ObjectiveTo explorethe method and effectivenessofarthroscopically assisted treatmentof rotator cuff injury. MethodsBetween November 2009 and March 2011, 27 patients with rotator cuff injury were treated. There were 17 males and 10 females with a mean age of 43.6 years (range, 29-66 years). The disease duration was1 to 36 months (mean, 27months). The location was theleft shoulder in 11 cases and theright shoulder in 16 cases. Of them, 12 cases had a history of trauma and 15 caseshad no obvious predisposing causes. All patients had limitation of shoulder flexionandabduction. Anteroposterior and lateral X-ray films of the shoulder and the out-let X-ray films of the supraspinous muscle were taken. According to the acromion classification of Bigliani, there were 5 cases of type I, 13 cases of type II, and 9 cases of type III. MRI images showed all patients had rupture of the rotator cuff. The examination of shoulder arthroscope showed complete rupture of the supraspinatus muscle in 27 cases and acromion impingement in 23 cases. The patients without impingement underwent tear debridement, and the patients with impingement underwent acromioplasty and resection of subacromial bursa after tear debridement. The 3-4 cm incision was made with arthroscopically assisted positioning, and the metal suture anchorwas placed on the greater tubercle of humerus to repair rotator cuff. ResultsAll incisions healed primarily. All patients were followed up 13-27 months (mean, 19 months). No infection, loosening of internal fixation, and rotator cuffre-tearoccurred. Pain was relieved and the results was satisfactory after operation. The shoulder range of motion (ROM) at last follow-up was significantly improved when compared with preoperative ROM (P lt; 0.05). The visual analogue scale (VAS) score was significantly improved from 8.0 ± 1.8 at preoperation to 1.6 ± 0.7 at 2 weeks after operation and 0.8 ± 0.7 at last follow-up (Plt; 0.05); the University of California Los Angeles (UCLA) score of shoulder was significantly increased from 18.8 ± 6.6 at preoperation to 32.2 ± 3.3at 3months after operation and 33.6 ± 2.1 at last follow-up (P lt; 0.05). Conclusion The effectivenessofarthroscopically assisted treatmentof rotator cuff injury is satisfactory. However, long-termeffectiveness needs furtherfollow-up observation.
ObjectiveTo provides an objective tool to evaluate rotator cuff function in rats. MethodsSixty adult male Sprague Dawley rats, weighing (281.21± 20.12) g, were involved in this experiment. Botulinum toxin A (6 U/kg) was injected into the infraspinatus of 12 rats in Botox group. Infraspinatus tendons of 12 rats in tear group were cut by microinvasive method. Infraspinatus tendons of 12 rats in sham-operation group were exposed but not cut. No any treatment was performed on the 12 rats in normal control group. One shoulder joint of each rat was selected randomly as treatment side. After 7 days, cadence, rate of stand phase, support pressure, swing speed, stand speed, and stride length of rats in those 4 groups were measured. Treatment side and contralateral side ratio of each gait parameter was caculated. If parameters of Botox group and tear group both showed significant differences compared with those of normal control group and sham-operation group, the gait parameter was brought into rating scale as an item. Each item was assigned from 1 point to 5 points according to gait parameter. The chronic rotator cuff injury model was established in 12 rats of verification group and rating scale was used to evaluate rotator cuff function each week for 8 weeks after surgery. ResultsAll gait parameters of tear group were significantly less than those of Botox group (P＜0.05), and Botox group was significantly less than sham-operation group and normal control group (P＜0.05), but no significant difference was found between sham-operation group and normal control group (P>0.05). All gait parameters were brought into rating scale as items. All items were rated from 1 point to 5 points, so the total score was 30 points and the lowest score was 6 points. Thirty points meant normal function of infraspinatus (rotator cuff function was normal), and 6 points meant complete loss of infraspinatus function (rotator cuff function was severely damaged). Rotator cuff functional scores of rats in verification group were 27.00±1.86, 23.75±2.83, 21.33±1.92, 18.17±2.37, 13.17±1.64, 11.67±2.50, 8.17±1.27, 6.50±0.67 from the 1st week to the 8th week respectively. ConclusionThe rating scale of rat rotator cuff function may reflect the severity of rotator cuff injury and the functional status of rotator cuff to some extent in rats.
