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Factors affecting healing after arthroscopic rotator cuff repair

World Journal of Orthopedics 2015年第2期6卷 211-220页

作者： Amir M Abtahi erin K granger Robert Z Tashjian Department of Orthopaedic Surgery University of Utah

Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymalstem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair.

关键词： Shoulder Repair Healing Tendon Rotator cuff tear

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Functional outcomes assessment in shoulder surgery

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World Journal of Orthopedics 2014年第5期5卷 623-633页

作者： James D Wylie James T Beckmann erin granger Robert Z Tashjian Department of Orthopaedic Surgery University of Utah

The effective evaluation and management of orthopaedic conditions including shoulder disorders relies upon understanding the level of disability created by the disease process. Validated outcome measures are critical to the evaluation process. Traditionally, outcome measures have been physician derived objective evaluations including range of motion and radiologic evaluations. However, these measures can marginalize a patient's perception of their disability or outcome. As a result of these limitations, patient self-reported outcomes measures have become popular over the last quarter century and are currently primary tools to evaluate outcomes of treatment. Patient reported outcomes measures can be general health related quality of life measures, health utility measures, region specific health related quality of life measures or condition specific measures. Several patients self-reported outcomes measures have been developed and validated for evaluating patients with shoulder disorders. Computer adaptive testing will likely play an important role in the arsenal of measures used to evaluate shoulder patients in the future. The purpose of this article is to review the general health related quality-of-life measures as well as the jointspecific and condition specific measures utilized in evaluating patients with shoulder conditions. Advancesin computer adaptive testing as it relates to assessing dysfunction in shoulder conditions will also be reviewed.

关键词： Shoulder Functional outcome Quality-oflife Health utility measure Patient reported outcome

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