scholarly journals The Impact of Smoking on Clinical Results Following the Rotator Cuff and Biceps Tendon Complex Arthroscopic Surgery

2021 ◽  
Vol 10 (4) ◽  
pp. 599
Author(s):  
Jan Zabrzyński ◽  
Gazi Huri ◽  
Maciej Gagat ◽  
Łukasz Łapaj ◽  
Alper Yataganbaba ◽  
...  

The purpose of this study was to investigate the association of smoking and functional outcomes after arthroscopic treatment of complex shoulder injuries: rotator cuff tears (RCTs) with biceps tendon (LHBT) tears. This retrospective case-control study has been conducted on a cohort of patients who underwent shoulder arthroscopy between 2015 and 2017 due to complex injury treatment. The outcomes were assessed using the American Shoulder and Elbow Surgeons Score (ASES), the University of California at Los Angeles (UCLA) Shoulder Score, need for non-steroid anti-inflammatory drugs (NSAIDs) consumption and the visual analog scale (VAS). Complications and changes in smoking status were also noted. A cohort of 59 patients underwent shoulder arthroscopy, due to complex LHBT pathology and RCTs, and were enrolled in the final follow-up examination; with mean duration of 26.03 months. According to smoking status, 27 of patients were classified as smokers, and the remaining 32 were non-smokers. In the examined cohort, 36 patients underwent the LHBT tenotomy and 23 tenodesis. We observed a relationship between smoking status and distribution of various RCTs (p < 0.0001). The mean postoperative ASES and UCLA scores were 80.81 and 30.18 in the smoker’s group and 84.06 and 30.93 in the non-smoker’s group, respectively. There were no statistically significant differences in pre/postoperative ASES and postoperative UCLA scores between smokers and non-smokers (p > 0.05). The VAS was significantly lower in the non-smokers’ group (p = 0.0021). Multi-tendon injuries of the shoulder are a serious challenge for surgeons, and to obtain an excellent functional outcome, we need to limit the negative risk factors, including smoking. Furthermore, there is a significant association between smoking and the occurrence of massive rotator cuff tears, and the pain level measured by the VAS. Simultaneous surgical treatment of RC and LHBT lesions in the smoker population allowed us to obtain the functional outcomes approximated to non-smokers in the long-term follow-up. Of course, we cannot assert that smoking is the real cause of all complications, however, we may assume that this is a very important, negative factor in shoulder arthroscopy.

2021 ◽  
Vol 12 ◽  
pp. 204062232199026
Author(s):  
Jan Zabrzyński ◽  
Maciej Gagat ◽  
Łukasz Łapaj ◽  
Łukasz Paczesny ◽  
Alper Yataganbaba ◽  
...  

Aim: The purpose of this study was to investigate whether there is an association between smoking, the extent of the degeneration process in the biceps tendinopathy, including cells and extracellular matrix (ECM) alterations, and long-term surgical results. Methods: This study comprised 40 consecutive patients admitted for shoulder arthroscopy due to symptomatic biceps tendinopathy and classified into three groups based on smoking status: active smokers, former smokers, and non-smokers. According to the classical Bonar score criteria, the histopathologic evaluation of the harvested intra-articular portion of the tendon was done. The follow-up examination was based on the American Shoulder and Elbow Surgeons Score (ASES). Results: A cohort of 32 patients was enrolled in the final follow-up examination; mean 37.56 months. Histopathological evaluation according to the classical Bonar score revealed degeneration of the tendinous tissue in each group but there was no correlation between the extent of degeneration, smoking indexes and the ASES. After revision of Bonar scale within the vascularity criterion, we found a correlation between the extent of degeneration of tendinous tissue, smoking data, ASES score, and the severity of rotator cuff injury. Conclusion: In this paper, we indicate the ambiguous role of the neovascularization in the biceps tendinopathy, and it was used for modification of the classical Bonar score. Consequently, recalculated, modified Bonar score was correlated positively with smoking indexes and functional outcomes. Furthermore, the morphological alterations of rotator cuff tendons also correlated positively with the extent of biceps tendon degeneration, measured according to the modified scoring system.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1779.2-1779
Author(s):  
C. Silva ◽  
N. Mourão ◽  
J. Landim ◽  
L. Da Rocha ◽  
M. Lacerda ◽  
...  

