Mid‐Term Outcomes of Arthroscopic Rotator Cuff Repair in Patients with Rheumatoid Arthritis

Abstract

ObjectiveThe effectiveness of arthroscopic rotator cuff repair (ARCR) on rheumatoid arthritis (RA) patients remains a controversial topic. This study investigates the mid‐term outcomes of ARCR in RA patients and identifies the factors influencing clinical efficacy.MethodsThis retrospective study enrolled RA patients with small or medium rotator cuff tears (RCTs) between February 2014 and February 2019. Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Constant–Murley scores were collected at each follow‐up time. Ultimately, magnetic resonance imaging (MRI) and X‐ray were employed to assess rotator cuff integrity and progression of shoulder bone destruction, respectively. Statistical methods used two‐way repeated‐measures ANOVA or generalized estimation equations.ResultsA total of 157 patients were identified and divided into ARCR (n = 75) and conservative treatment (n = 82) groups. ARCR group continued to be divided into small tear (n = 35) and medium tear (n = 40) groups. At the final, all scores were better in ARCR group than in the conservative treatment group (p < 0.05). A radiographic evaluation of the final follow‐up demonstrated that the progression rate in ARCR group (18.67%) was significantly lower than that of the conservative treatment group (39.02%, p < 0.05). In the comparison of the small tear and medium tear groups, all scores increased significantly after surgery (p < 0.05), and the final follow‐up scores were better than preoperative scores (p < 0.05) but worse than those of the 6‐month postoperative follow‐up (p < 0.05). Comparison between the two groups revealed that all scores of the small tear group were significantly better than those of the medium tear group at 6‐month postoperative follow‐up (p < 0.05). Although the scores of small tear group remained better than those of the medium group at the final postoperative follow‐up, the difference was not statistically significant (p > 0.05). Radiographic assessment of the final follow‐up demonstrated that the progression rate in the small tear group (8.57%) was significantly lower than that in the medium group (27.50%, p < 0.05), and the retear rate of small tear group (14.29%) was significantly lower than that of the medium tear group (35.00%, p < 0.05).ConclusionARCR could effectively improve the quality of life for RA patients with small or medium RCTs, at least in the medium term. Despite the progression of joint destruction in some patients, postoperative retear rates were comparable to those in the general population. ARCR is more likely to benefit RA patients than conservative treatment.

Shoulder and Elbow Surgery Special Issue

“…The elbow section of this issue includes papers on arthroscopy, 1 open surgery in elbow stiffness, 2,3 fractures, 4 total elbow arthroplasty, 5 and conservative methods of treatment 6 . The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, 7–11 rotator cuff pathologies and fixation techniques, treatment of the post‐surgical or post‐traumatic glenohumeral stiffness, fractures of the proximal humerus, 5,12–21 the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models 22–31 …”

“…6 The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, [7][8][9][10][11] rotator cuff pathologies and fixation techniques, treatment of the post-surgical or post-traumatic glenohumeral stiffness, fractures of the proximal humerus, 5,[12][13][14][15][16][17][18][19][20][21] the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models. [22][23][24][25][26][27][28][29][30][31] Overall, this special issue contains plenty of meaningful readings for surgeons specializing in shoulder and elbow surgery and for general orthopaedic and trauma specialists, as well as for orthopaedic residents and young surgeons worldwide. Enjoy reading, sharing the data and the wonderful illustrations from this special issue, and we look forward to receiving your feedback.…”

“… 6 The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, 7 , 8 , 9 , 10 , 11 rotator cuff pathologies and fixation techniques, treatment of the post‐surgical or post‐traumatic glenohumeral stiffness, fractures of the proximal humerus, 5 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 …”