Objective To investigate the effectiveness of arthroscopic double fixation and enhanced suture of long head of biceps tendon (LHBT) in situ for repairing rotator cuff tear. Methods A retrospective analysis was conducted on 31 patients with rotator cuff tears and LHBT injuries admitted between June 2022 and November 2023. All patients underwent arthroscopic double fixation and enhanced suture of LHBT in situ. There were 12 males and 19 females, with an average age of 61.6 years (range, 53-76 years). There were 10 cases of acute injury and 21 cases of chronic injury. According to DeOrio and Cofield classification criteria, the degree of rotator cuff tear rated as medium-sized tears in 3 cases, large tears in 12 cases, and massive tears in 16 cases. Associated injuries included 5 cases of shoulder joint adhesions, 12 cases of subscapularis muscle tears, and 31 case of shoulder impingement syndromes. The shoulder range of motion (ROM) (forward flexion, abduction, lateral external rotation, lateral internal rotation) and pain/function scores [visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, Constant-Murley score] were recorded before operation and at last follow-up. MRI at last follow-up were taken to evaluate the rotator cuff healing and structural integrity. Results All 31 surgeries were successfully completed with operation time ranging from 90 to 210 minutes (mean, 144 minutes). The 3-5 anchors (mean, 3.8 anchors) were used during operation. All incisions healed by first intention. All patients were followed up 12-29 months (mean, 18.5 months). At 3 months after operation, 2 cases developed joint adhesions, 3 had internal rotation limitations, and 2 experienced residual pain at the intertubercular groove, all resolved with conservative management. No Popeye deformity occurred during follow-up. At last follow-up, shoulder ROM (forward flexion, abduction, lateral external rotation, lateral internal rotation) and pain/function scores (VAS, UCLA, and Constant-Murley scores) showed significant improvements compared to preoperative values (P<0.05). At last follow-up, MRI evaluation showed that the rotator cuff healing rate reached 90.3% according to the Sugaya classification criteria. LHBT exhibited normal morphology, course, and continuity without dislocation. Surrounding synovial sheath showed no thickening or effusion. Conclusion Arthroscopic double fixation and enhanced suture of LHBT in situ for repairing rotator cuff tear can significantly reduce shoulder joint pain, improve ROM, and achieve a high rotator cuff healing rate.
Objective To compare the effectiveness of the long head of the biceps tendon (LHBT) with or without proximal amputation after arthroscopic rotator cuff repair in the treatment of repairable rotator cuff tear with LHBT injury. Methods The clinical data of 68 patients with LHBT injury combined with supraspinatus tendon tear who met the selection criteria between January 2016 and June 2020 were retrospectively analyzed. According to whether the proximal end of LHBT was cut off or not after arthroscopic rotator cuff repair, they were divided into LHBT fixation without cutting group (group A, 32 cases) and LHBT fixation with cutting group (group B, 36 cases). There was no significant difference in gender, age, operating side, preoperative supraspinatus tear width, Constant-Murley shoulder function scale, University of California Los Angeles (UCLA) score, and visual analogue scale (VAS) score between the two groups (P>0.05). The operation time, elbow flexion muscle strength, and postoperative complications were compared between the two groups. The Constant-Murley shoulder function scale, UCLA score, and VAS score were used to evaluate the recovery of shoulder function before operation and at 3, 6, 12 months after operation. The acromion-humeral distance (AHD) was measured by Y-view X-ray film of the shoulder joint immediately after operation and at last follow-up. AHD and acromion-greater tubercle distance (AGT) were measured by musculoskeletal ultrasound at 0°, 30°, 60°, and 90° of abduction. Results There was no significant difference in operation time between the two groups (t=–0.740, P=0.463). Patients in both groups were followed up (13.0±0.7) months in group A and (13.1±0.8) months in group B, with no significant difference (t=0.127, P=0.899). At last follow-up, the elbow flexor muscle strength of the two groups reached grade Ⅴ. Complications (including shoulder pain, deltoid atrophy, and rotator cuff re-tear) occurred in 6 patients (18.75%) in group A and 9 patients (25.00%) in group B, without neurovascular injury, surgical site infection, joint stiffness, LHBT spasmodic pain, and Popeye deformity. There was no significant difference in the incidence of complications between the two groups (χ2=0.385, P=0.535). The Constant-Murley shoulder function scale, UCLA score, and VAS score significantly improved in both groups at 3, 6, and 12 months after operation (P>0.05). The above scores in group B were significantly better than those in group A at 3 and 6 months after operation (P<0.05), and there was no significant difference between the two groups at 12 months after operation (P>0.05). Y-view X-ray film measurement of the shoulder joint showed that the AHD of the two groups at last follow-up was less than that at immediate after operation, but the difference was not significant (Z=−1.247, P=0.212); the AHD of group A was significantly greater than that of group B at last follow-up (t=−2.291, P=0.025). During musculoskeletal ultrasound detection of abduction and shoulder lift, there was no significant difference in the reduction degree of AHD and AGT in group A with abduction of 0°-30° compared with group B (P>0.05). The reduction degree of AHD and AGT in group A with abduction of 30°-60°, and the reduction degree of AGT in group A with abduction of 60°-90° were significantly smaller than those in group B (P<0.05). Conclusion In arthroscopic rotator cuff repair, whether the proximal structure of LHBT is cut off or not after LHBT fixation can effectively improve the symptoms of patients and promote the recovery of shoulder joint function. Compared with preserving the proximal structure of LHBT, cutting the proximal structure of LHBT after LHBT fixation has more obvious pain relief within 6 months, and the latter had better stability above the shoulder joint.