Background:Rotator cuff tears (RCT) rank high among causes of shoulder pain in primary care. Surgical repair of RCT is indicated when judged refractory to clinical treatment. Comorbidities and environmental issues may impact the surgical result of RCT repair.Objectives:to determine the impact of Obesity and Smoking in the outcome of low-income patients subjected to RCT repair.Methods:Low-income (<5500,00 US$ annualpib per capta*) patients living in Fortaleza-CE, Brazil were prospectively (2016-2018) evaluated in the Orthopedic and Rheumatology Services of the Hospital Geral de Fortaleza. Demographics and clinical data focusing Obesity (BMI >/≤ 30) and Smoking status (present/absent) were registered. Pain (0 – 10 cm VAS) and functional shoulder score evaluation by the University of California at Los Angeles Shoulder Score (UCLA) and American Shoulder and Elbow Surgeons (ASES) scoring systems following at least 2 years post-operative follow-up were recorded.Results:Thirty-nine individuals, 60.9±7.1 years-old, 30 female (68.3%) with 5.1 ± 1.9 years follow-up were evaluated; 21 (44.7%) were Smokers and 12 (25.5%) Obese (BMI >30). Other comorbidities included 16 arterial hypertension, 18 dyslipidemia, 17 osteoarthritis, 4 rheumatoid arthritis, 1 gout. Pain VAS values were 5.1 ± 2.6 vs 3.1 ± 2.8 in Obese vs Non-Obese (p=0.03) and 4 ± 2.8 vs 3.37 ± 2.99 in Smokers vs Non-Smokers (p=0.26), respectively. UCLA was 22.4 ± 8.2 vs. 28.79 ± 5.6 in Obese vs Non-Obese (p=0.004) and 26.2 ± 6.5 vs. 27.75 ± 7.18 (p=0.25) in Smokers vs. Non-smokers, respectively. ASES was 47.89 ± 28.3 vs. 68.1 ± 25.78 (p=0.021) in Obese vs. Non-obese and 58.98 ± 26.69 vs 65.3 ± 28.1 (p=0.243) in Smokers vs Non-Smokers, respectively.Conclusion:Using Patient Reported Outcome instruments, these long-term data show that Obesity negatively impacts the outcome of surgical repair of RCT in low-income patients. Smoking status was apparently irrelevant but the number of cigarettes smoked daily was not considered. Emphasis on weight reduction is a practical, affordable though hard to implement measure that could improve surgical results when repairing RCT.References:*https://pt.wikipedia.org/wiki/Lista_de_munic%C3%ADpios_do_Brasil_por_PIBDisclosure of Interests:Christine Silva: None declared, Natalia Mourão: None declared, Joaquim Landim: None declared, Leila da Rocha: None declared, Marco Lacerda: None declared, Airton Rocha Speakers bureau: Not related to the present work


2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0027
Author(s):  
Brandon C. Cabarcas ◽  
Grant Hoerig Garcia ◽  
Joseph Liu ◽  
Gregory Louis Cvetanovich ◽  
Anirudh K. Gowd ◽  
...  

