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.
- MeSH
- cyklooxygenasa 2 * metabolismus genetika MeSH
- kosterní svalová vlákna metabolismus enzymologie patologie MeSH
- kosterní svaly metabolismus patologie MeSH
- kultivované buňky MeSH
- lidé MeSH
- poranění rotátorové manžety * metabolismus patologie enzymologie genetika MeSH
- proliferace buněk MeSH
- transkripční faktor STAT3 metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- ambulantní chirurgické výkony metody MeSH
- artroskopie * metody MeSH
- autologní transplantace metody MeSH
- kloubní chrupavka chirurgie zranění MeSH
- lidé MeSH
- nanomedicína metody MeSH
- poranění kolena chirurgie MeSH
- poranění rotátorové manžety chirurgie MeSH
- regenerace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
PURPOSE OF THE STUDY: This study investigated the relationship between the position of the tip of the coracoid process (CP) relative to the glenoid with subscapularis (Ssc) tears. We hypothesized that the coracoid tip is more inferior, lateral and posterior in patients with Ssc tear. MATERIAL AND METHODS: This research enrolled 34 isolated Ssc tears and 44 controls. We introduced the axial central glenoid-coracoid angle (acGCA) and sagittal central glenoid-coracoid angle (scGCA) to evaluate the position of the tip of the CP relative to the glenoid center on MRI images. In both groups, acGCA, scGCA on MRI and critical shoulder angle (CSA), glenoid inclination (GI) on true anterior-posterior shoulder radiography were evaluated. RESULTS: When both groups were compared in terms of acGCA, the acGCA values of the Ssc tear group were significantly higher than the control group (p<0.001). The best cut-off value of acGCA for Ssc tears was 28.3°. acGCA values higher than 28.3° showed 93.3% sensitivity and 93.1% specificity for Ssc tears (likelihood ratio:13.53, AUC: 0.979, 95% CI of AUC: 0.950- 0.999). In terms of acGCA, the power analysis between Ssc tears group and control group was 99.9% between Ssc tears and the control group (effect size d=2.63). When both groups were compared in terms of scGCA, the scGCA values of the Ssc tear group were significantly higher than the control group (p<0.001). The best cut-off value of scGCA for Ssc tears was 41.4°. Scores of scGCA greater than 41.8° showed 80% sensitivity and 89.7% specificity for Ssc tears (likelihood ratio: 7.73, AUC: 0.899 95% CI of AUC: 0.837-0.958). In terms of scGCA, the power analysis between Ssc tear and control group was 99.8% (effect size d=1.23). When both groups were compared in terms of CSA and GI; CSA and GI values in the Ssc tear group were significantly higher (p<0.001 and p<0.012, respectively). CONCLUSIONS: AcGCA values higher than 28.3° indicate that the coracoid tip is located more laterally and posteriorly; scGCA values higher than 41.8° indicate that the coracoid tip is located more inferiorly and these two new indexes are showing that more laterally, posteriorly and inferiorly coracoid tip is related to subscapularis tears. KEY WORDS: coracoid process, subscapularis tear, coracoid morphology, scapula morphology.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie * metody MeSH
- poranění rotátorové manžety * diagnostické zobrazování MeSH
- processus coracoideus * zranění diagnostické zobrazování MeSH
- ramenní kloub diagnostické zobrazování MeSH
- senzitivita a specificita MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY: In this study, we aimed to evaluate acromiohumeral distance (AHD) and supraspinatus tendon (ST) thickness measurements and their relationship with pain and function in ST pathologies. MATERIAL AND METHODS: The study included 111 patients and 25 healthy controls (HC). Patients were divided into 3 groups according to their diagnosis: non-tear tendinopathy (NTT), partial thickness tear (PTT), and full thickness tear (FTT). The AHD and ST thickness of the participants were measured with ultrasound. The pain and functional status of the patients were evaluated with the Numeric Rating Scale (NRS), The QuickDASH shortened version of the DASH Outcome Measure - Disabilities of the Arm Shoulder and Hand (QDASH), and Simple Shoulder Test (SST). RESULTS: The AHD value was significantly higher in the NTT group (p=0.000). The AHD value was significantly lower in the FTT group (p=0.000). ST thickness value was significantly lower in the PTT group compared to the NTT group (p=0.000). There was a positive correlation between ST thickness and BMI (r=0.553,p<0.01). There was a negative correlation between ST thickness and SST and a positive correlation between ST thickness (r=-0.223,p<0.05) and QDASH (r=0.276,p<0.05). CONCLUSIONS: We found that AHD and SST thicknesses significantly differed in the NTT, PTT, FTT, and HC groups. This difference may be important for diagnosis. In addition, the effect of obesity on ST thickness and the relationship between ST thickness and functional scores may be considered. Weight control may be effective at this point. KEY WORDS: acromiohumeral distance, supraspinatus tendon thickness, ultrasound.
