Does application of abduction brace after arthroscopic rotator cuff repair improve blood flow around posterosuperior rotator cuff and repair site, affecting pain levels and clinical and structural outcomes? A pilot randomized controlled trial

Pandey, Vivek; Madi, Sandesh; Maddukuri, Satish Babu; Acharya, Kiran; Karegowda, Lakshmikanth Halegubbi; Willems, W. Jaap

doi:10.1016/j.jseint.2020.07.021

Cited by 7 publications

(10 citation statements)

References 27 publications

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“…17 Moreover, a clinical study found that the use of an abduction brace increases blood flow in the repaired tendon at 1 day and 6 weeks postoperatively 14 ; however, this did not lead to significant differences in clinical outcomes and structural healing between the abduction brace and arm pouch groups at 12 months postoperatively. 14 In addition, recent research has suggested potential complications with the use of an abduction brace after shoulder surgery. 20 One study reported a significantly higher incidence of falls after rotator cuff repair with postoperative abduction brace shoulder immobilization than after total hip and knee replacement during the early postoperative period because of visual field loss and body imbalance caused by the abduction brace.…”

Section: Discussionmentioning

confidence: 99%

“…The use of randomization was mentioned in 3 studies. 3,7,14 Allocation concealment was adequate in 3 studies. 3,7,14 There were 2 studies that reported that the orthopaedic surgeons and physical medicine specialists were blinded to patient allocation.…”

Section: Included Studiesmentioning

confidence: 99%

“…3,7,14 Allocation concealment was adequate in 3 studies. 3,7,14 There were 2 studies that reported that the orthopaedic surgeons and physical medicine specialists were blinded to patient allocation. 3,14 One study discussed reporting bias, 7 while none of the studies reported incomplete outcome data or discussed any other sources of bias.…”

Section: Included Studiesmentioning

confidence: 99%

“…5,17 Moreover, an abducted shoulder position is reported to achieve higher blood flow in and around the posterosuperior rotator cuff. 14 However, recent studies have found no significant difference in clinical outcomes with postoperative shoulder immobilization using an abduction brace versus a sling after rotator cuff repair. 1,3,7 Sonoda et al 20 found that using an abduction brace for immobilization after rotator cuff repair is associated with gait impairment and an increased fall risk during the early postoperative period because of visual field loss and body imbalance caused by the abduction brace.…”

mentioning

confidence: 99%

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Sling Versus Abduction Brace Shoulder Immobilization After Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis

Gao,

Zhou,

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: The optimal immobilization position of the shoulder after rotator cuff repair is controversial. Purpose: To compare the clinical outcomes and incidence of retears after arthroscopic rotator cuff repair between patients who used an abduction brace versus a sling for postoperative shoulder immobilization. Study Design: Systematic review; Level of evidence, 1. Methods: This systematic review and meta-analysis was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched the PubMed, MEDLINE, and Embase electronic databases for randomized controlled trials (RCTs) that compared abduction brace and sling immobilization after arthroscopic rotator cuff repair using single-row, double-row, or suture-bridge fixation. Clinical scores, pain severity, and retear rates were compared between patients with abduction brace versus sling immobilization. Results: Of 1572 retrieved studies, 4 RCTs with a total of 224 patients (112 patients with abduction brace and 112 patients with sling) were included in the qualitative analysis, and 3 of the RCTs were included in the quantitative analysis (meta-analysis). There were no significant differences between the abduction brace and sling immobilization groups in the Constant-Murley score at 3 months (weighted mean difference [WMD], 0.26 [95% CI, –1.30 to 1.83]; P = .74; I 2 = 84%), 6 months (WMD, 1.91 [95% CI, –0.17 to 4.00]; P = .07; I 2 = 85%), and 12 months (WMD, 0.55 [95% CI, –1.37 to 2.47]; P = .57; I 2 = 0%); the visual analog scale score for pain at 1 week (WMD, 0.10 [95% CI, –0.20 to 0.41]; P = .51; I 2 = 0%), 3 weeks (WMD, –0.12 [95% CI, –0.34 to 1.00]; P = .29; I 2 = 0%), 6 weeks (WMD, –0.12 [95% CI, –0.30 to 0.06]; P = .20; I 2 = 0%), and 12 weeks (WMD, –0.13 [95% CI, –0.27 to 0.02]; P = .09; I 2 = 18%); or the retear rate at 3 months (risk ratio, 0.63 [95% CI, 0.09 to 4.23]; P = .64; Z = 0.47%) postoperatively. Conclusion: Our systematic review demonstrated a lack of significant differences between the abduction brace and sling immobilization groups regarding postoperative clinical scores, pain severity, and tendon healing.