Objectives: Superior capsular reconstruction (SCR) is a relatively new procedure to address irreparable rotator cuff tears and rotator cuff arthropathy. Biomechanical studies have produced favorable results on cadaveric models, but few studies have evaluated clinical outcomes, and none have addressed return to sport (RTS). The purpose of this study was to evaluate rates of RTS and functional outcomes after SCR compared to a reverse total shoulder arthroplasty (rTSA) matched cohort. Methods: A prospectively collected registry was queried retrospectively for consecutive patients who underwent SCR from 2015 to 2016. Inclusion criteria were ≥2 tendon irreparable rotator cuff tear by arthroscopic evaluation and minimum one-year follow up. All eligible SCR patients were matched by gender, age, handedness, and follow up time to patients that underwent rTSA with a similar preoperative diagnosis. All surgeries were performed by a single surgeon at one institution with consistent operative techniques. Patients were evaluated with the ASES questionnaire, VAS Pain Scale, as well as VR/SF-12 and VR6D. Patients were also administered a detailed outcomes survey regarding surgical history and return to sport and work activities. Results: Overall 75.0% of 32 eligible patients were available at follow up. Average age at surgery and follow up did not significantly differ between cohorts (p>0.500 both). Postoperative outcome scores for ASES, VAS, VR/SF-12, and VR6D did not differ (p>0.310 for all) between cohorts. Overall RTS rate was 77.8% for SCR and 87.5% for rTSA (p > 0.610). Average months to return to sports was significantly greater after SCR (7.3 ± 3.0) compared to rTSA (3.5 ± 2.2; p = 0.032). Patients in both cohorts participated in golf, weight-lifting, gym activity, basketball and cycling postoperatively. Direct RTS for these sports are displayed in Fig. 1. Return to work rate was 71.4% (10/14) SCR and 50.0% (4/8) rTSA (p = 0.326) at average 2.7 ± 2.8 and 1.9 ± 1.9 months, respectively (p = 0.591). Stratified by duty status, rates of return to work were sedentary (100% both SCR and rTSA), light (100% both SCR and rTSA), moderate (0% SCR and 66.67% rTSA), and heavy (0% both SCR and rTSA). Overall, 85.71% SCR patients and 90.0% rTSA patients were satisfied or very satisfied with their general postoperative outcome. Conclusion: At short-term follow-up, SCR patients had RTS rates comparable to rTSA patients with irreparable rotator cuff tears. However, time to RTS was more prolonged after SCR. Outcome scores did not significantly differ between the two cohorts, suggesting that SCR may achieve postoperative function and pain reduction similar to rTSA at one year. Return to work was also similar, although rates were not as high as return to sport. When stratified by duty status, return to more intense physical work demands was not consistent in either cohort. Despite this, over 85% of SCR and rTSA patients were satisfied postoperatively. The findings of this study demonstrate that SCR patients have high RTS levels, as well as similar functional outcomes and satisfaction compared to rTSA for irreparable rotator cuff tears. Clinicians can utilize this information for preoperative counseling, particularly with younger more athletic patients, considering SCR or rTSA for an irreparable rotator cuff tear.


2014 ◽  
Vol 17 (1) ◽  
pp. 44-47 ◽  
Author(s):  
Sung Jae Kim ◽  
Young Hwan Kim ◽  
Yong Min Chun

Typically, massive rotator cuff tears have stiff and retracted tendon with poor muscle quality, in such cases orthopaedic surgeons are confronted with big challenging to restore the cuff to its native footprint. Furthermore, even with some restoration of the footprint, it is related with a high re-tear rate due to less tension free repair and less tendon coverage. In this tough circumstance, the partial repair has yielded satisfactory outcomes at relatively short follow-up by re-creating the transverse force couple of the rotator cuff. Through this partial repair, the massive rotator cuff tear can be converted to the "functional rotator cuff tear" and provide improvement in pain and functional outcomes in patient's shoulder.


2020 ◽  
Vol 8 (2_suppl) ◽  
pp. 2325967120S0001
Author(s):  
Gabriel Lateur ◽  
Antonin Bentejac ◽  
Regis Pailhé ◽  
Maureen Cohen Bacry ◽  
Marie Anne Chanrion ◽  
...  

Background: The development of an ultrasound probe that can be used through an arthroscopic portal would provide direct access to the deep tissues of the shoulder. These structures are sometimes barely seen with an external ultrasound system and are also difficult to analyze under arthroscopy. Therefore, this intraoperative imaging technique could refine the diagnosis and surgical procedure and as a result provide more adequate therapy. The main objective of the study was to evaluate the feasibility of using an echo-endoscope to produce images during shoulder arthroscopy without causing secondary lesions. The secondary objective was to detect rotator cuff tears, calcific tendonitis, chondropathies, acromioclavicular arthropathy and labral tears. Methods: We used 6 shoulders of 3 anatomic subjects. The endo-ultrasound system used was the M15 probe developed by the society Cartimage Medical SAS® . The eleven structure of interest included in the principal objective of the study were: the tendon of the long head of the biceps, the glenoid and humeral cartilage surface, the gleno humeral ligament, the labrum, the rotator cuff tendon on their acromial and articular surfaces and the acromioclavicular joint. We noticed all lesions induced by the probe and we measured the acquisition time for the ultrasound images. The validation of the principles and secondary objectives were assessed by independent observer during the manipulations which were realized by one unique shoulder surgeon specialized in arthroscopic surgery. Results: We were able to produce ultrasound images of 68% of all the structures of interest. The inability to acquire certain images was partially due to the fact that the subjects were elderly (average age 90 years) and therefore, the structures of interest were no longer present. The secondary objective was partially fulfilled with the detection of complete tears of the supraspinatus tendon in 3 shoulders. We were also able to produce images of partial tears in the intra-tendinous cleavage. Intra-tendinous calcifications were explored in 1 shoulder. Humeral or glenoid chondropathy was identified in all the shoulders examined. Finally, no ultrasound-induced injuries were noted in any of the 6 shoulders in the study. The image acquisition time with the echo-endoscope was no more than 20 minutes for each shoulder, with an average time of 10 min 15 sec for shoulders with complete tissue evaluation. Conclusion: The echo-endoscope was easy and safe to use to acquire ultrasound images of the different glenohumeral or subacromial structures during shoulder arthroscopy. These results open the way for further explorations with the echo-endoscope.


