One-stage surgical treatment for concomitant rotator cuff tears with shoulder stiffness has comparable results with isolated rotator cuff tears: a systematic review

Sabzevari, Soheil; Kachooei, Amir Reza; Giugale, Juan M.; Lin, Albert

doi:10.1016/j.jse.2017.03.005

Cited by 28 publications

(17 citation statements)

References 19 publications

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“…Sabzevari et al 188 reported that preoperative stiffness is associated with decreased preoperative ROM among patients undergoing RC repair; however, postoperative outcomes did not differ between those with and without preoperative stiffness. Papalia et al 163 also cited strong evidence for arthroscopic capsular release among patients with shoulder stiffness secondary to RC repair.…”

Section: Resultsmentioning

confidence: 96%

A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff

Jancuska

Matthews

Miller

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:The number of systematic reviews and meta-analyses published on the rotator cuff (RC) has increased markedly.Purpose:To quantify the number of systematic reviews and meta-analyses published on the RC and to provide a qualitative summary of the literature.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic search for all systematic reviews and meta-analyses pertaining to the RC published between January 2007 and September 2017 was performed with PubMed, MEDLINE, and the Cochrane Database of Systematic Reviews. Narrative reviews and non–English language articles were excluded.Results:A total of 1078 articles were found, of which 196 met the inclusion criteria. Included articles were summarized and divided into 15 topics: anatomy and function, histology and genetics, diagnosis, epidemiology, athletes, nonoperative versus operative treatment, surgical repair methods, concomitant conditions and surgical procedures, RC tears after total shoulder arthroplasty, biological augmentation, postoperative rehabilitation, outcomes and complications, patient-reported outcome measures, cost-effectiveness of RC repair, and quality of randomized controlled trials.Conclusion:A qualitative summary of the systematic reviews and meta-analyses published on the RC can provide surgeons with a single source of the most current literature.

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Section: Resultsmentioning

confidence: 96%

A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff

Jancuska

Matthews

Miller

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…put shoulders at the risk of the disease [27,28,29]. Rehabilitation [30], arthroscopic repair [31], and intra-articular injections of steroid [32] are common modalities. Hyaluronic acid [33] and platelet-rich plasma injections [34] improve rotator cuff lesions in experimental animals.…”

Section: Discussionmentioning

confidence: 99%

MicroRNA-29a Mitigates Subacromial Bursa Fibrosis in Rotator Cuff Lesion with Shoulder Stiffness

Lian

Tsai

et al. 2019

IJMS

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Rotator cuff lesion with shoulder stiffness is a major cause of shoulder pain and motionlessness. Subacromial bursa fibrosis is a prominent pathological feature of the shoulder disorder. MicroRNA-29a (miR-29a) regulates fibrosis in various tissues; however, the miR-29a action to subacromial bursa fibrosis remains elusive. Here, we reveal that subacromial synovium in patients with rotator cuff tear with shoulder stiffness showed severe fibrosis, hypertrophy, and hyperangiogenesis histopathology along with significant increases in fibrotic matrices collagen (COL) 1A1, 3A1, and 4A1 and inflammatory cytokines, whereas miR-29a expression was downregulated. Supraspinatus and infraspinatus tenotomy-injured shoulders in transgenic mice overexpressing miR-29a showed mild swelling, vascularization, fibrosis, and regular gait profiles as compared to severe rotator cuff damage in wild-type mice. Treatment with miR-29a precursor compromised COL3A1 production and hypervascularization in injured shoulders. In vitro, gain of miR-29a function attenuated COL3A1 expression through binding to the 3’-untranslated region (3′-UTR) of COL3A1 in inflamed tenocytes, whereas silencing miR-29a increased the matrix expression. Taken together, miR-29a loss is correlated with subacromial bursa inflammation and fibrosis in rotator cuff tear with shoulder stiffness. miR-29a repressed subacromial bursa fibrosis through directly targeting COL3A1 mRNA, improving rotator cuff integrity and shoulder function. Collective analysis offers a new insight into the molecular mechanism underlying rotator cuff tear with shoulder stiffness. This study also highlights the remedial potential of miR-29a precursor for alleviating the shoulder disorder.

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“…Multiple studies have demonstrated that concomitant surgical management for adhesive capsulitis e which includes manipulation under anesthesia (MUA) with or without capsular release e at the time of RCR is an effective treatment with objective and subjective outcomes that are equal to RCR alone in patients without preoperative stiffness. [4][5][6][7][8][9][10] Surgically treating the stiffness and the cuff tear simultaneously works. 8,10 Because of this, my preferred approach is an arthroscopic capsular release, followed by a gentle MUA before proceeding into the subacromial space for the arthroscopic RCR.…”

Section: See Related Article On Page 2954mentioning

confidence: 99%

Editorial Commentary: Concomitant Surgical Management for Rotator Cuff Tears With Adhesive Capsulitis is an Effective Treatment for Managing a Vexing Problem

Lin

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Rotator cuff tears (RCT) with concomitant frozen shoulder is a challenging clinical scenario that I, along with many other shoulder surgeons, commonly encounter. Some controversy exists regarding the optimal treatment. Does one address the shoulder stiffness first and regain range of motion (ROM) via nonoperative or operative means, then treat the rotator cuff tear later, or should it all be done at the same time surgically via a concomitant arthroscopic capsular release with or without manipulation under anesthesia (MUA) followed by a rotator cuff repair (RCR) in the same setting? I believe there is overwhelming evidence in the literature to support the latter. Address both pathologies concomitantly through a single stage surgery! In the setting of the RCT with adhesive capsulitis, I routinely recommend early concomitant arthroscopic capsular release with gentle MUA and then perform an arthroscopic RCR in one stage. This is then followed by an accelerated postoperative protocol which is balanced with some protection for healing. We have reported excellent outcomes with this approach. Similarly, I have found this approach to be highly effective, reproducible, and efficient, with high patient satisfaction and outcomes comparable to my patients who undergo arthroscopic RCR without stiff shoulders.

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One-stage surgical treatment for concomitant rotator cuff tears with shoulder stiffness has comparable results with isolated rotator cuff tears: a systematic review

Cited by 28 publications

References 19 publications

A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff

A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff

MicroRNA-29a Mitigates Subacromial Bursa Fibrosis in Rotator Cuff Lesion with Shoulder Stiffness

Editorial Commentary: Concomitant Surgical Management for Rotator Cuff Tears With Adhesive Capsulitis is an Effective Treatment for Managing a Vexing Problem

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