Prognostic factors for improvement of shoulder function after arthroscopic rotator cuff repair: a systematic review

Stojanov, Thomas; Audigé, Laurent; Modler, Linda; Aghlmandi, Soheila; Appenzeller-Herzog, Christian; Loucas, Rafael; Loucas, Marios; Müller, A

doi:10.1016/j.jseint.2022.09.003

Cited by 5 publications

(3 citation statements)

References 72 publications

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“…Main strength of the present consensus is that this is the first paper which carefully reviewed and questioned every single step in the diagnostic‐treatment algorithm of rotator cuff tears, including burning questions on management of partial‐thickness tears up to massive irreparable tears. Moreover, major controversial predictors (eg: age, smoking, comorbidities and fatty infiltration) claimed by current systematic reviews [8, 10, 12, 16, 20, 24, 26] were contextualized in clinical scenarios.…”

Section: Discussionmentioning

confidence: 99%

High degree of consensus on diagnosis and management of rotator cuff tears: a Delphi approach

Saccomanno

Lisai²,

Romano³

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To develop a consensus on diagnosis and treatment of rotator cuff tears. The study focused on selected areas: imaging, prognostic factors, treatment options, surgical techniques. Methods Panel was composed of all members of the shoulder committee of the Italian Society of Arthroscopy, Knee, Upper arm, Sport, Cartilage and Orthopedic techniques (SIAGASCOT). Four rounds were performed. The first round consisted of gathering questions which were then divided into seven blocks referring to: imaging, patient‐related prognostic factors, treatment options, surgical steps, reparative techniques, surgical predictive factors, advanced techniques. Subsequent rounds consisted of condensation by means of online questionnaire and debates. Consensus was defined as two‐thirds agreement on one answer. Descriptive statistic was used to summarize the data. Results Forty‐one shoulder experts were involved. Fifty‐six statements were finally formulated. A consensus could be achieved on 51. Experts agreed that preoperative magnetic resonance imaging is strongly recommended because it allows a careful evaluation of tear characteristics, while the role of US remains debatable. Controversial patient‐related factors such as age, comorbidities, smoking and stiffness do not contraindicate the repair. From a surgical standpoint, the experts highlighted that pseudo‐paralysis is not a contraindication to rotator cuff repair. Consensus on specific surgical steps was also achieved: capsular release should be performed only in stiff shoulders; footprint preparation is mandatory, while debridement of tendon edges is not essential. If necessary, a rotator interval release could be performed without interrupting the continuity between subscapularis and supraspinatus tendon; posterior delamination should be always included in the repair. Advanced techniques such as tendon transfers should be selected based on the main clinical deficit, while the superior capsule reconstruction plays a role only in combination with a functional repair. Conclusion A consensus was achieved almost on every topic of controversy explored. Particularly, MRI was deemed necessary to determine tear characteristics, while radiographs remain important for differential diagnosis; age should not be considered a contraindication to surgery; pseudo‐paralysis does not represent a contraindication to arthroscopic rotator cuff repair, but superior capsule reconstruction plays a role only in combination with a functional repair. Latissimus dorsi transfer plays a role when the main functional deficit is in elevation, while the lower trapezius transfer plays a role when the main functional deficit is the external‐rotation. Level of evidence V.

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Section: Discussionmentioning

confidence: 99%

High degree of consensus on diagnosis and management of rotator cuff tears: a Delphi approach

Saccomanno

Lisai²,

Romano³

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…In prognostic research studies, associations between a given factor and an outcome have to be replicated across different studies in order to classify the factor as one with potential prognostic importance [ 28 ]. In our recent systematic review, we identified that low preoperative functional status was associated with greater improvement in PROMs, which seems logical given that patients with poorer outcome scores are expected to have a greater change in outcome [ 29 ]. In this case, the type of modeled outcome has substantial importance on the direction in which the associations occur.…”

Section: Discussionmentioning

confidence: 99%

Development and internal validation of a model predicting patient-reported shoulder function after arthroscopic rotator cuff repair in a Swiss setting

Stojanov,

Aghlmandi,

Müller

et al. 2023

Diagn Progn Res

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Background Prediction models for outcomes after orthopedic surgery provide patients with evidence-based postoperative outcome expectations. Our objectives were (1) to identify prognostic factors associated with the postoperative shoulder function outcome (the Oxford Shoulder Score (OSS)) and (2) to develop and validate a prediction model for postoperative OSS. Methods Patients undergoing arthroscopic rotator cuff repair (ARCR) were prospectively documented at a Swiss orthopedic tertiary care center. The first primary ARCR in adult patients with a partial or complete rotator cuff tear were included between October 2013 and June 2021. Thirty-two potential prognostic factors were used for prediction model development. Two sets of factors identified using the knowledge from three experienced surgeons (Set 1) and Bayesian projection predictive variable selection (Set 2) were compared in terms of model performance using R squared and root-mean-squared error (RMSE) across 45 multiple imputed data sets using chained equations and complete case data. Results Multiple imputation using data from 1510 patients was performed. Set 2 retained the following factors: American Society of Anesthesiologists (ASA) classification, baseline level of depression and anxiety, baseline OSS, operation duration, tear severity, and biceps status and treatment. Apparent model performance was R-squared = 0.174 and RMSE = 7.514, dropping to R-squared = 0.156, and RMSE = 7.603 after correction for optimism. Conclusion A prediction model for patients undergoing ARCR was developed using solely baseline and operative data in order to provide patients and surgeons with individualized expectations for postoperative shoulder function outcomes. Yet, model performance should be improved before being used in clinical routine.

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“…The clinical outcomes of rotator cuff repair are generally favorable. 28 However, the presence of muscle atrophy and fatty infiltration of the torn muscles is a predictor of irreparable tears 8 and a risk factor for retear after surgical repair of rotator cuff tears. 7 , 12 Although muscle degeneration is related to poor clinical outcomes, its pathology and the mechanisms of the muscle degeneration remain unclear.…”

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confidence: 99%

Quantitative evaluation of natural progression of fatty infiltration and muscle atrophy in chronic rotator cuff tears without tear extension using magnetic resonance imaging

Matsumura,

Kiyota,

Suzuki

et al. 2024

JSES International

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Prognostic factors for improvement of shoulder function after arthroscopic rotator cuff repair: a systematic review

Cited by 5 publications

References 72 publications

High degree of consensus on diagnosis and management of rotator cuff tears: a Delphi approach

High degree of consensus on diagnosis and management of rotator cuff tears: a Delphi approach

Development and internal validation of a model predicting patient-reported shoulder function after arthroscopic rotator cuff repair in a Swiss setting

Quantitative evaluation of natural progression of fatty infiltration and muscle atrophy in chronic rotator cuff tears without tear extension using magnetic resonance imaging

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