Volume 6 | Issue 1 | January-June 2021 | Page 39-47 | Andrew Arjun Sayampanathan, Marcus Wei Ping Tan, Denny Tjiauw Tjoen Lie
Author: Andrew Arjun Sayampanathan [1], Marcus Wei Ping Tan [2], Denny Tjiauw Tjoen Lie [1, 2]
[1] National Preventive Medicine Residency Programme, National University Health System, Singapore.
[2] Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Address of Correspondence:
Dr. Denny TT Lie,
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
E-mail: denny.lie.t.t@singhealth.com.sg
Abstract
Rotator cuff tears are known to result in significant societal burden. This review synthesises the evidence regarding the role and outcomes of conservatively managed rotator cuff tears. 17 prospective randomised controlled trials (RCTs) (Level 1 and 2 studies) were included in this systematic review. Modalities which were studied were classified into physical rehabilitative modalities, electrophysiological rehabilitative modalities, biological therapies, and pharmacologic therapies. Outcomes which were evaluated in the included RCTs comprised of clinical outcomes, functional outcomes, pain scores, quality of life scores, imaging based outcomes, and patient satisfaction scores. As the modalities and outcomes studied were varied, no quantitative analysis could be performed based on the primary data available. Nevertheless, most studies do suggest that conservative treatment remains beneficial for the management of rotator cuff tears. Based on these findings, an algorithm which proposes conservative therapy as the central mode of management for rotator cuff tear patients has been described. More high-quality studies are required in this area of study to allow for a quantitative review (meta-analysis and meta-regression) of the various non-surgical treatment
modalities of rotator cuff tears.
Keywords: Rotator Cuff Tears; Conservative; Non-operative; Management; Randomised controlled trials; Review.
References
1. Östör AJK, Richards CA, Prevost AT, Speed CA, Hazleman BL. Diagnosis and relation to general health of shoulder disorders presenting to primary care. Rheumatology. 2005;44(6):800-805. doi:10.1093/rheumatology/keh598
2. Minagawa H, Yamamoto N, Abe H, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop. 2013;10(1):8-12. doi:10.1016/j.jor.2013.01.008
3. Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elb Surg. 1999;8(4):296-299. doi:10.1016/S1058-2746(99)90148-9
4. Milgrom C, Schaffler M, Gilbert S, Van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Jt Surg – Ser B. 1995;77(2):296-298. doi:10.1302/0301-620x.77b2.7706351
5. Mather RC, Koenig L, Acevedo D, et al. The societal and economic value of rotator cuff repair. J Bone Jt Surg – Ser A. 2013;95(22):1993-2000. doi:10.2106/JBJS.L.01495
6. Silverstein BA, Viikari-Juntura E, Fan ZJ, Bonauto DK, Bao S, Smith C. Natural course of nontraumatic rotator cuff tendinitis and shoulder symptoms in a working population. Scand J Work Environ Heal. 2006;32(2):99-108. doi:10.5271/sjweh.985
7. Seida JC, LeBlanc C, Schouten JR, et al. Systematic review: Nonoperative and operative treatments for rotator cuff tears. Ann Intern Med. 2010;153(4):246-255. doi:10.7326/0003-4819-153-4-201008170-00263
8. Piper CC, Hughes AJ, Ma Y, Wang H, Neviaser AS. Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elb Surg. 2018;27(3):572-576. doi:10.1016/j.jse.2017.09.032
9. Lähteenmäki HE, Virolainen P, Hiltunen A, Heikkilä J, Nelimarkka OI. Results of early operative treatment of rotator cuff tears with acute symptoms. J Shoulder Elb Surg. 2006;15(2):148-153. doi:10.1016/j.jse.2005.07.006
10. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Jt Surg – Ser A. 2000;82(4):505-515. doi:10.2106/00004623-200004000-00006
11. Dunn WR, Schackman BR, Walsh C, et al. Variation in orthopaedic surgeons’ perceptions about the indications for rotator cuff surgery. J Bone Jt Surg – Ser A. 2005;87(9 I):1978-1984. doi:10.2106/JBJS.D.02944