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Section: Discussionmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

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Sling Versus Abduction Brace Shoulder Immobilization After Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis

Gao,

Zhou,

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…No clinical study supports limiting how much abduction can be tolerated to accommodate repair, and postoperative abduction bracing does not appear to provide a benefit to structural or clinical outcomes. 73 High tension at the repair site is common because of the natural history of muscle fiber and tendon stump shortening, 56 as well as loss of tissue elasticity 17 , 18 with long-standing tears. On a histologic level, the loss of elasticity is related to fatty infiltration, and scarring increases the passive tension of the musculotendinous unit.…”

Section: Definition Of Termsmentioning

confidence: 99%

Massive and Irreparable Rotator Cuff Tears: A Review of Current Definitions and Concepts

Sheth

Shah

2023

Orthopaedic Journal of Sports Medicine

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Background: While massive and irreparable rotator cuff tears (MIRCTs) have been abundantly studied, inconsistent definitions in the literature and theories about pain and dysfunction related to them can be difficult to navigate when considering an individual patient. Purpose: To review the current literature for definitions and critical concepts that drive decision-making for MIRCTs. Study Design: Narrative review. Methods: A search of the PubMed database was performed to conduct a comprehensive literature review on MIRCTs. A total of 97 studies were included. Results: Recent literature reflects added attention to clarifying the definitions of “massive, “irreparable,” and “pseudoparalysis.” In addition, numerous recent studies have added to the understanding of what generates pain and dysfunction from this condition and have reported on new techniques for addressing them. Conclusion: The current literature provides a nuanced set of definitions and conceptual foundations on MIRCTs. These can be used to better define these complex conditions in patients when comparing current surgical techniques to address MIRCTs, as well as when interpreting the results of new techniques. While the number of effective treatment options has increased, high-quality and comparative evidence on treatments for MIRCTs is lacking.

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Aktuelle Aspekte der Behandlung der Rotatorenmanschette

2022

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ZusammenfassungRotatorenmanschettenrupturen gehören zu den häufigsten muskuloskeletalen Erkrankungen und können mit ausgeprägten Schmerzen und Funktionseinschränkungen einhergehen. Für ihre Entstehung ist eine Vielzahl von Faktoren relevant, u. a. die individuelle Anatomie des Akromions. Mit Hilfe der heutigen technischen Möglichkeiten wurde nun festgestellt, dass zusätzlich zu seiner lateralen Ausdehnung auch die sagittale Ausdehnung des Akromions eine Rolle zu spielen scheint. Die bildgebende Darstellung der Rotatorenmanschette (RM) hat von den technischen Fortschritten der letzten Jahrzehnte ebenfalls profitiert. Magnetresonanztomographie (MRT) und MR-Arthrographie werden heute flächendeckend eingesetzt. Letztere bietet die höchste Sensitivität für die Entdeckung selbst kleiner Partialläsionen. Neue Sequenzen und Nachbearbeitungsmöglichkeiten können als hilfreiche tools für die operative Planung eingesetzt werden. Grundsätzlich richtet sich die Behandlung der RM neben der Symptomatik nach der Rupturgenese und -morphologie sowie der erwarteten Gewebequalität des Muskel-Sehnen-Kontinuums. Auch das Gesamtprofil, die Erwartungshaltung und die Rehabilitationsmöglichkeiten des Patienten sind wichtig. Die heutigen operativen Techniken werden durch spannende Entwicklungen der Industrie mitbestimmt, die in den letzten Jahren immer bessere Fadenankersysteme, aber auch Augmentationsmaterialien auf den Markt gebracht hat. Letztere zielen nicht nur auf die mechanische Verstärkung der Sehnenrekonstruktion, sondern auch auf die Optimierung der biologischen Eigenschaften des Konstrukts ab. Hinsichtlich Fixation konnte die biomechanische Forschung zeigen, dass zweireihige oder Suture-Bridge-Fixationen einreihigen oder transossären Fixationen überlegen sind. Diese Überlegenheit im Labor spiegelt sich noch nicht klar in den klinischen Ergebnissen wider, dennoch sind die meisten Chirurgen heute auf diese Technik übergegangen. Was die postoperative Nachbehandlung angeht, stellen jüngste randomisiert-kontrollierte Untersuchungen das Konzept der postoperativen Immobilisation in Abduktion in Frage. Hier scheint das letzte Wort noch nicht gesprochen zu sein.

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Does application of abduction brace after arthroscopic rotator cuff repair improve blood flow around posterosuperior rotator cuff and repair site, affecting pain levels and clinical and structural outcomes? A pilot randomized controlled trial

Cited by 7 publications

References 27 publications

Sling Versus Abduction Brace Shoulder Immobilization After Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis

Sling Versus Abduction Brace Shoulder Immobilization After Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis

Massive and Irreparable Rotator Cuff Tears: A Review of Current Definitions and Concepts

Aktuelle Aspekte der Behandlung der Rotatorenmanschette

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