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Objective To observe the effect of subacromial bursa injection of sodium vitrate combined with Thera-Band elastic band resistance training on shoulder joint function in patients with rotator cuff injury. Methods A total of 50 patients with rotator cuff injuries admitted to Department of Rehabilitation Medicine of the hospital from January 2022 to December 2023 were selected and divided into treatment group and control group according to randomized numerical table method, with 25 cases in each group. The control group was treated with subacromial bursa injection of sodium vitrate, and the treatment group was treated with subacromial bursa injection of sodium vitrate combined with Thera-Band elastic band resistance training. Comparison of the two groups of patients after treatment visual analog scoring method, University of California, Los Angeles shoulder joint score changes. Results The visual analog score of the treatment group patients after treatment (2.16±0.85) points was significantly lower than that of the control group [(3.32±0.90) points, and the excellent rate [92.0% (23/25)], and the shoulder joint score of the University of California, Los Angeles after treatment (30.28±2.26) points] was significantly higher than that of the control group [80.0% (20/25),(26.44±1.92) points, respectively, and the differences were statistically significant (P< 0.05). Conclusion Subacromial bursa injection of sodium vitrate combined with Thera-Band elastic band resistance training for rotator cuff injuries effectively reduces shoulder pain and improves shoulder function. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion Rotator cuff retear after arthroscopy repair is a difficult complication that is often due to poor tendon–bone healing. Decellularized amniotic membrane (DAM) has a variety of bioactive substances which have great potential to enhance tendon–bone healing. However, DAM has three layers, of which the middle basement layer is dense and thick. Whether DAM will hinder tendon–bone healing of rotator cuff after surgical repair is unclear. Our study aims to investigate the effect of DAM on tendon–bone healing of the rotator cuff after surgical repair.Thirty‐three Sprague–Dawley (SD) rats were selected to establish unilateral supraspinatus (ST) tear models and were randomly treated with only suturing repair (OSR group, n = 11), and suturing repair with DAM placed between the ST and bone (DAM group, n = 11). In the normal control group (NCT group, n = 11), the supraspinatus was only exposed but not detached or repaired. After 4 weeks the rats were sacrificed. The assessment of specimens was conducted by micro‐CT analysis, histopathological evaluation, and biomechanical testing.The DAM group had a significantly higher ultimate load to failure, new bone volume, and histological evaluation at 4 weeks after surgery than the OSR group. When comparing the DAM group to the NCT group, the DAM group performed slightly worse in biomechanical testing, micro‐CT analysis, and histological evaluation.When placed between tendon and bone at the rotator cuff footprint, DAM, despite its dense and thick basement layer, does not impede tendon–bone healing after surgical repair for rotator cuff injury, but rather promotes increased healing quality and biomechanical properties. However, the healing quality and biomechanical properties are still lower than that of the normal rotator cuff, and further improvement should be made to the application strategy of a DAM. [ABSTRACT FROM AUTHOR]

This study summarized the rehabilitation nursing of a patient with rotator cuff injury based on the ACTED framework. The ACTED framework (Assessment, Care, Treatment, Evaluation, Discharge) consisted of a detailed evaluation process, the formulation of multidisciplinary collaborative treatment, the implementation of individualized therapy, education for both patients and their family members, and mechanisms for continuous development and improvement. Nursing intervention based on the ACTED framework aimed to improve the recovery of shoulder function of the patient with rotator cuff injury, reduce pain and improve overall quality of life. (本文总结基于ACTED模式1例肩袖损伤患者的康复护理经验。ACTED康复护理模式涵盖了详细的评估流程、多学科协作治疗计划的制定、个性化的治疗方案实施、患者及其家属的教育, 以及持续的发展和改进机制, 通过跨学科合作改善肩袖损伤患者的肩关节功能障碍, 减轻疼痛, 加速康复进程, 并提升患者的整体生活质量。)

Nocturnal shoulder pain is seen in patients with rotator cuff tears (RCTs). The purpose of the present study was to determine whether Doppler ultrasound parameters predict the intensity of nocturnal pain in patients with RCTs. A total of 60 patients with RCTs were included. Doppler ultrasound parameters (peak systolic velocity in the anterior humeral circumflex artery, Doppler activity in the glenohumeral joint and subacromial space [SAS]) and clinical parameters were examined. For the presence of nocturnal pain, the clinical parameters were compared with and without nocturnal pain. For the intensity of the nocturnal pain, a multivariate analysis of clinical parameters and nocturnal pain intensity was performed. In all, 39 patients (65%) reported nocturnal pain, and the mean pain intensity was 47.0 (standard deviation, 26.0) on the visual analog scale. In nocturnal pain presence analysis, Doppler activity in the SAS showed significant associations (P <.001). In nocturnal pain intensity analysis, Doppler activity in the SAS and diabetes showed significant associations (P <.001, P =.01, respectively). Doppler activity in the SAS emerges as an independent factor associated with the presence and intensity of nocturnal pain in patients with RCTs. Our findings may provide a basis for further exploration and refinement of treatment strategies. [ABSTRACT FROM AUTHOR]

Abstract Background The factors influencing the clinical outcome of arthroscopic rotator cuff repair are not fully understood. Purpose To explore the factors related to the postoperative outcome of arthroscopic single-row rivet rotator cuff repair in patients with rotator cuff injury and to construct the related nomogram risk prediction model. Methods 207 patients with rotator cuff injury who underwent arthroscopic single-row rivet rotator cuff repair were reviewed. The differences of preoperative and postoperative Visual Analogue Score (VAS) scores and University of California, Los Angeles (UCLA) scores were analyzed and compared. The postoperative UCLA score of 29 points was taken as the critical point, and the patients were divided into good recovery group and poor recovery group, and binary logstic regression analysis was performed. According to the results of multivariate logistic regression analysis, the correlation nomogram model was constructed, and the calibration chart was used, AUC, C-index. The accuracy, discrimination and clinical value of the prediction model were evaluated by decision curve analysis. Finally, internal validation is performed using self-random sampling. Results The mean follow-up time was 29.92 ± 17.20 months. There were significant differences in VAS score and UCLA score between preoperative and final follow-up (p

Abstract The aim of this study was to investigate the effect of zoledronic acid (ZA) on postoperative healing and functional rehabilitation in osteoporotic patients with rotator cuff (RC) injury. 96 Patients were divided into three groups according to bone mineral density and ZA use (Group A: normal BMD; Group B: osteoporosis and intravenous ZA use; Group C: osteoporosis, without ZA use). Radiologic, functional and Serological outcomes were evaluated 6 months after surgery. The functional scores in all groups exhibited significant improvement 6 months after surgery. Inter-group comparison showed that Constant Shoulder joint function Score (CSS) of group A not significantly differing from that of group B, the other indicators were significantly better than those of group B and C. There were no significant differences in shoulder forward flexion, abductive Range of Motion between group B and C. Other indicators of group B were significantly improved compared to group C. The retear rate in group C (30.3%, 10/33) was higher than group A (6.1%, 2/33) and group B (13.3%, 4/30). In conclusion, the application of ZA can significantly reduce the rate of RC retear in elderly patients with osteoporosis after surgery, which is significant for postoperative shoulder joint functional rehabilitation.

Background: The factors influencing the clinical outcome of arthroscopic rotator cuff repair are not fully understood. Purpose: To explore the factors related to the postoperative outcome of arthroscopic single-row rivet rotator cuff repair in patients with rotator cuff injury and to construct the related nomogram risk prediction model. Methods: 207 patients with rotator cuff injury who underwent arthroscopic single-row rivet rotator cuff repair were reviewed. The differences of preoperative and postoperative Visual Analogue Score (VAS) scores and University of California, Los Angeles (UCLA) scores were analyzed and compared. The postoperative UCLA score of 29 points was taken as the critical point, and the patients were divided into good recovery group and poor recovery group, and binary logstic regression analysis was performed. According to the results of multivariate logistic regression analysis, the correlation nomogram model was constructed, and the calibration chart was used, AUC, C-index. The accuracy, discrimination and clinical value of the prediction model were evaluated by decision curve analysis. Finally, internal validation is performed using self-random sampling. Results: The mean follow-up time was 29.92 ± 17.20 months. There were significant differences in VAS score and UCLA score between preoperative and final follow-up (p < 0.05); multivariate regression analysis showed: Combined frozen shoulder (OR = 3.890, 95% CI: 1.544 ∼ 9.800), massive rotator cuff tear (OR = 3.809, 95%CI: 1.218 ∼ 11.908), More rivets number (OR = 2.118, 95%CI: 1.386 ∼ 3.237), lower preoperative UCLA score (OR = 0.831, 95%CI: 0.704–0.981) were adverse factors for the postoperative effect of arthroscopic rotator cuff repair. Use these factors to build a nomogram. The nomogram showed good discriminant and predictive power, with AUC of 0.849 and C-index of 0.900 (95% CI: 0.845 ∼ 0.955), and the corrected C index was as high as 0.836 in internal validation. Decision curve analysis also showed that the nomogram could be used clinically when intervention was performed at a threshold of 2%∼91%. Conclusion: Combined frozen shoulders, massive rotator cuff tears, and increased number of rivets during surgery were all factors associated with poor outcome after arthroscopic rotator cuff repair, while higher preoperative UCLA scores were factors associated with good outcome after arthroscopic rotator cuff repair. This study provides clinicians with a new and relatively accurate nomogram model. [ABSTRACT FROM AUTHOR]