Objective To compare the effectiveness of simultaneous and delayed repair of combined full-thickness rotator cuff rupture in proximal humerus fracture. Methods Between January 2015 and January 2017, 44 patients with proximal humerus fractures complicated with full-thickness rotator cuff injuries were included. Twenty-four patients underwent open reduction and internal fixation (ORIF) and rotator cuff repair simultaneously (simultaneous operation group), and 20 patients underwent delayed arthroscopic rotator cuff repair more than 90 days after ORIF (delayed operation group). There was no significant difference in gender, age, cause of injury, and side of injury between the two groups (P>0.05). The fracture healing was observed by X-ray films. The shoulder function was assessed at 3, 6, and 12 months after operation by using the University of California at Los Angeles (UCLA) score. Results All incisions healed by first intention. All patients were followed up 12-24 months (mean, 17 months). Fractures all healed at 3 months after operation in simultaneous operation group. According to UCLA score, the patients had achieved significantly better outcomes in function, active forward flexion, strength of forward flexion, and subjective satisfaction in simultaneous operation group than in delayed operation group at 3, 6, and 12 months after operation (P<0.05). However, there was no significant difference in pain between the two groups (P>0.05). Conclusion For patients with proximal humerus fracture complicated with full-thickness rotator cuff rupture, performing ORIF and simultaneous repair of rotator cuff can improve shoulder function and achieve better effectiveness when compared with delayed repair of rotator cuff.
Objective To explore the causal relationship between breast cancer and rotator cuff injury using bidirectional two-sample Mendelian randomization. Methods Instrumental variables for breast cancer and rotator cuff injury were extracted from published genome-wide association study data. The positive study used breast cancer as the exposure and rotator cuff injury as the outcome, with single nucleotide polymorphisms (SNPs) closely associated with both breast cancer and rotator cuff injury as genetic instrumental variables. The reverse study used rotator cuff injury as the exposure and breast cancer as the outcome, with SNPs closely associated with both breast cancer and rotator cuff injury as genetic instrumental variables. Bidirectional MR analysis was conducted using five models: inverse variance weighted (IVW), simple model, weighted median, weighted model, and MR-Egger to assess the causal relationship between breast cancer and rotator cuff injury. Cochran Q test was used to detect heterogeneity, MR-Egger to detect horizontal pleiotropy, and leave-one-out method for sensitivity analysis to ensure the robustness of the results. Results A total of 51 SNPs closely associated with breast cancer were included in the forward study. The results indicated a positive causal association between breast cancer and an increased risk of rotator cuff injury [IVW: odds ratio=1.08, 95% confidence interval (1.02, 1.12), P=0.014], with no evidence of heterogeneity in the causal relationship between breast cancer and rotator cuff injury (P>0.05). Horizontal pleiotropy test results showed no horizontal pleiotropy in the SNPs (P>0.05). Leave-one-out test results did not detect any SNP with a large impact on the results. In the reverse study, a total of 3 SNPs related to rotator cuff injury were included as instrumental variables. There was no strong evidence that rotator cuff injury had a causal effect on breast cancer incidence [IVW: odds ratio=0.95, 95% confidence interval (0.86, 1.05), P=0.334]. Conclusions There is a potential causal association between breast cancer and rotator cuff injury. Therefore, it is suggested to increase the screening for rotator cuff injury in breast cancer patients.
Objective To evaluate the clinical effectiveness and safety of tranexamic acid (TXA) in arthroscopic rotator cuff repair by meta-analysis. Methods Randomized controlled trials evaluating the clinical effectiveness and safety of TXA use in the perioperative period of arthroscopic rotator cuff repair were identified from the Cochrane Library, PubMed, Embase, VIP Chinese Science and Technology Periodical Database, Chinese National Knowledge Infrastructure, and Wanfang database, with a search time span from the inception of the database to August 2024. Meta-analysis was conducted using RevMan 5.3 software, and mean difference (MD) and risk difference (RD) were used as measures of effect size. Results A total of 7 randomized controlled trials were included. Meta-analysis demonstrated significant differences in good visual clarity [MD=9.10, 95% confidence interval (CI) (4.05, 14.15), P=0.0004] and operative time [MD=−12.07 min, 95%CI (−17.21, −6.93) min, P<0.00001]. There was no significant difference in mean arterial pressure [MD=−1.08 mm Hg (1 mm Hg=0.133 kPa), 95%CI (−3.13, 0.98) mm Hg, P=0.30] or adverse event rate [RD=0.02, 95%CI (−0.01, 0.06), P=0.22] between the two groups. Conclusion TXA is effective and safe in enhancing visual clarity and significantly reducing operative time in arthroscopic rotator cuff repair, without increasing the incidence of adverse events.