2019 ◽  
Vol 11 (5) ◽  
pp. 857-863 ◽  
Author(s):  
Jing‐hua Fang ◽  
Xue‐song Dai ◽  
Xin‐ning Yu ◽  
Jian‐yang Luo ◽  
Xiao‐nan Liu ◽  
...  

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769737 ◽  
Author(s):  
Roger V. Ostrander ◽  
Jeffrey M. Klauser ◽  
Sanjay Menon ◽  
Joshua G. Hackel

Background: Partial-thickness articular-sided rotator cuff tears are a frequent source of shoulder pain. Despite conservative measures, some patients continue to be symptomatic and require surgical management. However, there is some controversy as to which surgical approach results in the best outcomes for grade 3 tears. Hypothesis/Purpose: The purpose of this study was to evaluate repair integrity and the clinical results of patients treated with transtendinous repair of high-grade partial-thickness articular-sided rotator cuff tears. Our hypothesis was that transtendinous repairs would result in reliable healing and acceptable functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: Twenty patients with a minimum follow-up of 2 years were included in the study. All patients underwent arthroscopic repair of high-grade partial-thickness rotator cuff tears utilizing a transtendinous technique by a single surgeon. At latest follow-up, the repair integrity was evaluated using ultrasound imaging, and functional scores were calculated. Results: Ultrasound evaluation demonstrated that 18 of 20 patients had complete healing with a normal-appearing rotator cuff. Two patients had a minor residual partial tear. Sixteen of 20 patients had no pain on visual analog scale. Four patients complained of mild intermittent residual pain. All patients were rated as “excellent” by both the University of California at Los Angeles Shoulder Score and the Simple Shoulder Test. Conclusion: The transtendon technique for the repair of articular-sided high-grade partial rotator cuff tears results in reliable tendon healing and excellent functional outcomes.


2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110061
Author(s):  
Bei Liu ◽  
Hyeon Jang Jeong ◽  
Ji Hyun Yeo ◽  
Joo Han Oh

Background: Platelet-rich plasma (PRP) has been applied as an adjuvant treatment for arthroscopic rotator cuff repair (ARCR) to enhance rotator cuff healing. However, it remains debatable whether PRP enhances tendon-to-bone healing. Purpose: To assess the efficacy of intraoperative augmentation and postoperative injection of PRP that was prepared using the double-spin method and calcium activation without thrombin in patients with ARCR. Study Design: Randomized controlled trial; Level of evidence, 1; and cohort study; Level of evidence, 3. Methods: A total of 58 patients underwent ARCR using intraoperative PRP augmentation. Half of the patients were randomly assigned to receive an additional ultrasound-guided PRP injection at the repair site at 2 weeks postoperatively (PRP-booster group); the other half did not receive the booster injection (PRP-only group). A control group that did not receive any PRP treatment was retrospectively matched using propensity score matching. Structural integrity was assessed using magnetic resonance imaging at 1 year postoperatively, and healing rates were compared between patients with tear sizes ≤2 cm versus >2 cm. Functional outcomes were assessed using the visual analog scale (VAS) for pain; VAS for satisfaction; shoulder range of motion; and Constant, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores at minimum 2-year follow-up. Results: In patients with tears >2 cm, the rate of healing failure at 1-year follow-up was significantly less in the overall PRP group than in the control group (12.9% vs 35.7%, respectively; P = .040), however, the PRP-booster group did not present a better healing rate than did the PRP-only group. The overall PRP group had lower VAS for pain scores compared with the control group (0.5 ± 1.1 vs 1.3 ± 1.8, respectively; P = .016) and higher VAS for satisfaction scores (9.2 ± 1.2 vs 8.6 ± 1.7; P = .023) at the final follow-up, whereas no statistical difference was found between the PRP-only and PRP-booster groups in functional outcomes. Conclusion: Intraoperative PRP augmentation during ARCR demonstrated superior anatomic healing results in patients with rotator cuff tears >2 cm as well as reduced pain and increased subjective satisfaction. PRP booster injection provided no additional benefit to tendon integrity or functional recovery.