ObjectiveTo detect the differentially expressed circular RNA (circRNA) in rotator cuff tendinopathy and analyze the potential molecular mechanism of these parental genes.MethodsTen supraspinatus tendons donated from patients who underwent tendon repair surgery between June 2018 and June 2019 were used for RNA-sequence. All rotator cuff tendinopathy and normal tendon samples were confirmed by MRI, histological staining, and observation by arthroscopy. All pathological tendons were matched with tendon samples for patients’ age, gender, body mass index, and Bonar score. The bioinformatic analysis was performed based on the differentially expressed circRNA and their parental genes, including gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and competing endogenous RNA (ceRNA) network construction.ResultsThere were 94 differentially expressed circRNAs, including 31 up-regulated and 63 down-regulated, detected between the rotator cuff tendinopathy and normal tendon samples with |log2 fold change (FC)| >2, P<0.05. GO analysis showed that the genes were mostly enriched in response to cyclic adenosine monophosphate (cAMP). KEGG pathway analysis showed that the most genes were enriched in extracellular matrix-receptor interaction, protein digestion and absorption, cell cycle, and nuclear factor κB signaling pathway. ceRNA networks showed the interactions among circRNAs, mRNAs, and miRNAs. And circRNA.8951-has-miR-6089-DNMT3B was the most sum max energy.ConclusionThis bioinformatic study reveals several potential therapeutic targets for rotator cuff tendinopathy, which paves the way to better treatment and prevention of this disorder.
Objective To investigate the effectiveness of “hybrid” suture with en masse combined with double-layer repair under arthroscopy in repair of delaminated rotator cuff tear by comparison with en masse suture. MethodsFifty-six patients with delaminated rotator cuff tears met selection criteria between June 2020 and January 2022 were included in the study. Patients were divided into two groups (n=28) using a random number method. The patients in trial group underwent arthroscopic “hybrid” suture with the combination en masse and double-layer suture. The patients in control group underwent en masse suture under arthroscopy. There was no significant difference between the two groups (P>0.05) in terms of gender, age, rotator cuff tear side, tear size, cause of injury, disease duration, and preoperative American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, visual analogue scale (VAS) score, and shoulder range of motion (forward flexion and lateral external rotation). The operation time, the difference of ASES score, UCLA score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) between pre- and post-operation were recorded and compared between the two groups (P>0.05). The rotator cuff healing was examined by MRI and evaluated based on the classification criteria of rotator cuff healing proposed by Sugaya et al. Results Three cases (1 case in the trial group and 2 cases in the control group) were excluded from the study due to loss of follow-up. Twenty-seven cases in the trial group and 26 cases in the control group were included in the final study analysis. All operations of the two groups were completed successfully. There was no significant difference in the operation time between groups (P>0.05). The follow-up time was 10-12 months (mean, 10.9 months) in the trial group and 10-13 months (mean, 11.4 months) in the control group. All incisions healed by first intention. No surgery-related complications occurred. The UCLA score, ASES score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) of both groups at 9 months after operation were significantly superior to those before operation (P<0.05). The difference of UCLA score, ASES score, and VAS score between before and after operation in the trial group were significantly better than those in the control group (P<0.05). There was no significant differences between the two groups in the difference of shoulder range of motion (forward flexion and lateral lateral rotation) (P>0.05). At 9 months after operation, according to the classification criteria of rotator cuff healing proposed by Sugaya et al, MRI showed that the rotator cuff healing of the trial group was significantly better than that of the control group (P<0.05). Conclusion Compared with en masse suture, arthroscopic “hybrid” suture for the repair of delaminated rotator cuff tear has advantages in relieving pain and improving shoulder joint function, and the rotator cuff healing is better.
