Hasta el 90% de las cirugías de manguito de rotadores falla

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Hasta el 90% de las cirugías de manguito de rotadores falla

Notapor Fisio » Jue, 02 Ene 2014, 02:36

Hasta el 90% de las cirugías de manguito de rotadores falla

Large rotator cuff repairs retore at a rate of 57% in a series of 500 patients, researchers reported here at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.

In their study of rotator cuff repairs, researchers from the Orthopaedic Research Institute in Kogarah, Australia, found that repairs with the largest tears were more likely to tear again.

"The retear rate went up linearly with the tear size," said George A.C. Murrell, MD, who is director of the institute.

Previous research has shown that 20% to 90% of rotator cuff repairs retear. Patients whose rotator cuffs are intact 6 months after surgery have better outcomes at 6-month and 2-year follow-up than patients who don't have intact cuffs at that point, said Dr. Murrell.

But what factors predict the success of the surgery?

To answer that question, Dr. Murrell and colleagues followed 500 consecutive patients who had an arthroscopic rotator cuff repair performed by a single surgeon and an ultrasound evaluation of the repair 6 months afterward.

The researchers excluded patients with previous fractures or shoulder surgery, incomplete or partial rotator cuff repair, and concomitant arthroplasty.

They measured and mapped rotator cuff tear size intraoperatively. They also rated the quality and mobility of the tendon and the quality of the repair on predetermined scales.

"We were very diligent about reporting the size of the tear during surgery," said Dr. Murrell. "We were also very diligent in assessing the quality of the tendon and the mobility of the tendon."

They performed logistic regression analysis, with cuff integrity at 6 months as the dependent variable and tear or repair factors as the independent variables.

Overall, 19% of the repairs were retorn at 6-month follow-up. The preoperative tear size correlated closely with the retear rate (r = 0.33; p < .001).

Other factors correlated negatively with the retear rate, but the correlations were not as strong. For repair quality, the correlation was –0.17 (P < .001); for tendon mobility, it was –0.15 (P < .001); and for tendon quality, it was –0.14 (P < .01).

Using regression analysis, the researchers found that the retear rate at 6 months was best predicted by the preoperative tear size and surgeon-ranked repair quality; tendon quality or mobility did not contribute significantly to this prediction.

Asked to comment on this study, session moderator Stephen Weber, MD, told Medscape Medical News that the study had strengths and weaknesses. "It was a good paper, in that it had large numbers. Everybody had some type of follow-up. The bad part for me was that almost all the variables were very subjective."

There is no surprise in finding that larger tears are harder to repair, he pointed out. However, there are not a lot of good alternatives to this surgery for many patients. Debridement and partial repair can also leave much to be desired.

"It's just part of the upfront discussion you have with your patient," he said. "If they don't want to be laid up for a month, then it's your job to discuss the possibility of debridement."

Dr. Murrell and Dr. Weber report financial relationships with multiple companies that make products for orthopaedic surgery.

Y eso tios con intereses financieros con la venta de material...
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Re: Hasta el 90% de las cirugías de manguito de rotadores falla

Notapor Fisio » Jue, 02 Ene 2014, 02:37

Pues el 75% de desgarros en el manguito de los rotadores se recuperan si tuvieran acceso a fisioterapia

J Shoulder Elbow Surg. 2013 Oct;22(10):1371-9. doi: 10.1016/j.jse.2013.01.026. Epub 2013 Mar 27.
Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study.

To assess the effectiveness of a specific nonoperative physical therapy program in treating atraumatic full-thickness rotator cuff tears using a multicenter prospective cohort study design.

Patients with atraumatic full-thickness rotator cuff tears who consented to enroll provided data via questionnaire on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcome assessments (Short Form 12 score, American Shoulder and Elbow Surgeons score, Western Ontario Rotator Cuff score, Single Assessment Numeric Evaluation score, and Shoulder Activity Scale). Physicians recorded physical examination and imaging data. Patients began a physical therapy program developed from a systematic review of the literature and returned for evaluation at 6 and 12 weeks. At those visits, patients could choose 1 of 3 courses: (1) cured (no formal follow-up scheduled), (2) improved (continue therapy with scheduled reassessment in 6 weeks), or (3) no better (surgery offered). Patients were contacted by telephone at 1 and 2 years to determine whether they had undergone surgery since their last visit. A Wilcoxon signed rank test with continuity correction was used to compare initial, 6-week, and 12-week outcome scores.

The cohort consists of 452 patients. Patient-reported outcomes improved significantly at 6 and 12 weeks. Patients elected to undergo surgery less than 25% of the time. Patients who decided to have surgery generally did so between 6 and 12 weeks, and few had surgery between 3 and 24 months.

Nonoperative treatment using this physical therapy protocol is effective for treating atraumatic full-thickness rotator cuff tears in approximately 75% of patients followed up for 2 years.

No es tan espectacular como que te hagan una resonancia y te pongan anestesia y te operen... pero funciona. Y por eso no interesa.
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