía artroscópica ha permitido una mejor identificación, visualización y clasificación, y un mejor manejo de los pacientes. Además, la ruptura del manguito rotador o la fractura de la tuberosidad mayor del húmero incrementan el riesgo de lesión nerviosa (riesgo relativo -1,9), más significativa en pacientes >60 años. Se presenta a un paciente con ruptura postraumática del manguito rotador, quien requirió reparación artroscópica mínimamente invasiva, con evolución posoperatoria estacionaria y diagnóstico de lesión del nervio axilar, sin recuperación autolimitada atribuida a luxación anterior e inestabilidad secundaria al trauma inicial. Conclusiones: La lesión del nervio axilar es más frecuente que lo esperado y, en muchas ocasiones, la identificación temprana se pasa por alto debido a la alta asociación con otras lesiones. Por lo tanto, el diagnóstico y el manejo oportunos requieren mucho cuidado por parte del médico tratante. Nivel de Evidencia: IV


Introduction: The prevalence of shoulder pain varies between 6.7% and 66.7%; whereas rotator cuff disorders-especially rupture-can reach a prevalence of 22.1%. Due to the important advances and studies in the repair of this injury, arthroscopic surgery has allowed a better identification, visualization and classification, as well as a better handling of the patients. In addition, rotator cuff ruptures or greater tuberosity fractures increase the risk of nerve injury (relative risk -1.9), which is more significant in patients >60 years old. We discuss the case of a patient with post-traumatic rotator cuff rupture who required minimally invasive arthroscopic repair. No weight-bearing was allowed during the postoperative period. Patient presented a non-self-limited axillary nerve injury secondary to anterior dislocation and resulting instability after the original trauma. Conclusions: Axillary nerve injuries are more common than expected and, in many cases, early identification is not possible due to its high rate of association with other injuries. Therefore, treating physicians must be very careful in order to achieve a timely diagnosis and management of the patient. Level of Evidence: IV


Subject(s)
Middle Aged , Shoulder Joint/injuries , Axillary Artery/injuries , Rotator Cuff/surgery , Rotator Cuff Injuries/diagnosis , Postoperative Complications , Early Diagnosis
17.
Rev. Col. Bras. Cir ; 46(2): e2151, 2019. graf
Article in Portuguese | LILACS | ID: biblio-1003092

ABSTRACT

RESUMO O objetivo deste trabalho é descrever, em cadáver, a técnica de transferência do tendão longo do bíceps para o tratamento da instabilidade anterior do ombro. Nesta técnica, o tendão longo do bíceps braquial é desinserido do tubérculo supraglenoidal e transferido para a borda anterior da cavidade glenoidal, através da tenotomia do subescapular, reproduzindo o efeito tirante e aumentando o batente anterior. A técnica é de fácil execução, minimizando os riscos da transferência do processo coracoide e pode ser uma opção para o tratamento da instabilidade glenoumeral.


ABSTRACT Our objective is to describe the long biceps tendon transfer technique for the treatment of shoulder anterior instability. In this procedure, the long tendon of the biceps brachii is detached from the supraglenoid tubercle and transferred to the anterior edge of the glenoid cavity through a subscapularis tenotomy, reproducing the sling effect and increasing the anterior block. The technique is easy to perform and minimizes the risks of the coracoid process transfer. In conclusion, the transfer of the long tendon of the biceps brachii is an option for the treatment of glenohumeral instability.


Subject(s)
Humans , Shoulder Joint/surgery , Tendon Transfer/methods , Tendons/surgery , Rotator Cuff/surgery , Tenotomy/methods , Joint Instability/surgery , Reproducibility of Results , Treatment Outcome , Medical Illustration
18.
Acta cir. bras ; 32(12): 1045-1055, Dec. 2017. graf
Article in English | LILACS | ID: biblio-886197

ABSTRACT

Abstract Purpose: To evaluate the effect of transforming growth factor β1 (TGF-β1) on tendon-to-bone reconstruction of rotator cuff tears. Methods: Seventy-two rat supraspinatus tendons were transected and reconstructed in situ. At 8 and 16 weeks, specimens of three groups; that is control, L-dose (low dose), and H-dose (high dose) were harvested and underwent a biomechanical test to evaluate the maximum load and stiffness values. Histology sections of the tendon-to-bone interface were identified by hematoxylin-eosin or Masson trichrome stain. Collagen type III was observed by picric acid sirius red staining under polarized light. The level of insulin-like growth factor 1 (IGF-1) and vascular endothelial growth factor (VEGF) was measured by the enzyme-linked immunosorbent assay (ELISA) method. Results: Collagen type III of the H-dose group had a significant difference in histology structure compared with the L-dose group (P<0.05). The maximum load and stiffness decreased significantly in the control group compared with the values of the L-dose and H-dose groups. The stiffness among the three groups differed significantly at the same postoperative time (P<0.05). Interestingly, progressive reestablishment of collagen type III affected tendon-to-bone healing significantly in the later stages. Conclusion: The H-dose was associated with an increased collagen type III morphology stimulated by TGF-β1.