The mechanism of rotator cuff injury remains to be elucidated. And COX-2 plays a dual role in skeletal muscle injury and regeneration, would be associated with the development of rotator cuff injury. Therefore, we chose human skeletal muscle cells (HSKMC) as an in vitro muscle tissue model and transfected lentivirus with overexpressed COX-2 to simulate the in vitro environment of rotator cuff injury. To investigate the specific molecular biological mechanism of COX-2, transcriptome sequencing (RNA-Seq) was used to analyze the differentially expressed mRNAs in HSKMC overexpressing COX-2. Enrichment analysis was performed to analyze these differentially expressed genes and real-time quantitative PCR (RT-qPCR) was used to examine the mRNA levels of genes induced by overexpression. Subsequently, the role of COX-2 in cell proliferation was confirmed by cell counting kit-8 (CCK-8), and focal adhesion kinase (FAK) and signal transducer and activator of transcription 3 (STAT3) phosphorylation induced by COX-2 was utilized by western blotting (WB). The results showed that total of 30,759 differentially expressed genes were obtained, and the expression of CYP4F3 and GPR87 was significantly increased. COX-2 could bind CYP4F3 and GPR87 and co-localize with them in the cytoplasm. Finally, COX-2 promoted the proliferation of human skeletal muscle cells by activating the FAK and STAT3 pathways. [ABSTRACT FROM AUTHOR]

Introduction: While various interventions have been designed for managing rotator cuff tendinopathy, very little information exists on Kinesio taping in rehabilitation programs for overhead athletes. This study examines the effects of functional Kinesio taping on acromio humeral distance, pain, quality of life and disability in overhead athletes with rotator cuff tendinopathy. Material and methods: A randomized clinical trial was performed with 21 patients. The participants were randomly allocated into two treatment groups via the sealed envelope method. The experimental group received Kinesio taping with a rehabilitation program while the control group received a rehabilitation program only. Both groups received a six-week intervention and were evaluated at baseline and after six weeks by ultrasonography (USG), Western Ontario Rotator Cuff index (WORC), Disabilities of Shoulder, Arm and Hand questionnaire (DASH), and Visual Analogue Scale for pain (VAS). Results: No significant intergroup differences were found between the experimental and control groups regarding acromio humeral distance, VAS, DASH scores or WORC index (p = 0.05). Within-group analysis found significant improvements in all variables (VAS, AHD, DASH scores, WORC scores) between baseline and week 6 for both groups (p < 0.05). Conclusions: Both groups of overhead athletes with rotator cuff tendinopathy demonstrated improved acromiohumeral distance measured with 0° arm elevation based on ultrasound examination and pain, functional disability, and quality of life assessment after six-week intervention. However, the Kinesio taping did not provide any additional benefits over a rehabilitation program alone. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical effects of simple arthroscopic rivet fixation and arthroscopic assisted small incision rivet fixation in the treatment of rotator cuff injury. Methods: A total of 78 patients with rotator cuff injury admitted to our hospital from February 2018 to February 2021 were selected. The patients were divided into two groups according to the random number method, with 39 cases in each group. The observation group was treated with arthroscopic rivet fixation, and the control group was treated with arthroscopic assisted small incision rivet fixation. The perioperative conditions and Visual Analogue Scale (VAS) pain score of the patients were observed and compared; the shoulder range of motion at 6 and 12 months after operation was recorded. At the same time, the modified University of California Los Angeles Shoulder cores (UCLA) and Constant shoulder score were used for comprehensive evaluation, and the incidence of complications was recorded. Results: The operation time in the observation group was higher than that in the control group(P<0.05); The motion of shoulder abduction and external rotation in the observation group at 12 months after operation were better than those in the control group (P<0.05). The modified UCLA score and Constant shoulder score in the observation group at 12 months after operation were better than those in the control group (P<0.05). There was no significant difference in the rate of rotator cuff reinjury and the incidence of joint adhesion between the two groups (P>0.05). Conclusion: In the long-term curative effect observation of rotator cuff injury, simple arthroscopic rivet repair provides a better therapeutic effect. In order to ensure the long-term curative effect of rotator cuff injury, simple arthroscopic treatment is still a better choice. [ABSTRACT FROM AUTHOR]

The supraspinatus tendon plays a crucial role in shoulder abduction, making it one of the common structures affected by injury. Clinically, crescent-shaped tears are the most commonly seen tear shape. By developing six specimen-specific, three-dimensional, supraspinatus-infraspinatus finite element model with heterogeneous material properties, this study aimed to examine the changes in tissue deformation (maximum principal strain) of the supraspinatus tendon due to specimen-specific material properties and rotator cuff tear size. FE models with small- and medium-sized full-thickness crescent-shaped tears were subjected to loads seen during activities of daily living and physiotherapy. Six fresh-frozen cadaveric shoulders were dissected to mechanically test the supraspinatus tendon and develop and validate FE models that can be used to assess changes in strain due to small (< 1 cm, equivalent to 20-30% of the tendon width) and medium-sized (1–3 cm, equivalent to 40–50% of the tendon width) tears that are located in the middle and posterior regions of the supraspinatus tendon. FE predictions of maximum principal strain at the tear tips were examined to determine whether failure strain was reached during activities of daily living (drinking and brushing teeth) and physiotherapy exercises (prone abduction and external rotation at 90° abduction). No significant differences were observed between the middle and posterior tear failure loads for small- and medium-sized tears. For prone abduction, there was a potential risk for tear progression (exceeded failure strain) for medium-sized tears in the supraspinatus tendon's middle and posterior regions. For external rotation at 90° abduction, one model with a middle tear and two with posterior tears experienced failure. For all daily activity loads, the strain never exceeded the failure strain. Our three-dimensional supraspinatus-infraspinatus FE model shows that small tears appear unlikely to progress based on the regional strain response; however, medium-sized tears are at higher risk during more strenuous physiotherapy exercises. Furthermore, differences in patient-specific tendon material properties are important in determining whether the tear will progress. Therefore, patient-specific management plans based on tear size may be beneficial to improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: This narrative review aims to assess and compare the diagnostic accuracy of artificial intelligence (AI) techniques with ultrasound in the context of diagnosing rotator cuff pathology. Methods: A comprehensive search of electronic databases was conducted to identify relevant studies published from 2013 to 2023. Studies compared the diagnostic accuracy and precision of AI algorithms and ultrasound for rotator cuff pathology detection. Results: A total of eight studies met the inclusion criteria and were analysed. The review shows that AI techniques have shown promising results in diagnosing rotator cuff injuries, with reported comparative accuracy, specificity and sensitivity. Conclusion: The limited number of direct comparative studies makes it challenging to draw a definitive conclusion regarding superiority of one modality over another. However, the integration of AI in medical imaging holds significant potential to enhance diagnostic capabilities and streamline patient care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Macrophage polarization has been observed in the process of muscle injuries including rotator cuff (RC) muscle atrophy and fatty infiltration after large tendon tears. In our previous study, we showed that fibrogenesis and white adipogenesis of muscle residential fibro/adipogenic progenitors (FAPs) cause fibrosis and fatty infiltration and that brown/beige adipogenesis of FAPs promotes rotator cuff muscle regeneration. However, how polarized macrophages and their exosomes regulate FAP differentiation remains unknown. METHODS: We cultured FAPs with M0, M1, and M2 macrophages or 2 × 109 exosomes derived from M0, M1 and M2 with and without GW4869, an exosome inhibitor. In vivo, M0, M1, and M2 macrophages were transplanted or purified macrophage exosomes (M0, M1, M2) were injected into supraspinatus muscle (SS) after massive tendon tears in mice (n = 6). SS were harvested at six weeks after surgery to evaluate the level of muscle atrophy and fatty infiltration. RESULTS: Our results showed that M2 rather than M0 or M1 macrophages stimulates brown/beige fat differentiation of FAPs. However, the effect of GW4869, the exosome inhibitor, diminished this effect. M2 exosomes also promoted FAP Beige differentiation in vitro. The transplantation of M2 macrophages reduced supraspinatus muscle atrophy and fatty infiltration. In vivo injections of M2 exosomes significantly reduced muscle atrophy and fatty infiltration in supraspinatus muscle. CONCLUSION: Results from our study demonstrated that polarized macrophages directly regulated FAP differentiation through their exosomes and M2 macrophage-derived exosomes may serve as a novel treatment option for RC muscle atrophy and fatty infiltration.