Objective To investigate the effectiveness of proximal humerus internal locking system (PHILOS) plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture. MethodsThe clinical data of 48 patients with proximal humeral fractures admitted between January 2016 and December 2020 were retrospectively analyzed, including 18 males and 30 females. The age ranged from 28 to 69 years (mean, 56.3 years). The causes of injury included falling in 39 cases and traffic accident in 9 cases. The time from injury to operation was 2-5 days (mean, 2.8 days). All of them were Neer type Ⅳ proximal humerus fractures, including 11 patients with dislocation. All patients underwent internal fixation with a PHILOS plate after anatomical reduction of the greater nodule, and the rotator cuff was sutured to the plate to reinforce fixation. The operation time was recorded, the wound healing, fracture healing, and complications were observed. The visual analogue scale (VAS) score, Constant-Murley shoulder score, University of California Los Angeles (UCLA) score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder function before operation, at 3 months after operation, and at last follow-up. Results The operation time ranged from 65 to 90 minutes (mean, 76.9 minutes). All incisions healed by first intention. All patients were followed up 9-16 months (mean, 12 months). Fracture reduction was good and all fractures healed, the healing time was 2-6 months (mean, 4.6 months). There was no complication such as subacromial impingement, fracture redisplacement, and screw removal during follow-up. One patient had humeral head necrosis, but the basic function of the shoulder joint was acceptable, the symptoms were mild, and no treatment was performed. At 3 months after operation, the upper limb function of the patients basically recovered. The VAS score, Constant-Murley score, UCLA score, and ASES score significantly improved at 3 months after operation and at last follow-up when compared with preoperative, and further improved at last follow-up than at 3 months after operation (P<0.05). ConclusionPHILOS plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture has the advantages of promoting early postoperative rehabilitation exercise, improving postoperative function of shoulder joint, and reducing complications.
Objective To explore the causal relationship between breast cancer and rotator cuff injury using bidirectional two-sample Mendelian randomization. Methods Instrumental variables for breast cancer and rotator cuff injury were extracted from published genome-wide association study data. The positive study used breast cancer as the exposure and rotator cuff injury as the outcome, with single nucleotide polymorphisms (SNPs) closely associated with both breast cancer and rotator cuff injury as genetic instrumental variables. The reverse study used rotator cuff injury as the exposure and breast cancer as the outcome, with SNPs closely associated with both breast cancer and rotator cuff injury as genetic instrumental variables. Bidirectional MR analysis was conducted using five models: inverse variance weighted (IVW), simple model, weighted median, weighted model, and MR-Egger to assess the causal relationship between breast cancer and rotator cuff injury. Cochran Q test was used to detect heterogeneity, MR-Egger to detect horizontal pleiotropy, and leave-one-out method for sensitivity analysis to ensure the robustness of the results. Results A total of 51 SNPs closely associated with breast cancer were included in the forward study. The results indicated a positive causal association between breast cancer and an increased risk of rotator cuff injury [IVW: odds ratio=1.08, 95% confidence interval (1.02, 1.12), P=0.014], with no evidence of heterogeneity in the causal relationship between breast cancer and rotator cuff injury (P>0.05). Horizontal pleiotropy test results showed no horizontal pleiotropy in the SNPs (P>0.05). Leave-one-out test results did not detect any SNP with a large impact on the results. In the reverse study, a total of 3 SNPs related to rotator cuff injury were included as instrumental variables. There was no strong evidence that rotator cuff injury had a causal effect on breast cancer incidence [IVW: odds ratio=0.95, 95% confidence interval (0.86, 1.05), P=0.334]. Conclusions There is a potential causal association between breast cancer and rotator cuff injury. Therefore, it is suggested to increase the screening for rotator cuff injury in breast cancer patients.