12. Safran O, Schroeder J, Bloom R, Weil Y, Milgrom C. Natural history of nonoperatively treated symptomatic rotator cuff tears in patients 60 years old or younger. Am J Sports Med. 2011;39(4):710-714. doi:10.1177/0363546510393944
13. Millett PJ, Horan MP, Maland KE, Hawkins RJ. Long-term survivorship and outcomes after surgical repair of full-thickness rotator cuff tears. J Shoulder Elb Surg. 2011;20(4):591-597. doi:10.1016/j.jse.2010.11.019
14. Gladstone JN, Bishop JY, Lo IKY, Flatow EL. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med. 2007;35(5):719-728. doi:10.1177/0363546506297539
15. Inderhaug E, Kollevold KH, Kalsvik M, Hegna J, Solheim E. Preoperative NSAIDs, non-acute onset and long-standing symptoms predict inferior outcome at long-term follow-up after rotator cuff repair. Knee Surgery, Sport Traumatol Arthrosc. 2017;25(7):2067-2072. doi:10.1007/s00167-015-3845-8
16. Kuhn JE, Dunn WR, Sanders R, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: A multicenter prospective cohort study. J Shoulder Elb Surg. 2013;22(10):1371-1379. doi:10.1016/j.jse.2013.01.026
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42. Chechik O, Dolkart O, Mozes G, Rak O, Alhajajra F, Maman E. Timing matters: NSAIDs interfere with the late proliferation stage of a repaired rotator cuff tendon healing in rats. Arch Orthop Trauma Surg. 2014;134(4):515-520. doi:10.1007/s00402-014-1928-5
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How to Cite this article: Sayampanathan AA, Tan MWP, Lie DTT | Role And Outcomes of Conservative Treatment in Management of Rotator Cuff Tears: A Systematic Review of Randomised Controlled Trial |
Asian Journal of Arthroscopy | January- June 2021; 6(1): 39-47. |
Functional Outcome in Arthroscopic ACL Reconstruction with Immediate Full Weight Bearing Mobilization- Retrospective Study
Volume 6 | Issue 1 | January-June 2021 | Page 03-07 | Vijayamohan, Shyam Gopal V, Mohana Chandran, Aleena Antony
Author: Vijayamohan [1], Shyam Gopal V [1], Mohana Chandran [2], Aleena Antony [3]
[1] Department of Orthopaedics, Aster Centre of Excellence in Orthopaedics & Rheumatology, Aster Medcity, Kochi, Kerala, India.
[2] Department of Physiotherapy, Aster Centre of Excellence in Orthopaedics & Rheumatology, Aster Medcity, Kochi, Kerala, India
[3] Counsellor, Aster Centre of Excellence in Orthopaedics &Rheumatology, Aster Medcity, Kochi, Kerala, India.
Address of Correspondence:
Dr. Shyam Gopal V,
Specialist, Aster centre of Excellence in Orthopaedics & Rheumatology,
Aster Medcity, Kochi, Kerala, India.
E-mail: shyamg911@gmail.com
Abstract
Rehabilitation following anterior cruciate ligament surgery continues to evolve, with the current emphasis being on immediate weight bearing and range of motion, and progressive muscular strengthening, proprioception, dynamic stability, and neuromuscular control drills. In this study we evaluate the functional outcome of Immediate full weight bearing mobilization following arthroscopic ACL (Anterior Cruciate Ligament) reconstruction with quadrupled hamstring graft using endobutton and bioscrew. With the advancement of fixation techniques immediate weight bearing mobilization after arthroscopic ACL reconstruction can give better functional outcome and improved patient satisfaction. Although further large volume multicentric research is needed for establishing a
standardized rehabilitation protocol following arthroscopic ACL reconstruction, immediate weight bearing doesn’t cause any complications and has better outcome as per our study.
Keywords: Arthroscopic reconstruction, ACL, Immediate weight bearing.
References
1 . John T. Cavanaugh, Matthew PowersACL Rehabilitation Progression: Where Are We Now? Curr Rev Musculoskelet Med. 2017 Sep; 10(3): 289–296. Published online 2017 Aug 8. doi: 10.1007/s12178-017-9426-3
2. Tyler TF, McHugh MP, Gleim GW, Nicholas the effect of immediate weightbearing after anterior cruciate ligament reconstruction. SJClin Orthop Relat Res. 1998 Dec; (357):141-8.