Subject(s)
Animals , Male , Rats , Tendon Injuries/drug therapy , Wound Healing/physiology , Rotator Cuff/surgery , Vascular Endothelial Growth Factors/metabolism , Transforming Growth Factor beta1/metabolism , Rotator Cuff Injuries/surgery , Tendon Injuries/metabolism , Tensile Strength/physiology , Wound Healing/drug effects , Biomechanical Phenomena , Enzyme-Linked Immunosorbent Assay , Rotator Cuff/metabolism , Rats, Sprague-Dawley , Collagen Type III/metabolism , Disease Models, Animal , Elasticity/physiology , Transforming Growth Factor beta1/pharmacology , Muscle Strength/physiology , Fibroblasts/drug effects , Fibroblasts/physiology , Rotator Cuff Injuries/metabolism
19.
Notas enferm. (Córdoba) ; 17(30): 5-11, nov. 2017. ilus
Article in Spanish | LILACS, BDENF, BINACIS, UNISALUD | ID: biblio-907852

ABSTRACT

Introduccion: teniendo en cuenta la variedad de procedimientos que se pueden realizar hoy con el artroscopio y de acuerdo a los numeros estadisticos que se manejan en el Sanatorio Allende, se describiran dos cirugias artroscopicas y el trabajo multidisciplinario que se realiza en el quirofano.Objetivo: revisar, establecer y actualizar las competencias del instrumentador quirurgico en procedimiento artroscopico de lesion de Bankart y Maguito rotador.Tipo de estudio: exploratorio y bibliografico, que se realizo durante enero 2016 a abril 2017.Resultados: en el periodo de estudio del presente trabajo en el departamento de Hombro del Sanatorio Allende se realizaron un total de 237 cirugias de hombro, dentro de las cuales 70 correspondieron a inestabilidad primaria, revision de inestabilidad y cirugias de Latarjet, 154 a manguito rotador y cirugia de revision de manguito rotador y 13 pertenecieron a luxacion acromioclavicular, Slap y reconstruccion de capsula superior.Cuando el instrumentador prepara una mesa quirurgica completa, se alcanza el exito de la cirugia y se aumenta el numero de intervenciones.Conclusiones: el reconocimiento del instrumentador respecto a la preparación de la cirugia, como así tambien de la tecnica quirurgica es de suma importancia porque va a reducir el tiempo quirurgico para el paciente, aportando beneficios como menor tiempo de anestesia, menos estres y mejora de tiempo de recuperacion inmediata.


Subject(s)
Humans , Arthroscopy , Bankart Lesions/surgery , Operating Room Technicians , Professional Competence , Rotator Cuff/surgery , Postoperative Care , Preoperative Period
20.
Rev. chil. ortop. traumatol ; 58(1): 13-20, mar. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-909844

ABSTRACT

OBJETIVO: Determinar si la aplicación precoz de un programa de ejercicios submaximal, disminuye el dolor y aumenta el rango de movimiento glenohumeral en comparación a un protocolo convencional, en sujetos sometidos a artroscopia del supraespinoso. MATERIAL Y MÉTODO: El presente estudio corresponde a un diseño casi experimental, longitudinal y prospectivo. La muestra contó con 30 sujetos, con un promedio de edad de 52,8 años. Los sujetos se dividieron aleatoriamente por sorteo simple. Un grupo recibió un protocolo de ejercicios submaximales de forma precoz, y el otro, péndulo de Codman. Las variables analizadas fueron: dolor y rango de movimiento glenohumeral. RESULTADOS: Ambos grupos mostraron diferencias estadísticamente significativas al término de las intervenciones para todas las variables (p < 0,05). Al comparar la efectividad entre ambos tratamientos, la rehabilitación submaximal precoz mostró una disminución del dolor y un aumento en la rotación externa glenohumeral estadísticamente significativa en comparación con el tratamiento con péndulo de Codman (p = 0,004 p = 0,001 respectivamente). DISCUSIÓN: Estudios hechos han establecido un margen seguro para la activación del manguito rotador, menor al 20% de la contracción voluntaria máxima para tendones reparados mediante cirugía. Nuestros resultados arrojan que este protocolo de ejercicios que cumple con esos niveles de activación aplicados de forma precoz, muestran beneficios sobre el rango y el dolor. CONCLUSIONES: La aplicación de un programa de ejercicio submaximal de forma precoz, podría disminuir el dolor y aumentar los rangos de flexión, abducción y rotación externa glenohumeral, disminuyendo las complicaciones de la inmovilización.


OBJECTIVE: Determine if the application of an early submaximal exercise program reduces pain and increases the glenohumeral joint range of motion in comparison to a conventional protocol, in subjects with supraspinatus arthroscopic surgery. METHOD: The present study corresponds to a prospective quasi-experimental longitudinal design study. The sample was formed by 30 subjects, with a mean aged of 52,8 years old. The subjects were randomly divided by a simple draw. One of the groups received the early submaximal exercise protocol, and the other the Codman pendulum exercises. The analyzed variables were; pain, glenohumeral range of motion. RESULTS: Both groups showed significant statistical differences for all variables at the end of the intervention (p < 0.05). When the effectiveness of both treatments were compared, the early submaximal rehabilitation showed a significant statistical difference in pain decreased, and an increased in glenohumeral external rotation, in comparison to the Codman pendulum treatment plan (p = 0.004 and p = 0.001 respectively). DISCUSSION: Studies have established a secure margin for the rotator cuff activation of less than 20% of maximal voluntary contraction for the surgery repaired tendons. Our results show that this exercise protocol complies with these levels of activation when applied in an early stage, show benefits in range of motion and pain. CONCLUSSIONS: The application on an early submaximal exercise program might decrease pain and increased glenohumeral flexion, abduction and external rotation range of motion, decreasing the complication due to immobilization.


Subject(s)
Humans , Male , Female , Middle Aged , Rotator Cuff/surgery , Rotator Cuff/physiology , Exercise Therapy/methods , Pain, Postoperative/prevention & control , Arthroscopy , Rehabilitation , Prospective Studies , Longitudinal Studies , Range of Motion, Articular/physiology , Physical Therapy Modalities , Immobilization
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