2021 ◽  
Vol 49 (2) ◽  
pp. 298-304
Author(s):  
Marie Caroline Merlet ◽  
Virginie Guinet ◽  
Thomas Rousseau ◽  
Floris van Rooij ◽  
Mo Saffarini ◽  
...  

Background: Rotator cuff tears are common shoulder injuries that often cause pain and loss of function. Nonanatomic side-to-side techniques facilitate repair by minimizing tensions within tendons to improve healing and optimize the thickness of sutured tissues. Purpose/Hypothesis: The purpose was to evaluate long-term clinical and radiographic outcomes of arthroscopic side-to-side repair of massive rotator cuff tears (mRCTs). The hypothesis was that, at a minimum follow-up of 12 years, arthroscopic side-to-side repair maintains clinically important improvements. Study Design: Case series; Level of evidence, 4. Methods: The authors reviewed records of all patients who underwent arthroscopic repair of mRCTs over 2 consecutive years. A total of 30 adult patients met the eligibility criteria and underwent side-to-side repair. Patients were evaluated clinically using the Constant score (CS) and ultrasound to assess retears at 3 timepoints after surgery: 2 to 4 years, 5 to 7 years, and 12 to 14 years. Results: At first follow-up (3.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 13 retears (43%). At second follow-up (6.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 2 new retears (total 50%). At final follow-up (13.0 ± 0.7 years), only 21 patients had clinical assessment (1 died and 8 could not be reached), and only 19 patients had ultrasound assessment, which revealed 6 new retears (total 79%). Both absolute CS and age-/sex-adjusted CS improved significantly from baseline values at first follow-up (73.5 and 96.6, respectively), and remained stable at second follow-up (69.0 and 91.9, respectively), and final follow-up (64.4 and 87.0, respectively). Compared to shoulders with intact repairs, those with retears tended to have lower absolute CS at all follow-up visits, although differences were not statistically significant. Conclusion: Patients with mRCTs maintain satisfactory clinical scores at 12 to 14 years after arthroscopic side-to-side repair despite a high incidence of retears. Repair is a safe and effective treatment for mRCTs, providing a less invasive and less complex alternative to reverse shoulder arthroplasty and tendon transfer procedures.


2020 ◽  
Author(s):  
Zafer Volkan Gokce

Abstract Background: The aim of the present study was to evaluate the clinical and radiological outcomes of the patients who underwent open surgical repair with the diagnosis of rotator cuff rupture. Methods: Twenty-eight rotator cuff tear patients refractory to conservative treatment and underwent open rotator cuff repair between April 2012 and April 2017 were retrospectively included in the study. Patients were assessed radiologically and clinically before and after surgery. Patients' age, gender, duration of complaints, the type of the rupture, the data obtained during operation (rupture size, shape, affected tendon, the presence of retraction if any), postoperative complications were recorded. Functional assessments of the patients were performed at 6th and 12th months preoperatively and postoperatively with objective assessments using Constant and UCLA scoring. All patients' operated shoulders were evaluated with MRI during their recent follow-up. Results: The mean postoperative follow-up period of the patients was 30.4 (range: 13-72) months. Preoperative and postoperative mean UCLA scores of the patients were 10.85±1.89, and 28.8±3.34, respectively (p < 0.001). Pre-, and postoperative average Constant scores were 38.1 (range, 7.0 to 56.0), and 72.4 (range, 52.0 to 98.0), respectively (p < 0.001). Rotator cuff continuity was assessed in shoulder MRIs obtained during recent follow-ups of patients, and four recurrent tears were observed. Correlation tests revealed that tear size observed during surgery showed a significant (p = 0.002) and a weakly negative (r = -0.468) correlation with preoperative Constant scores, and a significant (p = 0.0001) and moderately negative (r = -0.645) relationship with postoperative Constant scores. UCLA and Constant functional outcomes were worse in patients over 60 years of age, than younger patients and recurrent tears were more often observed in the elderly population. A significant relationship was revealed between the age of the patients and tendon healing (p < 0.05). Conclusion: The results of this study suggest that open repair is a reasonable and successful treatment option in patients with rotator cuff tears. Overall satisfactory clinical outcomes could be achieved.


Sign in / Sign up

Export Citation Format

Share Document