3. Rafael F. Escamilla, PT, PhD, CSCS, FACSM1Toran D. MacLeod, PT, PhD2Kevin E. Wilk, PT, DPT3Lonnie Paulos, MD4James R. Andrews, MD5ACL Strain and Tensile Forces for Weight Bearing and Non—Weight-Bearing Exercises After ACL Reconstruction: A Guide to Exercise SelectionJournal of Orthopaedic & Sports Physical TherapyPublished Online:March 1, 2012Volume42Issue3Pages208-220
https://www.jospt.org/doi/10.2519/jospt.2012.3768
4. Heijne A, Werner S. Early versus late start of open kinetic chain quadriceps exercises after ACL reconstruction with patellar tendon or hamstring grafts: a prospective randomized outcome study. Knee Surg Sports Traumatol Arthrosc. 2007;15:402-414. http://dx.doi. org/10.1007/s00167-006-0246-
5.Agarwal AR, Dussa KR, Singhal A, et al. A retrospective analysis of arthroscopic ACL reconstruction with hamstring tendon graft. J. Evid. Based Med. Healthc. 2017; 4(64), 3841-3845. DOI: 10.18410/jebmh/2017/767
6. Jorgensen U, Jensen CM, Scanvenius M, et al. Rehabilitation with or without initial weightbearing: a prospective randomized study. Presented at: Sports Medicine 2000; June 6-8, 1995; Stockholm, Sweden.
7. Lysholm J, Gillquist J. (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med; 10-3:150-4
8. Tegner Y, Lysolm J. (1985) Rating Systems in the Evaluation of Knee Ligament Injuries. Clinical Orthopedics and Related Research. Vol. 198: 43-49.
9. Tajima T, Yamaguchi N, Nagasawa M, Morita Y, Nakamura Y, Chosa E. Early weight-bearing after anterior cruciate ligament reconstruction with hamstring grafts induce femoral bone tunnel enlargement: a prospective clinical and radiographic study. BMC Musculoskelet Disord. 2019;20(1):274. Published 2019 Jun 4. doi:10.1186/s12891-019-2653-6
10. Rizer M, Foremny GB, Rush A, III, Singer AD, Baraga M, Kaplan LD, Jose J. Anterior cruciate ligament reconstruction tunnel size: causes of tunnel enlargement and implications for single versus two-stage revision reconstruction. Skeletal Radial. 2017;46:161–169. doi: 10.1007/s00256-016-2535-z.
Arthroscopic ACL Reconstruction with Immediate Full Weight Bearing Mobilization-Retrospective Study | Asian Journal of Arthroscopy | January- June 2021; 6(1): 03-07.
(Abstract Text HTML) (Download PDF)
Role And Outcomes of Conservative Treatment in Management of Rotator Cuff Tears: A Systematic Review of Randomised Controlled Trials
Volume 6 | Issue 1 | January-June 2021 | Page 39-47 | Andrew Arjun Sayampanathan, Marcus Wei Ping Tan, Denny Tjiauw Tjoen Lie
Author: Andrew Arjun Sayampanathan [1], Marcus Wei Ping Tan [2], Denny Tjiauw Tjoen Lie [1, 2]
[1] National Preventive Medicine Residency Programme, National University Health System, Singapore.
[2] Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Address of Correspondence:
Dr. Denny TT Lie,
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
E-mail: denny.lie.t.t@singhealth.com.sg
Abstract
Rotator cuff tears are known to result in significant societal burden. This review synthesises the evidence regarding the role and outcomes of conservatively managed rotator cuff tears. 17 prospective randomised controlled trials (RCTs) (Level 1 and 2 studies) were included in this systematic review. Modalities which were studied were classified into physical rehabilitative modalities, electrophysiological rehabilitative modalities, biological therapies, and pharmacologic therapies. Outcomes which were evaluated in the included RCTs comprised of clinical outcomes, functional outcomes, pain scores, quality of life scores, imaging based outcomes, and patient satisfaction scores. As the modalities and outcomes studied were varied, no quantitative analysis could be performed based on the primary data available. Nevertheless, most studies do suggest that conservative treatment remains beneficial for the management of rotator cuff tears. Based on these findings, an algorithm which proposes conservative therapy as the central mode of management for rotator cuff tear patients has been described. More high-quality studies are required in this area of study to allow for a quantitative review (meta-analysis and meta-regression) of the various non-surgical treatment
modalities of rotator cuff tears.
Keywords: Rotator Cuff Tears; Conservative; Non-operative; Management; Randomised controlled trials; Review.
