Preoperative Lymphocyte to Monocyte Ratio Can Be a Prognostic Factor in Arthroscopic Repair of Small to Large Rotator Cuff Tears

Abstract

Background: Complete arthroscopic repair can treat small to large rotator cuff tears (RCTs) with good outcomes; however, the repair might be compromised by inflammation. Purpose: To investigate the prognostic value of preoperative lymphocyte to monocyte ratio (LMR), a marker of systemic inflammation before surgery, in arthroscopic rotator cuff repair. Study Design: Case-control study; Level of evidence, 3. Methods: Between January 2014 and January 2016, primary small to large RCTs without stiffness, significant muscle fatty infiltration, or atrophy were completely repaired in 110 consecutive patients and followed. Preoperative LMR was obtained from blood routinely examined 1 day before surgery. Descriptive data and pre- and intraoperative variables were collected. Correlation analysis and multivariable linear regression analysis were used to determine the relationship between preoperative LMR and recovery including American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, Fudan University Shoulder Score (FUSS), visual analog scale (VAS) score for pain, and range of motion (ROM). Poor recovery was defined as ASES score <80, shoulder stiffness as external rotation ≤20°, and pain as VAS score >3. The predictive value of preoperative LMR was determined by receiver operating characteristic (ROC) curve. Results: A total of 99 patients (101 shoulders) were followed for 2.88 ± 0.43 years. Overall, mean ASES, Constant-Murley, FUSS, and VAS scores were significantly improved at the final follow-up; however, 27 cases had either ASES <80, shoulder stiffness, pain, or a combination of these. Correlation analysis and multivariable linear analysis showed that preoperative LMR was the only factor independently associated with functional recovery, pain, and ROM. Patients with poor recovery had lower preoperative LMR than those with good recovery. Based on the ROC curve, the cutoff value of preoperative LMR was 4.760. Patients with preoperative LMR <4.760 had significantly inferior clinical outcomes compared with their counterparts. The corresponding specificity was 0.542, and sensitivity was 0.779. Conclusion: Arthroscopic repair for small to large RCTs yielded good outcomes; however, some patients still had inferior functional scores, shoulder stiffness, or pain, which correlated with the level of preoperative systemic inflammation. As a marker of systemic inflammation, preoperative LMR could be prognostic for rotator cuff repair.

Identification of Diagnostic Biomarkers Associated with Stromal and Immune Cell Infiltration in Fatty Infiltration After Rotator Cuff Tear by Integrating Bioinformatic Analysis and Machine-Learning

“… 71 Sun et al found that preoperative lymphocyte to monocyte ratio less than 4.760 was a poor prognostic factor for arthroscopic rotator cuff repair. 72 Moreover, circulating monocytes could recruit and switch into macrophages after skeletal muscle injury, 73 while macrophages would infiltrate in fatty degenerative rotator cuff muscles. 21–23 Mast cells could boost myoblast proliferation in injured skeletal muscle.…”

The Serum from Patients with Secondary Frozen Shoulder Following Rotator Cuff Repair Induces Shoulder Capsule Fibrosis and Promotes Macrophage Polarization and Fibroblast Activation

“…Specifically, for the detection of systematic inflammation level between patients with and without sFS, one-side P < 0.05 was considered significant, since it is proved that patients with sFS had higher systematic inflammation level than those without. 3…”

“…Rotator cuff repair (RCR) has been widely used for rotator cuff tear (RCT) with overall satisfactory results; 1 however, 4.9% to 32.7% cases were reported to develop shoulder stiffness, or secondary frozen shoulder (sFS), 2 which may last more than 2 years. 3 Many systematic conditions, such as diabetes, 4 hypothyroidism 5 and low serum vitamin D level, 6 are found to be related to sFS, and cases with these disorders usually have high systematic inflammatory level. [7][8][9] Considering that systematic inflammation can be evaluated by blood routine, 10,11 recent studies confirmed that white cell counts and ratios correlate with compromised RCR outcomes and sFS.…”

“…[7][8][9] Considering that systematic inflammation can be evaluated by blood routine, 10,11 recent studies confirmed that white cell counts and ratios correlate with compromised RCR outcomes and sFS. 3,12 In the serum of the patients with systematic inflammation, levels of pro-inflammatory and pro-fibrotic cytokines, metabolites and other pathological factors are usually elevated. 13,14 These factors promote macrophagespolarization and fibroblastsactivation via NF-κB, Smads and other pathways, [15][16][17] and are potential biomarkers and drivers of liver, 18 renal 19 or lung fibrosis.…”

Kolesteatom Varliğinin Öngörülebi̇lmesi̇nde Kandaki̇ Nötrofi̇l/Lenfosi̇t Oraninin Önemi̇

“…Son yıllarda, tam kan sayımı parametrelerinden lenfosit, nötrofil, platelet, monosit ve eozinofil gibi değişkenlerin oranlarındaki değişimlerle ilgili çok sayıda çalışma yapılmıştır. İnflamatuar patolojilerde, bulaşıcı hastalıkların takiplerinde, kardiyak patolojilerde, acil cerrahi patolojilerde, postoperatif komplikasyonlarda, farklı kanser türlerinde nötrofil/lenfosit oranının (NLO), platelet/lenfosit oranının (PLO) ve lenfosit/monosit oranının (LMO) tanı ve takipte kullanılabileceği önceki çalışmalarda raporlanmıştır (6)(7)(8)(9)(10). Kolesteatom etyopatogenezinde de yer aldığı gibi, bir mikro ortam tarafından tetiklenen inflamasyonun; inflamatuar sitokin sentezi, akut faz reaktanları, nötrofil ve lenfositlerin serum seviyeleri dâhil olmak üzere hematolojik içerikleri değiştirdiği hipotezi öne sürülmüştür (11).…”