Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing. A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ2. The association between retear rate after surgery and patients’ age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used. Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3–6 months follow-up, 16% at 6–12 months follow-up, 21% at 12–24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures). Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results.

/pdf/retear-rates-after-rotator-cuff-surgery-a-systematic-review-4qcivbrrqh.pdf

Retear rates after rotator cuff surgery: a systematic review and meta-analysis

Senile Dementis: Outlook for the Future. localised neurons with discrete well defined Modern Aging Research Vol 5. Edited by projections. The recent advances in neuroJean Wertheimer & Maurice Marois. (Pp anatomical techniques are also reflected in 562; £52-00.) New York: Alan R Liss Inc, the final chapter on anatomical pathways. 1984. Chapters on the volume regulation of secretion and cardiovascular regulation and hyThe book comprises the proceedings of the pertension complete the five chapters of this Internal Conference \"Senile Dementia in the book. Course of the New Two Decades\" held in The use of vasporessin as a model system Lausanne in May 1983. A wide range of topin many different disciplines enables these ics relating to dementia are encompassed inchapters to be read with interest in their own cluding neurochemistry, pathogenesis, right. Overall, however, the book lacks coepidemilology, therapeutic possibilities and hesion and one wishes for a greater editorial the social and economic consequences of presence. A general introduction or even a cerebral atrophy. Sir Martin Roth draws topreface, would have been valuable. The lack gether these various strands of research into of cross-referencing is obvious; for example a final chapter of General Conclusions. in the chapter on cardiovascular regulation Despite the fact that this is a hardback it is stated that no vasopressin neurons have volume, the individual papers retain their been observed outside the hypothalamus, original typography and the eccentric transand yet recent studies using colchicine which lation of the mainly non-English condemonstrate perikarya in amygdala and lotributions, while not detracting from their cus caeruleus are fully discussed in chapter scientific content, preserves the idiomatic five. Finally the coverage appears uneven for flavour of the various languages. For those a book on the neurobiology of vasopressin. with special interest in the field, some of the A great deal is written on the peripheral contributions are now a little outdated and effects but there is no reference to the behavat a cost of £52 the book is unlikely to prove ioural effects. The question of whether the attractive to the general reader and is desobserved behavioural changes with vasotined for the library shelves. pressin are secondary to an influence on D NEARY arousal or more specifically to an effect on memory systems is an unresolved but important question, and the large amount of available data would justify a chapter in itself.

https://jnnp.bmj.com/content/jnnp/49/6/734.3.full.pdf

Pain Measurement in Man. Neurophysiological Correlates of Pain.

It is once again an honor and a privilege to be asked to present this update for the subspecialty of sports medicine. Sports medicine continues to be an expanding subspecialty field that crosses many boundaries. As mentioned in previous updates, however, our central mission remains the same—the care of the athlete.

This update is based on scientific and organizational activities in sports medicine that took place from September 2003 to August 2004. It includes a summary of the Annual and Specialty Day Meetings of the American Orthopaedic Society for Sports Medicine (AOSSM), the Arthroscopy Association of North America (AANA), and the American Academy of Orthopaedic Surgeons (AAOS). These meetings featured more than 200 scientific presentations, including both clinical and basic-science studies, that focused primarily on sports medicine.

The three most influential journals in our field will be reviewed again this year, specifically, The Journal of Bone and Joint Surgery, The American Journal of Sports Medicine, and Arthroscopy. 

### Anterior Cruciate Ligament

The optimum graft choice for anterior cruciate ligament reconstruction remains controversial. Several recent randomized, controlled studies showed equivalent results in association with both bone-patellar tendon-bone and quadrupled hamstring grafts, effectively endorsing a “double gold standard.” An additional randomized, prospective trial from Australia showed satisfactory functional outcomes in association with both types of grafts after three years of follow-up1. As in other studies, however, the authors noted increased kneeling pain in the bone-patellar tendon-bone group and slightly increased laxity and femoral tunnel widening in the hamstring group. Recent histological studies have shown that neither type of graft regenerates to a normal functional tendon. In two independent studies involving the use of magnetic resonance imaging and ultrasound examination following bone-patellar tendon-bone graft harvest, the patellar tendon had not normalized by six to ten years postoperatively2,3. Both groups of authors …

What's new in sports medicine.