References
1. Östör AJK, Richards CA, Prevost AT, Speed CA, Hazleman BL. Diagnosis and relation to general health of shoulder disorders presenting to primary care. Rheumatology. 2005;44(6):800-805. doi:10.1093/rheumatology/keh598
2. Minagawa H, Yamamoto N, Abe H, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop. 2013;10(1):8-12. doi:10.1016/j.jor.2013.01.008
3. Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elb Surg. 1999;8(4):296-299. doi:10.1016/S1058-2746(99)90148-9
4. Milgrom C, Schaffler M, Gilbert S, Van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Jt Surg – Ser B. 1995;77(2):296-298. doi:10.1302/0301-620x.77b2.7706351
5. Mather RC, Koenig L, Acevedo D, et al. The societal and economic value of rotator cuff repair. J Bone Jt Surg – Ser A. 2013;95(22):1993-2000. doi:10.2106/JBJS.L.01495
6. Silverstein BA, Viikari-Juntura E, Fan ZJ, Bonauto DK, Bao S, Smith C. Natural course of nontraumatic rotator cuff tendinitis and shoulder symptoms in a working population. Scand J Work Environ Heal. 2006;32(2):99-108. doi:10.5271/sjweh.985
7. Seida JC, LeBlanc C, Schouten JR, et al. Systematic review: Nonoperative and operative treatments for rotator cuff tears. Ann Intern Med. 2010;153(4):246-255. doi:10.7326/0003-4819-153-4-201008170-00263
8. Piper CC, Hughes AJ, Ma Y, Wang H, Neviaser AS. Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elb Surg. 2018;27(3):572-576. doi:10.1016/j.jse.2017.09.032
9. Lähteenmäki HE, Virolainen P, Hiltunen A, Heikkilä J, Nelimarkka OI. Results of early operative treatment of rotator cuff tears with acute symptoms. J Shoulder Elb Surg. 2006;15(2):148-153. doi:10.1016/j.jse.2005.07.006
10. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Jt Surg – Ser A. 2000;82(4):505-515. doi:10.2106/00004623-200004000-00006
11. Dunn WR, Schackman BR, Walsh C, et al. Variation in orthopaedic surgeons’ perceptions about the indications for rotator cuff surgery. J Bone Jt Surg – Ser A. 2005;87(9 I):1978-1984. doi:10.2106/JBJS.D.02944
12. Safran O, Schroeder J, Bloom R, Weil Y, Milgrom C. Natural history of nonoperatively treated symptomatic rotator cuff tears in patients 60 years old or younger. Am J Sports Med. 2011;39(4):710-714. doi:10.1177/0363546510393944
13. Millett PJ, Horan MP, Maland KE, Hawkins RJ. Long-term survivorship and outcomes after surgical repair of full-thickness rotator cuff tears. J Shoulder Elb Surg. 2011;20(4):591-597. doi:10.1016/j.jse.2010.11.019
14. Gladstone JN, Bishop JY, Lo IKY, Flatow EL. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med. 2007;35(5):719-728. doi:10.1177/0363546506297539
15. Inderhaug E, Kollevold KH, Kalsvik M, Hegna J, Solheim E. Preoperative NSAIDs, non-acute onset and long-standing symptoms predict inferior outcome at long-term follow-up after rotator cuff repair. Knee Surgery, Sport Traumatol Arthrosc. 2017;25(7):2067-2072. doi:10.1007/s00167-015-3845-8
16. Kuhn JE, Dunn WR, Sanders R, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: A multicenter prospective cohort study. J Shoulder Elb Surg. 2013;22(10):1371-1379. doi:10.1016/j.jse.2013.01.026
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Asian Journal of Arthroscopy | January- June 2021; 6(1): 39-47.
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Natural History of Rotator Cuff Tears
Volume 6 | Issue 1 | January-June 2021 | Page 36-38 | W. Jaap Willems
Author: W. Jaap Willems [1, 2]
[1] Lairesse Kliniek, Amsterdam, The Netherlands.
[2] International Knee and Joint Centre, Abu Dhabi, UAE.
Address of Correspondence:
Dr. W. Jaap Willems,
Shoulder Unit, Lairesse Kliniek, Amsterdam, The Netherlands.
International Knee and Joint Centre, Abu Dhabi, UAE.