Abstract Backgroup The pathogenesis of shoulder impingement syndrome (SIS) is still unclear, and its questionable causal relationship with rotator cuff (RC) injury has led to confusion in treatment. The purpose of this study was to explore the bidirectional causal relationship between SIS and RC injury. Methods SIS and RC injury datasets downloaded from the IEU Open GWAS project and GWAS catalog databases. Inverse variance weighted (IVW), MR Egger, Weighted median, and Weighted mode were used in this Mendelian randomization (MR) analysis. Cochran’s Q test, leave-one-out, and funnel plot method were used to evaluate heterogeneity between single nucleotide polymorphisms (SNPs). MR-Egger regression was used to test the horizontal pleiotropy of this study. Results The IVW method (OR = 1.189, P = 0.0059) suggest the putative causal effect of RC injury on SIS. The results of MR Egger method (OR = 1.236, P = 0.2013), weighted median method (OR = 1.097, P = 0.2428) and weighted mode method (OR = 1.013, P = 0.930) showed no statistically significant (OR = 1.069071, P = 0.6173). Heterogeneity test and horizontal pleiotropy analysis suggested that there was no significant heterogeneity and horizontal pleiotropy in the results of this MR analysis. The reverse MR analysis showed heterogeneity, and the conclusion needs to be further explored. Conclusions The results of MR analysis support that RC injury may be causally associated with SIS.

Abstract Background This study aimed to compare the clinical effect of modified anterolateral and traditional acromioplasty in arthroscopic rotator cuff repair. Methods The clinical data of 92 patients with total rotator cuff tears admitted to the Department of Joint Surgery of Jinhua Central Hospital from January 2016 to December 2019 were retrospectively analyzed. Among them, 42 patients underwent traditional acromioplasty during arthroscopic rotator cuff repair, and 50 underwent modified anterolateral acromioplasty. Patients were evaluated for preoperative and postoperative shoulder function, pain and critical shoulder angle, and incidence of rotator cuff re-tear at 12 months postoperatively. Results The preoperative general data of patients in the classic and modified anterolateral acromioplasty groups did not differ significantly (P > 0.05) and were comparable. The UCLA, ASES, and Constant shoulder joint scores were significantly improved in both groups. The VAS score was significantly decreased at 12 months postoperative than preoperative, with a statistically significant difference (P ≤ 0.05). Shoulder function and pain scores did not differ significantly between the two groups at 12 months postoperatively (P > 0.05). The CSA did not differ significantly between preoperative and postoperative 12 months in the traditional acromioplasty group (P > 0.05). However, 12 months postoperative CSA in the modified anterolateral acromioplasty group was significantly smaller than the preoperative CSA, with a statistically significant difference (P ≤ 0.05). The rates of rotator cuff re-tears were 16.67% (7/42) and 4% (2/50) in the two groups at 12 months postoperatively, respectively, with statistically significant differences (P ≤ 0.05). Conclusions Traditional and modified anterolateral acromioplasty while treating total rotator cuff tears using arthroscopic rotator cuff repair significantly improves shoulder joint function. However, modified anterolateral acromioplasty significantly reduced the CSA value and decreased the incidence of rotator cuff re-tears.

Ming Zhang,1,2 Yu Zhang2 1School of Nursing, Yangzhou University, Yangzhou, Jiangsu, 225001, People’s Republic of China; 2Department of Orthopedics and Sports Medicine, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, 225001, People’s Republic of ChinaCorrespondence: Yu Zhang, School of Nursing, Yangzhou University, Yangzhou, Jiangsu, 225001, People’s Republic of China, Email yizhangyu@yzu.edu.cnObjective: Postoperative rehabilitation is particularly important for Rotator cuff injury. However, type 2 diabetic patients with RCI (T2DM-RCI) are at an elevated risk of rehabilitation failure. The factors influencing the postoperative rehabilitation management of these patients have yet to be elucidated. The objective of this study was to investigate the factors influencing the postoperative rehabilitation of T2DM-RCI patients.Methods: Data was collected using a descriptive qualitative research design. The sample included 22 interviewees, who were recruited in Subei People’s Hospital according to the purposive sampling method. Colaizzi’s method was employed for the purpose of evaluation in the course of the data analysis.Findings: Thematic analysis of the postoperative rehabilitation views of the interviewees identified eight sub-themes connected to three main themes in accordance with the Behaviour Change Wheel Theory. These were capability-related, opportunity-related, and motivation-related factors.Conclusion: It is imperative to enhance the glycaemic control and health perception of T2DM-RCI patients. To this end, rehabilitation programmes, comprising exercise and dietary modifications, must be tailored to the specific needs of each patient. Furthermore, it is crucial to harness the potential of family and social support to motivate patients to maintain a positive outlook.Keywords: postoperative rehabilitation, qualitative study, type 2 diabetic, rotator cuff injury, facilitating/obstructing factors

Musculoskeletal pathologies affecting shoulder girdle joints, other than gleno-humeral joint such as acromioclavicular joint arthritis, tendonitis, subacromial bursitis, subdeltoid bursitis, and osteochondritis dissecans, are relatively rare. In Middle East and Asian countries, public health services are generally availed by a large number of patients in primary health centres, rural hospitals, and district hospitals, but the scarcity of specialist orthopaedic surgeons in such hospitals usually leads to misdiagnosis of rare musculoskeletal pathologies, which may result in complications and morbidity. The study aims to determine the presentation, progression, diagnostic evaluation, and treatment of musculoskeletal pathologies affecting the shoulder girdle and develop an algorithm to screen such pathologies. A systematic literature search of four medical databases (PubMed, Scopus, Web of Science and Google Scholar) was conducted, from 1st January 1950 to 31st December 2022. Studies (case reports, prospective studies, review articles) reporting pathological conditions affecting shoulder girdles, with a focus on clinical presentation, physical examination tests required for diagnostic evaluation, and management, were included. The relevant data was extracted from the selected studies and tabulated for analysis. Seventeen studies were included in the final analysis. Several case reports, case series and review articles showed that very few musculoskeletal conditions can be correctly diagnosed based on only physical examination tests. Radiological and anatomical basis of each of the cases were discussed. An algorithm was prepared to help diagnose shoulder girdle pathologies based on clinical presentation and examination findings.

Abstract Background The effects of the timing of surgical repair on the outcomes of traumatic and non-traumatic rotator cuff injuries (RCI) remain elusive. Thus, this study aimed to compare differences in outcomes following the repair of traumatic and non-traumatic RCI at varying time points. Methods The study population comprised 87 patients with traumatic and non-traumatic RCI who underwent arthroscopic rotator cuff repair and were followed up for a minimum of 6 months. Next, the trauma and the non-trauma groups were stratified into subgroups according to the time of injury (early repair: occurring within 3 months; delayed repair: occurring after 3 months). Measurements before and after surgical interventions were compared to evaluate the effect of the duration of RCI on the functional status of patients in the trauma and non-trauma groups. Primary evaluation indices included the Visual Analog Scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Constant shoulder function score, and the University of California, Los Angeles (UCLA) shoulder score. Secondary evaluation indices consisted of shoulder range of motion (ROM), postoperative rotator cuff retear rate, and incidence of joint stiffness. Results Among the 40 patients in the trauma group, 22 underwent early repair, whereas the remaining 18 underwent delayed repair. In the non-trauma group consisting of 47 patients, 18 underwent early repair, whereas the remaining 29 underwent delayed repair. The minimum clinical follow-up time was 6 months, with an average follow-up time of 10.2 months. During postoperative follow-up, 1 and 6 patients who underwent early and delayed repair experienced re-tear in the trauma group, respectively. Contrastingly, 3 and 8 patients who underwent early and delayed repair presented with re-tear in the non-trauma group, respectively. Conclusion Early repair of traumatic RCI yielded superior outcomes, including improved range of motion, lower pain symptoms, and lower risk of postoperative re-tears compared to delayed repair. Additionally, non-surgical treatment is recommended as the preferred approach for patients with non-traumatic RCI.

