Predictors of outcomes after rotator cuff repair—A meta-analysis

Raman, Jayaprakash; Walton, David M.; MacDermid, Joy C.; Athwal, George S.

doi:10.1016/j.jht.2016.11.002

Cited by 72 publications

(53 citation statements)

References 43 publications

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“…DM is a risk factor for rotator cuff disease. 45 , 72 A meta-analysis 61 showed that diabetes had a significant negative effect on retears, with an odds ratio of 2.13 with homogeneity, in 2 cohorts. Thus, the results of this study confirmed what has been previously documented: DM is associated with a significantly increased risk of retears after rotator cuff repair, and improved glycemic control may reduce the risk of retears.…”

Section: Resultsmentioning

confidence: 99%

Clinical and Structural Outcomes After Rotator Cuff Repair in Patients With Diabetes: A Meta-analysis

Yang

Zhang

Ruan

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The impact of diabetes on clinical and structural outcomes after rotator cuff repair remains controversial. Purpose/Hypothesis: The purpose of this study was to compare clinical outcomes and retear rates after rotator cuff repair in patients with and without diabetes. Our hypotheses were that adequate control of diabetes would decrease the retear rate after rotator cuff repair and that patients with diabetes would have worse clinical outcomes. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Embase, and Cochrane Library databases were searched for studies comparing outcomes in patients with and without diabetes after full-thickness rotator cuff repair. Clinical outcome analysis included the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and the University of California–Los Angeles shoulder rating scale; we compared preoperative, postoperative, and change in functional scores from baseline to final follow-up among the included studies. The pooled relative risk was calculated using a random-effects model for retear rates. Clinical outcomes were also pooled using a random-effects model. Results: Overall, 10 studies were included. Compared with patients without diabetes, patients with diabetes had a worse preoperative ASES score ( P = .009) as well as worse postoperative Constant score (final follow-up range, 9-103 months; P = .0003). However, there was no significant difference in the absolute mean change in clinical outcomes between patients with and without diabetes. Diabetes was associated with a higher retear rate (19.3% in patients without diabetes vs 28.2% in patients with diabetes; P < .0001). The retear rate according to the severity of sustained hyperglycemia in the subgroup analysis was 14.6% in patients without diabetes, versus 22.7% in patients with well-controlled diabetes (<7.0% of preoperative serum HbA1c level; P = .12) and 40.0% in patients with uncontrolled diabetes (HbA1c level ≥7.0%; P < .00001). Conclusion: This meta-analysis suggests that diabetes mellitus is associated with an increased risk of retears after rotator cuff repair, and improved blood glucose control may reduce the risk of retears in patients with diabetes mellitus. Although effective glycemic control was associated with a decreased risk of retears in patients with diabetes, we could not prove causation because of potential bias and confounding in the included studies.

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Section: Resultsmentioning

confidence: 99%

Clinical and Structural Outcomes After Rotator Cuff Repair in Patients With Diabetes: A Meta-analysis

Yang

Zhang

Ruan

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…There are several patient-related factors that may influence the outcome of cuff tear in light of cuff integrity, shoulder function and patient satisfaction, such as tear size, number of involved tendons and fatty infiltration of the rotator cuff musculature 61. In the ACCURATE, these factors are controlled by precise exclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

Acute Cuff Tear Repair Trial (ACCURATE): protocol for a multicentre, randomised, placebo-controlled trial on the efficacy of arthroscopic rotator cuff repair