Purpose Locking plate constructs for proximal humerus fractures can fail due to varus collapse, especially in the presence of osteoporosis and comminution of the medial cortex. Augmentation using a fibular allograft as an intramedullary bone peg may strengthen fixation preventing varus collapse. This study compared the ability of the augmented locking plate construct to withstand repetitive varus stresses relative to the non-augmented construct in cadaveric specimens. Method Proximal humerus fractures with medial comminution were simulated by performing wedge-shaped osteotomies at the surgical neck in cadaveric specimens. For each cadaver (n=8), one humeral fracture was fixated with the locking plate construct alone and the other with the locking plate construct plus ipsilateral fibular autograft augmentation. The humeral head was immobilized and a repetitive, medially-directed load was applied to the humeral shaft until failure (significant construct loosening or humeral head screw pull-out). Results No augmented construct failed, withstanding either 20 000 cycles or five times the cycles of the contralateral non-augmented construct [average (standard deviation) = 27958 (4633) cycles], while six of the eight non-augmented constructs failed (p=0.007). Failure in the six non-augmented constructs occurred after an average of 5928 (2543) cycles. Conclusion Fibular allograft augmentation increased the ability of the locking plate construct to withstand repetitive varus loading. Clinically, this may assist proximal humerus fracture fixation in osteoporotic bone with medial cortex comminution.

Proximal humerus fracture fixation: locking plate construct +/− intramedullary fibular allograft

Objective To investigate the effectiveness of early rehabilitation compared with delayed/standard rehabilitation after rotator cuff repair for pain, function, range of movement, strength, and repair integrity. Design Systematic review and meta-analyses. Methods We searched databases and included randomised controlled trials (RCTs) comparing early with delayed/standard rehabilitation for patients undergoing rotator cuff repair surgery. We assessed risk of bias of the RCTs using the Cochrane RoB 2 tool. Results Twenty RCTs, with 1841 patients, were included. The majority of the RCTs were of high or unclear risk of overall bias. We found substantial variations in the rehabilitation programmes, time in the sling and timing of exercise progression. We found no statistically significant differences for pain and function at any follow-up except for the outcome measure Single Assessment Numeric Evaluation at six months (MD: 6.54; 95%CI: 2.24–10.84) in favour of early rehabilitation. We found statistically significant differences in favour of early rehabilitation for shoulder flexion at six weeks (MD: 7.36; 95%CI: 2.66–12.06), three (MD: 8.45; 95%CI: 3.43–13.47) and six months (MD: 3.57; 95%CI: 0.81–6.32) and one year (MD: 1.42; 95%CI: 0.21–2.64) and similar differences for other planes of movement. In terms of repair integrity, early mobilisation does not seem to increase the risk of re-tears (OR:1.05; 95%CI: 0.64–1.75). Discussion Current approaches to early mobilisation, based largely on early introduction of passive movement, did not demonstrate significant differences in most clinical outcomes, although we found statistically significant differences in favour of early rehabilitation for range of movement. Importantly, there were no differences in repair integrity between early and delayed/standard rehabilitation. Most rehabilitation programmes did not consider early active movement as soon as the patient feels able. With ongoing variation in rehabilitation protocols there remains a need for large high quality RCT to inform the optimal approach to rehabilitation after rotator cuff repair surgery.

/pdf/effectiveness-of-early-versus-delayed-rehabilitation-1ufqlz55xc.pdf

Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses.

Purpose To compare the effect of early mobilization (EM) with standard rehabilitation (SR) over the initial 24 months following arthroscopic rotator cuff (RC) repair. Methods A total of 206 patients with full-thickness RC tears undergoing arthroscopic repair were randomized following preoperative assessment of shoulder range of motion (ROM), pain, strength, and health-related quality of life (HRQOL) to either EM (n = 103; self-weaned from sling and performed pain-free active ROM during the first 6 weeks) or SR (n = 103; wore a sling for 6 weeks with no active ROM). Shoulder ROM, pain, and HRQOL were reassessed at 6 weeks and 3, 6, 12, and 24 months postoperatively by a blinded assessor. At 6, 12, and 24 months, strength was reassessed. At 12 months, ultrasound verified RC integrity. Independent t tests assessed 6-week group differences and 2-way repeated measures analysis of variance assessed changes over time between groups. Results The groups were similar preoperatively (P > .12). The mean age of participants was 55.9 (minimum, 26; maximum, 79) years, and 131 (64%) were men. A total of 171 (83%) patients were followed to 24 months. At 6 weeks postoperatively, EM participants had significantly better forward flexion and abduction (P .08), and pain (P > .06), strength (P = .35), or HRQOL (P > .20) at any time. Fifty-two (25%) subjects (30% EM; 33% SR) had a full-thickness tear present at 12-month postoperative ultrasound testing (P > .8). Conclusions EM did not show significant clinical benefits, but there was no compromise of postoperative ROM, pain, strength, or HRQOL. Repair integrity was similar at 12 months postoperatively between groups. Consideration should be given to allow pain-free active ROM within the first 6 weeks following arthroscopic RC repair. Level of Evidence Level I, high-quality randomized controlled trial.