E-mail: w.j.willems@xs4all.nl
Abstract
Rotator cuff tears are a frequent phenomenon with an increasing incidence when the patient gets older. A considerable number of tears remain asymptomatic during a lifetime. However, still, a substantial number of asymptomatic tears become symptomatic. There is, at present evolving evidence that surgical treatment of small to medium-sized tears does better than conservative treatment, even after a long term follow-up. A treatment algorithm is suggested to help the clinician in decision making, where tear size and age are important factors in the prognosis of surgical treatment.
Keywords: Rotator cuff; Ruptures; Natural historyf tears; Partial rotator cuff tears; Subscapularis tears; Geometric Classification; Arthroscopic Classification; Rotator cuff retraction; Rotator cuff tendon quality; Prognosis for Rotator Cuff tears.
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Classification Systems in Rotator Cuff Tears
Volume 6 | Issue 1 | January-June 2021 | Page 31-35 | Ram Chidambaram, Reet Mukhopadhyay
Author: Ram Chidambaram [1], Reet Mukhopadhyay [2]
[1] Department of Shoulder, Elbow, Hand and Sports Injuries, MGM Healthcare, Aminjikarai, Chennai, Tamil Nadu, India.
[2] Department of Orthopaedics, R.G.Kar Medical College & Hospital, Kolkata, West Bengal, India.
Address of Correspondence:
Dr. Reet Mukhopadhyay,
Department of Orthopaedics, R.G.Kar Medical College & Hospital, Kolkata, West Bengal, India.
E-mail: reetm.2008@gmail.com
Abstract
Rotator cuff pathology is one of the most common conditions affecting the shoulder joint. Several classification systems have been used to describe rotator cuff tears in orthopedic literature. However, no comprehensive classification inclusive of all types and characteristics currently exists. Rotator cuff tears are classified based on various parameters. These include: 1. Tear depth 2. Tear Size/Extent 3. Tear Retraction 4. Tendon Quality 5. Tear Progression 6. Arthroscopic Classification. This review article aims to establish an algorithm based on the various existing classification systems so as to arrive at the best surgical or non-surgical solution as well as prognosticate the patient regarding the outcome. Special consideration needs to be made for massive tears which are irreparable.
Keywords: Rotator cuff tears; Rotator cuff tear classification; Massive irreparable rotator cuff tears; Partial rotator cuff tears; Subscapularis tears; Geometric Classification; Arthroscopic Classification; Rotator cuff retraction; Rotator cuff tendon quality; Prognosis for Rotator Cuff tears.
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Diagnostic Clinical Tests in Rotator Cuff Tear: Which and Why?
Volume 6 | Issue 1 | January-June 2021 | Page 24-30 | Vivek Pandey
Author: Vivek Pandey [1]
[1] Sports Medicine and Arthroscopy Division, Orthopaedic Surgery, Kasturba Medical College, Manipal, Udupi, Karnataka, India.
Address of Correspondence:
Dr. Vivek Pandey
Sports Medicine and Arthroscopy Division, Orthopaedic Surgery,
Kasturba Medical College, Manipal, Karnataka, Manipal Academy of
Higher Education, Udupi, Karnataka, India.
E-mail: vivekortho@gmail.com
Abstract
Rotator cuff tear is a leading cause of shoulder pain resulting in varying degree of disability to perform activities of daily living. A methodical history taking and focussed clinical examination helps in establishing the clinical diagnosis. A number of tests are mentioned in the literature to test the integrity of rotator cuff. This narrative review will focus upon methodology of each test, and their diagnostic accuracy.
Keywords: Rotator cuff tear; Impingement; Clinical tests; Diagnosis.
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Journal of Arthroscopy | January- June 2021; 6(1): 24-30..
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Spectrum of Imaging Findings In Rotator Cuff Tears – A Descriptive Review
Volume 6 | Issue 1 | January-June 2021 | Page 15-23 | Anupama Patil, Joban Babhulkar, Pranav Mahadeokar
Author: Anupama Patil [1], Joban Babhulkar [1], Pranav Mahadeokar [1]
[1] Star Imaging & Research Centre , Pune , India.
Address of Correspondence:
Dr. Anupama Patil,
Star Imaging & Research Centre , Pune , India
E-mail: anupama.patil2003@gmail.com
Abstract
The rotator cuff is instrumental in movements of the shoulder, while at the same time producing balanced compressive forces to stabilise the glenohumeral joint (dynamic stabiliser) Cuff tears are usually diagnosed clinically but before a decision regarding surgery is taken, some form of cross-sectional imaging, USG and/or MRI, is a must. This descriptive review is an attempt to highlight key concepts from the existing literature, along with our experience to image these injuries and assist the clinicians to formulate protocols in the day to day management of
rotator cuff pathologies.