Backgroup: The pathogenesis of shoulder impingement syndrome (SIS) is still unclear, and its questionable causal relationship with rotator cuff (RC) injury has led to confusion in treatment. The purpose of this study was to explore the bidirectional causal relationship between SIS and RC injury. Methods: SIS and RC injury datasets downloaded from the IEU Open GWAS project and GWAS catalog databases. Inverse variance weighted (IVW), MR Egger, Weighted median, and Weighted mode were used in this Mendelian randomization (MR) analysis. Cochran's Q test, leave-one-out, and funnel plot method were used to evaluate heterogeneity between single nucleotide polymorphisms (SNPs). MR-Egger regression was used to test the horizontal pleiotropy of this study. Results: The IVW method (OR = 1.189, P = 0.0059) suggest the putative causal effect of RC injury on SIS. The results of MR Egger method (OR = 1.236, P = 0.2013), weighted median method (OR = 1.097, P = 0.2428) and weighted mode method (OR = 1.013, P = 0.930) showed no statistically significant (OR = 1.069071, P = 0.6173). Heterogeneity test and horizontal pleiotropy analysis suggested that there was no significant heterogeneity and horizontal pleiotropy in the results of this MR analysis. The reverse MR analysis showed heterogeneity, and the conclusion needs to be further explored. Conclusions: The results of MR analysis support that RC injury may be causally associated with SIS. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the clinical effect of modified anterolateral and traditional acromioplasty in arthroscopic rotator cuff repair. Methods: The clinical data of 92 patients with total rotator cuff tears admitted to the Department of Joint Surgery of Jinhua Central Hospital from January 2016 to December 2019 were retrospectively analyzed. Among them, 42 patients underwent traditional acromioplasty during arthroscopic rotator cuff repair, and 50 underwent modified anterolateral acromioplasty. Patients were evaluated for preoperative and postoperative shoulder function, pain and critical shoulder angle, and incidence of rotator cuff re-tear at 12 months postoperatively. Results: The preoperative general data of patients in the classic and modified anterolateral acromioplasty groups did not differ significantly (P > 0.05) and were comparable. The UCLA, ASES, and Constant shoulder joint scores were significantly improved in both groups. The VAS score was significantly decreased at 12 months postoperative than preoperative, with a statistically significant difference (P ≤ 0.05). Shoulder function and pain scores did not differ significantly between the two groups at 12 months postoperatively (P > 0.05). The CSA did not differ significantly between preoperative and postoperative 12 months in the traditional acromioplasty group (P > 0.05). However, 12 months postoperative CSA in the modified anterolateral acromioplasty group was significantly smaller than the preoperative CSA, with a statistically significant difference (P ≤ 0.05). The rates of rotator cuff re-tears were 16.67% (7/42) and 4% (2/50) in the two groups at 12 months postoperatively, respectively, with statistically significant differences (P ≤ 0.05). Conclusions: Traditional and modified anterolateral acromioplasty while treating total rotator cuff tears using arthroscopic rotator cuff repair significantly improves shoulder joint function. However, modified anterolateral acromioplasty significantly reduced the CSA value and decreased the incidence of rotator cuff re-tears. [ABSTRACT FROM AUTHOR]

Background: The effects of the timing of surgical repair on the outcomes of traumatic and non-traumatic rotator cuff injuries (RCI) remain elusive. Thus, this study aimed to compare differences in outcomes following the repair of traumatic and non-traumatic RCI at varying time points. Methods: The study population comprised 87 patients with traumatic and non-traumatic RCI who underwent arthroscopic rotator cuff repair and were followed up for a minimum of 6 months. Next, the trauma and the non-trauma groups were stratified into subgroups according to the time of injury (early repair: occurring within 3 months; delayed repair: occurring after 3 months). Measurements before and after surgical interventions were compared to evaluate the effect of the duration of RCI on the functional status of patients in the trauma and non-trauma groups. Primary evaluation indices included the Visual Analog Scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Constant shoulder function score, and the University of California, Los Angeles (UCLA) shoulder score. Secondary evaluation indices consisted of shoulder range of motion (ROM), postoperative rotator cuff retear rate, and incidence of joint stiffness. Results: Among the 40 patients in the trauma group, 22 underwent early repair, whereas the remaining 18 underwent delayed repair. In the non-trauma group consisting of 47 patients, 18 underwent early repair, whereas the remaining 29 underwent delayed repair. The minimum clinical follow-up time was 6 months, with an average follow-up time of 10.2 months. During postoperative follow-up, 1 and 6 patients who underwent early and delayed repair experienced re-tear in the trauma group, respectively. Contrastingly, 3 and 8 patients who underwent early and delayed repair presented with re-tear in the non-trauma group, respectively. Conclusion: Early repair of traumatic RCI yielded superior outcomes, including improved range of motion, lower pain symptoms, and lower risk of postoperative re-tears compared to delayed repair. Additionally, non-surgical treatment is recommended as the preferred approach for patients with non-traumatic RCI. [ABSTRACT FROM AUTHOR]

Background: Shoulder pain is one of the most important musculoskeletal conditions affecting the upper extremities. Glenohumeral osteoarthritis (GHOA) and rotator cuff injuries (RCIs) are notable for their high prevalence. The critical shoulder angle (CSA) is a significant radiological measure for determining the diagnosis and progression of patients with these conditions. Although there are reports in the international literature about this measure, in our country, guideline values considering these two pathologies are unknown. Objective: Our objective was to assess patients diagnosed with GHOA and RCI using an AP X-ray view and the CSA. Methods: To conduct this, we identified differences between sexes and age categories. Fifty-nine adult patients with GHOA and RCI were included. CSA grades varied depending on the age category and type of injury evaluated. Results: Significant differences between the age ranges of 40 and 54 (p = 0.05), 55–69 (p = 0.001), and 70–84 (p = 0.017) were observed. Conclusions: Patients with RCI tended to be younger and have a higher CSA compared to those with GHOA. It is important to have more normative values and to continue monitoring the critical shoulder angle in these patients. [ABSTRACT FROM AUTHOR]

The adherence of rehabilitation exercise of rotator cuff repair patients is very important for the recovery of shoulder joint function, but the situation is not ideal. By searching the literature of domestic and foreign databases, this paper reviewed the status quo of rehabilitation exercise compliance of patients with rotator cuff repair, analyzed the influence of physiological and psychological factors, rehabilitation exercise load, social support and medical support on rehabilitation exercise adherence of patients with rotator cuff repair, and explained relevant nursing intervention modes, aiming at providing reference for improving rehabilitation exercise adherence of patients with rotator cuff repair. [ABSTRACT FROM AUTHOR]

Aims: Rotator cuff (RC) injuries are characterized by tendon rupture, muscle atrophy, retraction, and fatty infiltration, which increase injury severity and jeopardize adequate tendon repair. Epigenetic drugs, such as histone deacetylase inhibitors (HDACis), possess the capacity to redefine the molecular signature of cells, and they may have the potential to inhibit the transformation of the fibro-adipogenic progenitors (FAPs) within the skeletal muscle into adipocyte-like cells, concurrently enhancing the myogenic potential of the satellite cells. Methods: HDACis were added to FAPs and satellite cell cultures isolated from mice. The HDACi vorinostat was additionally administered into a RC injury animal model. Histological analysis was carried out on the isolated supra- and infraspinatus muscles to assess vorinostat anti-muscle degeneration potential. Results: Vorinostat, a HDACi compound, blocked the adipogenic transformation of muscle-associated FAPs in culture, promoting myogenic progression of the satellite cells. Furthermore, it protected muscle from degeneration after acute RC in mice in the earlier muscle degenerative stage after tenotomy. Conclusion: The HDACi vorinostat may be a candidate to prevent early muscular degeneration after RC injury. Cite this article: Bone Joint Res 2024;13(4):169–183.