Objective To evaluate the effectiveness of tendon insertion medialized repair in treatment of large-to-massive rotator cuff tears (L/MRCT). Methods The clinical and imaging data of 46 L/MRCT patients who underwent arthroscopic insertion medialized repair between October 2015 and June 2019 were retrospectively analyzed. There were 26 males and 20 females with an average age of 57.7 years (range, 40-75 years). There were 20 cases of large rotator cuff tears and 26 cases of massive rotator cuff tears. Preoperative imaging evaluation included fatty infiltration (Goutallier grade), tendon retraction (modified Patte grade), supraspinatus tangent sign, acromiohumeral distance (AHD), and postoperative medializaiton length and tendon integrity. The clinical outcome was evaluated by visual analogue scale (VAS) score, American Society for Shoulder and Elbow Surgery (ASES) score, shoulder range of motion (including anteflexion and elevation, lateral external, and internal rotation) and anteflexion and elevation muscle strength before and after operation. The patients were divided into two groups (the intact tendon group and the re-teared group) according to the integrity of the tendon after operation. According to the medializaiton length, the patients were divided into group A (medialization length ≤10 mm) and group B (medialization length >10 mm). The clinical function and imaging indexes of the patients were compared. Results All patients were followed up 24-56 months, with an average of 31.8 months. At 1 year after operation, MRI showed that the medializaiton length of supraspinatus tendon was 5-15 mm, with an average of 10.26 mm, 33 cases in group A and 13 cases in group B. Eleven cases (23.91%) had re-teared, including 5 cases (45.45%) of Sugaya type Ⅳ and 6 cases (54.55%) of Sugaya type Ⅴ. At last follow-up, the VAS score, ASES score, shoulder anteflexion and elevation range of motion, lateral external rotation range of motion, and anteflexion and elevation muscle strength significantly improved when compared with those before operation (P<0.05); there was no significant difference in internal rotation range of motion between pre- and post-operation (P>0.05). The Goutallier grade and modified Patte grade of supraspinatus muscle in the re-teared group were significantly higher than those in the intact tendon group, and the AHD was significantly lower than that in the intact tendon group (P<0.05). There was no significant difference in other baseline data between the two groups (P>0.05). Except that the ASES score of the intact tendon group was significantly higher than that of the re-teared group (P<0.05), there was no significant difference in the other postoperative clinical functional indicators between the two groups (P>0.05). There was no significant difference in the incidence of re-tear, VAS score, ASES score, range of motion of shoulder joint, and anteflexion and elevation muscle strength between group A and group B (P>0.05). ConclusionTendon insertion medialized repair may be useful in cases with L/MRCT, and shows good postoperative shoulder function. Neither tendon integrity nor medialization length shows apparent correlations with postoperative shoulder function.
Objective To evaluate the effect of biodegradable magnesium alloy materials in promoting tendon-bone healing during rotator cuff tear repair and to investigate their potential underlying biological mechanisms.Methods Forty-eight 8-week-old Sprague Dawley rats were taken and randomly divided into groups A, B, and C. Rotator cuff tear models were created and repaired using magnesium alloy sutures in group A and Vicryl Plus 4-0 absorbable sutures in group B, while only subcutaneous incisions and sutures were performed in group C. Organ samples of groups A and B were taken for HE staining at 1 and 2 weeks after operation to evaluate the safety of magnesium alloy, and specimens from the supraspinatus tendon and proximal humerus were harvested at 2, 4, 8, and 12 weeks after operation. The specimens were observed macroscopically at 4 and 12 weeks after operation. Biomechanical tests were performed at 4, 8, and 12 weeks to test the ultimate load and stiffness of the healing sites in groups A and B. At 2, 4, and 12 weeks, the specimens were subjected to the following tests: Micro-CT to evaluate the formation of bone tunnels in groups A and B, HE staining and Masson staining to observe the regeneration of fibrocartilage at the tendon-bone interface after decalcification and sectioning, and Goldner trichrome staining to evaluate the calcification. Immunohistochemical staining was performed to detect the expressions of angiogenic factors, including vascular endothelial growth factor (VEGF) and bone morphogenetic protein 2 (BMP-2), as well as osteogenic factors at the tendon-bone interface. Additionally, immunofluorescence staining was used to examine the expressions of Arginase 1 and Integrin beta-2 to assess M1 and M2 macrophage polarization at the tendon-bone interface. The role of the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway in tendon-bone healing was further analyzed using real-time fluorescence quantitative PCR. Results Analysis of visceral sections revealed that magnesium ions released during the degradation of magnesium alloys did not cause significant toxic effects on organs such as the heart, liver, spleen, lungs, and kidneys, indicating good biosafety. Histological analysis further demonstrated that fibrocartilage regeneration at the tendon-bone interface in group A occurred earlier, and the amount of fibrocartilage was significantly greater compared to group B, suggesting a positive effect of magnesium alloy material on tendon-bone interface repair. Additionally, Micro-CT analysis results revealed that bone tunnel formation occurred more rapidly in group A compared to group B, further supporting the beneficial effect of magnesium alloy on bone healing. Biomechanical testing showed that the ultimate load in group A was consistently higher than in group B, and the stiffness of group A was also greater than that of group B at 4 weeks, indicating stronger tissue-carrying capacity following tendon-bone interface repair and highlighting the potential of magnesium alloy in enhancing tendon-bone healing. Immunohistochemical staining results indicated that the expressions of VEGF and BMP-2 were significantly upregulated during the early stages of healing, suggesting that magnesium alloy effectively promoted angiogenesis and bone formation, thereby accelerating the tendon-bone healing process. Immunofluorescence staining further revealed that magnesium ions exerted significant anti-inflammatory effects by regulating macrophage polarization, promoting their shift toward the M2 phenotype. Real-time fluorescence quantitative PCR results demonstrated that magnesium ions could facilitate tendon-bone healing by modulating the PI3K/AKT signaling pathway. ConclusionBiodegradable magnesium alloy material accelerated fibrocartilage regeneration and calcification at the tendon-bone interface in rat rotator cuff tear repair by regulating the PI3K/AKT signaling pathway, thereby significantly enhancing tendon-bone healing.