Keywords: Rotator cuff injuries; Cuff tears ; Cuff arthropathy; Post operative imaging.
References
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2. Moosikasuwan JB, Miller TT, Burke BJ. Rotator cuff tears: clinical, radiographic, and US findings. Radiographics. 2005;25(6):1591-1607. doi:10.1148/rg.256045203.
3. Palmer W, Bancroft L, Bonar F, et al. Glossary of terms for musculoskeletal radiology. Skeletal Radiol. 2020;49(Suppl 1):1-33. doi:10.1007/s00256-020-03465-1.
4. Blanchard TK, Bearcroft PW, Constant CR, Griffin DR, Dixon AK. Diagnostic and therapeutic impact of MRI and arthrography in the investigation of full-thickness rotator cuff tears. Eur Radiol. 1999;9(4):638-642. doi:10.1007/s003300050724.
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ACL Reconstruction With BPTB Graft Using an Oblique Incision Reduces the Incidence of Anterior Knee Pain- Mid Term Follow-up Study
Volume 5 | Issue 2 | September-December 2020 | Page 02-06 | Divya Bandari, David V. Rajan, Santosh Sahanand
Author: Divya Bandari [1], David V. Rajan[1], Santosh Sahanand [1]
[1] Department of Orthopaedics, Gandhi Medical College/Hospital, Musheerabad, Hyderabad, Telangana, India.
[2] Ortho-One Orthopaedic Speciality centre, Hyderabad, Telangana, India.
Address of Correspondence:
Dr. Divya Bandari,
Assistant Proffesor, Gandhi Medical College/Hospital 1-6-129 , Opp. kausalya nivas , near Bharat seva samaj
Musheerabad, Hyderabad, Telangana, India. 500020
E-mail: divi.bandari15@gmail.com
Abstract
Introduction: A BPTB graft is the preferred choice of graft fixation, especially for young athletes who are involved in contact sports. However, there have been limited studies to determine and quantify the degree and characteristics of anterior knee pain and differentiate it from kneeling pain as a separate entity.
Study type: Prospective Study
Materials and methods: In our study we have followed 60 patients 30 each of BPTB and STG graft ACL reconstruction from 2013 to 2016 visiting Ortho one orthopaedic speciality centre with a minimum follow up period of 2 years and assessed the anterior knee pain and kneeling pain in terms of difficulty with the help of IKDC score and also quantified them with the help of VAS scores. We divided Anterior knee pain and Kneeling pain into no pain(VAS 0), mild pain (VAS 1-3), moderate pain(VAS 4-7) and severe pain (VAS 8-10).
Results: On quantifying the pain using the VAS score for anterior knee pain the BPTB and STG group showed no patients with severe pain (8 to 10) at the end of 12 and 24 months. Moderate pain (4 to 7) at 12 months was seen in 12 patients each (40%) and at 24 months in 5 patients (15%) in BPTB group and 4 patients (13.3%) in STG group. There was statistically no diff between both groups at 1 and 2 years follow up. (>0.05)Our study showed less incidence and severity than previously published studies.
Conclusion: The results of the present study showed a trend toward better subjective results with the use of a small oblique incision for the harvest of BPTB graft for ACL reconstruction.
Keywords: Anterior cruciate ligament; Bone patellar tendon bone; semitendinosus; Gracilis; Prospective; Pain; Quantification.
References
1. Noyes FR, Butler DL, Grood ES, et al: Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg 66 A : 344–352, 1984
2. Schatzmann L, Brunner P, Sta¨ubli HU: Effect of cyclic preconditioning on the tensile properties of human quadriceps tendons and patellar ligaments. Knee Surg Sports Traumatol Arthrosc 6 : S56–S61, 1998 .
3. Woo SLY, Hollis JM, Adams DJ, et al: Tensile properties of the human femur-anterior cruciate ligament-tibia complex: The effects of specimen age and orientation. Am JSports Med 1 9 : 217–225, 199
4. Erickson BJ, Harris JD, Fillingham YA, et al. Anterior cruciate ligament reconstruction practice patterns by NFL and NCAA football team physicians. Arthroscopy. 2014;30(6):731e738.