Objective: We compared the effects of early and delayed rehabilitation on the function of patients after rotator cuff repair by meta-analysis to find effective interventions to promote the recovery of shoulder function. Methods: This meta-analysis was registered in PROSPERO (CRD42023466122). We manually searched the randomized controlled trials (RCTs) in the Cochrane Library, Pubmed, Cochrane Library, EMBASE, the China National Knowledge Infrastructure (CNKI), the China VIP Database (VIP), and the Wanfang Database to evaluate the effect of early and delayed rehabilitation after arthroscopic shoulder cuff surgery on the recovery of shoulder joint function. Review Manager 5.3 software was used to analyze the extracted data. Then, the PEDro scale was employed to appraise the methodological quality of the included research. Results: This research comprised nine RCTs and 830 patients with rotator cuff injuries. According to the findings of the meta-analysis, there was no discernible difference between the early rehabilitation group and the delayed rehabilitation group at six and twelve months after the surgery in terms of the VAS score, SST score, follow-up rotator cuff healing rate, and the rotator cuff retear rate at the final follow-up. There was no difference in the ASES score between the early and delayed rehabilitation groups six months after the operation. However, although the ASES score in the early rehabilitation group differed significantly from that in the delayed rehabilitation group twelve months after the operation, according to the analysis of the minimal clinically important difference (MCID), the results have no clinical significance. Conclusions: The improvement in shoulder function following arthroscopic rotator cuff surgery does not differ clinically between early and delayed rehabilitation. When implementing rehabilitation following rotator cuff repair, it is essential to consider the paradoxes surrounding shoulder range of motion and tendon anatomic healing. A program that allows for flexible progression based on the patient's ability to meet predetermined clinical goals or criteria may be a better option. [ABSTRACT FROM AUTHOR]

Musculoskeletal pathologies affecting shoulder girdle joints, other than gleno-humeral joint such as acromioclavicular joint arthritis, tendonitis, subacromial bursitis, subdeltoid bursitis, and osteochondritis dissecans, are relatively rare. In Middle East and Asian countries, public health services are generally availed by a large number of patients in primary health centres, rural hospitals, and district hospitals, but the scarcity of specialist orthopaedic surgeons in such hospitals usually leads to misdiagnosis of rare musculoskeletal pathologies, which may result in complications and morbidity. The study aims to determine the presentation, progression, diagnostic evaluation, and treatment of musculoskeletal pathologies affecting the shoulder girdle and develop an algorithm to screen such pathologies. A systematic literature search of four medical databases (PubMed, Scopus, Web of Science and Google Scholar) was conducted, from 1st January 1950 to 31st December 2022. Studies (case reports, prospective studies, review articles) reporting pathological conditions affecting shoulder girdles, with a focus on clinical presentation, physical examination tests required for diagnostic evaluation, and management, were included. The relevant data was extracted from the selected studies and tabulated for analysis. Seventeen studies were included in the final analysis. Several case reports, case series and review articles showed that very few musculoskeletal conditions can be correctly diagnosed based on only physical examination tests. Radiological and anatomical basis of each of the cases were discussed. An algorithm was prepared to help diagnose shoulder girdle pathologies based on clinical presentation and examination findings. [ABSTRACT FROM AUTHOR]

Background: Rotator cuff injury (RCI) is a common shoulder injury, which is difficult to be completely repaired by surgery. Hence, new strategies are needed to promote the healing of tendon-bone. Objective: We aimed to investigate the effect of human umbilical cord mesenchymal stem cells (hUC-MSCs) overexpressing RUNX1 on the tendon-bone healing after RCI, and to further explore its mechanism. Methods: Lentiviral vector was used to mediate the overexpression of RUNX1. RUNX1-overexpressed UCB-MSCs (referred to as MSC-RUNX1) were co-cultured with osteoclasts, and TRAP staining was performed to observe the formation of osteoclasts. Then MSC-RUNX1 was cultured in osteogenic differentiation medium, Alizarin red staining was conducted to detect osteogenic differentiation. The expression of markers of osteogenesis and osteoclast was detected by RT-qPCR. EA. hy926 cells were co-cultured with MSC-RUNX1. Transwell assay was used to detect the migration, and the expression of angiogenesis related-genes VEGF and TGF-β was detected by RT-qPCR. The rat rotator cuff reconstruction model was established and MSCs were injected at the tendon-bone junction. Biomechanical test and micro-CT scanning were performed, and HE, Masson and Alcian Blue staining were used for histological evaluation of tendon-bone healing. TUNEL and PCNA immunofluorescence (IF) staining were performed to evaluate apoptosis and proliferation at the tendon-bone healing site. The levels of TNF-α, IL-6 and IL-8 in serum were detected by ELISA. The expression of CD31 and Endomucin that related to angiogenesis was detected by IF. Safranin O-fast and TRAP/CD40L immunohistochemical staining were used to assess the levels of osteoclasts and osteoblasts at the tendon-bone healing site. Results: hUC-MSCs overexpressing RUNX1 inhibited osteoclast formation and promoted osteogenic differentiation. MSC-RUNX1 could promote the migration and tube formation of EA. hy926 cells, and up-regulate the levels of VEGF and TGF-β. Model mice treated with MSC-RUNX1 partially restored the biomechanical indexes. Treatment of MSC-RUNX1 obviously increased the bone density, accompanied by the formation of new bone. In vivo experiments showed that MSC-RUNX1 treatment could promote tendon-bone healing and inhibit inflammatory response in rats. MSC-RUNX1 treatment also promoted angiogenesis at the tendon-bone healing site, while inhibiting osteoclast formation and promoting osteogenic differentiation. Conclusion: hUC-MSCs overexpressing RUNX1 can inhibit the formation of osteoclasts and differentiation of osteoblasts, promote angiogenesis and inhibit inflammation, thereby promoting tendon-bone healing after RCI. [ABSTRACT FROM AUTHOR]

Objective: Rotator cuff injury is one prevalent shoulder condition that often leads to pain and dysfunction. The study explored the clinical effects of sodium hyaluronate combined with platelet-rich plasma (PRP) injection on rotator cuff injury in arthroscopic repair. Methods: A total of 92 cases with rotator cuff injury were randomly divided into the control group (n = 46, treated with shoulder arthroscopy repair combined with subacromial space injection of sodium hyaluronate) and the experimental group (n = 46, treated with subacromial space injection of autologous PRP on the basis of the treatment in the control group). Visual analogue scale (VAS), Constant-Murley scale (CMS), University of California, Los Angeles (UCLA), American Shoulder and Elbow Society (ASES), and quality of life (QOL) scores, as well as complications were compared in the two groups before surgery and at 3 and 6 months after surgery. Shoulder range of motion (ROM) was measured before and after surgery. Results: VAS scores of patients in the two groups at 3 and 6 months after surgery were lower than those before surgery, and the VAS scores of patients in the experimental group at 3 and 6 months after surgery were much lower than those in the control group (all P 0.05). Conclusion: Arthroscopic rotator cuff repair and sodium hyaluronate combined with PRP injection can effectively reduce pain symptoms, improve shoulder joint function and shoulder ROM, and improve QOL in patients with rotator cuff injury.

Abstract Background Macrophage polarization has been observed in the process of muscle injuries including rotator cuff (RC) muscle atrophy and fatty infiltration after large tendon tears. In our previous study, we showed that fibrogenesis and white adipogenesis of muscle residential fibro/adipogenic progenitors (FAPs) cause fibrosis and fatty infiltration and that brown/beige adipogenesis of FAPs promotes rotator cuff muscle regeneration. However, how polarized macrophages and their exosomes regulate FAP differentiation remains unknown. Methods We cultured FAPs with M0, M1, and M2 macrophages or 2 × 109 exosomes derived from M0, M1 and M2 with and without GW4869, an exosome inhibitor. In vivo, M0, M1, and M2 macrophages were transplanted or purified macrophage exosomes (M0, M1, M2) were injected into supraspinatus muscle (SS) after massive tendon tears in mice (n = 6). SS were harvested at six weeks after surgery to evaluate the level of muscle atrophy and fatty infiltration. Results Our results showed that M2 rather than M0 or M1 macrophages stimulates brown/beige fat differentiation of FAPs. However, the effect of GW4869, the exosome inhibitor, diminished this effect. M2 exosomes also promoted FAP Beige differentiation in vitro. The transplantation of M2 macrophages reduced supraspinatus muscle atrophy and fatty infiltration. In vivo injections of M2 exosomes significantly reduced muscle atrophy and fatty infiltration in supraspinatus muscle. Conclusion Results from our study demonstrated that polarized macrophages directly regulated FAP differentiation through their exosomes and M2 macrophage-derived exosomes may serve as a novel treatment option for RC muscle atrophy and fatty infiltration.