Ryösä¹,

Kukkonen

Hallgren

et al. 2019

BMJ Open

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IntroductionRotator cuff tear is a very common and disabling condition that can be related to acute trauma. Rotator cuff tear surgery is a well-established form of treatment in acute rotator cuff tears. Despite its widespread use and almost a gold standard position, the efficacy of an arthroscopic rotator cuff repair is still unknown. The objective of this trial is to investigate the difference in outcome between arthroscopic rotator cuff repair and inspection of the shoulder joint defined as placebo surgery in patients 45–70 years of age with an acute rotator tear related to trauma.Methods and analysisAcute Cuff Tear Repair Trial (ACCURATE) is a randomised, placebo-controlled, multicentre efficacy trial with sample size of 180 patients. Concealed allocation is done in 1:1 ratio. The randomisation is stratified according to participating hospital, gender and baseline Western Ontario Rotator Cuff Index (WORC). Both groups receive the same standardised postoperative treatment and physiotherapy. The primary outcome measure is the change in WORC score from baseline to 2-year follow-up. Secondary outcome measures include Constant-Murley Score, the Numerical Rating Scale for pain, subjective patient satisfaction and the health-related quality of life instrument 15 dimensions (15D). Patients and outcome assessors are blinded from the allocated intervention. The primary analysis of results will be conducted according to intention-to-treat analysis.Ethics and disseminationThe study protocol for this clinical trial has been approved by the Ethics Committee of the Hospital District of Southwest Finland and Regional Ethics Committee in Linköping Sweden and Regional Committees for Medical and Health Research Ethics South East in Norway. Every recruiting centre will apply local research approvals. The results of this study will be submitted for publication in peer-reviewed journals.Trial registration numberNCT02885714; Pre-results.

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“…4,[7][8][9][10] Apart from the severity of pathology, chronicity, age, sex, and mechanism of injury, the length of wait time to surgery is reported to affect recovery. 8,[11][12][13][14][15][16][17][18][19] Considering the linear relationship between wait times to receive surgery and developing chronic disability, [20][21][22][23][24] expediting surgery is expected to help with a more successful return to normal function. Expediting surgery in injured workers is not a new concept in Canada.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of expedited rotator cuff surgery in injured workers: Impact of pathology on readiness for return to work

Singh

Mann

Razmjou

2018

J Orthop Surg (Hong Kong)

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Objectives: The objectives of this study were to (1) examine the overall recovery and satisfaction following an expedited rotator cuff (RC) decompression or repair at 3-6 months and (2) explore group differences (repair vs. decompression) in demographics, clinical, disability, and psychosocial factors. Methods: This was a prospective longitudinal study of injured workers whose surgery was expedited. The outcome measures were Quick disabilities of the arm, shoulder, and hand (QuickDASH), the Hospital Anxiety and Depression Scale (HADS), the readiness for return to work (RRTW) scale, and satisfaction with surgery and overall recovery. Results: Of 118 patients participated in the study, 106 patients, age: 51 (9), 71 males (67%) completed the study. Sixty-four (60%) patients underwent a RC repair and 42 (40%) had RC decompression. Patients improved on average in QuickDASH (p ¼ 0.004), anxiety (p ¼ 0.003), and depression scores (p ¼ 0.004). The majority of patients (75%) were satisfied with surgery. In the decompression group, the pre-contemplation (PC) stage of the RRTW which documents the absence of desire or planning for return to work in the non-working sample (r ¼ 0.81, p ¼ 0.008) and the uncertain maintenance (UM) stage of the RRTW which explores the worker's struggle to stay at work in the working sample correlated with physical disability as measured by the QuickDASH scores (r ¼ 0.62, p ¼ 0.0001). In the repair group, the above domains correlated with the depression HADS scores (PC: r ¼ 0.64, p ¼ 0.001 and UM: r ¼ 0.57, p < 0.0001). Conclusion: Expedited RC surgery improved physical disability and mental well-being and was associated with a relatively high satisfaction at a maximum of 6 months. The poorer report of readiness for return to work was associated with higher physical disability in the decompression group and higher report of depression in the repair group. These differential associations may emphasize the importance of physical versus psychological management in patients with different levels of pathology.

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Predictors of outcomes after rotator cuff repair—A meta-analysis

Cited by 72 publications

References 43 publications

Clinical and Structural Outcomes After Rotator Cuff Repair in Patients With Diabetes: A Meta-analysis

Clinical and Structural Outcomes After Rotator Cuff Repair in Patients With Diabetes: A Meta-analysis

Acute Cuff Tear Repair Trial (ACCURATE): protocol for a multicentre, randomised, placebo-controlled trial on the efficacy of arthroscopic rotator cuff repair

Outcomes of expedited rotator cuff surgery in injured workers: Impact of pathology on readiness for return to work

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