- MeSH
- akromion diagnostické zobrazování MeSH
- bolest ramene etiologie diagnostické zobrazování patofyziologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření bolesti metody MeSH
- poranění rotátorové manžety * diagnostické zobrazování patofyziologie MeSH
- rotátorová manžeta * diagnostické zobrazování patofyziologie MeSH
- studie případů a kontrol MeSH
- tendinopatie diagnostické zobrazování patofyziologie MeSH
- ultrasonografie * metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The current study aimed to investigate the intra- and inter-observer reliability of the Ellman classification system in partialthickness rotator cuff tears through magnetic resonance imaging (MRI) scans instead of arthroscopic views. MATERIAL AND METHODS Pre-operative MRI scans of 45 patients, with confirmed partial-thickness rotator cuff rupture in previous arthroscopic surgeries (performed by the senior author), were obtained from Picture Archiving and Communication Systems records. The observers (n=8) were asked to categorize MRI scans according to Ellman's classification of location and grade. There were four orthopedic surgeons less experienced in rotator cuff operations in the first group and four more experienced orthopedic surgeons in the second group. They were asked to re-evaluate the MRI scans six weeks later, without access to their previous answers. Reliability evaluation was performed within and among the groups. It was also evaluated if the surgeon's experience increased the reliability of the classification. Fleiss kappa coefficient was used for the inter-observer reliability and Cohen kappa coefficient for the intra-observer reliability, and post hoc analysis was performed. RESULTS When all observers were examined in the inter-observer evaluation, it was seen that there was moderate agreement in the first location evaluation (κ=0.414); however, there was fair agreement in all other evaluations in both groups (κ=0.339- 0.383-0.337, respectively). When all observers were examined in the mean intra-observer evaluation, it was seen that there was substantial agreement in both evaluations (κ=0.795-0.721, respectively). DISCUSSION A classification system must be valid, reliable, and reproducible. It should establish a standard terminology for both surgeons and researchers. The correct identification of the tear configuration is crucial for selecting the correct repair technique. In our study, in which we evaluated the Ellman classification, which is frequently used in arthroscopic diagnosis, we investigated its intra-observer and inter-observer reliability on MRI scans. Although the mean intra-observer evaluation results were substantial agreement (κ=0.795-0.721, respectively), inter-observer evaluation results were fair agreement (κ=0.339- 0.383-0.337, respectively) except for the first location evaluation (κ=0.414). CONCLUSIONS Although intra-observer reliability was satisfactory, the Ellman system used in the classification of partial-thickness rotator cuff tears was not found to be useful by using only MRI views because of fair inter-observer reliability except for the first location evaluation, which was moderate agreement. Key words: partial, rotator cuff, tear, Ellman classification, reliability, validity.
- MeSH
- fraktury humeru diagnóza terapie MeSH
- klíční kost zranění MeSH
- lidé MeSH
- lopatka zranění MeSH
- luxace ramenního kloubu diagnóza terapie MeSH
- ortopedické výkony metody MeSH
- poranění ramene * diagnostické zobrazování patologie terapie MeSH
- poranění rotátorové manžety diagnóza patologie terapie MeSH
- ramenní kloub anatomie a histologie patologie MeSH
- syndrom zhmožděného ramene diagnóza etiologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- artroskopie metody MeSH
- bolest ramene diagnóza etiologie MeSH
- burzitida chirurgie diagnóza farmakoterapie MeSH
- diferenciální diagnóza MeSH
- luxace ramenního kloubu chirurgie diagnóza etiologie MeSH
- pooperační péče metody rehabilitace MeSH
- poranění ramene chirurgie etiologie MeSH
- poranění rotátorové manžety chirurgie diagnóza MeSH
- ramenní kloub * chirurgie patofyziologie MeSH
- syndrom zhmožděného ramene chirurgie diagnóza farmakoterapie MeSH
- techniky fyzikální terapie * MeSH
- věkové faktory MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY: Superior Capsule Reconstruction (SCR) of the shoulder joint has recently been included in the portfolio of interventions as a solution to irreparable rotator cuff tears. One of the options is to use a long head of the biceps tendon (LHBT) autograft. This paper presents the fi rst clinical outcomes of the SCR of the shoulder joint using the LHBT autograft. MATERIAL AND METHODS It is a prospective non-randomised study in which 14 patients were included, namely 7 men and 7 women. The patients were evaluated using the pain VAS, UCLA (The University of California at Los Angeles) Shoulder Rating Scale and ASES (The American Shoulder and Elbow Surgeons) Shoulder Score. The minimum follow-up was 12 months after surgery. The measured values were analysed using the standard statistical methods. RESULTS From August 2020 to January 2022, a total of 14 SCR with biceps tendon autograph were performed at our department. The mean age of the patients was 62 years (40-72). The mean value of the UCLA Shoulder Score was 12.36 ± 2.92 points preoperatively, while after surgery the obtained values increased to the mean value of 28.86 ± 3.08 points. The ASES score was 25.48 ± 3.89 points preoperatively and 82.41 ± 7.95 points at one year after surgery. The preoperative mean VAS score was 6.14 ± 1.10 points and 1.36 ± 0.93 points at one year after surgery. The mean active shoulder fl exion