Abstract Objective Develop and evaluate an ensemble clinical machine learning–deep learning (CML-DL) model integrating deep visual features and clinical data to improve the prediction of supraspinatus/infraspinatus tendon complex (SITC) injuries. Methods Patients with suspected SITC injuries were retrospectively recruited from two hospitals, with clinical data and shoulder x-ray radiographs collected. An ensemble CML-DL model was developed for diagnosing normal or insignificant rotator cuff abnormality (NIRCA) and significant rotator cuff tear (SRCT). All patients suspected with SRCT were confirmed by arthroscopy examination. The model’s performance was evaluated using sensitivity, specificity, accuracy, and area under the curve (AUC) metrics, and a two-round assessment was conducted to authenticate its clinical applicability. Results A total of 974 patients were divided into three cohorts: the training cohort (n = 828), the internal validation cohort (n = 89), and the external validation cohort (n = 57). The CML-DL model, which integrates clinical and deep visual features, demonstrated superior performance compared to individual models of either type. The model’s sensitivity, specificity, accuracy, and area under curve (95% confidence interval) were 0.880, 0.812, 0.836, and 0.902 (0.858–0.947), respectively. The CML-DL model exhibited higher sensitivity and specificity compared to or on par with the physicians in all validation cohorts. Furthermore, the assistance of the ensemble CML-DL model resulted in a significant improvement in sensitivity for junior physicians in all validation cohorts, without any reduction in specificity. Conclusions The ensembled CML-DL model provides a solution to help physicians improve the diagnosis performance of SITC injury, especially for junior physicians with limited expertise. Critical relevance statement The ensembled clinical machine learning–deep learning (CML-DL) model integrating deep visual features and clinical data provides a superior performance in the diagnosis of supraspinatus/infraspinatus tendon complex (SITC) injuries, particularly for junior physicians with limited expertise. Key points 1. Integrating clinical and deep visual features improves diagnosing SITC injuries. 2. Ensemble CML-DL model validated for clinical use in two-round assessment. 3. Ensemble model boosts sensitivity in SITC injury diagnosis for junior physicians. Graphical Abstract

Objective We compared the effects of early and delayed rehabilitation on the function of patients after rotator cuff repair by meta-analysis to find effective interventions to promote the recovery of shoulder function. Methods This meta-analysis was registered in PROSPERO (CRD42023466122). We manually searched the randomized controlled trials (RCTs) in the Cochrane Library, Pubmed, Cochrane Library, EMBASE, the China National Knowledge Infrastructure (CNKI), the China VIP Database (VIP), and the Wanfang Database to evaluate the effect of early and delayed rehabilitation after arthroscopic shoulder cuff surgery on the recovery of shoulder joint function. Review Manager 5.3 software was used to analyze the extracted data. Then, the PEDro scale was employed to appraise the methodological quality of the included research. Results This research comprised nine RCTs and 830 patients with rotator cuff injuries. According to the findings of the meta-analysis, there was no discernible difference between the early rehabilitation group and the delayed rehabilitation group at six and twelve months after the surgery in terms of the VAS score, SST score, follow-up rotator cuff healing rate, and the rotator cuff retear rate at the final follow-up. There was no difference in the ASES score between the early and delayed rehabilitation groups six months after the operation. However, although the ASES score in the early rehabilitation group differed significantly from that in the delayed rehabilitation group twelve months after the operation, according to the analysis of the minimal clinically important difference (MCID), the results have no clinical significance. Conclusions The improvement in shoulder function following arthroscopic rotator cuff surgery does not differ clinically between early and delayed rehabilitation. When implementing rehabilitation following rotator cuff repair, it is essential to consider the paradoxes surrounding shoulder range of motion and tendon anatomic healing. A program that allows for flexible progression based on the patient’s ability to meet predetermined clinical goals or criteria may be a better option.

Background: Platelet-rich plasma (PRP) has demonstrated beneficial effects on healing of the bone-tendon interface (BTI). Purpose: To determine the optimal initiation time for PRP application after rotator cuff repair in an animal model. Study Design: Controlled laboratory study. Methods: A total of 136 C57BL/6 mice were included; 40 mice were used to prepare PRP, while 96 mice underwent acute supraspinatus tendon (SST) repair. The animals were randomly divided into 4 groups: a control group and 3 groups in which PRP was injected into the injury interface immediately after surgery, on the 7th postoperative day (PRP-7d), and on the 14th postoperative day. At 4 and 8 weeks postoperatively, the animals were sacrificed, blood was collected by eyeball removal, and samples of the SST-humerus complex were collected. Histological, imaging, immunological, and biomechanical data were compared among the groups using 1-way analysis of variance with the Bonferroni post hoc test. Results: Histological analysis revealed that the fibrocartilage layer at the BTI was larger in the PRP-7d group compared to the other groups at both 4 and 8 weeks postoperatively. Moreover, the PRP-7d group exhibited improved proteoglycan content and distribution compared to the other groups. Enzyme-linked immunosorbent assay results demonstrated that at 4 weeks postoperatively, higher concentrations of transforming growth factor–β1 and platelet-derived growth factor–BB (PDGF-BB) were seen in the PRP-7d group versus the PRP-14d and control gruops (P <.05), and at 8 weeks postoperatively, the concentration of PDGF-BB was higher in the PRP-7d group versus the control group (P <.05). Biomechanical testing at 4 weeks postoperatively revealed that the failure load and ultimate strength of the SST-humerus complex were superior in the PRP-7d group compared to the other groups (P <.05), at 8 weeks, PRP-7d group was superior to the control group (P <.05). Additionally, at 8 weeks postoperatively, the PRP-7d group exhibited a greater trabecular number and trabecular thickness at the BTI compared to the PRP-14d and control gruops (P <.05). Conclusion: PRP promoted healing of the BTI after a rotator cuff injury at an early stage. Clinical Relevance: A PRP injection on the 7th postoperative day demonstrated superior therapeutic effects compared with injections at other time points. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of arthroscopic triple release combined with rotator cuff repair in the treatment of rotator cuff injury combined with frozen shoulder and its influence on the range of motion and pain score of shoulder joint, and the levels of serum pain mediators. Methods: This was prospective study. A total of 132 patients with rotator cuff injury combined with frozen shoulder admitted to The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine from December 2020 to December 2022 were prospectively selected and divided into two groups according to the random number table method: control group (n=67) and observation group (n=65). Patients in the control group were treated with arthroscopic rotator cuff repair alone, while those in the observation group were treated with arthroscopic triple release combined with rotator cuff repair, and the surgical effects of the two groups were compared. Results: Three months after treatment, the external rotation, internal rotation, abduction, forward flexion, β-endorphin(β-EP), prostagranin E2 (PGE2) and substance P(SP)in the observation group were better than those in the control group (P<0.05), while the weight-bearing strength of the affected limb in internal rotation, external rotation and forward flexion was higher than that of the control group(P<0.05). Meanwhile, the Visual Analogue Scale (VAS) score of the observation group was lower than that of the control group at one month and three months after treatment, while the University of California at Los Angeles shoulder rating scale (UCLA) score and Constant-Murley Score (CMS) were higher than those of the control group (P< 0.05). Conclusion: Arthroscopic triple release combined with rotator cuff repair improves various effects for patients with rotator cuff injury combined with frozen shoulder, such as ameliorating the muscle strength of the affected limb and improving the level of pain mediators. [ABSTRACT FROM AUTHOR]

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Background: Various muscle contraction modalities have differing effects on the musculoskeletal system. To understand the magnitude of these effects, the authors investigated the effects of eccentric and concentric contractions on the bone-tendon interface after rotator cuff repair in mice. Hypothesis: Eccentric contraction promotes healing of the bone-tendon interface after rotator cuff repair in mice better than other muscle contraction patterns. Study Design: Controlled laboratory study. Methods: The authors performed acute supraspinatus tendon repair of the right shoulder in 104 C57BL/6 mice. Animals were randomized into 4 groups postoperatively: control group (Con group), horizontal running group (Horz group), +15° uphill running group (Up group), and −15° downhill running group (Down group), with 26 animals in each group. At 4 and 8 weeks postoperatively, the authors removed the eyeball, collected blood samples, and extracted the supraspinatus tendon–humerus complex for histological, immunological, bone morphological, and biomechanical tests. Results: At 4 and 8 weeks postoperatively, the Down group exhibited a better collagen cell arrangement and fibrocartilage layer than the other 3 groups. At 4 weeks postoperatively, anti-inflammatory macrophages (M2 macrophages) were observed at the repair site in all groups except for the Con group. At 8 weeks postoperatively, M2 macrophages were withdrawn from the tendon site in all groups. The transforming growth factor β1 concentration in the Down group was greater than that in the other 3 groups at 4 weeks postoperatively, and it was higher than that in the Con group at 8 weeks postoperatively. The bone volume fraction, number of trabeculae, and thickness of trabeculae at the repair site in the Down group, as well as the ultimate strength and failure load in the biomechanical tests, were greater than those in the other 3 groups at 8 weeks postoperatively. Conclusion: Eccentric contraction promotes healing of the bone-tendon interface after rotator cuff repair in mice better than other muscle contraction patterns. Clinical Relevance: After clinical rotator cuff repair, patients can be rehabilitated by eccentric training to speed up the functional recovery of the shoulder joint. [ABSTRACT FROM AUTHOR]