5. Papageorgiou CD, Ma CB, Abramowitch SD, Clineff TD, Woo SL. A multidisciplinary study of the healing of an intraarticular anterior cruciate ligament graft in a goat model. Am J Sports Med. 2001;29(5):620e626.
6. Schuette HB, Kraeutler MJ, Houck DA, McCarty EC. Bone-patellar tendon-bone versus hamstring tendon autografts for primary anterior cruciate ligament reconstruction: a systematic review of overlapping meta-analyses. Orthopaed J Sports Med. 2017;5(11), 2325967117736484.
7. Kartus, J., Ejerhed, L., Sernert, N., Brandsson, S., & Karlsson, J. (2000). Comparison of Traditional and Subcutaneous Patellar Tendon Harvest: A Prospective Study of Donor Site-Related Problems After Anterior Cruciate Ligament Reconstruction Using Different Graft Harvesting Techniques. The American Journal of Sports Medicine, 28(3), 328–335.
8. Tsuda, E., Okamura, Y., Ishibashi, Y., Otsuka, H., & Toh, S. (2001). Techniques for Reducing Anterior Knee Symptoms after Anterior Cruciate Ligament Reconstruction Using a Bone-Patellar Tendon-Bone Autograft. The American Journal of Sports Medicine, 29(4), 450–456.
9. Gaudot F, Leymarie JB, Drain O, Boisrenoult P, Charrois O, Beaufils P. Doubleincision mini-invasive technique for BTB harvesting: its superiority in reducing anterior knee pain following ACL reconstruction. Orthopaed Traumatol Surger Res: OTSR. 2009;95(1):28e35.
10. Niki Y, Hakozaki A, Iwamoto W, et al. Factors affecting anterior knee pain following anatomic double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2012;20(8):1543e1549.
11. Feller, J. A., & Webster, K. E. (2003). A Randomized Comparison of Patellar Tendon and Hamstring Tendon Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine, 31(4), 564–573.
12. Spindler KP, Kuhn JE, Freedman KB, Matthews CE, Dittus RS, Harrell FE. Anterior cruciate ligament reconstruction autograft choice: bonetendon-bone versus hamstring. Does it really matter? A systematic review. Am J Sports Med. 2004;32(8):1986-1995
13. Webster, K. E., Feller, J. A., Hartnett, N., Leigh, W. B., & Richmond, A. K. (2016). Comparison of Patellar Tendon and Hamstring Tendon Anterior Cruciate Ligament Reconstruction: A 15-Year Follow-up of a Randomized Controlled Trial. The American Journal of Sports Medicine, 44(1), 83–90
Oblique Incision Reduces the Incidence of Anterior Knee Pain- Mid Term Follow-up Study study| Asian Journal of Arthroscopy | July- December 2020; 5(2): 02-06.
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Arthroscopic Capsular Release of Adhesive Capsulitis- A Systematic Review
Volume 5 | Issue 2 | September-December 2020 | Page 07-12 | Abdul Azeem Badurudeen, Balaji Sambandam
Author: Abdul Azeem Badurudeen [1], Balaji Sambandam [2]
[1] Department of Orthopaedics, Institute of Medical Sciences, Melmaruvathur, Tamilnadu, India.
[2] Department of Orthopaedics, Atlas Hospital, Trichy, Tamilnadu, India.
Address of Correspondence:
Dr. Balaji Sambandam,
Orthopaedic Consultant, Atlas Hospital, Trichy, Tamilnadu, India.
E-mail: balajinimrotz@gmail.com
Abstract
Background: Adhesive capsulitis is one of the commonest disabling problem of the shoulder. Management of this pathology has multiple conservative and surgical options. Among the surgical options arthroscopic capsular release is the most researched technique. The aim of this study is to find the relevance of the procedure in current practice, by systematically reviewing the recent literatures.
Methods: A rigorous online data search was done for scientific English publications between 2000 and 2020. Search engines used were Medline, Google scholar and Cochrane. Keywords used were shoulder stiffness, adhesive capsulitis, frozen shoulder, capsular release and shoulder arthroscopy. Inclusion criteria were original studies, minimum sample size of 10 patients, arthroscopic capsular release as one of the treatment modalities, minimum follow up duration of 6 months, minimum duration of symptoms of 3 months. Studies with secondary adhesive capsulitis, additional procedures such as rotator cuff repairs were excluded from this review. All articles were evaluated by both the authors and data were extracted and analyzed.