ObjectiveTo investigate the feasibility and effectiveness of “tail compression fixation+suture bridge” technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff. Methods The clinical data of 11 patients with primary tear in medial enthesis of rotator cuff who met the selection criteria between October 2020 and October 2022 were retrospectively analyzed, including 3 males and 8 females, aged 39-79 years, with an average of 61.0 years. Rotator cuff injury was caused by traumatic fall in 8 cases, and the time from injury to admission was 1-4 months, with an average of 2.0 months; the remaining 3 cases had no obvious inducement. The active range of motion of the affected shoulder was limited, with an active forward flexion range of motion of (64.1±10.9)°, abduction of (78.1±6.4)°, internal rotation of (48.2±6.6)°, and external rotation of (41.8±10.5)°; 5 cases had shoulder stiffness. The preoperative visual analogue scale (VAS) score was 7.8±0.8 and the American Society of Shoulder and Elbow Surgeons (ASES) score was 23.9±6.4. The patients were treated with “tail compression fixation+suture bridge” technology under shoulder arthroscopy, and the pain and functional recovery were evaluated by VAS score, ASES score, and active range of motion of shoulder joint at last follow-up; MRI was performed after operation, and the integrity of rotator cuff was evaluated by Sugaya classification system. Results All the 11 patients were followed up 2-22 months, with an average of 13.5 months. All incisions healed by first intention, and there was no complication such as infection, rotator cuff re-tear, and anchor falling off. At last follow-up, the VAS score was 0.8±0.7 and the ASES score was 93.5±4.2, which significantly improved when compared with those before operation (P<0.05). All 11 patients had no significant swelling in the shoulders, and the active range of motion was (165.1±8.8)° in flexion, (75.3±8.4)° in abduction, (56.6±5.5)° in internal rotation, and (51.8±4.0)° in external rotation, which significantly improved when compared with those before operation (P<0.05). Shoulder MRI showed adequate tendon thickness and good continuity in 9 cases, including 4 cases with partial high signal area; and 2 cases with inadequate tendon thickness but high continuity and partial high signal area. According to Sugaya classification system, there were 4 cases of type 1 (36.4%), 5 cases of type 2 (45.5%), and 2 cases of type 3 (18.1%).Conclusion For the patients with primary tear in medial enthesis of rotator cuff, the “tail compression fixation+suture bridge” technology under shoulder arthroscopy is simple and effective.
Objective To compare effectiveness of injecting platelet-rich plasma (PRP) with different concentrations of leukocytes under ultrasound in treatment of supraspinatus tendon injury. Methods A clinical data of 30 patients with supraspinatus tendon injury, who met the selection criteria and were admitted between December 2022 and December 2023, was retrospectively analyzed. Thirty patients were treated with 4 injections of leukocyte-poor PRP (LP-PRP, n=10), leukocyte-rich PRP (LR-PRP, n=11), and triamcinolone (n=9), with an interval of 7-10 days between each injection. There was no significant difference between groups (P>0.05) in the age, gender, disease duration, affected shoulder side, Ellman classification, preoperative visual analogue scale (VAS) score, Constant score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and American Shoulder and Elbow Surgeons (ASES) score. At 1, 3, and 6 months after injection, the shoulder pain and function were evaluated by using the VAS score, Constant score, DASH score, and ASES score. MRI was conducted to observe supraspinatus tendon healing. Results No severe adverse reactions was observed in all groups. All patients were followed up 6-7 months, with an average of 6.5 months. After injection, the ASES score and Constant score gradually increased in the LR-PRP group and LP-PRP group, while the VAS score and DASH score decreased, with significant differences compared to before injection (P<0.05). Except for no significant difference between 3 and 6 months after injection in LR-PRP group (P>0.05), the above scores showed significant differences between different time points (P<0.05). At 1 month after injection, the Constant score in triamcinolone group significantly increased compared to before injection, while the VAS score significantly decreased (P<0.05). There was no significant difference in all scores between other time points in the triamcinolone group (P>0.05). Except for 1 month after injection, there was no significant difference in Constant score and VAS score between groups (P>0.05). At all other time points, the LR-PRP group and LP-PRP group had better scores than the triamcinolone group (P<0.05). There was no significant difference between the LR-PRP group and the LP-PRP group (P>0.05). MRI showed that only 4 patients in the LP-PRP group had signs of repair at the supraspinatus tendon injury site at 6 months after injection, while no significant tendon repair sign was observed in the other patients. Conclusion Compared with triamcinolone treatment, multiple injections of LP-PRP and LR-PRP under ultrasound can promote the recovery of shoulder joint function and significantly relieve pain in patients with supraspinatus tendon injury, and imaging improvement can be seen after LP-PRP treatment.