measured preoperatively was 140 degrees, whereas at one year after surgery it was 171 degrees. The mean active abduction reached 123 degrees before surgery and 169 degrees after surgery. The mean active external rotation of the shoulder joint was 59 degrees preoperatively and 52 degrees postoperatively. The mean active external rotation at 90 degrees of abduction was 52 degrees preoperatively and 60 degrees postoperatively. Whereas the improvement as against the preoperative status measured by the UCLA, ASES and pain VAS was signifi cant, the differences in the range of motion were signifi cant in the case of active fl exion and abduction only. DISCUSSION Painful irreparable rotator cuff tear constitutes an indication for SCR. The reconstruction is performed using autografts, allografts and xenografts. In literature, several SCR surgical techniques using a long head of the biceps tendon have been presented. In most of these techniques the supraglenoid insertion of the LHBT was left intact. Our study showed a signifi - cant relief from problems and good functional outcomes at 1 year after surgery when the biceps tendon had been used. Similar results are reported also by other studies using the biceps tendon for SCR. When comparing this study and the other study we published earlier on SCR with xenografts, there is no signifi cant difference in the clinical outcomes between these two techniques. On the very contrary, they are slightly better in some parameters. CONCLUSIONS Arthroscopic SCR of the shoulder joint with the biceps tendon reports good clinical outcomes at one year after surgery both with regard to the relief from problems and range of motion. Due to low morbidity of graft harvesting, low cost, and easy surgical technique, it appears to be the fi rst-choice method for superior capsule reconstruction of an irreparable tear of supraspinatus or infraspinatus if the long head of the biceps tendon is preserved. A longer follow-up period and evaluation of a larger study population would be necessary to defi nitely confi rm the success rate of the described procedure. KEY WORDS: massive rotator cuff tears, irreparable rotator cuff tears, superior capsular reconstruction, autograft, long head of the biceps tendon.
- MeSH
- autologní štěp MeSH
- bolest MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- loket * MeSH
- následné studie MeSH
- poranění rotátorové manžety * chirurgie MeSH
- prospektivní studie MeSH
- senioři MeSH
- šlachy chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- MeSH
- akromioklavikulární kloub patologie MeSH
- diferenciální diagnóza MeSH
- lidé MeSH
- lopatka patologie MeSH
- muskuloskeletální nemoci * diagnostické zobrazování klasifikace patologie terapie MeSH
- nemoci kloubů diagnostické zobrazování klasifikace patologie terapie MeSH
- poranění rotátorové manžety diagnostické zobrazování etiologie terapie MeSH
- ramenní kloub diagnostické zobrazování patologie MeSH
- sternoklavikulární kloub patologie MeSH
- tendinopatie diagnostické zobrazování terapie MeSH
- tortikolis chirurgie etiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY To present the technique, learning curve, complications, postoperative pain levels and cost-effectiveness analysis of 24 patients with symptomatic rotator cuff tear operated with Drillbone Tunneler - a novel transosseous suture-passing device designed for arthroscopic use. MATERIAL AND METHODS Between February and May 2021, 24 patients underwent arthroscopic transosseous rotator cuff repair. During the study, the time spent preparing the tunnels was recorded along with the occurrence of complications during the operation. Price calculation of the delivered transosseous cuff repair and an alternative procedure with suture anchors was made. During the postoperative period, the patients rated their pain (on the VAS scale) twice a day, in the morning and in the evening, for 4 weeks, based on which the average values per each week were calculated. RESULTS The average time it took to prepare the tunnels and pull through the sutures was 6.2 minutes. In one case it was impossible to pull the shuttle loop through and that is why during the surgery arthroscopic transosseous-equivalent repair using suture anchors was performed instead. Apart from this, no other complications occurred. The patients reported rapid reduction of postoperative pain during the second and third week after surgery. The cost price analysis proved an average saving of CZK 9.463 per procedure. DISCUSSION There is a growing body of evidence that arthroscopic transosseous rotator cuff repairs achieve equivalent clinical outcomes as suture anchor repairs or even better clinical outcomes. These techniques are safe and effective; there is an earlier reduction of postoperative pain. Healing is more biological due to better vascularity, larger footprint coverage and clinically optimal biomechanical strength. Moreover, these techniques significantly save costs and meet requirements of the upcoming era of value-based surgery. CONCLUSIONS In our cohort, a favourable learning curve and minimum occurrence of complications were established. The study confirmed the data published so far on early relief of postoperative pain. We also proved that significant saving of costs of the materials used was achieved. Key words: arthroscopic transosseous rotator cuff repair, suture anchor, postoperative pain, cost-benefit analysis, Drillbone Tunneler.
- MeSH
- artroskopie škodlivé účinky metody MeSH
- lidé MeSH
- pooperační bolest chirurgie MeSH
- poranění rotátorové manžety * chirurgie MeSH
- rotátorová manžeta * chirurgie MeSH
- šicí techniky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