Results: Twenty articles met with all inclusion criteria. There were 10 prospective and 10 retrospective studies. Two were level 2 studies, four were level 3 studies and 14 were level 4 studies. Total of 797 patients (810 shoulder) underwent arthroscopic capsular release. The average age was 52. 285 were males. 466 were females. 205 were right shoulders. 204 were left shoulders. Average follow up was 20.25 months. Arthroscopic capsular release resulted in significant improvement in range of motion at all planes and reduced VAS scores. There was a significant improvement in post-operative shoulder functional outcome scores. Complication rate was 3.1%, but none of them were major and recurrence rate was 0.25%.
Conclusion: Arthroscopic capsular release is a very good option for adhesive capsulitis with failed conservative treatment. It results in a significant improvement in range of motion and functional outcome scores. Good result of arthroscopic capsular release was observed very quickly and was maintained in long term. It is a very safe procedure with very minimal complication.
Keywords: Periarthritis; Adhesive capsulitis; Frozen shoulder; Arthroscopic capsular release; Shoulder arthroscopy.
References
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Anterior Tibial Spine Avulsion Fracture With Concomitant Tibial Side Anterior Cruciate Ligament Tear in an Adolescent Male: A Case Report
Volume 5 | Issue 2 | September-December 2020 | Page 13-16 | Ajit Swamy, Ishan Shevate, Girish Nathani, Yogesh Khandalkar
Author: Ajit Swamy [1], Ishan Shevate [1], Girish Nathani [1], Yogesh Khandalkar [1]
[1] Department of Orthopaedics, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra,
India.
Address of Correspondence:
Dr. Ishan Shevate,
Assistant Professor, Department of Orthopaedics, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India.
E-mail: ishanshevate@gmail.com
Abstract
Introduction: Tibial spine avulsion fractures are common in children and adolescents. Tibial spine avulsion fracture along with an Anterior cruciate ligament(ACL) tear are rarely reported in paediatric age group. We present a case of an adolescent child with avulsion of the anterior tibial spine with a complete tear of antero-medial bundle and near-total tear of a postero-lateral bundle.
Case Report: An adolescent male child presented with twisting injury to right knee while playing football. Local examination revealed positive patellar tap, Lachman test and anterior drawer test were grade 2 positive. Radiographs showed type 3 tibial spine avulsion fracture. Magnetic Resonance Imaging(MRI) and arthroscopy confirmed the diagnosis of avulsion with complete ACL tear. We decided to do transphyseal ACL reconstruction using hamstring autograft and excision of the avulsed fragment. Post operatively physiotherapy and weight bearing were started as per pain tolerance. Patient achieved full range of motion and returned to pre injury activity and sports 1 year post operatively.
Discussion: After reviewing the literature we found that anterior tibial spine fractures along with ACL tear are most uncommon reported in paediatric age group. In nearly 30-60% cases of displaced tibial eminence fracture, concomitant injury either to the meniscus, ligaments or the articular cartilage were diagnosed on MRI. Reported literature shows no difference in percentage of growth abnormalities in transphyseal verses physeal sparing techniques.
Conclusion: A thorough preoperative evaluation with radiographs and MRI is important to detect these injuries and planning the treatment accordingly. Primary ACL reconstruction gives good results in these cases.
Keywords: ACL avulsion fracture with tear; Paediatric sports injury; ACL reconstruction; Concomitant ACl avulsion and tear.
References
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17. Mubark IM, Ragab AH, Nagi AA, Motawea BA. Evaluation of the results of management of frozen shoulder using the arthroscopic capsular release. Ortop Traumatol Rehabil. 2015;17(1):21-8.
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19. Smith CD, Hamer P, Bunker TD. Arthroscopic capsular release for idiopathic frozen shoulder with intra-articular injection and a controlled manipulation. Ann R Coll Surg Engl. 2014;96(1):55-60.
20. Dattani R, Ramasamy V, Parker R, Patel VR. Improvement in quality of life after arthroscopic capsular release for contracture of the shoulder. Bone Joint J. 2013 Jul;95-B(7):942-6.
21. Baums MH, Spahn G, Nozaki M, Steckel H, Schultz W, Klinger HM. Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis. Knee Surg Sports Traumatol Arthrosc. 2007;15(5):638–44.
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