BACKGROUND: Most rotator cuff injuries occur in the supraspinatus tendon. Clinical treatment of rotator cuff injuries is very limited due to the lack of blood vessels and the complex anatomical structure of the rotator cuff. The rapid development of tissue engineering technology and stem cell biology has brought new hope for improving the quality of tendon repair. OBJECTIVE: To prepare human umbilical cord mesenchymal stem cells/gelatin methacrylate composite scaffolds by bio-3D printing technology to observe the effect of this scaffold on repairing rotator cuff injury. METHODS: (1) In vitro cell assay: The gelatin microcarrier was prepared. The tissue engineered stem cells were constructed by inoculating human umbilical cord mesenchymal stem cells on the surface of gelatin microcarrier. Gelatin methacrylate hydrogel printing ink was prepared. Tissue engineered stem cells were re-suspended with gelatin methacrylate hydrogel printing ink and put into the bio-ink container of 3D printer for printing. Human umbilical cord mesenchymal stem cells/gelatin methacrylate composite scaffold was obtained after 5 minutes of blue light irradiation and curing. The activity of human umbilical cord mesenchymal stem cells in scaffolds was detected by dead/alive staining and CCK-8 assay. (2) In vivo animal experiments: A random block design method was used to randomly assign 24 SD rats to 4 groups with 6 rats in each group. No treatment was given in the normal group. The rotator cuff injury model of supratinatus tendon tear was established in the rotator cuff injury group, the simple scaffold group, and the cellular scaffold group. The gelatin methacrylate scaffold and human umbilical cord mesenchymal stem cell/gelatin methacrylatecomposite scaffold were implanted into the tendon injury after the model was made in the simple scaffold group and the cellular scaffold group, respectively. Four weeks after operation, behavioral tests and histopathological morphology observation of supraspinatus tendon of rotator cuff were performed. RESULTS AND CONCLUSION: (1) In vitro cellular assay: The dead/alive staining showed that gelatin microcarrier could reduce the damage of human umbilical cord mesenchymal stem cells caused by 3D printing process. With the extension of culture time, the survival rate of human umbilical cord mesenchymal stem cells increased in the scaffold. The results of CCK-8 assay showed that with the extension of culture time, the activity of human umbilical cord mesenchymal stem cells in the scaffold did not change significantly. (2) In vivo animal experiments: Behavioral test results showed that compared with rotator cuff injury group and simple scaffold group, cellular scaffold group significantly improved limb motor function. The results of hematoxylin-eosin and Masson staining of rotator cuff supraspinatus tendon showed that compared with rotator cuff injury group and simple scaffold group, the muscle fiber arrangement in the cellular scaffold group was more regular; there was no obvious inflammatory cell infiltration, and the percentage of collagen volume decreased. The results of immunofluorescence staining showed that the expression levels of interleukin 6 and tumor necrosis factor α in the rotator cuff supraspinatus tendon were significantly decreased in the cellular scaffold group compared with the rotator cuff injury group and the simple scaffold group. (3) The results showed that bio3D-printed cell scaffolds encapsulating human umbilical cord mesenchymal stem cells/gelatin methacrylate could promote tissue repair and regeneration of rotator cuff injuries. [ABSTRACT FROM AUTHOR]

AIM. To evaluate the effectiveness of the comprehensive rehabilitation program for patients with rotator cuff injury using virtual realitytechnology.MATERIAL AND METHODS. The study examined 59 patients, 29 (49.2%) male and 30 (50.8%) female, the average weight was 79[70.00;87.50] kg, the average height was 1.72 [1.63;1.78] m, the average age was 48 [32.00;54.00] years, randomly divided into twogroups. The control group consisted of 30 patients, including 16 men and 14 women, the average age was 47.00 [27.00;54.00] years,the average height and weight were 1.71 [1.63;1.78] m and 77.50 [70.50;88.25] kg, respectively. Patients of the control group receiveda standard rehabilitation methodology. The study group consisted of 29 people, 13 men and 16 women, mean age 48 [39.50;56.50]years, mean height 1.72 [1.62;1.78] m, mean weight 81.00 [70.00;86.00] kg, who received classes with the inclusion of virtual realitytechnologies against the background of the standard method.RESULTS AND DISCUSSION. The study showed a positive dynamics of pain syndrome, an improvement of the functional state of theshoulder joint according to the results of the DASH questionnaire, an increase in the volume of the shoulder joint motions. The averageindicators of dynamic strength and muscular endurance and performance in the “inward/outward rotation” test increased by 58% and68.5%. In the “ adduction/abduction” tests, the strength indicators of patients with rotator cuff tears increased by 67.5%, and muscleendurance and performance by an average of 82.3%. According to the results of isokinetic testing, the growth of strength values in the“extension / flexion” test was 64.5%, and muscle endurance and performance were 79%.CONCLUSION. The inclusion of virtual reality technologies at the stage of medical rehabilitation of patients with rotator cuff injuriescan significantly reduce shoulder pain, improve upper extremity functioning, increase joint range of motion, and significantly improvestrength, muscular endurance and performance.

AIM. To assess the degree of change in functional and biomechanical characteristics of the shoulder joint in patients with rotator cuffinjury.MATERIAL AND METHODS. The study included 119 patients, 59 patients with rotator cuff injury and 60 practically healthy volunteerswith no history of injuries and shoulder disorders, aged 18 to 66 years. All patients completed DASH questionnaires and underwentclinical examination by a traumatologist, neurologist and physical therapist, as well as a biomechanical examination of the shoulderjoint. The biomechanical parameters of the shoulder joint were studied using the «Con-Trex MJS» (Physiomed, Germany) computerizedisokinetic dynamometer. We chose the inward/outward rotation test as the diagnostic test. The inward/outward rotation test wasperformed lying on the back. The elbow was bent at an angle of 90º, the upper limb was moved 90º at the shoulder joint. The handle ofthe dynamometer was set individually according to the patient’s limb length. The axis of rotation of the dynamometer coincided withthe axis of rotation in the shoulder joint. The maximum allowable amount of motion in the test was limited to 90º movement of theexternal rotation and 80º internal rotation. The neutral position of the shoulder joint retraction equal to 90 ° and the elbow joint flexionat 90 ° were taken as the zero point of reference.RESULTS AND DISCUSSION. Patients with rotator cuff injury have a high shoulder pain level, 6.00 [5.00;7.00] VAS, a severe degree offunctional limitations 63.33 [55.92;66.67] scores on the DASH questionnaire, a pronounced decrease in shoulder range of motions, aswell as a significant deficit in dynamic strength and endurance indices and muscle performance.CONCLUSION. Patients with shoulder rotator cuff injury experience extensive functional limitations expressed in a high level of pain inthe shoulder joint, high points of the questionnaire of the upper limb functioning (DASH, more – worse) and a significant decrease inthe biomechanical indicators of the shoulder joint and upper limb in general, which ultimately leads to a serious limitation of functionalactivity, a decrease in the working capacity and, consequently, a decrease in the quality of life.

ObjectiveTo explore the clinical effect of wrist-ankle acupuncture （WAA） with midnight-noon ebb-flow at selection time on postoperative pain and rehabilitation after rotator cuff injury repair. MethodsA total of 68 inpatients for rehabilitation at 4-6 weeks after rotator cuff repair in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2022 to June 2022 were selected. They were randomly divided into conventional WAA group （n=34, control group） and WAA at selection time group （n=32, observation group, excluding 2 cases）. In control group, WAA was conducted around 10:30 on the morning, taking the acupoints in upper 4 region （alone the large intestine meridian of hand-Yangming）, in upper 5 region （along the meridian of Hand-Shaoyang） and in upper 6 region （along meridian of Hand-Taiyang）, with 30 minutes for needle retention, once a day for 7 days. In observation group, WAA was performed at around 14:00 with the same acupoints and treatment duration as control group. The Visual Analogue Scale （VAS）, shoulder passive range of motion （ROM）, Pittsburgh Sleep Quality Index （PSQI） and University of California-Los Angeles （UCLA） Shoulder Scale were observed and compared between two groups before and after treatment . b>ResultsCompared with those before treatment, VAS and PSQI scores significantly decreased, and ROM and UCLA Shoulder Scale increased after treatment in both groups （P＜0.05）. In observation group, VAS score was lower than that in control group, and shoulder ROM and UCLA Shoulder Scale were significantly higher than those in control group （P＜0.05）. ConclusionWAA at selection time based on midnight-noon ebb-flow can effectively alleviate postoperative pain of rotator cuff injury, improve joint mobility and promote rapid recovery of shoulder joint function.