Objectives To compare the clinical therapeutic effect of arthroscope and mini-open in treating rotator cuff impairment with Meta-analysi. Methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (Jun 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2007), MEDLINE, EMBASE, and CBM, conference proceedings and reference lists of articles. Selection criteria: Randomized or comparative studies on all arthroscopic rotator cuff repairs and mini-open repairs. Results There were no randomized controlled trials (Level I) was found. Pooled results from all 12 trials showed that postoperative shoulder pain in all arthroscope group was statistically less than in the mini-open group (RR=0.94, 95%CI 0.28 to 1.60). Meanwhile, another evaluates outcomes such as ROM-Forward flexion (RR=0.17, 95%CI –0.10 to 0.45), patient’s satisfaction (RR=1.03, 95%CI 0.98 to 1.08), complication (RR=1.11, 95%CI 0.54 to 2.27), and shoulder functional score (RR=0.04, 95%CI –0.10 to 0.19) indicated no statistical difference in two groups. Conclusions According to Limited evidence, there are some findings as follows: comparing with mini-open treatment of rotator cuff impairment, all arthroscopic surgery can reduce the shoulder pain. Moreover, we found no statistical difference in shoulder functional score, ROM-Forward flexion, patient’s satisfaction and complication. Attention should be paid to outcome assessment in future trials.
Objective To explore the mid-term effectiveness of arthroscopic “mini incision” transtendon repair for partial articular-sided supraspinatus tendon avulsion (PASTA) lesion. Methods A clinical data of 39 patients with PASTA lesions, who underwent the arthroscopic “mini incision” transtendon repair and met the selected criteria between May 2017 and April 2021, was retrospectively analyzed. There were 13 males and 26 females, with an average age of 63.7 years (range, 43-76 years). Nine patients underwent trauma history, and no obvious inducement was found in the other 30 patients. The main clinical symptom was shoulder pain with positive hug resistance test. The interval from symptom onset to operation was 3-21 months (mean, 8.3 months). The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, American Association of Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion (ROM) of forward flexion, abduction, and external rotation were used to evaluate shoulder function. MRI was performed to assess the structural integrity and tension of reattached tendon. Patient satisfactions were calculated at last follow-up. Results All incisions healed by first intention with no complications such as incision infection or nerve injury. All patients were followed up 24-71 months (mean, 46.9 months). The VAS, UCLA, and ASES scores significantly improved at 24 months after operation when compared with preoperative ones (P<0.05). The ROMs of forward flexion and external rotation of the shoulder joint significantly increased at 3 and 24 months, and further increased at 24 months compared to 3 months, with significant differences (P<0.05). However, the ROM of abduction of the shoulder joint at 3 months did not significantly improve compared with that before operation (P>0.05), and it was significantly greater at 24 months than before operation and at 3 months after operation (P<0.05). At last follow-up, the patients were very satisfied with the effectiveness in 30 cases (76.9%), satisfied in 5 cases (12.8%), and dissatisfied in 4 cases (10.3%). At 6 months after operation, 31 patients underwent reviews of MRI scans, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing, and 3 patients underwent tendon re-tear. ConclusionArthroscopic “mini incision” transtendon repair in treatment of PASTA lesion could obtain satisfying mid-term effectiveness with low risk of tendon re-tear.