Early Active Motion Versus Sling Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

Background Loss of reduction (LoR) can occur after locking plate fixation of proximal humerus fractures (PHFs). This study determined biomechanical features of fracture fixation associated with preventing LoR postoperatively. One-year reoperation rates were also compared between those with/without LoR. Methods Population-based administrative data for 359 adults treated using a locking plate for PHF between 2010 and 2016 were examined. Two trained assessors reviewed standardized shoulder radiographs. LoR (Yes/No) was defined as any fracture displacement >0.5 cm, and/or >10° change in neck-shaft angle (NSA) alignment relative to intraoperative imaging. Multiple logistic regression assessed how the following affected maintaining reduction: (1) sex, (2) age, (3) Neer classification, (4) shaft impaction (SI), (5) shaft medialization (SM), (6) calcar reduction (CR), (7) NSA alignment, and (8) screw use. Results LoR was seen in 79 (22%) patients. LoR was significantly associated with increasing age (odds ratio [OR] = 1.06/yr, P < .001), fracture severity (4-part vs. 2-part fracture; OR = 4.63, P = .001), and varus NSA alignment (<125° vs. ≥145°: OR = 5.6, P = .02; <125° vs. 125-145°, OR = 2.2, P = .02]). Patients achieving simultaneous SI, SM, and CR were significantly less likely (OR = 0.009, P < .001) to lose reduction, after controlling for age, fracture severity, and NSA alignment. If only SI was achieved, patients were still significantly less likely to lose reduction relative to achieving none of these mechanical features (OR = 0.17, P = .006). Reoperations were higher when LoR occurred (n = 26/77 [33.4%]) compared with no LoR (n = 20/276 [7.2%]) (P < .001). Conclusions SI was strongly associated with preventing LoR in patients treated using a locking plate for PHF. SI with concurrent SM, CR, and a neutral or valgus NSA had the lowest rates of LoR. LoR was associated with higher rates of reoperation.

Factors associated with maintaining reduction following locking plate fixation of proximal humerus fractures: a population-based retrospective cohort study.

Background Providing physical therapists with evidence-based and consensus-derived guidelines to manage postoperative shoulder patients is essential; these guidelines should be readily available and provide clinically applicable information. Knowledge translation (KT) initiatives that encourage interaction between clinicians and researchers, that have multifaceted components and use a variety of strategies, can significantly change practice. Objective The objective of this study was to determine the uptake and acceptability of standardized postoperative shoulder guidelines with an accompanying online KT resource through evaluation of website analytics and a quantitative survey. Design A multi-pronged approach was used to assess uptake and acceptability of the guidelines and online KT resource. Methods Website analytics of usage and geographical location of users was measured as were physical therapist survey responses. Results Website analytics revealed that 5406 individuals used the online resource between October 2012 and September 2013 with the average visit lasting 8 minutes; only 47% of users were within the guideline developers' surgical referral region. Physical therapists who used the new shoulder guidelines were very satisfied or satisfied (96%) with the guidelines, reporting they promoted patient-specific clinical decision-making extremely or very well (68%). They viewed the online KT resource positively, with 79% rating it as "very useful" or "quite useful." Physical therapists from regions beyond those expected to use the new shoulder guidelines were also aware of the website and also rated it as very useful. Limitations The survey sample was relatively small and did not directly assess patient outcomes. Conclusions An online KT web resource developed in conjunction with standardized postoperative shoulder guidelines was perceived as useful based on website analytics and survey responses. Active KT strategies such as this can improve uptake and dissemination of best practice in physical therapy.

Evaluating the Uptake and Acceptability of Standardized Postoperative Rehabilitation Guidelines Using an Online Knowledge Translation Approach

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Early Active Motion Versus Sling Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

Factors associated with maintaining reduction following locking plate fixation of proximal humerus fractures: a population-based retrospective cohort study.

Evaluating the Uptake and Acceptability of Standardized Postoperative Rehabilitation Guidelines Using an Online Knowledge Translation Approach