Aims: Rotator cuff muscle atrophy and fatty infiltration affect the clinical outcomes of rotator cuff tear patients. However, there is no effective treatment for fatty infiltration at this time. High-intensity interval training (HIIT) helps to activate beige adipose tissue. The goal of this study was to test the role of HIIT in improving muscle quality in a rotator cuff tear model via the β3 adrenergic receptor (β3AR). Methods: Three-month-old C57BL/6 J mice underwent a unilateral rotator cuff injury procedure. Mice were forced to run on a treadmill with the HIIT programme during the first to sixth weeks or seventh to 12th weeks after tendon tear surgery. To study the role of β3AR, SR59230A, a selective β3AR antagonist, was administered to mice ten minutes before each exercise through intraperitoneal injection. Supraspinatus muscle, interscapular brown fat, and inguinal subcutaneous white fat were harvested at the end of the 12th week after tendon tear and analyzed biomechanically, histologically, and biochemically. Results: Histological analysis of supraspinatus muscle showed that HIIT improved muscle atrophy, fatty infiltration, and contractile force compared to the no exercise group. In the HIIT groups, supraspinatus muscle, interscapular brown fat, and inguinal subcutaneous white fat showed increased expression of tyrosine hydroxylase and uncoupling protein 1, and upregulated the β3AR thermogenesis pathway. However, the effect of HIIT was not present in mice injected with SR59230A, suggesting that HIIT affected muscles via β3AR. Conclusion: HIIT improved supraspinatus muscle quality and function after rotator cuff tears by activating systemic sympathetic nerve fibre near adipocytes and β3AR. Cite this article: Bone Joint Res 2023;12(8):455–466.

Objective: Develop and evaluate an ensemble clinical machine learning–deep learning (CML-DL) model integrating deep visual features and clinical data to improve the prediction of supraspinatus/infraspinatus tendon complex (SITC) injuries. Methods: Patients with suspected SITC injuries were retrospectively recruited from two hospitals, with clinical data and shoulder x-ray radiographs collected. An ensemble CML-DL model was developed for diagnosing normal or insignificant rotator cuff abnormality (NIRCA) and significant rotator cuff tear (SRCT). All patients suspected with SRCT were confirmed by arthroscopy examination. The model's performance was evaluated using sensitivity, specificity, accuracy, and area under the curve (AUC) metrics, and a two-round assessment was conducted to authenticate its clinical applicability. Results: A total of 974 patients were divided into three cohorts: the training cohort (n = 828), the internal validation cohort (n = 89), and the external validation cohort (n = 57). The CML-DL model, which integrates clinical and deep visual features, demonstrated superior performance compared to individual models of either type. The model's sensitivity, specificity, accuracy, and area under curve (95% confidence interval) were 0.880, 0.812, 0.836, and 0.902 (0.858–0.947), respectively. The CML-DL model exhibited higher sensitivity and specificity compared to or on par with the physicians in all validation cohorts. Furthermore, the assistance of the ensemble CML-DL model resulted in a significant improvement in sensitivity for junior physicians in all validation cohorts, without any reduction in specificity. Conclusions: The ensembled CML-DL model provides a solution to help physicians improve the diagnosis performance of SITC injury, especially for junior physicians with limited expertise. Critical relevance statement: The ensembled clinical machine learning–deep learning (CML-DL) model integrating deep visual features and clinical data provides a superior performance in the diagnosis of supraspinatus/infraspinatus tendon complex (SITC) injuries, particularly for junior physicians with limited expertise. Key points: 1. Integrating clinical and deep visual features improves diagnosing SITC injuries. 2. Ensemble CML-DL model validated for clinical use in two-round assessment. 3. Ensemble model boosts sensitivity in SITC injury diagnosis for junior physicians. [ABSTRACT FROM AUTHOR]

BACKGROUND: As the largest and only anterior rotator cuff muscle in the rotator cuff muscle group, the subscapularis muscle is often neglected for its injury, and the local injury of the subscapular muscle is still difficult to diagnose. In recent years, studies have found that the coracohumeral distance and coracoid overlap distance were used as predictors of subscapularis muscle injury. OBJECTIVE: To investigate the relationship between the coracohumeral distance, coracoid overlap distance and the difference between the coracohumeral distance of the patient’s bilateral shoulder joint and subscapularis injury, and to evaluate the diagnostic efficacy of each parameter on subscapularis injury. METHODS: Preoperative clinical and imaging data of patients with degenerative rotator cuff injury from February 2021 to June 2022 were retrospectively collected, and patients were divided into the group with rotator cuff injury combined with subscapularis tear (subscapularis tear group, 28 patients) and the group with rotator cuff injury without subscapularis tear (control group, 56 patients) based on intraoperative arthroscopic findings. The CT data of the enrolled patients were imported into Mimics software in DICOM format. The scapula and proximal humerus of the patients were reconstructed; the measurement points were determined to establish the measurement plane; the coracohumeral distance and coracoid overlap distance of the patients were measured in 3-matic software. The differences in parameters between the two groups of patients and bilateral differences within the groups were compared, and receiver operating characteristic curve analysis was performed for each parameter to determine the area under the curve and the optimal cut-off value for each parameter. RESULTS AND CONCLUSION: (1) Coracohumeral distance among groups: (7.00±0.87) mm in the subscapularis tear group and (9.08±1.02) mm in the control group. Coracohumeral distance in the subscapularis tear group was significantly smaller than that in the control group (P < 0.01). Coracoid overlap distance among groups: (21.05±1.98) mm in the subscapularis tear group and (19.46±1.55) mm in the control group. Coracoid overlap distance in the subscapularis tear group was significantly larger than that in the control group (P < 0.01). (2) Difference in coracohumeral distance between the two groups: The coracohumeral distance of the affected side of the subscapularis tear group (7.00±0.87) mm was significantly smaller than that of the healthy side (9.26±0.87) mm, and the difference was statistically significant (P < 0.01). (3) The receiver operating characteristic analysis: the areas under the curve for the difference in coracohumeral distance, coracoid overlap distance, and bilateral coracohumeral distance were 0.884, 0.729, and 0.905, respectively; the best cut-off values were 7.65 mm, 20.2 mm, and 1.15 mm, respectively. (4) It is concluded that the coracohumeral distance, coracoid overlap distance, and bilateral coracohumeral distance difference are all related to subscapularis injury, and all can be used as predictors of subscapularis injury, with coracohumeral distance difference having the highest predictive efficacy, and the three measured parameters can provide some reference values in preoperative clinical diagnosis. [ABSTRACT FROM AUTHOR]

Traumatic anterior dislocation of the shoulder is often associated with anterior glenoid fracture or bankart injury. It can also be associated with rotator cuff injury, humeral greater tuberosity fracture, or brachial plexus injury. However, there are few clinical reports of all the above-mentioned injuries at the same time. We report a case of the left "Shoulder terrible tetrad." After closed reduction of the left shoulder dislocation, we performed one-stage arthroscopic massive rotator cuff repair (Chinese-Way technique) and anchor repair of the bony bankart injury. After 2 years follow-up, the left shoulder function recovered well and the range of motion was satisfactory. A detailed physical examination and electromyography (EMG) examination should be performed in time to avoid misdiagnosis and missed diagnosis, when the clinical manifestation of brachial plexus nerve injury appears after shoulder dislocation. The repairable rotator cuffs tears and bankart injuries can be repaired under shoulder arthroscopy in one stage. [ABSTRACT FROM AUTHOR]

This review delves into the intersection of two prevalent conditions, hyperlipidemia and rotator cuff injuries, both of which bear substantial healthcare burdens. Our investigation begins with an exploration of rotator cuff injuries, common musculoskeletal disorders that severely impair shoulder functionality and quality of life. These injuries are notably pervasive among sports enthusiasts and the older adult, with an incidence rate estimated at 5–10% in the general population. Despite their widespread occurrence and the diverse, multifactorial etiological factors, effective treatment strategies remain elusive. We then examine hyperlipidemia, a metabolic disorder affecting approximately 40% of the global adult population. Characterized by elevated levels of cholesterol and triglycerides, hyperlipidemia can precipitate severe cardiovascular complications and presents a significant socioeconomic burden. Although current management strategies encompass lifestyle modifications and pharmacological interventions, the condition remains a formidable health challenge. Central to this review is the exploration of a potential association between hyperlipidemia and rotator cuff injuries. We aim to synthesize the current understanding of hyperlipidemia’s role in the pathophysiology of rotator cuff injuries, thereby offering fresh insights into their common etiological underpinnings, potential therapeutic targets, and drugs, such as Statins. The influence of other lipid-lowering therapeutics on tendon health is also considered, and further research into the molecular pathways and potential therapeutic benefits of these drugs is required. This pursuit aligns with broader efforts to enhance patient outcomes, minimize healthcare burdens, and contribute to the global understanding of these prevalent conditions.